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Identification of admission values predictive of complicated acute alcoholic pancreatitis
Christine Dauphine1, Jeffrey Kovar, Bruce E Stabile
1Department of Surgery, Harbor-UCLA Medical Center, Torrance, CA 90509, USA.
Background:
Hospital admission indexes (serum urea nitrogen level, serum glucose level, heart rate, and white blood cell count) have been previously identified as useful predictors for the development of both severe systemic complications and death in patients with gallstone pancreatitis.
Hypothesis:
We hypothesized that (1) these same 4 indexes would predict complications and/or death in first-time acute alcoholic pancreatitis and (2) these indexes would compare favorably with an admission Ranson score.
Design:
Retrospective cohort study.
Setting:
A university-affiliated, urban, public teaching hospital.
Patients:
One hundred five patients who experienced first episodes of alcoholic pancreatitis treated between January 1, 1992, and June 30, 2003.
Main Outcome Measures:
Major systemic complications (pulmonary, cardiac, renal, infectious) requiring intensive care unit admission and/or death.
Results:
A total of 105 patients were identified. Twenty-six patients (25%) (95% confidence interval [CI], 17%-34%) had a major systemic complication, and 6 patients (6%) (95% CI, 2%-12%) died. A serum glucose level of 160 mg/dL (8.9 mmol/L) or higher combined with a white blood cell count of 17 x 10(3)/ micro L or more had a positive predictive value of 80% (95% CI, 44%-98%), and an admission Ranson score of 3 or higher had a positive predictive value of 100% (95% CI, 48%-100%) for determining the likelihood of a systemic complication. Both an admission Ranson score of 1 or more and a white blood cell count of 17 x 10(3)/ micro L or more, independent of each other, had equally high negative predictive values (100% [95% CI, 94%-100%] and 99% [95% CI, 94%-100%], respectively) with respect to mortality.
Conclusions:
Two simple admission laboratory values--white blood cell count and serum glucose level--are useful predictors for development of major systemic complications and/or mortality in patients with first-time alcoholic pancreatitis. The predictive values of leukocytosis and hyperglycemia compare favorably with those of the admission Ranson score.
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Pancreatitis is the inflammation of the pancreas, which occurs when the immune system becomes active and causes swelling, pain, and disruptions in organ function. Pancreatitis can manifest as either an acute or chronic condition.
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