In severe acute pancreatitis, it is clinically important at the time of admission to predict the likelihood of early death.
The team aimed to clarify the factors predicting early death in severe acute pancreatitis.
|Combination of base excess and serum creatinine raised the positive predictive value to 50%|
|Journal of Gastroenterology|
The team defined early death 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.
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 revealed 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 serum creatinine 3.0 mg/dl was 31% and 36%, respectively.
The team found that the combination of base excess and serum creatinine raised the positive predictive value to 50%.
The combination of these markers was equally able to predict early death as the Japanese Severity Score, which was the most useful of the 3 conventional scoring systems used.
The team found all early-death patients had pancreatic necrosis, and their Japanese Severity Score was 15.
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 serum 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."