Gastroenterology
Volume 137, Issue 1 , Pages 129-135 , July 2009

Early Changes in Blood Urea Nitrogen Predict Mortality in Acute Pancreatitis

  • Bechien U. Wu

      Affiliations

    • Brigham and Women's Hospital, Center for Pancreatic Disease, Division of Gastroenterology, Harvard Medical School, Boston, Massachusetts
    • Corresponding Author InformationReprint requests Address requests for reprints to: Bechien U. Wu, MD, MPH, Division of Gastroenterology, Brigham & Women's Hospital, 75 Francis Street, Boston, Massachusetts 02115. fax: 617-264-5277
    • ,
  • Richard S. Johannes

      Affiliations

    • Brigham and Women's Hospital, Center for Pancreatic Disease, Division of Gastroenterology, Harvard Medical School, Boston, Massachusetts
    • Cardinal Health, Marlborough, Massachusetts
    • ,
  • Xiaowu Sun

      Affiliations

    • Cardinal Health, Marlborough, Massachusetts
    • ,
  • Darwin L. Conwell

      Affiliations

    • Brigham and Women's Hospital, Center for Pancreatic Disease, Division of Gastroenterology, Harvard Medical School, Boston, Massachusetts
    • ,
  • Peter A. Banks

      Affiliations

    • Brigham and Women's Hospital, Center for Pancreatic Disease, Division of Gastroenterology, Harvard Medical School, Boston, Massachusetts

Received 9 September 2008 ,Accepted 26 March 2009.

