Has blood glucose level measured on admission to hospital in a patient with acute pancreatitis any prognostic value?
BACKGROUND
Early detection of pancreatic necrosis allows better management of the disease. Contrast-enhanced computed tomography (CT) as the gold standard for detecting pancreatic necrosis is expensive.


OBJECTIVE
This study was to evaluate for the first time whether blood glucose estimation on hospital admission--a simple, cheap, readily available laboratory parameter--may detect pancreatic necrosis and have prognostic value in acute pancreatitis.


METHODS
Single blood glucose estimation upon hospital admission was evaluated prospectively for detecting pancreatic necrosis and as a prognostic indicator. The study included 241 nondiabetic patients with a first attack of acute pancreatitis. All underwent CT within 72 h of admission.


RESULTS
High blood glucose (> 125 mg/dl) correlated significantly with complex high clinical and biochemical prognostic scores (Ranson, Imrie), a high Balthazar score, pancreatic pseudocysts, and a long hospital stay, but not with organ failure, indication for artificial ventilation, dialysis, surgery, length of intensive care, and mortality. Pancreatic necrosis detection sensitivity of high blood glucose was 83%, specificity 49%, positive predictive value 28%, and negative predictive value 92%.


CONCLUSIONS
A patient with normal blood glucose on admission is unlikely to have pancreatic necrosis. Contrast-enhanced CT would not be needed unless the patient fails to improve.
Department of Internal Medicine, Municipal Clinic of Lüneburg.
P G
PG
Lankisch
T
T
Blum
A
A
Bruns
M
M
Dröge
G
G
Brinkmann
K
K
Struckmann
M
M
Nauck
P
P
Maisonneuve
A B
AB
Lowenfels
D000208:Acute Disease; D001786:Blood Glucose / Q000378:metabolism*; D003955:Diagnostic Tests, Routine; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010195:Pancreatitis / Q000097:blood / Q000175:diagnosis*; D011237:Predictive Value of Tests; D011379:Prognosis; D011446:Prospective Studies; D012720:Severity of Illness Index
D001786:Blood Glucose