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Overview :
Clinical and laboratory findings in patients with acute
pancreatitis are associated with increased risk of a poor outcome. High risk
patients may benefit from more aggressive therapy.
Clinical parameters in patients with acute pancreatitis
associated with increased mortality if present at the time of admission:
(1)
hypotension (systolic blood pressure < 90 mm Hg, and to a lesser degree <
100 mm Hg)
(2) tachycardia (heart rate > 140 beats per minute)
(3) fever (temperature > 38° C)
(4) abdominal mass
(5) abnormal examination of the lung fields
Laboratory findings on admission correlated with increased
mortality:
(1) minimum serum albumin < 3 g/dL
(2) maximum prothrombin time > 14 seconds
(3) maximum white blood cell count > 20,000 per µL
(4) maximum hematocrit < 30 per cent
(5) maximum serum creatinine > 2 mg/dL
(6) maximum blood urea nitrogen > 30 mg/dL
(7) maximum serum total bilirubin > 4 mg/dL
Laboratory findings over the first 48 hours of
hospitalization associated with mortality:
(1) minimum hematocrit <= 30 per cent
(2) minimum serum calcium <= 8 mg/dL
Laboratory findings not correlating with prognosis:
(1) maximum
amylase
(2) maximum
lipase
(3)
alkaline phosphatase
(4) minimum
PaO2 (although not all patients had blood gases available early in study
period)
Complications developing over hospitalization associated with
poorest prognosis:
(1) shock
(2) massive colloid requirements
(3) hypocalcemia (serum calcium <= 7 mg/dL)
(4) renal failure
(5) respiratory failure requiring endotracheal intubation
Limitations:
• The
absolute mortality rates have changed due to the passage of time since 1977, but
the relative significance is probably still valid.
• Blood
gases were not available for some of the early patients in the study period and
so these values were not always available for correlation with outcome.
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