Abstract
Background and aimsThe revised Atlanta classification is widely used for the evaluation of acute pancreatitis (AP) severity. However, this classification cannot be used within 48 hours of AP onset. The aim of this study was to investigate the predictive factors of mortality in patients with AP on admission.MethodsWe evaluated the association between AP mortality and clinical parameters at the time of admission in patients with AP from April 2013 to December 2017 at one university hospital and one tertiary care referral center.ResultsA total of 203 consecutive patients were enrolled. Nine patients (4.4%) died despite multidisciplinary treatment. In a multivariable analysis, hematocrit ≥ 40% (odds ratio [OR], 1.07; 95% confidence interval [CI], 1.01–1.13; P = 0.021), blood urea nitrogen (BUN) ≥ 40 mg/dL (OR, 1.26; 95% CI, 1.11–1.42; P < 0.001), base excess < -3.0 mmol/L (OR, 1.15; 95% CI, 1.04–1.26; P = 0.004), and inflammation extending to the rectovesical excavation (OR, 1.19; 95% CI, 1.10–1.30; P < 0.001) on admission were significantly associated with mortality.ConclusionAmong the imaging findings, inflammation extending to the rectovesical excavation was the only independent predictive factor for mortality in AP. This simple finding, obtained on computed tomography without contrast agent on admission, might be a promising prognostic factor for AP.
Highlights
Acute pancreatitis (AP) is a common but heterogeneous pancreatic disease, ranging from mild disease to disease associated with high morbidity and mortality
Hematocrit 40%, blood urea nitrogen (BUN) 40 mg/dL (OR, 1.26; 95% confidence interval (CI), 1.11–1.42; P < 0.001), base excess < -3.0 mmol/L (OR, 1.15; 95% CI, 1.04–1.26; P = 0.004), and inflammation extending to the rectovesical excavation (OR, 1.19; 95% CI, 1.10–1.30; P < 0.001) on admission were significantly associated with mortality
Inflammation extending to the rectovesical excavation was the only independent predictive factor for mortality in AP
Summary
Acute pancreatitis (AP) is a common but heterogeneous pancreatic disease, ranging from mild disease to disease associated with high morbidity and mortality. Two new classification systems have been developed: the 2012 revised Atlanta classification [3] and the determinant-based classification [4] These two scales introduce the concept of persistent OF as a major determinant for the prognosis of AP. Based on these classifications, disease severity is determined after 48 hours of admission, but AP patients sometimes die within this timeframe. The revised Atlanta classification is widely used for the evaluation of acute pancreatitis (AP) severity. This classification cannot be used within 48 hours of AP onset. The aim of this study was to investigate the predictive factors of mortality in patients with AP on admission
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