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Overview :
Dauphine et al identified risk factors on hospital admission
that can predict a complicated course for a patient with acute alcoholic
pancreatitis. This can help identify a patient who may require more aggressive
management and closer monitoring. The authors are from the Harbor-UCLA Medical
Center in Torrance, California, and Denver Health Medical Center in
Colorado.
Outcomes:
(1) organ failure (respiratory, cardiac, renal) or sepsis
(2) death
Parameters:
(1) white blood cell (WBC) count
(2) serum glucose
(3) Ranson score (see above)
Admission parameters associated with one or more organ
failures:
(1) serum glucose >= 160 mg/dL and a WBC count >=
17,000 per µL
(2) Ranson score >= 3
Admission parameters associated with low risk of death:
(1) WBC count < 17,000 per µL
(2) admission Ranson = 0
Performance:
• The
combination of elevated WBC count and serum glucose had a low sensitivity (31%)
but high specificity (97%) for organ failure. The positive predictive value was
80% and negative predictive value 81%.
• The
elevated Ranson score had a low sensitivity (19%) but high specificity (100%)
for organ failure. The positive predictive value was 100% and negative
predictive value 79%.
• The
negative predictive value for death was 99% for WBC count and 100% for Ranson
score. Both showed low positive predictive values.
Limitations:
• The
cutoffs for the Ranson score are based on laboratory values which can vary
between methods and laboratories.
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