Fatal outcome in acute pancreatitis: Its occurrence and early prediction
Fatal outcome in acute pancreatitis: Its occurrence and early prediction
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DOI：
10.1159/000055817
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发表时间：
2001-01-01
期刊：
影响因子：
3.6
通讯作者：
Lankisch, PG
中科院分区：
文献类型：
--
作者：
Blum, T;Maisonneuve, P;Lankisch, PG
背景/目的：本研究旨在确定德国一家二级医院急性胰腺炎患者死亡的可预测性。研究方法：这项研究是正在进行的急性胰腺炎流行病学研究的一部分，涵盖了1988年至1999年在Luneburg县首次发作急性胰腺炎的368例患者。早期和晚期死亡率定义为入院后小于或等于1周和> 1周。使用以下参数确定入院时死亡的可能性：24小时内或之后入院，伴有急性发作、腹部压痛、腹膜炎体征、血清淀粉酶和脂肪酶、白细胞、红细胞压积、钾、钠、钙、补液后肌酐、血糖、胆红素、血清谷氨酰胺-乙酸转氨酶（SGOT）、血清乳酸脱氢酶（SLDH）、动脉pO（2），APACHE II评分、兰森和Imrie评分。结果：368例中死亡17例（5%），其中7例早期死于多器官功能衰竭，10例晚期死于感染性并发症。间质性和坏死性胰腺炎的死亡率分别为3%和17%。只有血清肌酐升高（>2.0 mg/dl）和血糖> 250 mg与死亡率显著相关。兰森和Imrie评分也与死亡率显著相关;然而，这些评分不是在入院时获得的，而是在48 h后获得的。在单因素分析中，入院时APACHE II评分≥ 6分和入院时脂肪酶> 1,000 U/l为早期和晚期死亡患者提供了高灵敏度和阴性预测值。结论：急性胰腺炎约一半的死亡是由于多器官功能衰竭或脓毒性并发症。必须找到新的方法来对抗这些严重的并发症。可以通过简单的实验室参数（如高血清肌酐和血糖）预测致死性结局。APACHE II评分大于或等于6分，入院时脂肪酶水平大于或等于1,000 U/l，提示重度胰腺炎。版权所有（C）2001 S. Karger AG、巴塞尔和IAP。
Background/Aims: This study aims to determine predictability of death in acute pancreatitis at a secondary-care hospital in Germany. Methods: This study is part of an ongoing study on the epidemiology of acute pancreatitis and covers 368 patients with a first attack of acute pancreatitis in Luneburg county from 1988 to 1999. Early and late mortality were defined as less than or equal to 1 weeks and > 1 week after admission. The following parameters were used to establish on admission likelihood of death: admission within 24 h or later with an acute attack, abdominal tenderness, signs of peritonitis, amylase and lipase in serum, leukocytes, hematocrit, potassium, sodium, calcium, creatinine after rehydration, blood glucose, bilirubin, serum glutamate-oxalacetate transaminase (SGOT), serum lactate dehydrogenase (SLDH), arterial pO(2), APACHE II score, Ranson and Imrie scores. Results: Of the 368 patients 17 (5%) died, 7 early because of multiple organ failure and 10 late because of septic complications. Mortality rates in interstitial and necrotising pancreatitis were 3 and 17%, respectively. Only an elevated serum creatinine (>2.0 mg/dl) and a blood glucose > 250 mg significantly correlated with mortality. Ranson and Imrie scores were also significantly correlated with mortality; however, they were not obtained on admission, but only after 48 h. In univariate analysis, APACHE II score greater than or equal to 6 on admission and lipase > 1,000 U/l on admission provided a high sensitivity and negative predictive value for early and late mortality patients. Conclusion: Approximately half of the deaths in acute pancreatitis occur because of multiple organ failure or septic complications. New approaches have to be found to counteract these severe complications. A fatal outcome may be predicted by simple laboratory parameters such as a high serum creatinine and blood glucose. An APACHE II score greater than or equal to 6 and a lipase level on admission greater than or equal to 1,000 U/l indicate severe pancreatitis. Copyright (C) 2001 S. Karger AG, Basel and IAP.