Please use this identifier to cite or link to this item: http://hdl.handle.net/2440/105086
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Type: Journal article
Title: Predictors and outcomes of acute pancreatitis in critically ill patients presenting to the emergency department of a tertiary referral centre in Australia
Author: Sundararajan, K.
Schoeman, T.
Hughes, L.
Edwards, S.
Reddi, B.
Citation: Emergency Medicine Australasia, 2017; 29(2):184-191
Publisher: Blackwell Publishing
Issue Date: 2017
ISSN: 1742-6731
1742-6723
Statement of
Responsibility: 
Krishnaswamy Sundararajan, Tom Schoeman, Lara Hughes, Suzanne Edwards and Benjamin Reddi
Abstract: Objective: To provide a current review of the clinical characteristics, predictors and outcomes in critically ill patients presenting to the ED with acute pancreatitis and subsequently admitted to an intensive care unit (ICU) of a tertiary referral centre in Australia. Methods: A retrospective single-centre study of adult patients admitted with pancreatitis. Severe acute pancreatitis defined by Bedside Index of Severity in Acute Pancreatitis (BISAP) score ≥2. Results: Eighty-seven patients fulfilled criteria for inclusion during the study period, representing 0.9% of all ICU admissions. The median age of patients was 54. Survival was independent of patients' age, sex, aetiology and comorbidities. Mortality was 30.8% for both inpatient referrals to the ICU and for direct referrals via the ED. Higher mortality was identified among patients requiring mechanical ventilation (74.2 vs 24.6% in survivors; P < 0.0001), vasopressor support (85.7 vs 33.8% in survivors; P < 0.0001) or renal replacement therapy (60 vs 16.9% in survivors; P < 0.002). BISAP score surpasses Ranson's and Acute Physiological and Chronic Health Examination (APACHE) II scores in discriminating between survivors and non-survivors among unselected patients with acute pancreatitis admitted to ICU, whereas APACHE II discriminates better in the cohort admitted from ED. Conclusion: Severe acute pancreatitis is associated with high mortality. Aetiology and comorbidity did not predict adverse outcomes in this population. BISAP score is non-inferior to APACHE II score as a prognostic tool in critically ill patients with acute pancreatitis and could be used to triage admission. Evidence of persistent organ dysfunction and requirements for organ support reliably identify patients at high-risk of death.
Keywords: APACHE II score; BISAP score; emergency department; intensive care unit; severe acute pancreatitis
Description: First published: 26 January 2017
Rights: © 2017 Australasian College for Emergency Medicine and Australasian Society for Emergency Medicine
RMID: 0030066778
DOI: 10.1111/1742-6723.12737
Appears in Collections:Public Health publications

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