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Predictors of early death in severe acute pancreatitis

The latest issue of the Journal of Gastroenterology investigates predictors of early death in severe acute pancreatitis.

News image

In severe acute pancreatitis, it is clinically important at the time of admission to predict the likelihood of early death.

Dr Makoto Shinseki and colleagues from Japan clarified the factors predicting early death in severe acute pancreatitis.

Early death was defined as death within 10 days after disease onset.

Prediction factors for early death were evaluated from data obtained on admission from 93 patients with severe acute pancreatitis.

The characteristics of patients who died early were analyzed.

All early-death patients had pancreatic necrosis
Journal of Gastroenterology

Between the early-death and early-survival groups, significant factors were base excess, serum creatinine, blood sugar, serum glutamate oxaloacetic transaminase, and serum calcium.

The team found that base excess was an independent prediction factor for early death.

The early-death rate in patients with base excess less than -5.5 mEq/l and creatinine values of 3.0 mg/dl was 31% and 36%, respectively.

The combination of base excess and creatinine raised the positive predictive value to 50%.

The researchers noted that this was equally able to predict early death as the Japanese Severity Score, which was the most useful of the three conventional scoring systems used.

The team found that all early-death patients had pancreatic necrosis, and their Japanese Severity Score was 15, equivalent to Stage 4.

Characteristically, early-death patients had lactate dehydrogenase over 1300 IU/l, or they had serious preexisting comorbidities.

Dr Shinzeki's team concluded, "As a single parameter, base excess was most useful for predicting early death."

"The combination of base excess and creatinine could predict early death as well as the Japanese Severity Score."

"An extreme rise of lactate dehydrogenase and serious preexisting comorbidity may also be risk factors for early death."

J Gastroenterol 2008: 43(2): 152-8
31 March 2008

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