Prediction of early death in severe acute pancreatitis.
BACKGROUND
In severe acute pancreatitis (SAP), it is clinically important at the time of admission to predict the likelihood of early death. This investigation aimed to clarify the factors predicting early death in SAP.


METHODS
Early death was defined as death within 10 days after disease onset. Prediction factors for early death were evaluated from data obtained on admission from 93 patients with SAP, and the characteristics of patients who died early were analyzed.


RESULTS
Between the early-death and early-survival groups, significant factors were base excess (BE), serum creatinine (Cr), blood sugar, serum glutamate oxaloacetic transaminase, and serum calcium. Multivariate analysis revealed that BE was an independent prediction factor for early death. The early-death rate in patients with BE < -5.5 mEq/l and Cr >or= 3.0 mg/dl was 31% and 36%, respectively. The combination of BE and Cr raised the positive predictive value to 50%, and was equally able to predict early death as the Japanese Severity Score (JSS), which was the most useful of the three conventional scoring systems used. All early-death patients had pancreatic necrosis, and their JSS was >or= 15 (stage 4). Characteristically, early-death patients had lactate dehydrogenase (LDH)>1300 IU/l, or they had serious preexisting comorbidities.


CONCLUSIONS
As a single parameter, BE was most useful for predicting early death. The combination of BE and Cr could predict early death as well as the JSS. An extreme rise of LDH and serious preexisting comorbidity may also be risk factors for early death.
Shinzeki
Makoto
M
Department of Gastroenterological Surgery, Kobe University Graduate School of Medical Sciences, 7-5-2 Kusunoki, Chuo-ku, Kobe, 650-0017 Japan.
Ueda
Takashi
T
Takeyama
Yoshifumi
Y
Yasuda
Takeo
T
Matsumura
Naoki
N
Sawa
Hidehiro
H
Nakajima
Takahiro
T
Matsumoto
Ippei
I
Fujita
Tsunenori
T
Ajiki
Tetsuo
T
Fujino
Yasuhiro
Y
Kuroda
Yoshikazu
Y
D000208:Acute Disease; D000368:Aged; D001219:Aspartate Aminotransferases / Q000097:blood; D003404:Creatinine / Q000097:blood; D005260:Female; D006801:Humans; D007770:L-Lactate Dehydrogenase / Q000097:blood; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010195:Pancreatitis / Q000209:etiology / Q000401:mortality*; D019512:Pancreatitis, Alcoholic / Q000401:mortality; D011237:Predictive Value of Tests; D012720:Severity of Illness Index; D016019:Survival Analysis
D003404:Creatinine; D007770:L-Lactate Dehydrogenase; D001219:Aspartate Aminotransferases