Sepsis indicators in acute pancreatitis.
Twenty-one routine clinical and laboratory data in 161 patients with necrotizing pancreatitis (NP) undergoing surgical treatment were analyzed. The necrotic tissue at operation was bacterially infected in 41% of the patients. The goal of the study was to evaluate whether there was any special clinical feature in cases of an infection. The parameters were recorded during 48 h after admission as well as during 48 h before operation, and the frequencies submitted to both a univariate and a multivariate analysis (logistic regression model). In the period after admission, patients with infected necrosis significantly more often had a rectal temperature greater than 38.5 degrees C (p = 0.001). Before operation (i.e., after maximum conservative treatment), four findings were significantly related to an infection: rectal temperature greater than 38.5 degrees C, base excess greater than -4 mmol/L, hematocrit less than 35% (all p = 0.0001), and paO2 less than 60 mm Hg (p = 0.001). The multivariate analysis, which calculates and quantifies the mutual influence of factors, showed a combination of three findings (rectal temperature greater than 38.5 degrees C, base excess greater than -4 mmol/L, and hematocrit less than 35%) to be related to necrosis infection before operation. All three criteria in a patient imply a probability of infection of 83%. It is noteworthy that the sepsis indicators were equally distributed in patients with focal, extended, or subtotal/total infected necrosis, but correlated with the necrosis extent in sterile necrotizing pancreatitis. Moreover, all parameters not related to the pancreatic infection [e.g., hyperglycemia, hypocalcemia, rise of lactic dehydrogenase (LDH), and the white blood cell count] correlated with the three necrosis categories.
Block
S
S
Department of General Surgery, University of Ulm, F.R.G.
Büchler
M
M
Bittner
R
R
Beger
H G
HG
D000137:Acid-Base Imbalance / Q000209:etiology; D000208:Acute Disease; D000367:Age Factors; D001424:Bacterial Infections / Q000175:diagnosis* / Q000473:pathology / Q000601:surgery; D003937:Diagnosis, Differential; D004322:Drainage; D005260:Female; D005334:Fever / Q000209:etiology; D006400:Hematocrit; D006801:Humans; D008297:Male; D008875:Middle Aged; D009336:Necrosis; D010100:Oxygen / Q000502:physiology; D010179:Pancreas / Q000601:surgery; D010195:Pancreatitis / Q000175:diagnosis* / Q000473:pathology / Q000601:surgery; D010313:Partial Pressure; D011336:Probability; D011446:Prospective Studies; D007507:Therapeutic Irrigation
D010100:Oxygen