Acute biliary pancreatitis

a prospective cohort study

Abstract

OBJECTIVE: Acute biliary pancreatitis (ABP) is a disease with high morbidity and mortality rates but poorly studied in Brazil. Our objective was to describe the differential  diagnosis for the etiology of ABP and assess the severity and treatment of the disease at the Hospital de Clínicas de Porto Alegre, in 1999.

MATERIALS AND METHODS: We carried out a cohort, prospective study in 65 (78.4%) patients who presented amylase greater than 440 mg/dl and acute biliary pancreatitis (ABP). We assessed biliary Ranson scores, modified Glasgow scores, APACHE-II and APACHE-O of our population in order to determine the severity of the disease. These scores and values were followed-up during the evolution of the disease.

RESULTS: Twelve patients presented clinical evolution of the disease. The systemic complications were kidney failure (n=4), respiratory failure (n=3), shock (n=3), and sepsis associated with cholangitis (n=1). The local complications, in turn, were peripancreatic fluid collection (n=3), pancreatic necroses (n=3), pancreatic pseudocyst (n=1), and pancreatic fistula (n=1). There was only one case of death, which occurred due to acute myocardial infarction and refractory hypocalcemia. The prognostic criteria, according to the number of positive parameters, indicated relative risk (RR) from 4.7 to 11.2, sensitivity from 33.3% to 83.3%, specificity from 79.2% to 98.1%, positive predictive value from 45.0% to 83.3%, negative predictive value from 86.4% to 95.5%, and accuracy from 78.5% to 89.6%. The parameters that presented a separate correlation with severity were white blood cell count >18,000/mm3 , LDH >400 UI/l, 10% decrease in hematocrit levels, serum calcium levels <8 mg/dl, increase in urea nitrogen levels >2 mg/dl, AST >200 mg/dl, LDH >600 UI/l, white cell count >15,000/mm3 , urea >45 mg/dl, arterial pH £7.33 or ³7.49, creatinine levels £0.6 or ³1.4, hematocrit levels £30 or ³45,9, white cell count £3,000 or ³14,900.

CONCLUSION: biliary Ranson scores, modified Glasgow scores, APACHE-II and APACHE-O presented good sensitivity and specificity. Multidisciplinary protocols should be implemented in order to achieve optimal treatment results.