TY - JOUR
T1 - Fatal Outcome in Acute Pancreatitis
T2 - Its Occurrence and Early Prediction
AU - Blum, Torsten
AU - Maisonneuve, Patrick
AU - Lowenfels, Albert B.
AU - Lankisch, Paul Georg
PY - 2001
Y1 - 2001
N2 - Background/Aims: This study aims to determine predictability of death in acute pancreatitis at a secondary-care hospital in Germany. Methods: This study is part of an ongoing study on the epidemiology of acute pancreatitis and covers 368 patients with a first attack of acute pancreatitis in Lüneburg county from 1988 to 1999. Early and late mortality were defined as ≤1 weeks and >1 week after admission. The following parameters were used to establish on admission likelihood of death: admission within 24 h or later with an acute attack, abdominal tenderness, signs of peritonitis, amylase and lipase in serum, leukocytes, hematocrit, potassium, sodium, calcium, creatinine after rehydration, blood glucose, bilirubin, serum glutamate-oxalacetate transaminase (SGOT), serum lactate dehydrogenase (SLDH), arterial pO2, APACHE II score, Ranson and Imrie scores. Results: Of the 368 patients 17 (5%) died, 7 early because of multiple organ failure and 10 late because of septic complications. Mortality rates in interstitial and necrotising pancreatitis were 3 and 17%, respectively. Only an elevated serum creatinine (>2.0 mg/dl) and a blood glucose >250 mg significantly correlated with mortality. Ranson and lmrie scores were also significantly correlated with mortality; however, they were not obtained on admission, but only after 48 h. In univariate analysis, APACHE II score ≥6 on admission and lipase >1,000 U/l on admission provided a high sensitivity and negative predictive value for early and late mortality patients. Conclusion: Approximately half of the deaths in acute pancreatitis occur because of multiple organ failure or septic complications. New approaches have to be found to counteract these severe complications. A fatal outcome may be predicted by simple laboratory parameters such as a high serum creatinine and blood glucose. An APACHE II score ≥6 and a lipase level on admission ≥1,000 U/l indicate severe pancreatitis.
AB - Background/Aims: This study aims to determine predictability of death in acute pancreatitis at a secondary-care hospital in Germany. Methods: This study is part of an ongoing study on the epidemiology of acute pancreatitis and covers 368 patients with a first attack of acute pancreatitis in Lüneburg county from 1988 to 1999. Early and late mortality were defined as ≤1 weeks and >1 week after admission. The following parameters were used to establish on admission likelihood of death: admission within 24 h or later with an acute attack, abdominal tenderness, signs of peritonitis, amylase and lipase in serum, leukocytes, hematocrit, potassium, sodium, calcium, creatinine after rehydration, blood glucose, bilirubin, serum glutamate-oxalacetate transaminase (SGOT), serum lactate dehydrogenase (SLDH), arterial pO2, APACHE II score, Ranson and Imrie scores. Results: Of the 368 patients 17 (5%) died, 7 early because of multiple organ failure and 10 late because of septic complications. Mortality rates in interstitial and necrotising pancreatitis were 3 and 17%, respectively. Only an elevated serum creatinine (>2.0 mg/dl) and a blood glucose >250 mg significantly correlated with mortality. Ranson and lmrie scores were also significantly correlated with mortality; however, they were not obtained on admission, but only after 48 h. In univariate analysis, APACHE II score ≥6 on admission and lipase >1,000 U/l on admission provided a high sensitivity and negative predictive value for early and late mortality patients. Conclusion: Approximately half of the deaths in acute pancreatitis occur because of multiple organ failure or septic complications. New approaches have to be found to counteract these severe complications. A fatal outcome may be predicted by simple laboratory parameters such as a high serum creatinine and blood glucose. An APACHE II score ≥6 and a lipase level on admission ≥1,000 U/l indicate severe pancreatitis.
KW - Acute pancreatitis
KW - APACHE II
KW - Computed tomography
KW - Glasgow factors
KW - Lipase
KW - Mortality
KW - Ranson score
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U2 - 10.1159/000055817
DO - 10.1159/000055817
M3 - Article
C2 - 12120201
AN - SCOPUS:0035553208
VL - 1
SP - 237
EP - 241
JO - Pancreatology
JF - Pancreatology
SN - 1424-3903
IS - 3
ER -