Persistent Systemic Inflammatory Response Syndrome predicts the need for tertiary care in Acute Pancreatitis

Patients with Acute Pancreatitis (AP) presenting with Systemic Inflammatory Response syndrome (SIRS) are more likely to have severe acute pancreatitis and are at increased risk of complications. Additionally, persistence of SIRS at 48 hrs after admission is associated with persistent organ failure and a worse outcome. We investigated the usefulness of SIRS as a criterion for referring patients to a tertiary pancreatic care centre.

Retrospective analyses of patients admitted with AP over a one year period. Patients were classified into 2 severity groups - 1) Mild AP, 2) Moderate and Severe AP (MASP) as per the Revised Atlanta Classification. SIRS was determined at presentation and following 48 hours of best medical management. Outcomes were compared between patients who had no SIRS at presentation, transient SIRS(SIRS≤48hrs) and persistent SIRS(>48hrs).

134 patients were included in the study. SIRS at presentation had a sensitivity of 88%(95% CI 75-96) and a specificity of 66%(95% CI 55-75) in predicting MASP. However, persistent SIRS and recovery from SIRS within 48hrs were poor predictors of MASP. Only 23/43 (53.5%) patients with MASP had persistent SIRS. Interestingly, MASP patients with persistant SIRS had a significant higher risk of complications, readmission, intervention, culture positivity and hospital stay as compared to those with transient SIRS.

Persistent SIRS could be used to identify patients with MASP requiring tertiary care. This could be used as an effective tool by community hospitals with limited facilities. Further, prospective studies are required to validate our findings.