References 

  1. Banks PA, Freeman ML. Practice guidelines in acute pancreatitis. Am J Gastroenterol. 2006;101:2379–2400
  2. Harrison DA, D'Amico G, Singer M. The Pancreatitis Outcome Prediction (POP) Score: a new prognostic index for patients with severe acute pancreatitis. Crit Care Med. 2007;35:1703–1708
  3. UK guidelines for the management of acute pancreatitis. Gut. 2005;54(Suppl 3):iii1–iii9
  4. Sarr MG. IAP guidelines in acute pancreatitis. Dig Surg. 2003;20:1–3
  5. Takeda K, Takada T, Kawarada Y, et al. JPN Guidelines for the management of acute pancreatitis: medical management of acute pancreatitis. J Hepatobiliary Pancreat Surg. 2006;13:42–47
  6. Pandol SJ, Saluja AK, Imrie CW, et al. Acute pancreatitis: bench to the bedside. Gastroenterology. 2007;133:1056 e1–1056 e25
  7. Knoefel WT, Kollias N, Warshaw AL, et al. Pancreatic microcirculatory changes in experimental pancreatitis of graded severity in the rat. Surgery. 1994;116:904–913
  8. Strate T, Mann O, Kleinhans H, et al. Microcirculatory function and tissue damage is improved after therapeutic injection of bovine hemoglobin in severe acute rodent pancreatitis. Pancreas. 2005;30:254–259
  9. Freitag M, Standl TG, Kleinhans H, et al. Improvement of impaired microcirculation and tissue oxygenation by hemodilution with hydroxyethyl starch plus cell-free hemoglobin in acute porcine pancreatitis. Pancreatology. 2006;6:232–239
  10. Huber W, Umgelter A, Reindl W, et al. Volume assessment in patients with necrotizing pancreatitis: a comparison of intrathoracic blood volume index, central venous pressure, and hematocrit, and their correlation to cardiac index and extravascular lung water index. Crit Care Med. 2008;36:2348–2354
  11. Spitzer AL, Barcia AM, Schell MT, et al. Applying Ockham's razor to pancreatitis prognostication: a four-variable predictive model. Ann Surg. 2006;243:380–388
  12. Wu BU, Johannes RS, Sun X, et al. The early prediction of mortality in acute pancreatitis: a large population-based study. Gut. 2008;57:1698–1703
  13. Ranson JH, Rifkind KM, Roses DF, et al. Objective early identification of severe acute pancreatitis. Am J Gastroenterol. 1974;61:443–451
  14. Baillargeon JD, Orav J, Ramagopal V, et al. Hemoconcentration as an early risk factor for necrotizing pancreatitis. Am J Gastroenterol. 1998;93:2130–2134
  15. Brown A, Orav J, Banks PA. Hemoconcentration is an early marker for organ failure and necrotizing pancreatitis. Pancreas. 2000;20:367–372
  16. Iezzoni LI, Hotchkin EK, Ash AS, et al. MedisGroups data bases (The impact of data collection guidelines on predicting in-hospital mortality). Med Care. 1993;31:277–283
  17. Iezzoni LI, Moskowitz MA. A clinical assessment of MedisGroups. JAMA. 1988;260:3159–3163
  18. Tabak YP, Johannes RS, Silber JH. Using automated clinical data for risk adjustment: development and validation of six disease-specific mortality predictive models for pay-for-performance. Med Care. 2007;45:789–805
  19. Zhang D. Generalized linear mixed models with varying coefficients for longitudinal data. Biometrics. 2004;60:8–15
  20. Ammori BJ, Barclay GR, Larvin M, et al. Hypocalcemia in patients with acute pancreatitis: a putative role for systemic endotoxin exposure. Pancreas. 2003;26:213–217
  21. Blum T, Maisonneuve P, Lowenfels AB, et al. Fatal outcome in acute pancreatitis: its occurrence and early prediction. Pancreatology. 2001;1:237–241
  22. Kawa S, Mukawa K, Kiyosawa K. Hypocalcemia <7.5 mg/dl: early predictive marker for multisystem organ failure in severe acute necrotizing pancreatitis, proposed by the study analyzing post-ERCP pancreatitis. Am J Gastroenterol. 2000;95:1096–1097
  23. Halonen KI, Leppaniemi AK, Lundin JE, et al. Predicting fatal outcome in the early phase of severe acute pancreatitis by using novel prognostic models. Pancreatology. 2003;3:309–315
  24. Dauphine C, Kovar J, Stabile BE, et al. Identification of admission values predictive of complicated acute alcoholic pancreatitis. Arch Surg. 2004;139:978–982
  25. Fan ST, Choi TK, Lai EC, et al. Prediction of severity of acute pancreatitis: an alternative approach. Gut. 1989;30:1591–1595
  26. Paajanen H, Laato M, Jaakkola M, et al. Serum tumour necrosis factor compared with C-reactive protein in the early assessment of severity of acute pancreatitis. Br J Surg. 1995;82:271–273
  27. Werner J, Hartwig W, Uhl W, et al. Useful markers for predicting severity and monitoring progression of acute pancreatitis. Pancreatology. 2003;3:115–127
  28. DeLong ER, DeLong DM, Clarke-Pearson DL. Comparing the areas under two or more correlated receiver operating characteristic curves: a nonparametric approach. Biometrics. 1988;44:837–845
  29. Jiang CF, Shiau YC, Ng KW, et al. Serum interleukin-6, tumor necrosis factor alpha and C-reactive protein in early prediction of severity of acute pancreatitis. J Chin Med Assoc. 2004;67:442–446
  30. Papachristou GI, Whitcomb DC. Inflammatory markers of disease severity in acute pancreatitis. Clin Lab Med. 2005;25:17–37
  31. Rau BM, Kemppainen EA, Gumbs AA, et al. Early assessment of pancreatic infections and overall prognosis in severe acute pancreatitis by procalcitonin (PCT): a prospective international multicenter study. Ann Surg. 2007;245:745–754
  32. Rau B, Schilling MK, Beger HG. Laboratory markers of severe acute pancreatitis. Dig Dis. 2004;22:247–257
  33. Dominguez-Munoz JE, Villanueva A, et al. Accuracy of plasma levels of polymorphonuclear elastase as early prognostic marker of acute pancreatitis in routine clinical conditions. Eur J Gastroenterol Hepatol. 2006;18:79–83
  34. Neoptolemos JP, Kemppainen EA, Mayer JM, et al. Early prediction of severity in acute pancreatitis by urinary trypsinogen activation peptide: a multicentre study. Lancet. 2000;355:1955–1960
  35. Dickerson RN, Vehe KL, Mullen JL, et al. Resting energy expenditure in patients with pancreatitis. Crit Care Med. 1991;19:484–490
  36. Bouffard YH, Delafosse BX, Annat GJ, et al. Energy expenditure during severe acute pancreatitis. JPEN J Parenter Enteral Nutr. 1989;13:26–29
  37. Shaw JH, Wolfe RR. Glucose, fatty acid, and urea kinetics in patients with severe pancreatitis (The response to substrate infusion and total parenteral nutrition). Ann Surg. 1986;204:665–672
  38. Bradley EL. A clinically based classification system for acute pancreatitis (Summary of the International Symposium on Acute Pancreatitis, Atlanta, Ga, September 11 through 13, 1992). Arch Surg. 1993;128:586–590
  39. Fagenholz PJ, Castillo CF, Harris NS, et al. Increasing United States hospital admissions for acute pancreatitis, 1988–2003. Ann Epidemiol. 2007;17:491–497

 This work was developed as part of the Laboratory Evaluation of Acute Pancreatitis (LEAP) study.

 Conflicts of interest The authors disclose no conflicts.

PII: S0016-5085(09)00520-4

doi: 10.1053/j.gastro.2009.03.056

Gastroenterology
Volume 137, Issue 1 , Pages 129-135 , July 2009

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