Evaluation of laboratory and radiological imaging results in terms of hospitalization and mortality in acute pancreatitis cases

Abstract

AIM: Acute pancreatitis (AP) is a common diagnosis in emergency services and is very important in terms of morbidity and mortality. It was aimed to evaluate the relationship of laboratory and imaging findings of AP cases with hospitalization and mortality outcomes. METHODS: This retrospective study was conducted with 225 cases over the age of 18 who applied to the emergency department between 1 September 2020 and 1 March 2021. Age, gender, laboratory and imaging data of the patients were recorded and evaluated on groups formed according to hospitalization and mortality status. RESULTS: The mean age of 225 acute pancreatitis cases was 54.10±19.07 years, and 116 (51.6%) were female. 169 (75.1%) individuals were hospitalized and seven (3.1%) patients resulted in mortality. Age was associated with mortality (p<0.001). Lipase levels in the mortality group were substantially higher, with 3474.71±3013.69 U/L (p= 0.046). Similarly, elevated urea was found to be related with mortality (p=0.019). On ultrasonography, pancreatic edema was found to be associated with mortality (p=0.012). The presence of intrahapatic bill duct dilatation (p=0.002), pancreatic edema (p=0.045) and peripancreatic fluid (p=0.009) in magnetic resonance cholangiopancreatography (MRCP) was significant at hospitalization. Tomography and MRCP findings did not correlate with mortality. CONCLUSION: Laboratory parameters and imaging findings in the emergency department may be predictive of hospitalization and mortality outcomes in AP.

Keywords

• acute pancreatitis
• emergency department
• laboratory
• imaging methods
• hospitalization
• mortality

Akut pankreatit olgularında hospitalizasyon ve mortalite durumunun laboratuvar ve radyolojik görüntüleme sonuçları ile değerlendirilmesi

Abstract

Amaç: Akut pankreatit (AP) acil servislerde sık rastlanan bir başvuru nedeni olup morbidite ve mortalite açısından oldukça önemlidir. AP olgularının laboratuvar ve görüntüleme sonuçlarının hastaneye yatış ve mortalite sonuçları ile ilişkisinin değerlendirilmesi amaçlandı. Yöntemler: Bu retrospektif çalışmada, 1 Eylül 2020-1 Mart 2021 tarihleri arasında acil servise başvuran 18 yaş üstü 225 olgu dahil edilmiştir.Hastaların yaş, cinsiyet, laboratuvar ve görüntüleme verileri kayıt altına alınarak hastaneye yatış ve mortalite durumlarına göre oluşturulan gruplar üzerinde değerlendirildi. Bulgular: Akut pankreatitli 225 olgunun yaş ortalaması 54,10±19,07 yıl olup, 116'sı (%51,6) kadındı. 169(%75,1) kişi hospitalize edildi ve 7 (%3,1) olgu ölümle sonuçlandı. Yaş ile mortalite arasında anlamlı ilişki izlendi (p<0.001). Mortalite grubundaki lipaz seviyeleri 3474,71±3013,69 U/L (p= 0,046) değeri ile oldukça yüksekti. Benzer şekilde üre yüksekliğinin de mortalite ile ilişkili olduğu görüldü(p=0,019). Ultrasonografide pankreas ödemi mortalite ile ilişkili bulundu (p=0,012). Hastaneye yatışta manyetik rezonans kolanjiyopankreatografide (MRCP) intrahapatik safra kanalı dilatasyonu (p=0,002), pankreas ödemi (p=0,045) ve peripankreatik sıvı (p=0,009) varlığı anlamlıydı. Tomografi ve MRCP bulguları mortalite ile korele değildi. Sonuç: Acil serviste AP olgularının laboratuvar parametreleri ve görüntüleme sonuçları hospitalizasyon ve mortalite konusunda prediktif olabilir.

Keywords

• akut pankreatit
• acil servis
• laboratuvar
• görüntüleme yöntemleri
• hospitalizasyon
• mortalite

References

1. Akshintala VS, Kamal A, Singh VK. Uncomplicated acute pancreatitis: evidenced-based management decisions. Gastrointest Endosc Clin N Am. 2018;28(4):425-438.
2. Fagenholz PJ, Castillo CF, Harris NS, Pelletier AJ, Camargo CA Jr. Increasing United States hospital admissions for acute pancreatitis, 1988-2003. Ann Epidemiol. 2007;17(7):491-497.
3. Peery AF, Crockett SD, Barritt AS, et al. Burden of gastrointestinal, liver, and pancreatic diseases in the United States. Gastroenterology. 2015;149(7):1731-1741.e3.
4. Tan JW, Zhang XQ, Geng CM, Peng LL. Development of the national early warning score-calcium model for predicting adverse outcomes in patients with acute pancreatitis. J Emerg Nurs. 2020;46(2):171-179.
5. Gullo L, Migliori M, Oláh A, et al. Acute pancreatitis in five European countries: etiology and mortality. Pancreas. 2002;24(3):223-227.
6. Malka D, Rosa-Hézode I. Comment faire le diagnostic positif et étiologique de pancréatite aiguë? [Positive and etiological diagnosis of acute pancreatitis]. Gastroenterol Clin Biol. 2001;25(1 Suppl):1S153-1S168.
7. Banks PA, Bollen TL, Dervenis C, et al. Classification of acute pancreatitis--2012: revision of the Atlanta classification and definitions by international consensus. Gut. 2013;62(1):102-111.
8. Carroll JK, Herrick B, Gipson T, Lee SP. Acute pancreatitis: diagnosis, prognosis, and treatment. Am Fam Physician. 2007;75(10):1513-1520.

