Background/Purpose: Early assessment of the severity of acute pancreatitis (AP) is a highly challenge for a physicians’ practice to improve the management and decrease the mortality. We aimed to determine early prognostic factors for AP related in-hospital mortality. Methods: Upon hospital admission, predictors of AP related in-hospital mortality were prospectively assessed using regression analysis over 129 consecutive AP patients. Predictive abilities of these prognostic factors were compared using the area under receiver operating characteristic curve (AUC). Results: AP related in-hospital mortality was 10.9%. Red cell distribution (RDW), serum creatinine, glucose and albumin were associated with AP mortality. RDW had the highest AUC followed by serum creatinine and albumin (AUC: 914, 95% CI: 0.797 - 0.975; 0.797, 95% CI: 0.695 - 0.878; 0.798, 95% CI: 0.677 - 0.865 respectively). The cut-off with the best ability to predict in-hospital mortality was 14.2 for RDW. By coupling RDW and serum creatinine, AUC was improved to 0.940, 95% CI: 0.839 - 0.986. Conclusion: RDW, serum creatinine, albumin, and glucose even with borderline level changes may predict AP related in-hospital mortality, where, RDW has the highest prognostic accuracy. Coupling RDW and serum creatinine model significantly improves their predictive accuracy that may aid in further improvement of the quality of care of AP patients.
KeywordsAcute PancreatitisIn-Hospital MortalityRed Cell Distribution Width
Weitz, G., Woitalla, J., Wellhöner, P., Schmidt, K., Büning, J. and Fellermann, K. (2015) Does Etiology of Acute Pancreatitis Matter? A Review of 391 Consecutive Episodes. JOP, 16, 171-175.
Wang, X., Cui, Z., Zhang, J., Li, H., Zhang, D., Miao, B., Cui, Y., Zhao, E., Li, Z. and Cui, N. (2010) Early Predictive Factors of in Hospital Mortality in Patients with Severe Acute Pancreatitis. Pancreas, 39, 114-115. https://doi.org/10.1097/MPA.0b013e3181b65dd5
Dambrauskas, Z., Giese, N., Gulbinas, A., Giese, T., Berberat, P.O., Pundzius, J., Barauskas, G. and Friess, H. (2010) Different Profiles of Cytokine Expression during Mild and Severe Acute Pancreatitis. World Journal of Gastroenterology, 16, 1845-1853. https://doi.org/10.3748/wjg.v16.i15.1845
Abu-Zidan, F.M., Bonham, M.J. and Windsor, J.A. (2000) Severity of Acute Pancreatitis: A Multivariate Analysis of Oxidative Stress Markers and Modified Glasgow Criteria. British Journal of Surgery, 87, 1019-1023. https://doi.org/10.1046/j.1365-2168.2000.01464.x
Bhatia, M., Wong, F.L., Cao, Y., Lau, H.Y., Huang, J., Puneet, P. and Chevali, L. (2005) Pathophysiology of Acute Pancreatitis. Pancreatology, 5, 132-144. https://doi.org/10.1159/000085265
McKay, C.J. and Imrie, C.W. (2004) The Continuing Challenge of Early Mortality in Acute Pancreatitis. British Journal of Surgery, 91, 1243-1244. https://doi.org/10.1002/bjs.4750
Ranson, J.H., Rifkind, K.M., Roses, D.F., Fink, S.D., Eng, K. and Spencer, F.C. (1974) Prognostic Signs and the Role of Operative Management in Acute Pancreatitis. Surgery, Gynecology & Obstetrics, 139, 69-81.
Knaus, W.A., Draper, E.A., Wagner, D.P. and Zimmerman, J.E. (1985) APACHE II: A Severity of Disease Classification System. Critical Care Medicine, 13, 818-829. https://doi.org/10.1097/00003246-198510000-00009
Fisic, E., Poropat, G., Bilic-Zulle, L., Licul, V., Milic, S. and Stimac, D. (2013) The Role of IL-6, 8, and 10, sTNFr, CRP, and Pancreatic Elastase in the Prediction of Systemic Complications in Patients with Acute Pancreatitis. Gastroenterology Research and Practice, Article ID: 282645. https://doi.org/10.1155/2013/282645
Banks, P.A., Bollen, T.L., Dervenis, C., Gooszen, H.G., Johnson, C.D., Sarr, M.G., Tsiotos, G.G. and Vege, S.S. (2013) Classification of Acute Pancreatitis-2012: Revision of the Atlanta Classification and Definitions by International Consensus. Gut, 62, 102-111. https://doi.org/10.1136/gutjnl-2012-302779
Forsmark, C.E., Vege, S.S. and Wilcox, C.M. (2017) Acute Pancreatitis. The New England Journal of Medicine, 376, 598-599.
