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. 2019 Jul;26(4):251-259.
doi: 10.1159/000493762. Epub 2018 Nov 14.

Prediction of Self-Limited Acute Pancreatitis Cases at Admission to Emergency Unit

Yusuf Kayar  1 , Hakan Senturk  1 , Mukaddes Tozlu  1 , Birol Baysal  1 , Musa Atay  2 , Ali Tuzun Ince  1
Affiliations

Prediction of Self-Limited Acute Pancreatitis Cases at Admission to Emergency Unit

Yusuf Kayar et al. GE Port J Gastroenterol. 2019 Jul.

Abstract
in English, Portuguese

Background: While acute pancreatitis (AP) resolves spontaneously with supportive treatment in most patients, it may be life-threatening. Predicting the disease severity at onset dictates the management strategy. We aimed to define the patients with mild pancreatitis who may be considered for outpatient management with significant cost-savings.

Materials and methods: This prospective observational study included 180 patients with mild AP according to the harmless acute pancreatitis score (HAPS) and Imrie score. The relationships of biochemical parameters with the changes in the Balthazar score and clinical course were examined.

Results: The study included 180 patients (111 females, 69 males; mean age: 53.9 ± 17.2 years; range: 17-92 years). The etiology was biliary in 118 (65%) patients and remained undetermined in 38 (21.1%) patients. Computed tomography (CT) performed within the first 12 h revealed mild and moderate AP in 159 (88.3%) and 21 (11.7%) patients, respectively. CT repeated at 72 h revealed mild, moderate, and severe AP in 155 (86.1%), 24 (13.3%), and 1 (0.6%) patients, respectively. Comparisons between stages A + B + C and D + E showed significant differences in the amylase levels on day 1 and 3, and in C-reactive protein on day 3. Also, in stage D and E disease, narcotic analgesic intake, oral intake onset time, and pain were significantly higher.

Conclusion: There were no significant changes in the CT findings of patients with mild AP at 12 and 72 h. Most patients (n = 179; 99.4%) recovered uneventfully. Patients with mild pancreatitis according to the HAPS and Imrie scores can be considered for outpatient management. The recovery is longer in stage D and E disease.

Introdução: Apesar da pancreatite aguda resolver espontaneamente com medidas de suporte na maioria dos doentes, esta também pode ser grave e fatal. A prediçãoinicial da gravidade da doença orienta a estratégia terapêutica.O nosso objetivo foi definir os doentes com pancreatite ligeira que podem ser considerados para terapêutica em ambulatório com redução dos custos.

Material e métodos: Estudo prospetivo observacional com 180 doentes com pancreatite aguda ligeira segundo os scores de HAPS e Imrie. As relações entre os parâmetros bioquímicos, as alterações no score de Balthazar e o curso clinico foram examinadas.

Resultados: Este estudo incluiu 180 doentes (111 mulheres, 69 homens; idade média 53.9±17.2 anos). A etiologia foi biliar em 118 (65%) e permaneceu indeterminada em 38 (21.1%) doentes, respetivamente. A tomografia computorizada (TC) realizada nas primeiras 12 h revelou pancreatite ligeira e moderada em 159 (88.3%) e 21 (11.7%) doentes, respetivamente. A TC repetida às 72h revelou pancreatite aguda, moderada e grave em 155 (86.1%), 24 (13.3%), e 1 (0.6%) dos doentes, respetivamente. As comparações entre os estadios A+B+C e D+E mostraram diferenças significativas nos níveis de amílase nos dias 1 e 3, e na PCR no dia 3. Também nos estadios D e E, a toma de narcóticos, tempo de inicio da dieta oral e a dor foram significativamente superiores.

Conclusão: Não se verificaram alterações significativas na TC dos doentes com pancreatite ligeira nem às 12 nem às 72h. A maioria dos doentes (99.4%) recuperou sem complicações.Doentes com pancreatite ligeira segundos os scores de HAPS e Imrie podem ser considerados para orientação em ambulatório. A recuperação é mais longa nos estadios D e E da doença.

Keywords: Acute pancreatitis; Balthazar score; Severity.

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Conflict of interest statement

The authors declare that there is no conflict of interest regarding the publication of this paper.

Figures

Fig. 1
Fig. 1
Receiver operating characteristics curves for amylase on days 1 (a) and 3 (b), C-reactive protein on day 3 (c), and the C-reactive protein rate (d).
See this image and copyright information in PMC

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