Serum creatinine and chest radiographs in the early assessment of acute pancreatitis.
BACKGROUND
We previously identified serum creatinine values >2 mg/dL (176.8 micromol/L) and pathological chest radiographs due to the presence of pleural effusions or pulmonary densifications as two early prognostic factors of life-threatening acute pancreatitis (AP). The aim of the present study was to validate their prognostic efficacy in combination.


METHODS
We analyzed as prognostic factors only the data obtained within 24 hours of admission in 539 cases of AP, including 163 patients (30.2%) with acute necrotizing pancreatitis (NP). Eleven patients (2%) presented with infected pancreatic necrosis, and 20 patients (3.7%) died.


RESULTS
One hundred and nine cases (20.2%) presented pathological chest radiographs: 32 (5.9%) pulmonary densifications and 77 (14.3%) pleural effusions (18 right, 25 left, 34 bilateral). Fifty-one patients (9.5%) had serum creatinine values >2 mg/dL. Pathological chest radiographs and serum creatinine values >2 mg/dL were significantly associated both with mortality risk (P <0.00001), with a diagnosis of NP (P <0.00001), and with risk of developing infected necrosis (P <0.0001). Considering positivity of either or both tests, the mortality risk sensitivity was 90% (95% confidence interval [CI] 70.7 to 98.3) with a specificity of 76% (CI 72.5 to 79.8), for the NP diagnosis the sensitivity was 60% (CI 52.5 to 67.4) and the specificity 88% (CI 85.0-91.5), whereas for the risk of infected necrosis the sensitivity was 73% (CI 42.2 to 92.6) and specificity 75% (CI 70.1 to 78.4). These data are comparable to those obtained with the Ranson or Glasgow scores at 24 hour in this patient group, with a cut-off > or =3.


CONCLUSIONS
Serum creatinine and chest radiographs are two indices capable of identifying, within 24 hour of admission, a subgroup of acute pancreatitis patients with a more severe or adverse clinical course.
Talamini
G
G
Gastroenterological Department, University of Verona, Italy.
Uomo
G
G
Pezzilli
R
R
Rabitti
P G
PG
Billi
P
P
Bassi
C
C
Cavallini
G
G
Pederzoli
P
P
D000328:Adult; D000368:Aged; D002423:Cause of Death; D003404:Creatinine / Q000097:blood*; D005260:Female; D006801:Humans; D008168:Lung / Q000000981:diagnostic imaging*; D008297:Male; D008875:Middle Aged; D009102:Multiple Organ Failure / Q000401:mortality; D010186:Pancreatic Function Tests; D019283:Pancreatitis, Acute Necrotizing / Q000097:blood / Q000000981:diagnostic imaging* / Q000401:mortality; D010996:Pleural Effusion / Q000097:blood / Q000000981:diagnostic imaging* / Q000401:mortality; D011379:Prognosis; D011859:Radiography; D015996:Survival Rate
D003404:Creatinine