ROLE OF SIMPLIFIED ADMISSION CRITERIA FOR PREDICTING SEVERE COMPLICATIONS OF GALL STONE PANCREATITIS
Abstract
Background: Gallstone Pancreatitis (GP) is not an uncommon disease in our country and is associatedwith large number of morbidity and mortality especially if severe complications develop. Different
criteria have been developed to predict the complications of GP. Simple admission criteria are better
predictors of severe complications of GP than an APACHE II score of 5 or greater, a modified Imrie
(Glasgow) score of 3 or greater, and a Biliary Ranson score of 3 or greater. The purpose of this study
was to determine the role of simplified admission criteria in predicting severe complications of
Gallstone Pancreatitis. Methods: This was a descriptive study conducted in Surgical '˜A' Unit, Khyber
Teaching Hospital Peshawar between July 16th 2007 to November 30th 2008. Total 52 patients (42
women and 10 men, aged range from 18 to 76 years, with mean age, 39 years) who presented to our
unit with gallstone pancreatitis were included in the study through technique of non-probability
convenient sampling. The main outcome measures were major local and systemic complications
requiring intensive care unit care, and death. Physiologicalfactors and laboratory data were collected on
admission and recorded daily. Results: Seven patients (14%) had severe complications with mortality
of 2%. On univariate analysis, a white blood cell count of 14500/dL or more (p=0.03), a serum glucose
level of or more ‰¥150 mg/dL (8.3 mmol/L) (p<0.001), anAPACHE II score of 5 or greater (p=0.008), a
modified Imrie score of 3 or greater (p<0.001), and a biliary Ranson score of 3 or greater (p=0.03) were
statistically associated with the development of severe complications. On multivariate analysis, only a
serum glucose level of ‰¥150 mg/dL or more (8.3 mmol/L) was predictive of adverse events (p<0.001).
Conclusions: Glucose level (‰¥150 mg/dL) is the best single admission predictor of severe
complications of Gallstone Pancreatitis and is superior to an APACHE II score of 5 or greater, a
modified Imrie score of 3 or greater, anda biliary Ranson score of 3 or greater.
Keywords: Gallstones pancreatitis, admission criteria, complications
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