Bakker, O.J., Issa, Y., van Santvoort, H.C., Besselink, M.G., Schepers, N.J., Bruno, M.J., Boermeester, M.A. and Gooszen, H.G. (2014) Treatment Options for Acute Pancreatitis. Nature Reviews Gastroenterology & Hepatology, 11, 462-469. https://doi.org/10.1038/nrgastro.2014.39
Moharamzadeh, P., Nia, K.S., Somil, M., Pouraghaei, M., Fadaeihaghi, A. and Rahmani, F. (2018) Red Blood Cell Distribution Width: A Determinant of Hospital Mortality in Pancreatitis. Journal of Emergency Practice and Trauma, 4, 34-38. https://doi.org/10.15171/jept.2017.26
Talamini, G., Bassi, C., Falconi, M., Sartori, N., Frulloni, L., Di Francesco, V., Vesentini, S., Pederzoli, P. and Cavallini, G. (1996) Risk of Death from Acute Pancreatitis. International Journal of Pancreatology, 19, 15-24. https://doi.org/10.1007/BF02788371
Senol, K., Saylam, B., Kocaay, F. and Tez, M. (2013) Red Cell Distribution Width as a Predictor of Mortality in Acute Pancreatitis. American Journal of Emergency Medicine, 31, 687-689. https://doi.org/10.1016/j.ajem.2012.12.015
Ku, N.S., Kim, H.W., Oh, H.J., Kim, Y.C., Kim, M.H., Song, J.E., Oh, D.H., Ahn, J.Y., Kim, S.B., Jeong, S.J., Han, S.H., Kim, C.O., Song, Y.G., Kim, J.M. and Choi, J.Y. (2012) Red Blood Cell Distribution Width Is an Independent Predictor of Mortality in Patients with Gram-Negative Bacteremia. Shock, 38, 123-127. https://doi.org/10.1097/SHK.0b013e31825e2a85
Song, C.S., Park, D.I., Yoon, M.Y., Seok, H.S., Park, J.H., Kim, H.J., Cho, Y.K., Sohn, C.I., Jeon, W.K. and Kim, B.I. (2012) Association between Red Cell Distribution Width and Disease Activity in Patients with Inflammatory Bowel Disease. Digestive Diseases and Sciences, 57, 1033-1038. https://doi.org/10.1007/s10620-011-1978-2
Muddana, V., Whitcomb, D.C., Khalid, A., Slivka, A. and Papachristou, G.I. (2009) Elevated Serum Creatinine as a Marker of Pancreatic Necrosis in Acute Pancreatitis. The American Journal of Gastroenterology, 104, 164-170. https://doi.org/10.1038/ajg.2008.66
Wu, B.U., Johannes, R.S., Sun, X., Conwell, D.L. and Banks, P.A. (2009) Early Changes in Blood Urea Nitrogen Predict Mortality in Acute Pancreatitis. Gastroenterology, 137, 129-135. https://doi.org/10.1053/j.gastro.2009.03.056
Lipinski, M., Rydzewski, A. and Rydzewska, G. (2013) Early Changes in Serum Creatinine Level and Estimated Glomerular Filtration Rate Predict Pancreatic Necrosis and Mortality in Acute Pancreatitis: Creatinine and eGFR in Acute Pancreatitis. Pancreatology, 13, 207-211. https://doi.org/10.1016/j.pan.2013.02.002
Avinash, B., Kalyan, N., Lakshmi, A.Y., Padmanabhan, S. and Siva Kumar, V. (2005) Acute Renal Failure in Acute Pancreatitis—Role of Pancreatic Computed Tomograph.y Severity Index (CTSI). Indian Journal of Nephrology, 15, 14-16.
Lankisch, P.G., Weber-Dany, B., Maisonneuve, P. and Lowenfels, A.B. (2010) High Serum Creatinine in Acute Pancreatitis: A Marker for Pancreatic Necrosis? The American Journal of Gastroenterology, 105, 1196-1200. https://doi.org/10.1038/ajg.2009.688
Lankisch, P.G., Blum, T., Bruns, A., Dröge, M., Brinkmann, G., Struckmann, K., Nauck, M., Maisonneuve, P. and Lowenfels, A.B. (2001) Has Blood Glucose Level Measured on Admission to Hospital in a Patient with Acute Pancreatitis Any Prognostic Value? Pancreatology, 1, 224-229. https://doi.org/10.1159/000055815
Rajaratnam, S.G. and Martin, I.G. (2006) Admission Serum Glucose Level: An Accurate Predictor of Outcome in Gallstone Pancreatitis. Pancreas, 33, 27-30. https://doi.org/10.1097/01.mpa.0000222315.36490.9b
Ranson, J.H.C., Rifkind, K.M. and Turner, J.W. (1976) Prognostic Signs and Nonoperative Peritoneal Lavage in Acute Pancreatitis. Surgery, Gynecology & Obstetrics, 143, 209-219.
Blum, T., Maisonneuve, P., Lowenfels, A.B. and Lankisch, P.G. (2001) Fatalotcome in Acute Pancreatitis: Its Occurance and Early Prediction, Pancreatology, 1, 237-241. https://doi.org/10.1159/000055817
Triester, S.L. and Kowdley, K.V. (2002) Prognostic Factors in Acute Pancreatitis. Journal of Clinical Gastroenterology, 34, 167-176. https://doi.org/10.1097/00004836-200202000-00014
Goh, S.L., De Silva, R.P., Dhital, K. and Gett, R.M. (2015) Is Low Serum Albumin Associated with Postoperative Complications in Patients Undergoing Oesophagectomy for Oesophageal Malignancies? Interactive CardioVascular and Thoracic Surgery, 20, 107-113. https://doi.org/10.1093/icvts/ivu324
Li, S., Zhang, Y., Li, M., Xie, C. and Wu, H. (2017) Serum Albumin, a Good Indicator of Persistent Organ Failure in Acute Pancreatitis. BMC Gastroenterology, 17, 59. https://doi.org/10.1186/s12876-017-0615-8