review of literature on clinical pancreatology - The Pancreapedia

Single factorsRenal rim gradeMultifactor scoring systems, such as the Acute Physiology and Chronic Health Evaluation(APACHE) II, are useful for predicting the severity <strong>of</strong> acute pancreatitis; however, they arerather complicated. The aim <strong>of</strong> one study was to introduce renal rim grade (RRG) as aseverity assessment measure for acute pancreatitis. One hundred twenty-two eligible acutepancreatitis patients who underwent abdominal computed tomography (CT) on admissionwere evaluated for RRG (grades 1-3). The end points were the severity <strong>of</strong> illness andhospital mortality. Furthermore, RRG was compared with the Balthazar score, the CTseverity index, the Ranson score, and the APACHE II score, using a receiver operatingcharacteristic analysis. The exacerbation rates into severe disease were 3 percent (grade 1),48 percent (grade 2), and 89 percent (grade 3). The mortality rates were 3 percent (grade 1),8 percent (grade 2), and 31 percent (grade 3). The area under the receiver operatingcharacteristic curves to predict the severe disease and mortality using the RRG system wascomparable with other scoring systems. It was concluded that renal rim grade is useful forthe evaluation <strong>of</strong> the severity <strong>of</strong> AP [166].Organ failureOrgan failure (OF) is a main cause <strong>of</strong> death in severe acute pancreatitis (SAP). One studyhad the primary aim to evaluate the morbidity and mortality <strong>of</strong> patients admitted with SAPwith no OF (NOF), single OF (SOF), and multiple (>2) OF (MOF). Medical records <strong>of</strong> 207consecutive patients admitted with SAP to the Mayo Clinic between 1992 and 2001 were<strong>review</strong>ed. OF was defined according to the Atlanta classification and patients werecategorized in the three groups: NOF, SOF, and MOF. Primary outcomes were in-hospitalmortality, duration <strong>of</strong> hospitalization, need for the intensive care unit (ICU), and the meanlength <strong>of</strong> stay in the ICU. Organ failure occurred in 108 patients (52 %). Gastrointestinalbleeding occurred in 18 percent, respiratory failure in 36 percent, hypotension in 28 percent,and renal failure in 26 percent. Compared to patients with MOF, patients with NOF hadsignificantly shorter hospitalizations (28 vs 55 days), less need for ICU care (50 % vs 90 %),shorter time in the ICU (5 vs 34 days), and decreased in-hospital mortality (2 % vs 46 %).Odds ratios evaluating the risk <strong>of</strong> in-hospital mortality for subjects with any organ failure was28 (7-186), 10 (2-69) for patients with SOF, and 64 (15-464) for patients with MOF. It wasconcluded that patients with SAP and NOF have prolonged hospitalizations but low mortality.The Atlanta classification should be revised to include a patient group defined as "moderatelysevere acute pancreatitis" that identifies those patients currently classified as SAP withoutorgan failure [167].AlbuminSeveral studies indicated that the mortality rate <strong>of</strong> patients with acute pancreatitis is currentlyapproximately 3.8 to 7.0 percent, in severe acute pancreatitis (SAP), it varies from 7 to 42percent. In previous studies, several biological markers and clinical events had been used topredict the mortality. However, few studies have addressed the role <strong>of</strong> factors asindependent predictors that can early predict fatal outcome in hospitalized medical patients.The primary aim <strong>of</strong> one study was therefore to analyze the conventional clinical data andparameters within 24 hours after admission <strong>of</strong> 338 patients with SAP, particularly the effect <strong>of</strong>C-reactive protein (CRP), albumin (ALB), and total cholesterol (TC). The mean age <strong>of</strong> the338 patients with SAP was 54 years. The overall inhospital mortality rate was 8.3 percent(28/338). The mean time from hospital admission to death was 29 days (range, 9-47 days).Multivariate analysis indicated that the inhospital mortality increased significantly more than7-fold higher in patients with severe hypoalbuminemia (ALB < 30 g/L). The CRP levelsexceeding 170 mg/L were significantly associated with a 7-fold inhospital death. A serumtotal colesterol level between 4.37 to 5.23 mmol/L had significant protective effect. Totalcholesterol levels exceeding 5.23 mmol/L were risk factors to predict inhospital mortality with