title: Early measures of hemoconcentration and inflammation are predictive of prolonged hospitalization from post- endoscopic retrograde cholangiopancreatography pancreatitis.
abstract: OBJECTIVE
  Hemoconcentration markers are predictors of severe acute pancreatitis but have not been specifically evaluated in post-endoscopic retrograde cholangiopancreatography pancreatitis (PEP).
  
  
  METHODS
  Case-control study of patients undergoing ERCP for suspected sphincter of Oddi dysfunction. We identified patients with PEP (PEP positive) and controls (PEP negative) in a 1:2 ratio. blood urea nitrogen (BUN) and hematocrit (Hct) were measured before procedure, upon admission, and 24 hours later. Preprocedure levels of BUN and Hct were analyzed to control for confounders. Among the PEP-positive patients, BUN level, Hct level, and systemic inflammatory response syndrome are compared between severe and mild/moderate cases.
  
  
  RESULTS
  There were 149 PEP-positive patients, including 18 patients (12.1%) with severe PEP and 301 PEP-negative controls. After adjusting, higher preprocedure BUN level (odds ratio [OR], 1.05 [1.01, 1.10]; P < 0.02) and pancreatic sphincterotomy (OR, 1.60 [1.01, 2.55]; P < 0.05) were associated with PEP, whereas older age (OR, 0.98 [0.96, 0.99]; P < 0.02) and a greater body mass index (OR, 0.97 [0.94, 0.99]; P < 0.03) with a lower rate.Difference in BUN level of 0.0 or greater (failure to decline) had a sensitivity of 71% and a specificity of 79% for differentiating severe from mild/moderate PEP. Patients with severe PEP were more likely to have systemic inflammatory response syndrome upon admission (44.4% [21.5, 67.4]) and after 24 hours (61.1% [38.6, 83.6] versus mild/moderate (9.2% [4.2, 14.1], 10.6% [5.4,16.0]; P < 0.0001 for each).
  
  
  CONCLUSIONS
  Preprocedure BUN level is associated with the development of PEP. The preprocedure BUN level and failure of the BUN level to decline during the first 24 hours are associated with prolonged hospitalization.
authors: Department of Medicine, Indiana University School of Medicine, Indianapolis, IN 46202, USA. gcote@iu.edu
authors: Gregory A
authors: GA
authors: Coté
authors: Sashidhar V
authors: SV
authors: Sagi
authors: Suzette E
authors: SE
authors: Schmidt
authors: Glen A
authors: GA
authors: Lehman
authors: Lee
authors: L
authors: McHenry
authors: Evan
authors: E
authors: Fogel
authors: James
authors: J
authors: Watkins
authors: Stuart
authors: S
authors: Sherman
mesh_terms: D000208:Acute Disease; D000328:Adult; D001806:Blood Urea Nitrogen; D016022:Case-Control Studies; D002760:Cholangiopancreatography, Endoscopic Retrograde / Q000009:adverse effects*; D042241:Early Diagnosis; D005260:Female; D006400:Hematocrit; D006801:Humans; D007249:Inflammation / Q000175:diagnosis*; D007902:Length of Stay; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010195:Pancreatitis / Q000097:blood / Q000175:diagnosis* / Q000209:etiology; D011237:Predictive Value of Tests; D011379:Prognosis; D012307:Risk Factors; D009803:Sphincter of Oddi / Q000503:physiopathology / Q000601:surgery