Talamini et al evaluated the prognostic significance of an elevated serum creatinine and abnormal lung findings on chest X-ray for patients with acute pancreatitis. This can help identify a group of high risk patients who may benefit from more aggressive therapy. The authors are from Verona, Naples and Bologna in Italy.
Patient testing:
(1) serum creatinine: using > 2 mg/dL
(2) chest radiographs: presence of pleural effusions (unilateral or bilateral) and/or pulmonary infiltrates (densifications)
Risk Factor
Odds Ratio for Death
95% Confidence Interval
p
serum creatinine > 2 mg/dL
14.9
5.26 – 42.1
0.0001
abnormal chest radiographs
15.3
4.75 – 49.4
0.001
after Table IV, page 11
The rates of necrotizing pancreatitis and mortality are greater for patients with an abnormal serum creatinine and/or chest radiograph.
Chest X-ray
Serum Creatinine
Percent with Necrotizing Pancreatitis
Mortality Rate
normal
normal
16%
0.5%
normal
abnormal
72%
6%
abnormal
normal
62%
7%
abnormal
abnormal
100%
53%
after Figure 4, page 11 and Figure 2, page 10
Additional risk factors associated with mortality in the study:
(1) male gender
(2) serum glucose > 300 mg/dL
(3) serum calcium < 8 mg/dL
(4) serum LDH > 350 IU/L (method and upper limit of reference range not reported)
(5) WBC count > 16,000 per µL
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