Abstract
Background: The aim of the present study was to investigate risk factors for developing more severe pancreatitis, including moderately severe (MSAP) and severe acute pancreatitis (SAP), in patients admitted with mild acute pancreatitis (MAP).
 Material/Methods: This was a hospital based retrospective and prospective study conducted in the Department of Gastroentrology, SKIMS Soura,Srinagar, Kashmir for a period of 2 years w.e.f. September 2017 to September 2019 on patients of all age groups with clinical/Laboratory/imaging findings suggestive of acute pancreatitis. The protocol of the study was approved by the Institutional Ethical Committee. Patients admitted with MAP to our hospital were included and prospectively evaluated. Possible risk factors for developing MSAP or SAP were Evaluated.
 Results: Risk factors like BMI >25kg/m2 was observed in 61 (19.3%) patients with mild pancreatitis and 142 (42.5%) patients with moderate to severe pancreatitis. Waist circumference >100cm was observed in 23 (7.3%) and 129 (38.6%) patients of mild and moderate to severe pancreatitis. High blood sugar >200mg/dl was observed in 37 (11.7%) patients with mild pancreatitis and 152 (45.2%) patients with moderate to severe pancreatitis. 27 (8.5%) and 167 (50%) patients of mild and moderate to severe pancreatitis had hematocrit >44 whereas 13 (4.1%) patients with mild pancreatitis and 140 (41.9%) patients with moderate to severe pancreatitis had CRP >150mg/dl.
 This table concluded that there is statistically significant association between high BMI >25 Kg/m2, waist circumference >100 cm, high blood sugar >200 mg /dl, hematocrit >44, CRP >150 mg/d and worsening of AP.
 Conclusions: Significant risk factors for developing MSAP or SAP in patients admitted with MAP included BMI (≥25 kg/m2), APACHE-II (≥5), and blood glucose level on admission (>11.1 mmol/L). These factors should be used in the prediction of more severe pancreatitis in patients admitted with MAP.
 Keywords: Obesity, Pancreatitis, Risk Factors
Highlights
Acute pancreatitis is an inflammatory disease of the pancreas
The diagnosis of acute pancreatitis requires two of the following three[3]: Abdominal pain consistent with acute pancreatitis Serum lipase activity at least three times greater than the upper limit of normal; and Characteristic findings of acute pancreatitis on contrast-enhanced computed tomography (CECT) and less commonly magnetic resonance imaging (MRI) or trans abdominal ultrasonography[4]
Our study revealed gallstone is the major cause of Acute pancreatitis (AP) irrespective of age and gender, stones were more prominent in females (47.2%) as compared to males (31.5%).Compared to other studies, we observed different epidemiologies of AP in Kashmir valley with majority as gallstone(41.5%) followed by idiopathic AP(30.2%),ascariasis(8.5%),drug(4.2%),hyperparathy roidism(3.1%),hypertriglycredemia(3.1%), pancreaticobiliary tumor(3.1%), pregnancy(2.2%), alcohol (1.2%),trauma(1.2%),AIP(0.8%),pancreatic divisum(0.8%) and annular pancrease(0.3%).Two decades earlier parasites(ascariasis) induced AP were leading causes of AP in Kashmir valley but due to changing life style, improved hygiene, socioeconomic status, sedentary life style and obesity, parasites are replaced by gallstones followed by idiopathic group and other causes
Summary
Acute pancreatitis is an inflammatory disease of the pancreas. The etiology and pathogenesis of acute pancreatitis have been intensively investigated for centuries worldwide. The aim of the present study was to investigate risk factors for developing more severe pancreatitis, including moderately severe (MSAP) and severe acute pancreatitis (SAP), in patients admitted with mild acute pancreatitis (MAP). Results: Risk factors like BMI >25kg/m2 was observed in 61 (19.3%) patients with mild pancreatitis and 142 (42.5%) patients with moderate to severe pancreatitis. Conclusions: Significant risk factors for developing MSAP or SAP in patients admitted with MAP included BMI (≥25 kg/m2), APACHE-II (≥5), and blood glucose level on admission (>11.1 mmol/L). These factors should be used in the prediction of more severe pancreatitis in patients admitted with MAP.
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