ETIOLOGY, CLINICAL CHARACTERISTICS AND OUTCOMES OF PATIENTS WITH ACUTE PANCREATITIS IN KAUVERY CANTONMENT HOSPITAL (KCN), TRICHY

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

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

Aim

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

Methodology

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.
Patients’ demographics and other variables were recorded
Etiology, final outcome and interventions done were recorded
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.

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

Exclusion criteria

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

Results

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

Sex:

Male – 31 (77.5%)
Females – 9 (22.5%)

Etiology

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

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.

Interstitial Pancreatitis – 35
Necrotising Pancreatitis – 5

Severity of Pancreatitis

Severity

Organ failure

Yes – 17 (42%)

No – 23 (57%)

Systemic and local complications

Therapeutic procedures needed

No of patients	Therapeutic procedure
3	PCD placement
5	ERCP – Biliary clearance + stenting
1	Thoracentesis
1	Necrosectomy

Length of stay

< 7 days – 30
8-14 days – 6
>14 days – 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

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

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

Groups based on fluid resuscitation in first 24 hours

Aggressive resuscitation group (>5L in 24 hr) – 6
Moderate fluid resuscitation group (2.5-5 L) – 24
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%)

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

Where should the scope of improvement be?

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

Dr. K. Arivarasan

Consultant Medical Gastroenterologist

Ms. Meenatchi Sureshbabu

Physician assistant

ETIOLOGY, CLINICAL CHARACTERISTICS AND OUTCOMES OF PATIENTS WITH ACUTE PANCREATITIS IN KAUVERY CANTONMENT HOSPITAL (KCN), TRICHY