[Analysis of the factors that affect the mortality rate in severe acute pancreatitis].
OBJECTIVE
Severe acute pancreatitis occurs in about 20% of the patients with acute pancreatitis and can be associated with multiorgan failure and local complications. In patients with predicted severe acute pancreatitis, overall mortality rates are about 15-30%. The aim of this study was to determine the factors correlated with mortality in patients with severe acute pancreatitis.


METHODS
We reviewed five hundread and seventy two consecutive cases of acute pancreatitis from January, 2000 to December, 2005. Of them, 109 patients who fulfilled the criteria of Atlanta classification for severe acute pancreatitis were enrolled. Data were collected by chart reviews including age, gender, etiology, body mass index (BMI), modified Glasgow score, APACHE II score, APACHE III score, Balthazar CT index, and other laboratory parameters performed within 48 hours after the initial admission.


RESULTS
Severe acute pancreatitis was most commonly caused by alcohol. Overall mortality rate was 20.2% in severe acute pancreatitis and 10 (45%) deaths occurred within the first week. Multiple logistic regression analysis identified serum creatinine, corrected calcium concentrations, and CT index as predictors of mortality in patients with severe acute pancreatitis. The risk score (R) was calculated by combining 3 prognostic values with regression coefficients; R=2.512 loge (creatinine mg/dL)+1.729 loge (CT index)??4.780 loge (corrected calcium mg/dL). The AUC for this score was 0.877 and a cutoff level of 0 was determined to predict the mortality with 83.3% sensitivity and 89.5% specificity.


CONCLUSIONS
The newly designed risk score comprising 3 parameters can be used as the significant early predictor for hospital mortality in severe acute pancreatitis.
Lee
Beom Jae
BJ
Department of Internal Medicine, Institute of Digestive Disease and Nutrition, Korea University College of Medicine, Seoul, Korea.
Kim
Chang Duck
CD
Jung
Sung Woo
SW
Kwon
Yong Dae
YD
Kim
Yong Sik
YS
Yim
Hyung Joon
HJ
Jeen
Yoon Tae
YT
Lee
Hong Sik
HS
Kim
Jae Sun
JS
Chun
Hoon Jai
HJ
Um
Soon Ho
SH
Lee
Sang Woo
SW
Choi
Jai Hyun
JH
Ryu
Ho Sang
HS
D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009102:Multiple Organ Failure / Q000209:etiology; D015999:Multivariate Analysis; D010195:Pancreatitis / Q000150:complications / Q000175:diagnosis / Q000401:mortality*; D011237:Predictive Value of Tests; D011379:Prognosis; D012372:ROC Curve; D012189:Retrospective Studies; D012720:Severity of Illness Index; D016019:Survival Analysis