Acute pancreatitis in intensive care unit patients: value of clinical and radiologic prognosticators at predicting clinical course and outcome

Terrence H Liu, Karen L Kwong, Eric P Tamm, Brijesh S Gill, Steven D Brown, David W Mercer
Critical Care Medicine 2003, 31 (4): 1026-30

OBJECTIVE: To assess the value of clinical and/or radiographic prognostic indices in predicting the clinical course and outcome of patients with acute pancreatitis, in the intensive care unit.

DESIGN: Retrospective, single institution review.

SETTING: An adult medical and surgical intensive care unit in a public, urban teaching hospital.

PATIENTS: Patients with acute pancreatitis requiring intensive care unit admission between January 1, 1997 and June 30, 2000.

INTERVENTIONS: Standard care.

MEASUREMENTS AND MAIN RESULTS: A total of 477 patients were hospitalized with the diagnosis of acute pancreatitis. Of these, 28 patients (6%) were admitted to the intensive care unit. Ranson's, Imrie scores, Acute Physiologic and Chronic Health Evaluation (APACHE) II and III scores, simplified acute physiology scores, and multiple organ dysfunction scores were tabulated at 1, 2, 3, 7, and 14 days after intensive care unit admission. Abdominal computed tomography was available for review for 24 of the 28 patients (86%), where the mean Balthazar's computed tomography index was 4.5 +/- 0.4 (range = 2 to 10). Hospital mortality rate for the intensive care unit patients was 14% (4 of 28). The intensive care unit length of stay ranged from 1 to 79 days (mean 15 days, median 5 days). Fifty-seven percent of the patients developed organ dysfunction, and 36% of the patients required mechanical ventilatory support, ranging in duration from 1 to 70 days. Infectious morbidity occurred in 43% of patients. Thirty-six percent of the patients required operative intervention for intraabdominal complications. APACHE II scores at 7 days after intensive care unit admission correlated closely with ventilator days (r2 =.90; p =.003) and correlated with the occurrence of infectious complications (r2 =.71; p =.02). Patient age, APACHE III, simplified acute physiology scores, multiple organ dysfunction scores, Ranson, Imrie, computed tomography, and APACHE II scores before day 7 did not closely correlate with the occurrence of adverse clinical outcome.

CONCLUSIONS: The clinical course and outcomes of intensive care unit patients with acute pancreatitis can be highly variable. An APACHE II score <10 during the initial 48 hrs correlated with mild pancreatitis and uncomplicated intensive care unit course; however, multifactorial prognosticators were not useful for the early identification of patients who developed complications or required extended intensive care unit care.

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