Acute renal failure as a risk factor associated with acute pancreatitis

Background

With a retrospective study previously published by our team, we found that acute renal failure in patients with pancreatitis had a high mortality rate. The objective was to make a prospective study in which we could demonstrate whether renal failure was either associated with a deficit in cardiac preload or with hypotension.

Methods

A prospective study was conducted in all patients with diagnosis of acute pancreatitis that were admitted to the intensive care unit during the time of the study, and the following variables were evaluated at the moment of admittance: RANSON SCORE, APACHE II, SOFA, age, MAP, CVP, diuresis/hour, creatinin and BUN. The statistical analysis was realized by Student t test, values of P < 0.05 were considered significant.

Results

During the period of investigation 2449 patients were admitted to our intensive care unit, of which 46 were diagnosed with acute pancreatitits (1.8%) with a mortality of 30.4% (n = 14). In the group of deceased patients, the variables age, MAP, SOFA score and APACHE II score were not statistically significant, and therefore no difference was found between this group and those who stayed alive. On the contrary, we observed that the deceased patients presented lower diuresis and higher BUN retention. The mean arterial pressure (MAP) showed no difference between both group, and its values were found to be in normal ranges, which discards the possibility that the presence of hypotension causes acute renal failure. No decrease of preload volume was found, which suggests that the acute renal failure is caused by an intrinsic renal dysfunction, which should be studied in later investigations.

Conclusions

In patients with acute pancreatitis in our study, the acute renal failure seems to be a factor associated with mortality, and it does not seem to be conditioned by a diminished preload or hypotension, which suggest the possibility that an intrinsic renal damage is associated with acute pancreatitis.

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