Predictors of Severity in Acute Pancreatitis in Native Americans

Abstract

Introduction: Acute pancreatitis (AP) is the leading gastrointestinal cause of hospitalizations in the United States. The bedside index for severity in AP (BISAP), is a method to assess AP severity. Native Americans (NA) constitute a unique population who have not been investigated for predictors of severity in AP. The aim of this study is to use the BISAP score to identify NAs with severe AP and predict markers of severity in this population. Secondary aim is determining whether NAs have an increased severity of AP compared with Caucasians. Methods: We conducted a retrospective chart review of NA patients who were admitted for AP between Jan 2008 and Nov 2016. A randomly selected group of Caucasian patients were also selected for comparison. Patient demographics, clinical, laboratory data and BISAP score were recorded. The associations between BISAP and other measurements were evaluated using correlation coefficient and Fisher's exact test. Logistic regression was performed to build the predictive model of the severity of AP against multiple variables. Results: There were 92 NA patients with AP. BISAP score ≥ 3 defines severity. Five NA patients (5.4%) developed severe AP. BISAP score correlates with BMI, initial BUN, initial WBC, and systolic blood pressure (SBP) (P<0.05). There is no significant correlation between BISAP score and length of hospital stay, admission costs and total I.V. fluids. Age ≥60 years was associated with severe AP (P<0.05) using Fisher's exact test. Multivariate logistic regression demonstrates BUN and SBP associated with severe AP (P<0.05). One mg/dL increase of BUN would result in an increase of odds of severity by 6%. Similarly, one mmHg increase of systolic blood pressure would lead to 4% increase in odds of severity. NAs and Caucasians have no difference in severity of AP (OR=1.52; 95% CI, 0.50-4.81). No deaths were recorded in this cohort secondary to AP. Conclusion: A positive correlation between patient's BMI, WBC, BUN and SBP and BISAP score were found, suggesting increased severity in AP with these factors. In contrast, BISAP score didn't appear to correlate with length of stay, cost or total of IV fluids in NA as previously suggested in other studies. Only five NA patients developed severe AP and no deaths were recorded, which may limit conclusions able to be drawn from this study. There is no significant difference in severity between NAs and Caucasians indicating similar management is recommended in both groups.