High serum creatinine in acute pancreatitis: a marker for pancreatic necrosis?
OBJECTIVE
High serum creatinine is a well-known unfavorable prognostic parameter in acute pancreatitis. Elevated creatinine at 48 h after admission was recently described as a marker for pancreatic necrosis. As pancreatic necrosis is a serious complication of acute pancreatitis and its identification by a simple single laboratory test would be very helpful, the aim of this study was to test that statement.


METHODS
In a prospective multicenter study of 462 patients with a first attack of acute pancreatitis, serum creatinine was determined on admission, and at 24 and 48 h thereafter, and compared with the findings of contrast-enhanced computed tomography (CT) performed within 96 h of admission.


RESULTS
Pancreatic necrosis was present in 62 (13%) of the patients. Serum creatinine levels (abnormal > or = 2 mg/dl) on admission and after 24 and 48 h were evaluated vs. the presence or absence of pancreatic necrosis. Sensitivity rates varied between 14 and 23%, specificity between 95 and 97%, positive predictive values between 41 and 50%, and negative predictive values between 87 and 89%. Receiver operating characteristic curves revealed an area under the curve of between 0.604 and 0.669.


CONCLUSIONS
An elevated serum creatinine concentration at any time during the first 48 h of admission is not a marker for pancreatic necrosis in a first attack of acute pancreatitis. If serum creatinine is normal, necrotizing pancreatitis is unlikely, and contrast-enhanced CT need not be performed unless complications occur and/or the patient's condition deteriorates.
Lankisch
Paul Georg
PG
Department of General Internal Medicine, Municipal Clinic of Lüneburg, Lüneburg, Germany. paulgeorg.lankisch@t-online.de
Weber-Dany
Bettina
B
Maisonneuve
Patrick
P
Lowenfels
Albert B
AB
D000328:Adult; D000368:Aged; D015415:Biomarkers / Q000097:blood*; D003287:Contrast Media; D003404:Creatinine / Q000097:blood* / Q000378:metabolism; D016638:Critical Illness; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D019283:Pancreatitis, Acute Necrotizing / Q000097:blood* / Q000000981:diagnostic imaging* / Q000473:pathology; D011446:Prospective Studies; D011856:Radiographic Image Enhancement; D012307:Risk Factors; D012680:Sensitivity and Specificity; D013997:Time Factors; D014057:Tomography, X-Ray Computed / Q000379:methods
D015415:Biomarkers; D003287:Contrast Media; D003404:Creatinine