Original article—liver, pancreas, and biliary tract
Early Systemic Inflammatory Response Syndrome Is Associated With Severe Acute Pancreatitis

https://doi.org/10.1016/j.cgh.2009.08.012Get rights and content

Background & Aims

There have been few clinical studies of systemic inflammatory response syndrome (SIRS) in patients with acute pancreatitis. The aim of this study was to evaluate the role of SIRS in assessing severity of acute pancreatitis.

Methods

We prospectively enrolled 252 consecutive patients with acute pancreatitis who were admitted directly to our institution between 2005–2007. The incidence and duration of SIRS (transient ≤48 hours vs persistent >48 hours) during the first 7 days of hospitalization, and the number of SIRS criteria (0–4) on the first day of hospitalization (day 1) were evaluated with individual markers of severity, including persistent organ failure, pancreatic necrosis, need for intensive care unit, and mortality.

Results

SIRS occurred in 155/252 patients (62%) on day 1. SIRS on day 1 predicted severe disease with high sensitivity (85%–100%). The absence of SIRS on day 1 was associated with a high negative predictive value (98%–100%). Patients with a higher number of systemic inflammatory response (SIR) criteria on day 1 and persistent SIRS had an increased risk for severe disease (P < .01).

Conclusions

The majority of patients hospitalized with acute pancreatitis have SIRS on day 1. The severity of acute pancreatitis is greater among patients with SIRS on day 1 and, in particular, among those with 3 or 4 SIRS criteria, compared with those without SIRS on day 1.

Section snippets

Methods

The demographic, clinical, laboratory, and radiologic data for all patients directly admitted to our institution with a diagnosis of acute pancreatitis between June 2005 and December 2007 were collected for this study. All patients transferred from outside institutions were excluded. Data for all patients were prospectively collected for 7 days or until discharge if fewer than 7 days. This study was approved by the Partners Institutional Review Board.

Acute pancreatitis was defined as 2 or more

Results

Table 3 depicts the baseline clinical characteristics of 252 consecutive patients admitted directly to our institution over a 2 and a half year period. A majority of patients (73%) were experiencing their first episode of acute pancreatitis.

Table 4 demonstrates the distribution of markers of severity among the 252 patients. There were 38 (15%) patients with organ failure during the first 7 days of hospitalization: 25 (10%) with transient and 13 (5%) with persistent organ failure. Of the 13

Discussion

SIRS is the clinical manifestation of the inflammatory process that can occur after a variety of infectious and noninfectious insults. SIRS has been studied in several noninfectious diseases, including trauma,13 cirrhosis,14 and subarachnoid hemorrhage.15 However, to date, there has been no prospective clinical study that has examined the role of SIRS in assessing severity in acute pancreatitis.

In our study, 62% of all patients had SIRS on the first day of hospitalization, and 74% during the

Acknowledgments

The preliminary data for this study was presented as an oral presentation at the American Society for Gastrointestinal Endoscopy 11th Annual Young Investigators Conference, San Diego, April 21, 2007 and as a Poster of Distinction in the AGA Clinical Acute Pancreatitis Session, Digestive Diseases Week, Washington, DC, May 22, 2007.

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    Conflict of interest The authors disclose no conflicts.

    Funding This study was supported by a clinical research grant from the National Pancreas Foundation to PAB (Principle Investigator) and V.K.S (Co-Investigator).

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