Document Detail

Simplified admission criterion for predicting severe complications of gallstone pancreatitis.
MedLine Citation:
PMID:  10982509     Owner:  NLM     Status:  MEDLINE    
HYPOTHESIS: Simple admission criteria (white blood cell count, > or =14. 5 x 10(9)/L; blood urea nitrogen level, > or =4.3 mmol/L [> or =12 mg/dL]; heart rate, > or =100 beats per minute; and serum glucose level, > or =8.3 mmol/L [> or =150 mg/dL]) are better predictors of severe complications of gallstone pancreatitis than an Acute Physiology and Chronic Health Evaluation II (APACHE II) score of 5 or greater, a modified Imrie (Glasgow) score of 3 or greater, and a biliary Ranson score of 3 or greater. DESIGN: A prospective consecutive case study. SETTING: A university-affiliated, urban, public hospital. PATIENTS: Ninety-two consecutive patients (77 women and 15 men, aged 18 to 76 years [mean age, 39 years]) with gallstone pancreatitis. Seventy-seven patients were Hispanic. MAIN OUTCOME MEASURES: Major local and systemic complications requiring intensive care unit care, and death. RESULTS: Fourteen patients (15%) had severe complications with a mortality of 2%. On univariate analysis, a white blood cell count of 14.5 x 10(9)/L or more (P =.03), a serum glucose level of 8. 3 mmol/L or more (> or =150 mg/dL) (P<.001), an APACHE II score of 5 or greater (P =.008), a modified Imrie score of 3 or greater (P<.001), and a biliary Ranson score of 3 or greater (P =.03) were statistically associated with the development of severe complications; whereas a blood urea nitrogen level of 4.3 mmol/L or more (> or =12 mg/dL) and a heart rate of 100 beats per minute or more were not. On multivariate analysis, only a serum glucose level of 8. 3 mmol/L or more (> or =150 mg/dL) was predictive of adverse events (P<. 001). CONCLUSIONS: Glucose level (> or =8.3 mmol/L [> or =150 mg/dL]) is the best single admission predictor of severe complications of gallstone pancreatitis and is superior to an APACHE II score of 5 or greater, a modified Imrie score of 3 or greater, and a biliary Ranson score of 3 or greater.
K Meek; K Toosie; B E Stabile; M Elbassir; Z Murrell; R J Lewis; L Chang; C de Virgilio
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Archives of surgery (Chicago, Ill. : 1960)     Volume:  135     ISSN:  0004-0010     ISO Abbreviation:  Arch Surg     Publication Date:  2000 Sep 
Date Detail:
Created Date:  2000-09-28     Completed Date:  2000-09-28     Revised Date:  2004-11-17    
Medline Journal Info:
Nlm Unique ID:  9716528     Medline TA:  Arch Surg     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  1048-52; discussion 1052-4     Citation Subset:  AIM; IM    
Department of Surgery, Harbor-UCLA Medical Center, 1000 W Carson St, Box 25, Torrance, CA 90509, USA.
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MeSH Terms
Acute Disease
Blood Glucose / analysis
Cholelithiasis / complications*
Middle Aged
Pancreatitis / etiology*
Predictive Value of Tests
Severity of Illness Index*
Reg. No./Substance:
0/Blood Glucose
Comment In:
Arch Surg. 2001 Oct;136(10):1210   [PMID:  11585517 ]

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