title: The predictive value of proteinuria in acute pancreatitis.
abstract: OBJECTIVE
  Acute pancreatitis has a highly variable clinical course. Early and reliable predictors for the severity of acute pancreatitis are lacking. Proteinuria appears to be a useful predictor of disease severity and outcome in a variety of clinical conditions. This study aims to investigate the predictive value of proteinuria on admission for the severity of acute pancreatitis compared with other commonly used predictors; the APACHE II score, Modified Glasgow score and C-reactive protein (CRP).
  
  
  METHODS
  This is a post-hoc analysis of 64 patients admitted with acute pancreatitis treated in one teaching hospital, who participated in a previous randomized trial. Proteinuria was defined as a Protein/Creatinine (P/C) ratio >23 mg/mmol. The primary endpoint was severe acute pancreatitis. Secondary endpoints included infectious complications, need for invasive intervention, ICU stay and in-hospital mortality.
  
  
  RESULTS
  Proteinuria was present in 30/64 patients (47%). Eleven patients (17%) had severe acute pancreatitis. There was no difference in incidence of severe acute pancreatitis between patients with and without proteinuria: 6/30 patients (20%) versus 5/34 patients (15%) respectively (p = 0.58). Likewise, the occurrence of infectious complications, need for intervention and ICU stay and mortality did not differ significantly (p = 0.58, p = 0.99, p = 0.33 and p = 0.60 respectively). The diagnostic performance of the P/C ratio for the prediction of severe pancreatitis was inferior to the Modified Glasgow score (p = 0.04) and CRP (p = 0.03).
  
  
  CONCLUSIONS
  Proteinuria on admission does not seem to be a reliable predictor for disease severity in acute pancreatitis. The diagnostic performance of the P/C ratio is inferior to the Modified Glasgow score and CRP.
authors.affiliation: Department of Gastroenterology, St. Antonius Hospital Nieuwegein, The Netherlands. Electronic address: m.zuidema@antoniusziekenhuis.nl.
authors.forename: M J
authors.initials: MJ
authors.lastname: Zuidema
authors.affiliation: Department of Surgery, St. Antonius Hospital Nieuwegein, The Netherlands.
authors.forename: H C
authors.initials: HC
authors.lastname: van Santvoort
authors.affiliation: Department of Surgery, Academic Medical Center Amsterdam, The Netherlands.
authors.forename: M G
authors.initials: MG
authors.lastname: Besselink
authors.affiliation: Department of Surgery, St. Antonius Hospital Nieuwegein, The Netherlands.
authors.forename: B
authors.initials: B
authors.lastname: van Ramshorst
authors.affiliation: Department of Surgery, St. Antonius Hospital Nieuwegein, The Netherlands.
authors.forename: D
authors.initials: D
authors.lastname: Boerma
authors.affiliation: Department of Gastroenterology, St. Antonius Hospital Nieuwegein, The Netherlands.
authors.forename: R
authors.initials: R
authors.lastname: Timmer
authors.affiliation: Department of Radiology, St. Antonius Hospital Nieuwegein, The Netherlands.
authors.forename: T L
authors.initials: TL
authors.lastname: Bollen
authors.affiliation: Department of Gastroenterology, St. Antonius Hospital Nieuwegein, The Netherlands.
authors.forename: B L A M
authors.initials: BL
authors.lastname: Weusten
mesh_terms: D018806:APACHE; D000208:Acute Disease; D000368:Aged; D016208:Databases, Factual; D023381:Endpoint Determination; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D009426:Netherlands / Q000453:epidemiology; D010195:Pancreatitis / Q000175:diagnosis* / Q000401:mortality; D011237:Predictive Value of Tests; D011446:Prospective Studies; D011507:Proteinuria / Q000175:diagnosis* / Q000628:therapy; D016896:Treatment Outcome
keywords: Creatinine; Pancreatitis; Prognosis; Proteinuria; Severity; Urine