The effect of prognostic criteria on the outcome of patients with nontraumatic acute pancreatitis

Abstract

Objectives: Although the incidence is low in patients presenting to the emergency department (ED) with acute abdominal pain, acute pancreatitis is of great importance with its high mortality rate. Since early prediction of mortality may change treatment modalities, few prognostic criteria have been proposed. The purpose of this study is to compare the serum amylase levels, Ranson’s criteria, Balthazar classification and the abdominal ultrasonography (US) results used to diagnose and predict the prognosis on patients with suspected acute pancreatitis in the ED who subsequently had the diagnosis of acute pancreatitis confirmed during their hospital admission.
Materials and Methods: Patients over 15 years old presented to the ED at Akdeniz University Hospital between October 01, 2001 and May 31, 2005 and diagnosed with or suspected of having acute pancreatitis were analyzed retrospectively in this cross sectional study. Serum amylase levels, abdominal US, Ranson’s criteria scores and Balthazar classification scores (for cases which an abdominal computed tomography (CT) was ordered), were reviewed from the patients’ charts.
Results: A total of 116 patients (68 males [58.6%], 48 females [41.4%]; mean age 54.4±16.4), definitely diagnosed with acute pancreatitis after the ED presentation were analyzed. Biliary pancreatitis was diagnosed in 83% of women, whereas biliary disease accounted for 44% and long standing alcohol consumption caused 38%of pancreatitis in males. Two patients died during hospital admission. When the Ranson’s criteria calculated in the ED admission was compared with the outcome of patients after hospital admission, Ranson’s score of 3 and over was significantly correlate with predicting mortality. The Balthazar score was calculated only in 38 patients who had a CT, and the score of 4 or over was statistically significant with predicting mortality. Sensitivities of US and CT for acute pancreatitis were 25.6% and 68.4%, respectively.
Conclusion: Ranson’s criteria and Balthazar classification can be used to predict the prognosis of acute pancreatitis in the ED. However, further studies including more number of patients should be done to determine the efficacy of ordering imaging modalities, especially abdominal CT, in the ED.