| Elevated serum creatinine as a marker of pancreatic necrosis in acute pancreatitis. | |
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MedLine Citation:
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PMID: 19098865 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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OBJECTIVES: Pancreatic necrosis is a serious complication of acute pancreatitis. The identification of simple laboratory tests to detect subjects at risk of pancreatic necrosis may direct management and improve outcome. This study focuses on the association between routine laboratory tests and the development of pancreatic necrosis in patients with acute pancreatitis. METHODS: In a cohort of 185 patients with acute pancreatitis prospectively enrolled in the Severity of Acute Pancreatitis Study, patients with contrast-enhanced computerized tomography performed were selected (n=129). Serum hematocrit, creatinine, and urea nitrogen on admission and peak values within 48 h of admission were analyzed. The volume of intravenous fluid resuscitation was calculated for each patient. RESULTS: Of 129 patients, 35 (27%) had evidence of pancreatic necrosis. Receiver operating characteristic curves for pancreatic necrosis revealed an area under the curve of 0.79 for admission hematocrit, 0.77 for peak creatinine, and 0.72 for peak urea nitrogen. Binary logistic regression yielded that all three tests were significantly associated with pancreatic necrosis (P<0.0001), with the highest odds ratio, 34.5, for peak creatinine. The volume of intravenous fluid resuscitation was similar in patients with and without necrosis. Low admission hematocrit (< or =44.8%) yielded a negative predictive value of 89%; elevated peak creatinine (>1.8 mg/dl) within 48 h yielded a positive predictive value of 93%. CONCLUSIONS: We confirm that a low admission hematocrit indicates a low risk of pancreatic necrosis (PNec) in patients with acute pancreatitis. In contrast, an increase in creatinine within the first 48 h is strongly associated with the development of PNec. This finding may have important clinical implications and warrants further investigation. |
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Authors:
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Venkata Muddana; David C Whitcomb; Asif Khalid; Adam Slivka; Georgios I Papachristou |
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Publication Detail:
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Type: Journal Article; Research Support, N.I.H., Extramural; Research Support, U.S. Gov't, Non-P.H.S. |
Journal Detail:
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Title: The American journal of gastroenterology Volume: 104 ISSN: 1572-0241 ISO Abbreviation: Am. J. Gastroenterol. Publication Date: 2009 Jan |
Date Detail:
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Created Date: 2008-12-22 Completed Date: 2009-02-24 Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 0421030 Medline TA: Am J Gastroenterol Country: United States |
Other Details:
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Languages: eng Pagination: 164-70 Citation Subset: IM |
Affiliation:
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Division of Gastroenterology, Hepatology and Nutrition, Department of Medicine, UPMC Presbyterian Hospital, University of Pittsburgh School of Medicine, 200 Lothrop Street, Pittsburgh, PA 15213, USA. |
Export Citation:
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APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
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Adolescent Adult Aged Aged, 80 and over Biological Markers / blood Blood Urea Nitrogen Creatinine / blood* Female Hematocrit Humans Male Middle Aged Necrosis Pancreatitis, Acute Necrotizing / blood, diagnosis* Predictive Value of Tests ROC Curve Sensitivity and Specificity Young Adult |
| Grant Support | |
ID/Acronym/Agency:
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R01 DK 61451/DK/NIDDK NIH HHS |
| Chemical | |
Reg. No./Substance:
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0/Biological Markers; 60-27-5/Creatinine |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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