Abstract
Background and aims. Approximately 20% of acute pancreatitis progresses to a severe form characterised by multiple extrapancreatic organ dysfunction. Elevated intra-abdominal pressure (IAP), a frequent finding in these patients, further adds to the mortality. Currently used prognostication indices have their own set of limitations. We evaluated IAP at intensive care unit (ICU) admission as a predictor of mortality in severe acute pancreatitis (SAP).
Methods. A retrospective analysis of 50 patients with SAP admitted to the ICU of a tertiary-care Indian institute over a period of 3 years was done. Data relating to demographic profile, cause of pancreatitis, ICU admission, Acute Physiology and Chronic Health Evaluation II (APACHE II) score, Sequential Organ Failure Assessment (SOFA) score, IAP, interventions instituted and mortality were analysed.
Results. Biliary stones (38%) were the most common cause of acute pancreatitis. Survivors differed from non-survivors with respect to organ failure, APACHE II and SOFA scores and IAP on admission. There was a significant correlation between IAP on ICU admission and admission SOFA (r=0.56, p<0.001) and APACHE II (r=0.54, p<0.001) in predicting mortality. Patients with elective admission had a mortality rate of 53% (20/38) compared to 83% (10/12) for those admitted as emergencies. Analysis of receiver operating characteristic curves for detecting mortality revealed an area under the curve of 0.915 (95% confidence interval (CI) 0.83 - 0.99) for IAP, 0.826 (95% CI 0.71 - 0.93) for SOFA, and 0.831 (95% CI 0.71 - 0.94) for APACHE II.
Conclusion. IAP at ICU admission is a useful predictor of severity of illness and mortality in SAP.