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. 2025 Jul 28;31(28):108926.
doi: 10.3748/wjg.v31.i28.108926.

Ascites characteristics in acute pancreatitis: A prognostic indicator of organ failure and mortality

Jing-Wen Rao  1 , Jia-Rong Li  2 , Yao Wu  1 , Tian-Ming Lai  1 , Zhen-Gang Zhou  1 , Yue Gong  1 , Ying Xia  1 , Ling-Yu Luo  1 , Liang Xia  1 , Wen-Hao Cai  3 , Wei Huang  3 , Yin Zhu  1 , Wen-Hua He  4
Affiliations

Ascites characteristics in acute pancreatitis: A prognostic indicator of organ failure and mortality

Jing-Wen Rao et al. World J Gastroenterol. .

Abstract

Background: Acute pancreatitis (AP) is a severe condition, and abdominal effusion is a significant predictor of its severity and prognosis. However, the relationship between ascites characteristics and AP outcomes remains undefined.

Aim: To assess the correlation between ascites characteristics and clinical prognosis in AP patients by comparing color depth and turbidity of early ascites.

Methods: This study included 667 AP patients with ascites, categorized by color and turbidity into yellow clear (n = 54), yellow turbid (n = 293), red brown (n = 320). The trend χ 2 test was employed to analyze the incidence of organ failure (OF), infected pancreatic necrosis (IPN), and mortality across groups. Receiver operating characteristic (ROC) curves were used to evaluate the predictive value of ascites cell count, amylase, protein, and lactate dehydrogenase (LDH) for abdominal compartment syndrome (ACS) and intra-abdominal hemorrhage.

Results: AP patients with ascites exhibited higher scores of scoring systems (such as Bedside index for severity in AP, Acute Physiology and Chronic Health Examination II, etc.) and increased complications and mortality rates (all P < 0.05) compared to those without ascites. A linear association was observed between ascites color depth and turbidity and the incidence of OF, pancreatic necrosis, IPN, and mortality (P < 0.05). LDH in ascites demonstrated high accuracy in predicting ACS and intra-abdominal hemorrhage, with areas under the ROC curve of 0.77 and 0.79, respectively.

Conclusion: Early in AP, ascites correlates with OF, IPN, and mortality, showing linear associations with color depth and turbidity. Ascitic LDH reliably predicts ACS and intra-abdominal hemorrhage in AP patients.

Keywords: Acute pancreatitis; Ascites; Lactate dehydrogenase; Mortality; Organ failure.

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Conflict of interest statement

Conflict-of-interest statement: The authors declare no conflicts of interest for this article.

Figures

Figure 1
Figure 1
Distribution of acute pancreatitis patients with regard to available ascites. AP: Acute pancreatitis.
Figure 2
Figure 2
The percentage was observed between ascites color depth and turbidity and the incidence. A: Pancreatic necrosis; B: Infected pancreatic necrosis; C: Organ failure; D: Death. IPN: Infected pancreatic necrosis; OF: Organ failure; PN: Pancreatic necrosis.
Figure 3
Figure 3
Receiver operating characteristic curve of ascites laboratory parameters. A: Abdominal compartment syndrome; B: Intra-abdominal hemorrhage. LDH: Lactate dehydrogenase; ROC: Receiver operating characteristic.
See this image and copyright information in PMC

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