Hemoconcentration: an early marker of severe and/or necrotizing pancreatitis? a critical appraisal

Abstract

Hemoconcentration does not significantly correlate with important clinical outcome variables of acute pancreatitis including organ failure and mortality rate. Its prognostic value is comparable to the more complicated Ranson and Imrie scores obtained only after 48 h. The major value of this single easily obtainable and cheap parameter on admission lies in its high negative predictive value. In the absence of hemoconcentration, contrast-enhanced CT may be unnecessary on admission unless the patient does not improve.

Admission Hematocrit and Rise in Blood Urea Nitrogen at 24 h Outperform other Laboratory Markers in Predicting Persistent Organ Failure and Pancreatic Necrosis in Acute Pancreatitis: A Post Hoc Analysis of Three Large Prospective Databases

“…With regard to hematocrit, elevated levels on admission have been associated with development of pancreatic necrosis, organ failure, as well as prolonged hospitalization and need for intensive care unit (17)(18)(19). Th e cutoff values of hematocrit proposed in these studies ranged from 39% to 47%, with 44% being the most commonly reported.…”

“…Th e cutoff values of hematocrit proposed in these studies ranged from 39% to 47%, with 44% being the most commonly reported. One study even reported diff erent cutoff levels for men (hematocrit >43%) and women (>39.6%) associated with an odds ratio of 2.2 for pancreatic necrosis development ( 19 ).…”

“…Such laboratory parameters have great potential, because they are readily available, inexpensive, and have standardized reference ranges. Multiple studies have reported a signifi cant association between serum levels of BUN, hematocrit, and creatinine on admission and their changes over 24-48 h with severe disease (14)(15)(16)(17)(18)(19)(20)(21)(22). However, the majority of these studies are limited by small sample size, retrospective nature, and use of variable outcomes of severity.…”

Can C-reactive protein levels increase the accuracy of the Ranson score in predicting the severity and prognosis of acute pancreatitis? A prospective cohort study

“…Hemoconcentration and a high hematocrit level as predictors of severity have been studied and yielded variable results (20). Various serum markers have been studied to predict the severity of AP, including blood urea nitrogen, serum creatinine, serum glucose, serum calcium, amylase, and lipase (21).…”

Practice Guidelines in Acute Pancreatitis

“…Overall, 85% of patients have interstitial pancreatitis; 15% (range 4-47%) have necrotizing pancreatitis (25,44,46,50,68,83,86,128,140,169). Among patients with necrotizing pancreatitis, 33% (range 16-47%) have infected necrosis (62,66,68,83,91,111,113,117,118,120,121,147,159,169,170).…”