ROLE OF SIMPLIFIED ADMISSION CRITERIA FOR PREDICTING SEVERE COMPLICATIONS OF GALL STONE PANCREATITIS
AbstractBackground: 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, complications
Steinberg W, Tenner S. Acute pancreatitis. N Engl J Med
Ranson JHC, Rifkind KM, Roses DF, Fink SD, Eng K, Spencer
FC. Prognostic signs and the role of operative management in
acute pancreatitis. Surg Gynecol Obstet 1974;139:69–81.
Ranson JHC. Etiologic and prognostic factors in human acute
pancreatitis: a review. Am J Gastroenterol 1982;77:633–8.
Imrie CW, Benjamin IS, Ferguson JC, McKay AJ, Mackenzie I,
O’Neill J, Blumgart LH. A single-centre double-blind trial of
Trasylol therapy in primary acute pancreatitis. Br J Surg
Osborne DH, Imrie CW, Carter DC. Biliary surgery in the same
admission for gallstone-associated acute pancreatitis. Br J Surg
Blamey SL, Imrie CW, O'Neill J, Gilmour WH, Carter DC.
Prognostic factors in acute pancreatitis. Gut 1984;25:1340–6.
Arnell TD, de Virgilio C, Chang L, Bongard F, Stabile BE.
Admission factors can predict the need for ICU monitoring in
gallstone pancreatitis. Am Surg 1996;62:815–9.
de Virgilio C, Verbin C, Chang L, Linder S, Stabile B, Klein S.
Gallstone pancreatitis: the role of preoperative endoscopic
retrograde cholangiopancreatography. Arch Surg
Wilson C, Heath DI, Imrie CW. Prediction of outcome in acute
pancreatitis: a comparative study of APACHE II, clinical
assessment and multiple factor scoring systems. Br J Surg
Neoptolemos JP, Ogunbiyi O, Wilson PG, Carr-Locke DL.
Etiology, pathogenesis, natural history, and treatment of biliary
acute pancreatitis. In: Beger HG, Warshaw AL, Buchler MW,
(eds.) The Pancreas. London, England: Blackwell Scientific
Publishers Ltd; 1998.p. 521–47.
Leese T, Shaw D. Comparison of three Glasgow multifactor
prognostic scoring systems in acute pancreatitis. Br J Surg
Corfield AP, Cooper MJ, Williamson RC, Mayer AD, McMahon
MJ, Dickson AP, Shearer MG, Imirie CW. Prediction of severity
in acute pancreatitis: prospective comparison of three prognostic
indices. Lancet 1985;2(8452):403–7.
Larvin M, McMahon M. APACHE II score for assessment and
monitoring of acute pancreatitis. Lancet 1989;2:201–5.
McMahon MJ, Playforth MJ, Pickford IR. A comparative study
of methods for the prediction of severity of attacks of acute
pancreatitis. Br J Surg 1980;67:22–5.
Tran DD, Cuesta MA. Evaluation of severity in patients with
acute pancreatitis. Am J Gastroenterol 1992;87:604–8.
Fan ST, Lai ECS, Mok FPT, Lo C, Zheng S, Wong J. Prediction
of the severity of acute pancreatitis. Am J Surg 1993;166:262–9.
Fan ST, Choi TK, Lai ECS, Wong J. Prediction of severity of
acute pancreatitis: an alternative approach. Gut 1989;30:1591–5.
Seligson U, Cho J, Nygen A, Reichard P. Is glucose intolerance
after pancreatitis related to pancreatic tissue damage? Acta Med
Solomon SS, Duckwork WC, Jallepalli P, Bobal MA, Iyer R.
The glucose intolerance of acute pancreatitis; hormonal response
to arginine. Diabetes 1980;29:22–6.
Donowitz M, Hendler R, Spiro HM, Binder HJ, Felig P.
Glucagon secretion in acute and chronic pancreatitis. Ann Intern
Malecka-Panas E, Rogozinski R, Torzecka W, Krysiak G,
Kozlowska A. Diagnosis of diabetes mellitus and disorders of
glucose tolerance in patients after acute pancreatitis. Pol Tyg Lek.
Olszewski S, Kinalska I, Dlugosz J, Gabryelewicz A. The
glucose tolerance, insulin response and pancreatic exocrine
function in patients after acute pancreatitis. Endokrinologie
Journal of Ayub Medical College, Abbottabad is an OPEN ACCESS JOURNAL which means that all content is FREELY available without charge to all users whether registered with the journal or not. The work published by J Ayub Med Coll Abbottabad is licensed and distributed under the creative commons License CC BY ND Attribution-NoDerivs. Material printed in this journal is OPEN to access, and are FREE for use in academic and research work with proper citation. J Ayub Med Coll Abbottabad accepts only original material for publication with the understanding that except for abstracts, no part of the data has been published or will be submitted for publication elsewhere before appearing in J Ayub Med Coll Abbottabad. The Editorial Board of J Ayub Med Coll Abbottabad makes every effort to ensure the accuracy and authenticity of material printed in J Ayub Med Coll Abbottabad. However, conclusions and statements expressed are views of the authors and do not reflect the opinion/policy of J Ayub Med Coll Abbottabad or the Editorial Board.
USERS are allowed to read, download, copy, distribute, print, search, or link to the full texts of the articles, or use them for any other lawful purpose, without asking prior permission from the publisher or the author. This is in accordance with the BOAI definition of open access.
AUTHORS retain the rights of free downloading/unlimited e-print of full text and sharing/disseminating the article without any restriction, by any means including twitter, scholarly collaboration networks such as ResearchGate, Academia.eu, and social media sites such as Twitter, LinkedIn, Google Scholar and any other professional or academic networking site.