Systemic inflammatory response syndrome between 24 and 48 h after ERCP predicts prolonged length of stay in patients with post-ERCP pancreatitis: a retrospective study.
BACKGROUND
Early systemic inflammatory response syndrome (SIRS) has been associated with severe non-iatrogenic acute pancreatitis. The aims of this study were to determine whether early SIRS could be used to predict severe post-ERCP pancreatitis (PEP) and to determine the effect of prophylactic-pancreatic stenting (PS) on SIRS and severe PEP.


METHODS
Between 1/2000 and 6/2012, all patients admitted for PEP after an outpatient ERCP and who had ≥1 abdominal CT scan during hospitalization were retrospectively evaluated. The presence of SIRS was assessed between 0 and 24 h and 24 and 48 h after the time of ERCP completion. SIRS was evaluated as a predictor of severe PEP using area under receiver operating characteristic (AUROC) curve analysis.


RESULTS
There were 113 patients with PEP of whom 22 (19.5%) had severe PEP. SIRS was present in 44 (38.9%) and 33 (29.2%) patients between 0 and 24 h and 24 and 48 h, respectively. SIRS between 24 and 48 h had a higher predictive accuracy for severe PEP compared to SIRS between 0 and 24 h (AUROC = 0.7 vs. 0.5, p = 0.002). The prevalence of SIRS between 24 and 48 h was significantly less among the 19 patients who underwent PS (11% vs. 37%, p = 0.03). There was no difference between the prophylactic stenting and no stenting groups with regards to acute fluid collection(s), pancreatic necrosis, organ failure or mortality during hospitalization.


CONCLUSIONS
SIRS between 24 and 48 h after ERCP is an accurate, easy to obtain, and inexpensive predictor of severe PEP. PS is associated with a decreased prevalence of SIRS between 24 and 48 h after ERCP.
Department of Internal Medicine, Division of Gastroenterology and Hepatology, Johns Hopkins Medical Institutions, Baltimore, MD, USA. Electronic address: amitashasinha@gmail.com.
Amitasha
A
Sinha
Department of Internal Medicine, Division of Gastroenterology and Hepatology, Johns Hopkins Medical Institutions, Baltimore, MD, USA. Electronic address: rcader@me.com.
Rukshana
R
Cader
Department of Internal Medicine, Division of Gastroenterology and Hepatology, Johns Hopkins Medical Institutions, Baltimore, MD, USA. Electronic address: findsandeep.amc@gmail.com.
Venkata S
VS
Akshintala
Department of Internal Medicine, Division of Gastroenterology and Hepatology, Johns Hopkins Medical Institutions, Baltimore, MD, USA. Electronic address: shutfle1@jhmi.edu.
Susan M
SM
Hutfless
Pancreatitis Center, Johns Hopkins Medical Institutions, Baltimore, MD, USA; Department of Radiology and Radiological Science, Johns Hopkins Medical Institutions, Baltimore, MD, USA. Electronic address: azaheer1@jhmi.edu.
Atif
A
Zaheer
Department of Internal Medicine, Division of Gastroenterology and Hepatology, Johns Hopkins Medical Institutions, Baltimore, MD, USA. Electronic address: vinshinazkhan86@gmail.com.
Vinshi N
VN
Khan
Department of Internal Medicine, Division of Gastroenterology and Hepatology, Johns Hopkins Medical Institutions, Baltimore, MD, USA. Electronic address: mkhasha1@jhmi.edu.
Mouen A
MA
Khashab
Department of Internal Medicine, Division of Gastroenterology and Hepatology, Johns Hopkins Medical Institutions, Baltimore, MD, USA. Electronic address: amlennon@jhmi.edu.
Anne Marie
AM
Lennon
Pancreatitis Center, Johns Hopkins Medical Institutions, Baltimore, MD, USA; Department of Internal Medicine, Division of Gastroenterology and Hepatology, Johns Hopkins Medical Institutions, Baltimore, MD, USA. Electronic address: akalloo@jhmi.edu.
Anthony N
AN
Kalloo
Pancreatitis Center, Johns Hopkins Medical Institutions, Baltimore, MD, USA; Department of Internal Medicine, Division of Gastroenterology and Hepatology, Johns Hopkins Medical Institutions, Baltimore, MD, USA. Electronic address: vsingh1@jhmi.edu.
Vikesh K
VK
Singh
D000328:Adult; D002760:Cholangiopancreatography, Endoscopic Retrograde / Q000009:adverse effects*; D015331:Cohort Studies; D005260:Female; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D010195:Pancreatitis / Q000209:etiology* / Q000628:therapy; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D018746:Systemic Inflammatory Response Syndrome / Q000209:etiology*; D016896:Treatment Outcome
Cholangiopancreatography; Complications; Endoscopic retrograde; Pancreatitis; Stent; Systemic inflammatory response syndrome