ROLE OF SIMPLIFIED ADMISSION CRITERIA FOR PREDICTING SEVERE COMPLICATIONS OF GALL STONE PANCREATITIS
Abstract
Background: Gallstone Pancreatitis (GP) is not an uncommon disease in our country and is associatedwith large number of morbidity and mortality especially if severe complications develop. Differentcriteria have been developed to predict the complications of GP. Simple admission criteria are betterpredictors of severe complications of GP than an APACHE II score of 5 or greater, a modified Imrie(Glasgow) score of 3 or greater, and a Biliary Ranson score of 3 or greater. The purpose of this studywas to determine the role of simplified admission criteria in predicting severe complications ofGallstone Pancreatitis. Methods: This was a descriptive study conducted in Surgical ‘A’ Unit, KhyberTeaching Hospital Peshawar between July 16th 2007 to November 30th 2008. Total 52 patients (42women and 10 men, aged range from 18 to 76 years, with mean age, 39 years) who presented to ourunit with gallstone pancreatitis were included in the study through technique of non-probabilityconvenient sampling. The main outcome measures were major local and systemic complicationsrequiring intensive care unit care, and death. Physiologicalfactors and laboratory data were collected onadmission and recorded daily. Results: Seven patients (14%) had severe complications with mortalityof 2%. On univariate analysis, a white blood cell count of 14500/dL or more (p=0.03), a serum glucoselevel of or more ≥150 mg/dL (8.3 mmol/L) (p<0.001), anAPACHE II score of 5 or greater (p=0.008), amodified Imrie score of 3 or greater (p<0.001), and a biliary Ranson score of 3 or greater (p=0.03) werestatistically associated with the development of severe complications. On multivariate analysis, only aserum glucose level of ≥150 mg/dL or more (8.3 mmol/L) was predictive of adverse events (p<0.001).Conclusions: Glucose level (≥150 mg/dL) is the best single admission predictor of severecomplications of Gallstone Pancreatitis and is superior to an APACHE II score of 5 or greater, amodified Imrie score of 3 or greater, anda biliary Ranson score of 3 or greater.Keywords: Gallstones pancreatitis, admission criteria, complicationsReferences
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