Evaluation of Factors Predicting Fatal Outcome in Acute Pancreatitis
Introduction: With greater accessibility to computed tomography (CT) and its increasing utility to determine the severity and complications in patients with pancreatitis, various CT-based radiological scoring systems have been put into practice. Various studies demonstrate the usefulness of one score over the other. Nevertheless, worsening organ dysfunction is a matter of concern in acute pancreatitis.
Aims and Objectives: The present study evaluates the factors that predict mortality in patients of acute pancreatitis.
Materials and Methods: A prospective study involving 150 patients with acute pancreatitis admitted from January 2018 to July 2019 in Victoria Hospital, attached to Bangalore Medical College and Research Institute. A comparison of the performance of radiological CT scores, CT severity index (CTSI), extrapancreatic inflammation on CT (EPIC) score, and onset of organ failure (OF) in predicting the mortality in acute pancreatitis patients was assessed.
Results: Leukocytosis and thrombocytopenia are predictors of severe pancreatitis (P = 0.03 and 0.00, respectively). In 12% of patients, CT scan could not be done either due to deranged renal profile or hemodynamic instability. The mean CTSI score was 4.91 ± 2.72 and EPIC score was 3.5 ± 1.61, respectively. In 17.3% of patients, there was permanent OF. The occurrence of permanent OF in pancreatitis patients had a positive correlation with the mortality (P = 0.00). The area under receiver operator curve was 0.921 for OF, 0.733 for EPIC score, and 0.490 for CTSI, respectively, in predicting mortality in patients of acute pancreatitis.
Conclusion: The onset of permanent OF was the most important indicator of mortality in acute pancreatitis patients. EPIC score was more sensitive and specific compared to conventionally used CTSI in predicting the severity of pancreatitis and mortality in acute pancreatitis patients.