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©The Author(s) 2025. Published by Baishideng Publishing Group Inc. All rights reserved.
Ascites characteristics in acute pancreatitis: A prognostic indicator of organ failure and mortality
Jing-Wen Rao, Jia-Rong Li, Yao Wu, Tian-Ming Lai, Zhen-Gang Zhou, Yue Gong, Ying Xia, Ling-Yu Luo, Liang Xia, Wen-Hao Cai, Wei Huang, Yin Zhu, Wen-Hua He
Jing-Wen Rao, Yao Wu, Tian-Ming Lai, Zhen-Gang Zhou, Yue Gong, Ying Xia, Ling-Yu Luo, Liang Xia, Yin Zhu, Wen-Hua He, Department of Gastroenterology, Jiangxi Provincial Key Laboratory of Digestive Diseases, Jiangxi Clinical Research Center for Gastroenterology, Digestive Disease Hospital, The First Affiliated Hospital of Nanchang University, Nanchang 330006, Jiangxi Province, China
Jia-Rong Li, Department of Critical Care Medicine, Zhongshan People's Hospital, Zhongshan 528400, Guangdong Province, China
Wen-Hao Cai, Wei Huang, West China Centre of Excellence for Pancreatitis, Institute of Integrated Traditional Chinese and Western Medicine, West China-Liverpool Biomedical Research Centre, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
Co-first authors: Jing-Wen Rao and Jia-Rong Li.
Author contributions: Rao JW and Li JR were responsible for data collection and writing manuscript as the co-first authors of the paper; Rao JW, Li JR and Wu Y performed the formal analysis and drafted the initial manuscript; Rao JW, Li JR, Lai TM, Zhou ZG, Gong Y, Xia Y, Luo LY and Xia L were responsible for data collection; Rao JW and He WH developed the methodology; Li JR and He WH conceived and designed the study; Zhu Y and He WH were involved in funding acquisition, administered the project; Zhu Y provided supervision; Cai WH, Huang W, and He WH contributed to the review and editing of the manuscript; all of the authors read and approved the final version of the manuscript to be published.
Supported by National Natural Science Foundation of China, No. 82360136; and Jiangxi Clinical Research Center for Gastroenterology, No. 20223BCG74011.
Institutional review board statement: This study was approved by the Ethics Committee of The First Affiliated Hospital of Nanchang University.
Informed consent statement: This is a retrospective study and no informed consent is required.
Conflict-of-interest statement: The authors declare no conflicts of interest for this article.
Data sharing statement: The data that support the findings of this study are available on request from the corresponding author.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
https://creativecommons.org/Licenses/by-nc/4.0/ Corresponding author: Wen-Hua He, PhD, Associate Professor, Chief Physician, Department of Gastroenterology, Jiangxi Provincial Key Laboratory of Digestive Diseases, Jiangxi Clinical Research Center for Gastroenterology, Digestive Disease Hospital, The First Affiliated Hospital of Nanchang University, No. 17 Yong Wai Zheng Street, Nanchang 330006, Jiangxi Province, China.
hewenhua@ncu.edu.cn
Received: April 30, 2025
Revised: June 12, 2025
Accepted: July 7, 2025
Published online: July 28, 2025
Processing time: 85 Days and 17.5 Hours
BACKGROUND
Acute pancreatitis (AP) is a severe condition, and abdominal effusion is a significant predictor of its severity and prognosis. However, the relationship between ascites characteristics and AP outcomes remains undefined.
AIM
To assess the correlation between ascites characteristics and clinical prognosis in AP patients by comparing color depth and turbidity of early ascites.
METHODS
This study included 667 AP patients with ascites, categorized by color and turbidity into yellow clear (n = 54), yellow turbid (n = 293), red brown (n = 320). The trend χ2 test was employed to analyze the incidence of organ failure (OF), infected pancreatic necrosis (IPN), and mortality across groups. Receiver operating characteristic (ROC) curves were used to evaluate the predictive value of ascites cell count, amylase, protein, and lactate dehydrogenase (LDH) for abdominal compartment syndrome (ACS) and intra-abdominal hemorrhage.
RESULTS
AP patients with ascites exhibited higher scores of scoring systems (such as Bedside index for severity in AP, Acute Physiology and Chronic Health Examination II, etc.) and increased complications and mortality rates (all P < 0.05) compared to those without ascites. A linear association was observed between ascites color depth and turbidity and the incidence of OF, pancreatic necrosis, IPN, and mortality (P < 0.05). LDH in ascites demonstrated high accuracy in predicting ACS and intra-abdominal hemorrhage, with areas under the ROC curve of 0.77 and 0.79, respectively.
CONCLUSION
Early in AP, ascites correlates with OF, IPN, and mortality, showing linear associations with color depth and turbidity. Ascitic LDH reliably predicts ACS and intra-abdominal hemorrhage in AP patients.
Core Tip: This study establishes a correlation between the characteristics of ascites, including color depth and turbidity, and the clinical prognosis of acute pancreatitis (AP) patients. We demonstrate that lactate dehydrogenase levels in ascites can accurately predict the development of abdominal compartment syndrome and intra-abdominal hemorrhage in AP patients. This research provides novel insights into the utility of ascites characteristics as prognostic indicators in AP, potentially aiding in the early identification of patients at higher risk for severe complications and mortality.
