Predictors of vascular and gastrointestinal complications in severe acute pancreatitis.
OBJECTIVE
To determine prognostic factors for arterial injury and gastrointestinal perforation in patients with severe acute pancreatitis (AP).


METHODS
A prospective cohort study was performed in 39 patients with AP whose Ranson scores were > or =3. The following parameters were assessed: Ranson score, APACHE II score, C-reactive protein (CRP) concentration on admission and on day 7, and contrast-enhanced computed tomography (CT) scans on admission (first CT) and between days 6 and 8 (second CT). The Balthazar CT severity index was calculated.


RESULTS
Six patients developed seven vascular and/or gastrointestinal complications (duodenal perforations in 3 and arterial pseudoaneurysm in 4). CRP on day 7 and the CT severity indices at the second CT were significantly higher in the complication group than in the noncomplication group. A stepwise logistic regression analysis demonstrated that CRP > or =15 mg/dl on day 7 and CT severity index > or =7 at the second CT were independent risk factors (p = 0.02 and 0.04, respectively). The odds ratio for CRP > or =15 mg/dl was 23.0 and 15.7 for a CT severity index of > or =7.


CONCLUSIONS
A persistent elevation of the CRP concentration and a high CT severity index are independent risk factors for local complications associated with AP.
Hagiwara
Akiyoshi
A
Department of Traumatology, National Defense Medical College, Tokorozawa, Japan. boeihagi@ndmc.ac.jp
Miyauchi
Hiroshi
H
Shimazaki
Shuji
S
D018806:APACHE; D000208:Acute Disease; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017541:Aneurysm, False / Q000209:etiology; D002097:C-Reactive Protein / Q000032:analysis; D015331:Cohort Studies; D004378:Duodenal Diseases / Q000209:etiology; D005260:Female; D005767:Gastrointestinal Diseases / Q000209:etiology*; D006801:Humans; D007416:Intestinal Perforation / Q000209:etiology; D008297:Male; D008875:Middle Aged; D010195:Pancreatitis / Q000150:complications*; D011446:Prospective Studies; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D014057:Tomography, X-Ray Computed
D002097:C-Reactive Protein