Does the Duration of Abdominal Pain Prior to Admission Influence the Severity of Acute Pancreatitis?

摘要

Context In a prior report involving patientswith hemoconcentration at admission, those with necrotizing pancreatitispresented significantly earlier than those with interstitial disease suggestingthat duration of abdominal pain prior to presentation may have prognosticsignificance in acute pancreatitis. Objectives The aim of the presentstudy was to determine whether the duration of abdominal pain prior to admissioninfluences the severity of acute pancreatitis. Methods During a five-yearperiod, all patients presenting directly to our hospital with their firstepisode of acute pancreatitis were enrolled in a cohort study. We analyzed dataobtained from records of all such patients and performed a separate analysis onthose with hemoconcentration (hematocrit equal to, or greater than, 44%) atpresentation to determine whether duration of abdominal pain prior to presentationwas associated with severity of acute pancreatitis. Duration of abdominal pain wascategorized as persisting for either less than 12 h or 12 h or more prior toarrival. Prognostic markers of severity included admission hematocrit andblood urea nitrogen (BUN), as well as the development of systemic inflammatory responsesyndrome (SIRS) during the initial 24 h of hospitalization. Outcome measuresincluded pancreatic necrosis based on contrast-enhanced CT scanning, need forintensive care, length of hospitalization, and death. Radiologic severity ofperipancreatic inflammatory changes was assessed within 48 h of admission in accordancewith the Balthazar-Ranson scoring system (A-E). Results Among a total of318 patients, there were 62 (19.5%) with hemoconcentration at admission. Amongthe 318 patients, there was no significant difference in the prevalence ofpancreatic necrosis when comparing the less than 12 h group to the 12 h or moregroup. Among the 62 patients with hemoconcentration, those admitted within 12 hcompared to those admitted 12 h or more following the onset of abdominal painhad an increased radiologic severity of acute pancreatitis (Balthazar-Ransongrade D or E: 83.3% vs. 40.0%; P=0.006) and an increased prevalence ofpancreatic necrosis (21.1% vs. 2.3%; P=0.028). Conclusion Durationof abdominal pain prior to admission impacts the severity of acute pancreatitisonly among patients with hemoconcentration at presentation.