title: Predictors and outcomes of acute pancreatitis in critically ill patients presenting to the emergency department of a tertiary referral centre in Australia.
abstract: OBJECTIVE
  To provide a current review of the clinical characteristics, predictors and outcomes in critically ill patients presenting to the ED with acute pancreatitis and subsequently admitted to an intensive care unit (ICU) of a tertiary referral centre in Australia.
  
  
  METHODS
  A retrospective single-centre study of adult patients admitted with pancreatitis. Severe acute pancreatitis defined by Bedside Index of Severity in Acute Pancreatitis (BISAP) score ≥2.
  
  
  RESULTS
  Eighty-seven patients fulfilled criteria for inclusion during the study period, representing 0.9% of all ICU admissions. The median age of patients was 54. Survival was independent of patients' age, sex, aetiology and comorbidities. Mortality was 30.8% for both inpatient referrals to the ICU and for direct referrals via the ED. Higher mortality was identified among patients requiring mechanical ventilation (74.2 vs 24.6% in survivors; P < 0.0001), vasopressor support (85.7 vs 33.8% in survivors; P < 0.0001) or renal replacement therapy (60 vs 16.9% in survivors; P < 0.002). BISAP score surpasses Ranson's and Acute Physiological and Chronic Health Examination (APACHE) II scores in discriminating between survivors and non-survivors among unselected patients with acute pancreatitis admitted to ICU, whereas APACHE II discriminates better in the cohort admitted from ED.
  
  
  CONCLUSIONS
  Severe acute pancreatitis is associated with high mortality. Aetiology and comorbidity did not predict adverse outcomes in this population. BISAP score is non-inferior to APACHE II score as a prognostic tool in critically ill patients with acute pancreatitis and could be used to triage admission. Evidence of persistent organ dysfunction and requirements for organ support reliably identify patients at high-risk of death.
authors.affiliation: Intensive Care Unit, Royal Adelaide Hospital, Adelaide, South Australia, Australia.|Discipline of Acute Care Medicine, The University of Adelaide, Adelaide, South Australia, Australia.
authors.forename: Krishnaswamy
authors.initials: K
authors.lastname: Sundararajan
authors.affiliation: Queen Elizabeth Hospital, Central Adelaide Local Health Network, Adelaide, South Australia, Australia.
authors.forename: Tom
authors.initials: T
authors.lastname: Schoeman
authors.affiliation: Flinders Medical Centre, Southern Adelaide Local Health Network, Adelaide, South Australia, Australia.
authors.forename: Lara
authors.initials: L
authors.lastname: Hughes
authors.affiliation: Data, Design and Statistics Service, Adelaide Health Technology Assessment, School of Public Health, The University of Adelaide, Adelaide, South Australia, Australia.
authors.forename: Suzanne
authors.initials: S
authors.lastname: Edwards
authors.affiliation: Intensive Care Unit, Royal Adelaide Hospital, Adelaide, South Australia, Australia.|Discipline of Acute Care Medicine, The University of Adelaide, Adelaide, South Australia, Australia.
authors.forename: Benjamin
authors.initials: B
authors.lastname: Reddi
mesh_terms: D000328:Adult; D000368:Aged; D000437:Alcoholism / Q000150:complications; D001315:Australia / Q000453:epidemiology; D016638:Critical Illness / Q000453:epidemiology* / Q000401:mortality; D004636:Emergency Service, Hospital / Q000458:organization & administration / Q000706:statistics & numerical data; D005260:Female; D042882:Gallstones / Q000150:complications; D006801:Humans; D015601:Injury Severity Score; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D010195:Pancreatitis / Q000209:etiology / Q000401:mortality*; D063868:Patient Outcome Assessment; D011379:Prognosis; D012189:Retrospective Studies; D062606:Tertiary Care Centers / Q000458:organization & administration / Q000706:statistics & numerical data
keywords: 
  APACHE II score; 
  BISAP score; emergency department; intensive care unit; severe acute pancreatitis