Acute pancreatitis: predictors of mortality, pancreatic necrosis and intervention
Ramlal Prajapati1, Priyadarshini Manay2, Kavin Sugumar1, Vinay Rahandale3, Rajeev Satoskar3
1Department of Surgery, University Hospitals, Seidman Cancer Center, Cleveland, United States
2Department of Transplant Surgery, University of Iowa Hospitals & Clinics, Iowa City, United States
3Department of Surgery, Seth G.S Medical College and King Edward Memorial Hospital, Mumbai, India
Abstract
Objective: Several predictive scoring systems are used in the prognostication of acute pancreatitis (AP). However, the quantity of evidence of these prognostic systems in the Indian population remains sparse. The aim of our study was to evaluate the usefulness of such prognostic scores to predict mortality, incidence of pancreatic necrosis and intervention in AP.
Material and Methods: This was an observational study of patients diagnosed with AP between June 2012 and November 2013 in a tertiary referral center in India. Vital signs, biochemical tests and CT-findings were recorded to identify SIRS, Ranson’s score and CT-severity index at diagnosis. Chi square test was used to compare incidence of mortality, pancreatic necrosis, and intervention between mild versus severe acute pancreatitis groups.
Results: A total of 100 patients with AP were treated during out study period. Ranson’s score more than 7 and presence of pancreatic necrosis were significantly associated with increased mortality (p< 0.05). SIRS, CTSI score more than 7, inotropic support, and complications were more frequently associated with patients with necrosis. Prophylactic antibiotics did not decrease mortality, but decreased intervention rate (p< 0.05). Presence of systemic inflammatory response syndrome (SIRS), Ranson’s score > 7, necrosis, inotropic support and presence of complications were associated with a greater rate of interventions including surgery and percutaneous procedures (p< 0.05).
Conclusion: We validate SIRS, Ranson’s, and CTSI score as prognostic markers for AP in the Indian population. These predictors, when used in combination, can direct early monitoring and aggressive management in order to decrease mortality associated with severe AP.
Keywords: Acute pancreatitis, prognostic score, Ranson’s score, CT-severity index, necrosis, SIRS
Cite this article as: Prajapati R, Manay P, Sugumar K, Rahandale V, Satoskar R. Acute pancreatitis: predictors of mortality, pancreatic necrosis and intervention. Turk J Surg 2021; 37 (1): 30-38.
The approval for this study was obtained from Seth G.S Medical College and King Edward Memorial Hospital Ethics Committee (Decision no: IEC(II)/OUT/986/14 Date: 03.11.2014).
Externally peer-reviewed.
Concept - R.P., P.M., V.R., R.S.; Design - K.S., R.P., P.M.; Supervision - R.P., P.M., V.R., R.S.; Materials - K.S., R.P., P.M.; Data Collection and/or Processing - K.S., R.P., P.M.; Analysis and/or Interpratation - All of authors; Literature Review - K.S., R.P., P.M.; Writing Manuscript - K.S., R.P., P.M.; Critical Reviews - All of authors.
The authors declare that they have no conflict of interest.
The authors declared that this study has received no financial support.