A study on demographic and clinicopathological characteristics of severe acute pancreatitis in a tertiary-level intensive care unit in Nepal

Abstract

BACKGROUND AND AIMS Severe acute pancreatitis can have serious consequences and a high mortality rate and may necessarily require intensive care unit admission. This study is to describe the demographic and clinicopathological characteristics of severe acute pancreatitis (SAP) in a tertiary-level intensive care unit (ICU). METHODS The study was designed retrospectively with a diagnosis of severe acute pancreatitis (SAP) admitted to the tertiary-level adult ICU “between” January 2019 to December 2022. RESULTS A total of 52 patients were enrolled in this study. The maximum numbers of patients were between 41 to 52 years of age, with a median age of 47.6 years. Gallstone (biliary) was identified as the most important etiological factor associated with severe acute pancreatitis. Among the known etiological factors, 52% of the cases were related to gallstone disease, 28.8% were due to alcohol, 7 (13.4%) to other causes (such as idiopathic, post-viral, post-ERCP, and drug-induced), and 5.7% were due to triglycerides. In our study, the most common symptoms were abdominal pain and vomiting. And the majority of patients recovered with conservative treatment. The majority 48 (92.3%) of patients improved, while 4 (7.6%) died. Eighteen (34.6%) patients required Mechanical ventilation (MV), while 10 (19%) with vasopressor supports. Eleven patients (21%) had evidence of an acute kidney injury on admission. Three patients (5.7%) underwent surgery, including necrosectomy and open cholecystectomy. The median length of ICU stay was 6.3 days. CONCLUSIONS The most common cause of severe acute pancreatitis was gallstone, followed by alcohol-related. SAP was seen more commonly in the male gender in the age group of 41-52 years. The most common presenting symptoms were abdominal pain and vomiting. Most SAP cases could be managed conservatively.

A Descriptive Study of the Demographic and Clinicopathological Characteristics of Individuals With Gallstone-Induced Pancreatitis in a Tertiary-Level Hospital in Ranchi, Jharkhand

“…At the time of presentation, all patients had abdominal pain, whereas 44 (61%) and 22 (30%) had vomiting and fever, respectively. These findings are consistent with those reported by Khanal et al and Ramu et al [14,15].…”

“…Although many studies recommend ERCP within 72 hours of an acute gallstone-induced pancreatitis attack and have shown that it decreases complications [11], this study's participants were managed conservatively because ERCP facilities were unavailable. However, 23 (31.9%) participants with complications improved, whereas 47 (65%) had uneventful recoveries and only two (2.7%) died of complications that caused multi-systemic failure, which is consistent with the findings by Khanal et al [14].…”

“…The high incidence of severe cases might be because of late presentation at our tertiary center. In this study, the most frequent complications in patients with acute gallstone-induced pancreatitis were acute kidney injury (18 cases, 25%) and pleural effusion (13 cases, 18.1%), which is consistent with the findings by Khanal et al [14]. Although many studies recommend ERCP within 72 hours of an acute gallstone-induced pancreatitis attack and have shown that it decreases complications [11], this study's participants were managed conservatively because ERCP facilities were unavailable.…”

“…In the last two decades, pancreatitis incidence has increased by about 30% [10] and gallstone-induced pancreatitis accounts for 50%-70% of the cases [3,14]. Although gallstones most frequently present as acute cholecystitis, many studies have shown that gallstone-induced pancreatitis carries a mortality rate of 2%-17% [10].…”

“…A careful consideration of demographic and clinicopathological features is required to understand the association between the cause and acuteness of pancreatitis in various populations [14] but this crucial information is lacking for Jharkhand's population. Here, we sought to describe the demographic and clinicopathological features of gallstone-induced acute pancreatitis at a tertiary hospital in Ranchi.…”