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Overview :
Talamini et al evaluated the prognostic significance of an
elevated serum creatinine and abnormal lung findings on chest X-ray for patients
with acute pancreatitis. This can help identify a group of high risk patients
who may benefit from more aggressive therapy. The authors are from Verona,
Naples and Bologna in Italy.
Patient testing:
(1) serum
creatinine: using > 2 mg/dL
(2) chest
radiographs: presence of pleural effusions (unilateral or bilateral) and/or
pulmonary infiltrates (densifications)
|
Risk Factor |
Odds Ratio for
Death |
95% Confidence
Interval |
p |
|
serum
creatinine > 2 mg/dL |
14.9 |
5.26 –
42.1 |
0.0001 |
|
abnormal chest
radiographs |
15.3 |
4.75 –
49.4 |
0.001 |
after Table IV, page 11
The rates of necrotizing pancreatitis and mortality are
greater for patients with an abnormal serum creatinine and/or chest radiograph.
|
Chest X-ray |
Serum
Creatinine |
Percent with Necrotizing
Pancreatitis |
Mortality
Rate |
|
normal |
normal |
16% |
0.5% |
|
normal |
abnormal |
72% |
6% |
|
abnormal |
normal |
62% |
7% |
|
abnormal |
abnormal |
100% |
53% |
after Figure 4, page 11 and Figure 2, page 10
Additional risk factors associated with mortality in the
study:
(1) male gender
(2) serum glucose > 300 mg/dL
(3) serum calcium < 8 mg/dL
(4) serum LDH > 350 IU/L (method and upper limit of
reference range not reported)
(5) WBC count > 16,000 per µL
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