title: C-reactive protein may influence decisively the prescription of prophylactic antibiotics in acute pancreatitis: a population-based cohort study.
abstract: OBJECTIVE
  Prescription of prophylactic antibiotics in acute pancreatitis (AP) is controversial. We aimed to identify the patients' characteristics that may prompt clinicians to prescribe prophylactic antibiotics in AP.
  
  
  METHODS
  This single-center retrospective cohort study included 299 consecutive patients with AP from a Portuguese hospital in 2009 to 2010. Logistic regression was used to study the association of patients' characteristics with prescription of prophylactic antibiotics in AP.
  
  
  RESULTS
  Persistent organ failure developed in 7% of patients (9/136). The median C-reactive protein at 48 hours after hospital admission was 154 mg/L (interquartile range, 55-271 mg/L). Bedside Index for Severity in AP score greater than or equal to 3 occurred in 14% of patients (42/299). Pancreatic necrosis was diagnosed in 21% of the patients (35/169). Computerized Tomography Severity Index score greater than 3 occurred in 23% of patients (38/169). In-hospital mortality rate was 4% (10/299). Prophylactic antibiotics were prescribed to 14% of patients (42/299). After adjusting for persistent organ failure and Computerized Tomography Severity Index score greater than 3, C-reactive protein at 48 hours after hospital admission greater than or equal to 150 mg/L was significantly associated with higher likelihood of receiving prophylactic antibiotics (odds ratio, 12.2). Prophylactic antibiotics did not improve in-hospital mortality rate (P = 0.637).
  
  
  CONCLUSIONS
  C-reactive protein was the most influential in prescribing prophylactic antibiotics in AP. Clinicians may need better tools to support the decision to prescribe prophylactic antibiotics in AP.
authors.affiliation: From the Departments of *Gastroenterology and †Emergency, Hospital Prof. Doutor Fernando Fonseca, Amadora, Portugal.
authors.forename: Filipe S
authors.initials: FS
authors.lastname: Cardoso
authors.forename: Leonel
authors.initials: L
authors.lastname: Ricardo
authors.forename: Pedro
authors.initials: P
authors.lastname: Gondar
authors.forename: João R
authors.initials: JR
authors.lastname: Deus
authors.forename: David
authors.initials: D
authors.lastname: Horta
mesh_terms: D000208:Acute Disease; D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D015415:Biomarkers / Q000097:blood; D002097:C-Reactive Protein / Q000032:analysis*; D016009:Chi-Square Distribution; D018450:Disease Progression; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D018836:Inflammation Mediators / Q000097:blood*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D010195:Pancreatitis / Q000097:blood / Q000175:diagnosis / Q000188:drug therapy* / Q000276:immunology / Q000401:mortality; D019283:Pancreatitis, Acute Necrotizing / Q000175:diagnosis / Q000276:immunology / Q000401:mortality / Q000517:prevention & control*; D010343:Patient Admission; D018579:Patient Selection; D011174:Portugal; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents; D015415:Biomarkers; D018836:Inflammation Mediators; D002097:C-Reactive Protein