Shock, acute renal failure and MODS as mortality indicator in acute pancreatitis

Introduction

It has been described some scores to establish the prognosis in patients with acute pancreatitis. The Balthasar CT classification (1) allows to establish with a lot of certainty the mortality according to the gland compromise that its seen in the CT, however the certainty of the prognosis is improved if these combine with other severity criteria as the Ramson criteria. These associations could show that the degree of SIRS has a more closer direct relation with the prognosis then the lesion seen in the CT.

Objetive

To evaluate if the Balthasar classification has a high power of prognosis in those cases with a CT, classification of C, D, and E. In addition other factors that could be associated to morbility and mortality in patients with acute pancreatitis were evaluated.

Methods

The records of 49 patients with acute pancreatitis were reviewed. These patients entered to our unit in the period of July 1, 1999 to June 30, 2000. Every CT was reviewed with two radiologists to determine the Balthasar classification and in case of disagreement a third evaluation was asked. The kappa value was established for the CT evaluation. The variables shock, renal failure, MODS and Balthasar for the mortality prognosis were evaluated.

Results

(See Table.) The review of the Balthasar score had a kappa of 0.88, our results show a low specificity and predictive positive value of Balthasar score C, D, and E, to predict the probability of mortality. The variables shock, renal failure and MODS show more certainty to the prediction of mortality.

Table

Conclusion

The Balthasar score does not predict with certainty the probability of mortality by itself. Other variables related with the severity of SIRS as shock more certainty the mortality in patients with acute pancreatitis.