Comparison of Etiological and Prognostic Factors in Acute Nexrotizing Pancreatitis

Lim, Young Seok; Ryu, Ji Kon; Lee, Han Chu; Kim, Yong Tae; Yoon, Yong Bum; Kim, Chung Yong

Abstract

BACKGROUND/AIMS: About ten to twenty percent of patients with acute pancreatitis progress to pancreatic necrosis. Little is known about the etiology of necrotizing pancreatitis. It has been suggested that even in the necrotizing pancreatitis group, the prognosis of patients vary greatly according to the degree of necrosis of the pancreas.
METHODS
We investigated retrospectively the etiology and predictive value of four prognostic indicators (Ransons criteria, APACHE-II score, analysis of peritoneal fluid, CT severity index) in fourteen patients with necrotizing pancreatitis who were admitted to Seoul National University Hospital from Jan. 1987 to Jun. 19!)5.
RESULTS
The most common cause was alcohol(9 patients), and no case was associated with cholelithiasis. Of the fourteen patients, five died, and three had more than 3 major complications. In contrast, another six patients had less than 2 complications. The sensitivity and specificity for prediction of serious prognosis (death or more than 3 major complications) of four prognostic indicators were all more than 70%, however, the CT severity index was most valuable. There were. Significant correlation between the CT severity index and Ransons criteria and analysis of peritoneal fluid.
CONCLUSIONS
Alcohol seems to be the leading etiologic factor in necrotizing pancreatitis, and all prognostic indicators were effective for the prediction of serious prognosis. However, in the case of severe acute pancreatitis, the contrast enhanced dynamic CT(CECT) scan should be performed and proper management is necessary.