Acute pancreatitis: predictors of mortality, pancreatic necrosis and intervention

Ramlal Prajapati; Priyadarshini Manay; Kavin Sugumar; Vinay Rahandale; Rajeev Satoskar

doi:10.47717/turkjsurg.2021.5072

Acute pancreatitis: predictors of mortality, pancreatic necrosis and intervention

Turk J Surg. 2021 Mar 22;37(1):13-21. doi: 10.47717/turkjsurg.2021.5072. eCollection 2021 Mar.

Authors

Ramlal Prajapati¹, Priyadarshini Manay², Kavin Sugumar¹, Vinay Rahandale³, Rajeev Satoskar³

Affiliations

¹ Department of Surgery, University Hospitals, Seidman Cancer Center, Cleveland, United States.
² Department of Transplant Surgery, University of Iowa Hospitals & Clinics, Iowa City, United States.
³ Department of Surgery, Seth G.S Medical College and King Edward Memorial Hospital, Mumbai, India.

Abstract

Objectives: 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; CT-severity index; Ranson’s score; SIRS; necrosis; prognostic score.