Etiology, clinical characteristics and outcomes of patients with acute pancreatitis in Kauvery Cantonment Hospital (KCN), Trichy

K Arivarasan1, Meenatchi Sureshbabu2

Consultant Medical Gastroenterologist, Kauvery Hospital, Cantonment, Trichy

Physician Assistant, Kauvery Hospital, Cantonment, Trichy

Background

  1. Acute pancreatitis is a common cause of acute abdomen encountered in Gastroenterology practice.
  2. Severity of the disease varies widely, from mild disease needing conservative treatment to severe and complicated disease with high morbidity and mortality
  3. Fluid management is the cornerstone of initial management
  4. Adherence to current guidelines has shown to decrease morbidity and mortality.

Aim

  1. To profile the patients of acute pancreatitis based on their clinical profile, severity, organ failure and outcomes
  2. To identify research areas for future studies in patient population.

Methodology

  1. The medical records of all consecutive patients admitted to the Kauvery hospital, Cantonment under the department of Medical Gastroenterology with a diagnosis of acute pancreatitis from 1st January 2022 to 30th November 2023 were reviewed.
  2.  Patients’ demographics and other variables were recorded
  3. Etiology, final outcome and interventions done were recorded
  4. We assessed the role of fluid resuscitation on outcomes and complications.

Inclusion criteria

All patients with diagnosis of acute pancreatitis were included in this study

It was diagnosed based on at least two criteria of following.

  1. Typical abdominal pain,
  2. Lipase greater than 3 times,
  3. Radiological findings matching with acute pancreatitis.

Exclusion criteria

Patients with chronic pancreatitis, recurrent acute pancreatitis and pancreatic malignancy were excluded from the study.

Results

  1. Total of 40 patients were included in this study
  2. Age: 22-74 years
  3. Mean age of study population was 42 years.
Etiology1

Sex:

 

  1. Male – 31 (77.5%)
  2. Females – 9 (22.5%)

Etiology

Etiology

No. of Patients
Alcohol 21
Biliary 12
Post ERCP 2
Steroid 1
Idiopathic 4
Etiology2

Clinical and Laboratory Parameters

Mean

Minimum

Median

Standard deviation
TLC 14696 7600 29700

4343
Hematocrit 42 40 56

8
CRP 159 2 467

161
Amylase 1284 28 7509

1588
Lipase 2529 139 8184

2040
AST 117 17 725

140
Basal heart rate 103 68 162

20

Clinical presentation

Presenting clinical features

Total patients

Percentage (%)
Abdominal pain/tenderness 40 100
Abdominal distension 6 15
Nausea / Vomiting 29 72
Backache 3 7
Fever 4 10
Breathing difficulty 5 12
Oliguria 2 5
Altered mental status 2 5
Jaundice 6 15

Co morbidities

Co-morbid

Number of patients
Type II diabetes mellitus 11
Systemic hypertension 12
Heart disease 5
Kidney disease 1
Liver disease 2
Dyslipidemia 2
Hypothyroidism 3
Post cholecystectomy 3

Type of Pancreatitis

According to the Atlanta classification, acute pancreatitis can be divided into two broad categories.

1. Interstitial edematous acute pancreatitis

Acute inflammation of the pancreatic parenchyma and peri pancreatic tissues, but without recognizable tissue necrosis.

2. Necrotizing acute pancreatitis

Inflammation associated with pancreatic parenchymal necrosis and/or peri-pancreatic necrosis.

  1. Interstitial Pancreatitis – 35
  2. Necrotising Pancreatitis – 5

Severity of Pancreatitis

Etiology3

Severity

Etiology4

Organ failure

Yes – 17 (42%)

No – 23 (57%)

Systemic and local complications

Etiology5

Therapeutic procedures needed

Etiology6

No of patients

Therapeutic procedure
3 PCD placement
5 ERCP – Biliary clearance + stenting
1 Thoracentesis
1 Necrosectomy

Length of stay

  1. < 7 days – 30
  2. 8-14 days – 6
  3. >14 days – 4
  4. Maximum duration of stay – 26 days

Organ failure was significantly associated with increased length of stay.

Outcomes

Outcomes

No of patients
Alive 36
Dead 3
AMA 1
Etiology7

Mortality was assessed with respect to age, sex, etiology, co morbidities, requirement of oxygen, type of Pancreatitis, severity, organ failure.

Only requirement of oxygen was significantly associated with mortality.

Fluid resuscitation

Fluid resuscitation in pancreatitis

  1. Current guidelines advocate early aggressive fluid resuscitation in acute pancreatitis
  2. 20 ml per kg bolus followed by 3 ml per kg
  3. Recently published RCT, WATERFALL trial revealed aggressive fluid resuscitation did not alter severity of pancreatitis
  4. Aggressive resuscitation was associated with risk of volume overload.
Etiology8

Groups based on fluid resuscitation in first 24 hours

  1. Aggressive resuscitation group (>5L in 24 hr) – 6
  2. Moderate fluid resuscitation group (2.5-5 L) – 24
  3. Lower fluid resuscitation group (<2.5L) – 10

Outcomes

Vitals

N=

Organ failure

ARDS

Death
Modest fluid 10 2 (20%) 2 (20%) 0
Moderate fluid 24 13 (54%) 10 (41%) 2 (16%)
Aggressive fluid 6 4 (66%) 4 (66%) 2 (33%)
Etiology9

Rate of IV fluid did not result in difference in severity of the disease

Where should the scope of improvement be?

  1. Pancreatic protocol needs to be in place to standardise assessment, investigations, management
  2. Proper documentation
  3. Adherence to the current guidelines and changing practices
Etiology10

Dr. K. Arivarasan

Consultant Medical Gastroenterologist

Etiology11

Ms. Meenatchi Sureshbabu

Physician assistant

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