Early indicators for severity and prognosis in acute pancreatitis

Early and accurate assessment of severity in acute pancreatitis (AP) is of great importance to provide effective disease management and prevent mortality. In this study, we aim to evaluate early indicators that predict the mortality of AP. We retrospectively analyzed 24-hour clinical characteristics and laboratory data in 166 AP patients recruited between January 2014 and November 2015 in Baotou Central Hospital. In total, 18 patients did not survive the disease. Multivariate logistic regression showed that red cell distribution (RDW) (OR = 2.965, P=0.001) and creatinine (OR = 1.025, P=0.005) were early independent risk factors of AP mortality while albumin (OR = 0.920, P=0.032) levels reduced AP mortality. The corresponding optimal cut-off values were 14.45, 125.5, and 34.95, respectively. The positive predictive values of the AP mortality were 80.1%, 54.5%, and 69.5%. In combined measurement, the area under the curve of RDW, creatinine, and albumin was 0.964 (95% CI: 0.924 to 1.000, P<0.001). RDW ≥ 14.45%, creatinine ≥ 125.5 μmol/l, and albumin ≤ 34.95 g/l indicated a good predictive value for mortality in AP patients with a sensitivity of 100% and specificity of 64.2%. RDW, creatinine, and albumin may serve as early indicators for AP mortality which warrants further clinical investigation.

Download Full-text

Ultra-Early Indicators of Acute Hypertriglyceridemic Pancreatitis May Influence Treatment Decision-Making By Chinese Doctors

10.21203/rs.3.rs-493405/v1 ◽

2021 ◽

Author(s):

Jing Wu ◽

Yizhi Liang ◽

Xiaoting Tang ◽

Zilan Rao ◽

Chaowei Li ◽

...

Keyword(s):

Acute Pancreatitis ◽

Severe Acute Pancreatitis ◽

Serum Calcium ◽

Blood Purification ◽

Test Method ◽

Arterial Lactate ◽

Hospitalization Time ◽

Lactate Levels ◽

D Dimer ◽

Early Indicators

Abstract Background: This study investigates whether ultra-early indicators can predict severity of acute hypertriyceridemic pancreatitis (HTGP) and affect clinical decisions. Methods: For this observational retrospective study, we analyzed data of 110 HTGP patients enrolled between January 2017 and February 2020. HTGP patients were categorized into mild acute pancreatitis (MAP) and moderately severe acute pancreatitis-severe acute pancreatitis (MSAP-SAP) groups, based on their final clinical outcomes. Demographic and clinical data were collected and ultra-early indicators (serum calcium, triglyceride (TG), interleukin-6(IL-6), D-dimer, hemoglobin A1c(HbAc1), arterial lactate) levels were measured within 6 hours of admission. A multivariate logistic regression analysis model and receiver operating characteristic curve were used to determine ultra-early indicators values of high-risk patients. The chi-square test method was applied to estimate the hospitalization time and associated complications in MSAP-SAP group post-plasma exchange within or more than 24 hours. Results: Among the 110 HTGP patients, 56 were in the MAP group whereas, 54 were in the MSAP-SAP group. TG, IL-6, D-dimer, HbAc1, and arterial lactate levels measured within 6 hours after admission were significantly higher in the MSAP-SAP group, but serum calcium was significantly lower, versus the mild AP group. IL-6, D-dimer and serum calcium were identified as the risk factors for MSAP-SAP and were potential ultra-early indicators for predicting HTGP severity within 6 hours of admission. MSAP-SAP patients that underwent blood purification therapy within 24 hours of admission had a shorter hospitalization time than those treated 24 hours post-admission. Conclusion: The present study reveals IL-6, D-dimer, and serum calcium - ultra-early indicators - as promising biomarkers in the assessment of AP severity in HTGP patients within 6 hours. Early blood purification presents a novel therapy among MSAP-SAP patients within 24 hours and is associated with fewer complications and a shorter hospitalization time. However, traditional therapy can be further integrated to manage MAP patients effectively with less medical expenses.

Download Full-text