Score systems and cardiovascular function in a series of consecutive patients with acute severe acute pancreatitis

Introduction

The score systems in Severe Acute Pancreatitis (SAP) are based on the clinical and/or analytical variables and are useful in the Emergency Area Triage (EAT).

Objective

To compare general prediction model, disease-specific score systems and cardiovascular function situation through the pressure-adjusted heart rate (PAR) with mortality.

Method

Prospective study of clinical and laboratory testing in 93 SAP patients treated in the Intensive Care Unit over five years, from 1991–95. On apply APACHE II and Ranson Score at 24 and 48 h. Cardiovascular function at 24, 48 h and first week through PAR, calculated as the product of the heart rate (HR) multiplied by the ratio of the right atrial (central venous) pressure (RAP) to the mean arterial pressure (MAP); PAR=HR×RAP/mean BP [1].

Results

Average age of the 93 cases was 63.9± 13.9 years (26–88), 45.2% being women. Etiology was biliary in 53.5%, alcoholic in 12.8%, pharmacological in 2.8% and idiopathic in 31.4%.

Conclusions

In our SAP patients series 24 h APACHE II score has more prognostic value than Ranson score in mortality. Cardiovascular function at 48 h, pressure-adjusted heart rate (PAR), predict clinical outcomes; it is important to prevent the ocurrence of potentially-life threatening events if there is hemodynamically unstable with a PAR >8. Patients died when a PAR was >14.8 during first week.

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