Postburn pancreatitis.
OBJECTIVE
The authors examined the prevalence and complications of pancreatitis in severely burned patients. Factors predictive for the development of pancreatitis after burns are considered.


BACKGROUND
Pancreatitis has been documented at necropsy after burns; however, it is not clinically recognized as a common complication of burn injury. Recent improvements in survival rates could yield previously unrecognized complications, such as pancreatitis, particularly in those patients who previously would have not survived. The hypothesis is that pancreatitis is a frequent complication after major burn injury and causes significant morbidity for patients with large burns.


METHODS
This retrospective review of adult patients with large burns examines postburn pancreatitis using stepwise logistic regression analysis.


RESULTS
Forty-nine of 121 (40%) patients developed hyperamylasemia or hyperlipasemia well after the admission period (23 +/- 3 days), and all enzyme abnormalities were temporally associated with emerging infections. Most of these patients (40/49, 82%) had symptoms of pancreatitis. Three patients (6%) had pancreatic pseudocysts or abscesses. Inhalation injury (p = 0.0001), associated trauma (p = 0.0311), and escharotomy (p = 0.0415) were risk factors for pancreatitis. Using Fischer's exact test, patients with pancreatitis had increased mortality and length of stay. Patients with high enzyme elevations and > or = 50% body surface area burned were at severe risk of pancreatic pseudocyst or abscess development (43%; 90% confidence interval of 23-77%).


CONCLUSIONS
Pancreatitis is a frequent complication after large burn injuries. Patients at high risk for pancreatitis complications should receive surveillance examinations during their acute hospitalization.
Ryan
C M
CM
Sumner Redstone Burn Center, Massachusetts General Hospital, Boston 02114, USA.
Sheridan
R L
RL
Schoenfeld
D A
DA
Warshaw
A L
AL
Tompkins
R G
RG
D000038:Abscess / Q000209:etiology; D000328:Adult; D000681:Amylases / Q000097:blood; D001424:Bacterial Infections / Q000201:enzymology; D001830:Body Surface Area; D002056:Burns / Q000145:classification / Q000150:complications* / Q000601:surgery; D005260:Female; D005544:Forecasting; D006801:Humans; D007902:Length of Stay; D008049:Lipase / Q000097:blood; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009104:Multiple Trauma / Q000150:complications; D010182:Pancreatic Diseases / Q000209:etiology; D010192:Pancreatic Pseudocyst / Q000209:etiology; D010195:Pancreatitis / Q000201:enzymology / Q000209:etiology*; D012189:Retrospective Studies; D012307:Risk Factors; D015208:Smoke Inhalation Injury / Q000150:complications; D015996:Survival Rate
D008049:Lipase; D000681:Amylases