9. Maher MM, Lucey BC, Gervais DA, Mueller PR. Acute pancreatitis: the role of imaging and interventional radiology. Cardiovasc Intervent Radiol. 2004;27(3):208-225.
10. van Santvoort HC, Bakker OJ, Bollen TL, et al. A conservative and minimally invasive approach to necrotizing pancreatitis improves outcome. Gastroenterology. 2011;141(4):1254-1263.
11. Werge M, Novovic S, Schmidt PN, Gluud LL. Infection increases mortality in necrotizing pancreatitis: A systematic review and meta-analysis. Pancreatology. 2016;16(5):698-707.
12. Weiss FU, Laemmerhirt F, Lerch MM. Acute pancreatitis: genetic risk and clinical implications. J Clin Med. 2021;10(2):190.
13. Coşkun BN, Tandoğan G, Eroğlu A, et al. Akut pankreatit tanılı hastaların etyolojik ve prognostik faktörlerinin retrospektif incelenmesi. Uludağ Tıp Derg. 2012;38(2):67-73.
14. Demiral G, Yener O, Aksoy F, et al. Retrospective analysis of our acute pancreatitis patients. Göztepe Med J. 2011;26(1):4-9.
15. Ertas H, Duran C, Keskin M, Güney I. Examining the clinical and laboratory characteristics of patients diagnosed with acute pancreatitis. Aegean J Med Sci. 2018;3:97-102.
16. Shen HN, Wang WC, Lu CL, Li CY. Effects of gender on severity, management and outcome in acute biliary pancreatitis. PLoS One. 2013;8(2):e57504.
17. Francisco M, Valentín F, Cubiella J, Fernández-Seara J. Factors related to length of hospital admission in mild interstitial acute pancreatitis. Rev Esp Enferm Dig. 2013;105(2):84-92.
18. De Campos T, Cerqueira C, Kuryura L, et al. Morbimortality indicators in severe acute pancreatitis. JOP. 2008;9(6):690-697.
19. Mare TA, Treacher DF, Shankar-Hari M, et al. The diagnostic and prognostic significance of monitoring blood levels of immature neutrophils in patients with systemic inflammation. Crit Care. 2015;19(1):57.
20. Stirling AD, Moran NR, Kelly ME, Ridgway PF, Conlon KC. The predictive value of C-reactive protein (CRP) in acute pancreatitis - is interval change in CRP an additional indicator of severity?. HPB (Oxford). 2017;19(10):874-880.
21. Sternby H, Hartman H, Johansen D, Thorlacius H, Regnér S. IL-6 and CRP are superior in early differentiation between mild and non-mild acute pancreatitis. Pancreatology. 2017;17(4):550-554.
22. Faisst M, Wellner UF, Utzolino S, Hopt UT, Keck T. Elevated blood urea nitrogen is an independent risk factor of prolonged intensive care unit stay due to acute necrotizing pancreatitis. J Crit Care. 2010;25(1):105-111.
23. Smotkin J, Tenner S. Laboratory diagnostic tests in acute pancreatitis. J Clin Gastroenterol. 2002;34(4):459-462.
24. American Gastroenterological Association (AGA) Institute on “Management of Acute Pancreatits” Clinical Practice and Economics Committee; AGA Institute Governing Board. AGA Institute medical position statement on acute pancreatitis. Gastroenterology. 2007;132(5):2019-2021.
25. Vissers RJ, Abu-Laban RB. Acute and chronic pancreatitis. In: Tintinalli JE, Kelen GD, Stapczynski JS (eds.), Emergency medicine. A comprehensive study guide. 5th edition, New York: McGraw-Hill, 2000:pp.588-592.
26. Greenberg JA, Hsu J, Bawazeer M, et al. Clinical practice guideline: management of acute pancreatitis. Can J Surg. 2016;59(2):128-140.
27. Karaca E, Oktay C. The effect of prognostic criteria on the outcome of patients with nontraumatic acute pancreatitis. Turk J Emerg Med. 2008;8:18-25.
28. Sargent S. Pathophysiology, diagnosis and management of acute pancreatitis. Br J Nurs. 2006;15(18):999-1005.
29. Kim YS, Lee BS, Kim SH, Seong JK, Jeong HY, Lee HY. Is there correlation between pancreatic enzyme and radiological severity in acute pancreatitis?. World J Gastroenterol. 2008;14(15):2401-2405.
30. Mitchell RM, Byrne MF, Baillie J. Pancreatitis. Lancet. 2003;361(9367):1447-1455.
31. Abu-El-Haija M, Kumar S, Quiros JA, et al. Management of acute pancreatitis in the pediatric population: a clinical report from the North American Society for Pediatric Gastroenterology, Hepatology and Nutrition Pancreas Committee. J Pediatr Gastroenterol Nutr. 2018;66(1):159-176.