Gastric intramucosal pH predicts death in severe acute pancreatitis.
BACKGROUND
This study tested the hypothesis that gastric intramucosal pH (pHi) can predict death in severe acute pancreatitis.


METHODS
Seventeen consecutive patients with predicted severe acute pancreatitis were studied prospectively. Four died from complications related to pancreatitis. Gastric pHi was measured by nasogastric tonometry at least every 12 h for the first 48 h after admission and then on a daily basis during the first week.


RESULTS
The lowest pHi recorded during the first 48 h was significantly less in those admitted to the intensive care unit than that in those who remained on the surgical ward (P = 0.0015) and in nonsurvivors compared with the survivors (P = 0.009). A receiver-operator characteristic curve defined a pHi of 7.25 as the optimal cut-off point to predict death (sensitivity 100 per cent, specificity 77 per cent, overall predictive value 82 per cent).


CONCLUSIONS
These results suggest that splanchnic ischaemia may be an important determinant of outcome in patients with severe acute pancreatitis.
Bonham
M J
MJ
Department of Surgery, Faculty of Medicine and Health Sciences, University of Auckland, New Zealand.
Abu-Zidan
F M
FM
Simovic
M O
MO
Windsor
J A
JA
D000208:Acute Disease; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005544:Forecasting; D005753:Gastric Mucosa / Q000737:chemistry*; D006801:Humans; D006863:Hydrogen-Ion Concentration; D008297:Male; D008875:Middle Aged; D010195:Pancreatitis / Q000401:mortality* / Q000503:physiopathology; D011379:Prognosis; D011446:Prospective Studies