Three-tiered Critical Care Management of Acute Pancreatitis

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Acute pancreatitis (AP) can rapidly progress from a stable condition to multiple organ failure with high mortality. We aimed to describe the characteristics of AP patients requiring admission to a critical care facility and to identify predictors of disease progression. We conducted a post-hoc analysis using prospectively collected data from AP patients admitted to the high dependency unit (HDU) and intensive care unit (ICU) at the University of Pécs, Hungary, from 2016 to 2019. Patients were categorized according to critical care needs and severity. Daily records of organ function, organ support and laboratory parameters were kept. Descriptive analysis and predictive models were developed to forecast the need for escalated critical care and mortality. Analysis of 92 cases (65% male, mean age 63 (range 19-92) years) revealed a median critical care stay of 8 days (range 1-69) and a mortality rate of 47%. Naive Bayes prediction models using admission C-reactive protein (CRP) and amylase levels achieved 75% accuracy in predicting mortality and a 65% probability of requiring HDU and/or ICU admission. CRP levels increased significantly (47 vs 62mg/l, p: 0.015) from 48 to 24h before critical care admission, contrasting with controls, resulting in significantly higher CRP levels in critical care patients (62 vs 32mg/l, p: 0.007) 24h before admission. Our findings suggest that on-admission CRP and amylase cannot reliably predict progression of AP. However, elevated and increasing levels of CRP and amylase may indicate the need for early HDU admission to enable closer monitoring.