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Acute Pancreatitis: Identifying Patients at Greatest Risk
Am Fam Physician. 1999 May 1;59(9):2589.
Acute pancreatitis can cause death or morbidity in a significant number of cases. If the patients most vulnerable to poor outcomes could be detected early in the course of the disease, aggressive intervention could reduce morbidity and mortality rates. Talamini and colleagues assessed the effectiveness of a screening protocol based on chest radiographs and serum creatinine measurements that would allow high-risk patients with acute pancreatitis to be rapidly identified without the use of sophisticated diagnostic procedures.
Over 500 patients admitted to three Italian hospitals for treatment of acute pancreatitis were included in the study. The patients' ages ranged from 42 to 77 years, and just over one half of the patients were men. Necrotizing pancreatitis was diagnosed in 30.2 percent of the cases. Twenty patients died.
The rate of mortality correlated significantly with pleural effusions or pulmonary densities on chest radiography. Serum creatinine values greater than 2 mg per dL (177 μmol per L) were also significantly correlated with mortality. When both indicators were present, the mortality rate was 52.6 percent. The etiology of pancreatitis was only marginally associated with mortality. Idiopathic cases of pancreatitis were associated with mortality rates three times higher than those associated with biliary- or alcohol-associated cases. Logistic regression using multiple factors showed only serum creatinine level and abnormal chest radiograph to be factors associated with death. When either or both of these factors were positive, the sensitivity and specificity to predict mortality were 90 percent and 76 percent, respectively. These two factors also predicted necrotizing pancreatitis (sensitivity 60 percent and specificity 88 percent) and infected necrosis (sensitivity 73 percent and specificity 75 percent).
The authors conclude that this system of identifying patients at highest risk from acute pancreatitis compares favorably in accuracy to established scoring systems such as the Ranson, Glasgow and Hong Kong systems. The new system has the advantage of being very easy to use and requiring only two measures, both of which are likely to be available within a short time of onset of symptoms—even in centers where sophisticated facilities are lacking.
Talamini G, et al. Serum creatinine and chest radiographs in the early assessment of acute pancreatitis. Am J Surg. January 1999;177:7–14.
Copyright © 1999 by the American Academy of Family Physicians.
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