Severity, Treatment, and Outcome of Acute Pancreatitis in Thailand: The First Comprehensive Review Using Revised Atlanta Classification

Abstract

Background. Severity and outcome of acute pancreatitis (AP) in Thailand are unknown. Methods. A retrospective study of 250 patients with AP during 2011–2014 was performed. Severity, treatment, and outcome were evaluated. Severity was classified by revised Atlanta classification. Results. The mean age was 58 years and 56% were men. Etiologies were gallstones (45%), alcohol (16%), postendoscopic retrograde cholangiopancreatography (14%), and idiopathic (15%). Overall, 72%, 16%, and 12% of patients had mild, moderately severe, and severe AP, respectively. Two major types of initial intravenous fluid were normal saline (64%) and Ringer's lactate solution (RLS, 28%). Enteral nutrition was given in 77% of patients with severe AP, median duration 48 hours, and via a nasogastric tube in 67% of patients. Necrotizing pancreatitis (NP) developed in 7% of patients, and 29% of them developed infection (median 17 days). The median length of stay was 6, 9, and 13 days, and the mortality rate was 1%, 3%, and 42% in mild, moderately severe, and severe AP, respectively. The overall mortality rate was 6%. Conclusion. The severity of AP in Thailand was mild, moderately severe, and severe in 72%, 16%, and 12% of patients, respectively. NP was not prevalent. Mortality was high in severe AP. Most treatments complied with standard guidelines except the underuse of RLS.

Comparison of bedside index of severity in acute pancreatitis (BISAP) and acute physiology and chronic health evaluation (APACHE II) score in assessing severity of acute pancreatitis

“…As per Bidarkundi et al the main etiology was alcoholism (46.67%), while Singh et al, Papachristou et al and pongprasobchai et al found gall stone disease to be the main etiological factor with 27%, 36% and 45% respectively. 1,[11][12][13] In present study, nine patients out of 14 with BISAP score more than or equal to three had severe AP and the values are statistically significant p value <0.01. In the studies by Singh et On depicting sensitivity and specificity of BISAP score and APACHE II score for severity in ROC curve, the best cut-off point is obtained at 3 and 10 respectively.…”

A systematic review and meta-analysis of the aetiology of acute pancreatitis

“…For the Asia subgroup, 9 studies were selected 9,12,27,33,37,39,49,50,52 from China, India, Taiwan, Oman, Korea and Thailand. One article from Australia 40 was included and represented Oceania in the combined summary effects representation (Fig.…”

“…Other causes of AP Forty-one articles [8][9][10][11][12][13][15][16][17][18][19][20][21][22][23][24][25][26][28][29][30][31][32][33][35][36][37][38][39][40][41][42][43][44][45][47][48][49][50][51][52] assessed other less frequent aetiologies of AP and are summarized in Supplementary Table 2. These miscellaneous causes were responsible for 2-29% of the presentations with AP.…”

Role of diffusion-weighted MR imaging in diagnosis of acute pancreatitis

“…Among the radiological studies, CT with contrast is the most prevalent modality used for disease staging and for determining severity. It is used in evaluation of the pancreatic parenchyma and detecting pancreatic and extra pancreatic inflammation, which is closely linked to the severity of the course of the disease [3]. However, CT cannot be used in patients who have contraindications for iodinated contrast media, as it has been found to aggravate the disease and worsen the renal failure often caused by acute pancreatitis.…”