Siraj G Rajaratnam1, Iain G Martin. 1. Department of Surgery, Middlemore Hospital, South Auckland, New Zealand. sirajrajaratnam@hotmail.com
Abstract
OBJECTIVES: Early identification of patients at high risk of complications from acute pancreatitis is important; as yet, no simple and accurate method has been identified. The aim was to evaluate admission serum glucose as a prognostic marker in gallstone pancreatitis. METHODS: Retrospective review of consecutive admissions with gallstone pancreatitis to a large urban hospital was made. Serum glucose levels, Glasgow scores, and Acute Physiology and Chronic Health Evaluation (APACHE) II scores were recorded. Outcomes considered were death, intensive care requirement, local complications, and length of hospital stay. RESULTS: There was a total of 184 admissions (122 women and 62 men; mean age, 55.4 years). Serum glucose of 8.3 mmol/L or higher was as good as APACHE II score of 8 or above (likelihood ratios [LRs] of 2.51 and 2.84, respectively) in predicting mortality (overall probability, 4.3%). Overall, 9.2% of the patients were admitted to intensive care units, and risk was significantly higher in patients with glucose of 8.3 mmol/L or higher (LR, 3.23; P < 0.001) or APACHE II score of 8 or above (LR, 1.9; P < 0.02). Local complications occurred in 12.0% of the patients, and the risk significantly increased in patients with glucose of 8.3 mmol/L or higher (LR, 2.61; P < 0.001) but not for APACHE II or Glasgow scores. Patients with admission serum glucose of 8.3 mmol/L or higher had a mean length of stay of 17.9 days as compared with 7.1 days for patients with admission serum glucose of less than 8.3 mmol/L (P < 0.001). CONCLUSIONS: In gallstone pancreatitis, an elevated admission serum glucose level offers more prognostic information than Glasgow and APACHE II scores.
OBJECTIVES: Early identification of patients at high risk of complications from acute pancreatitis is important; as yet, no simple and accurate method has been identified. The aim was to evaluate admission serum glucose as a prognostic marker in gallstone pancreatitis. METHODS: Retrospective review of consecutive admissions with gallstone pancreatitis to a large urban hospital was made. Serum glucose levels, Glasgow scores, and Acute Physiology and Chronic Health Evaluation (APACHE) II scores were recorded. Outcomes considered were death, intensive care requirement, local complications, and length of hospital stay. RESULTS: There was a total of 184 admissions (122 women and 62 men; mean age, 55.4 years). Serum glucose of 8.3 mmol/L or higher was as good as APACHE II score of 8 or above (likelihood ratios [LRs] of 2.51 and 2.84, respectively) in predicting mortality (overall probability, 4.3%). Overall, 9.2% of the patients were admitted to intensive care units, and risk was significantly higher in patients with glucose of 8.3 mmol/L or higher (LR, 3.23; P < 0.001) or APACHE II score of 8 or above (LR, 1.9; P < 0.02). Local complications occurred in 12.0% of the patients, and the risk significantly increased in patients with glucose of 8.3 mmol/L or higher (LR, 2.61; P < 0.001) but not for APACHE II or Glasgow scores. Patients with admission serum glucose of 8.3 mmol/L or higher had a mean length of stay of 17.9 days as compared with 7.1 days for patients with admission serum glucose of less than 8.3 mmol/L (P < 0.001). CONCLUSIONS: In gallstone pancreatitis, an elevated admission serum glucose level offers more prognostic information than Glasgow and APACHE II scores.