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World J Gastroenterol. Jun 14, 2007; 13(22): 3090-3094
Published online Jun 14, 2007. doi: 10.3748/wjg.v13.i22.3090
Evaluation of diagnostic findings and scoring systems in outcome prediction in acute pancreatitis
Ekrem Kaya, Adem Dervişoğlu, Cafer Polat
Ekrem Kaya, Adem Dervişoğlu, Cafer Polat, Ondokuz Mayıs University School of Medicine Department of Surgery, Samsun, Turkey
Author contributions: All authors contributed equally to the work.
Correspondence to: Ekrem Kaya, MD, Uludag University School of Medicine, Department of Surgery, HPB Unit, Gorukle-Bursa 16059, Turkey. ekremkaya@uludag.edu.tr
Telephone: +90-224-4428398 Fax: +90-224-4428398
Received: November 10, 2006
Revised: December 30, 2006
Accepted: January 21, 2007
Published online: June 14, 2007
Abstract

AIM: To determine factors related to disease severity, mortality and morbidity in acute pancreatitis.

METHODS: One hundred and ninety-nine consecutive patients were admitted with the diagnosis of acute pancreatitis (AP) in a 5-year period (1998-2002). In a prospective design, demographic data, etiology, mean hospital admission time, clinical, radiological, biochemical findings, treatment modalities, mortality and morbidity were recorded. Endocrine insufficiency was investigated with oral glucose tolerance test. The relations between these parameters, scoring systems (Ranson, Imrie and APACHE II) and patients’ outcome were determined by using invariable tests and the receiver operating characteristics curve.

RESULTS: One hundred patients were men and 99 were women; the mean age was 55 years. Biliary pancreatitis was the most common form, followed by idiopathic pancreatitis (53% and 26%, respectively). Sixty-three patients had severe pancreatitis and 136 had mild disease. Respiratory rate > 20/min, pulse rate > 90/min, increased C-reactive protein (CRP), lactate dehydrogenase (LDH) and aspartate aminotransferase (AST) levels, organ necrosis > 30% on computed tomography (CT) and leukocytosis were associated with severe disease. The rate of glucose intolerance, morbidity and mortality were 24.1%, 24.8% and 13.6%, respectively. CRP > 142 mg/L, BUN > 22 mg/dL, LDH > 667 U/L, base excess > -5, CT severity index > 3 and APACHE score > 8 were related to morbidity and mortality.

CONCLUSION: APACHE II score, LDH, base excess and CT severity index have prognostic value and CRP is a reliable marker for predicting both mortality and morbidity.

Keywords: Acute pancreatitis; Mortality; C-reactive protein; APACHE II; CT severity index