Research Article
Volume 8 Issue 10 - 2021
Therapeutic Way to Predicting Acute Pancreatitis Non-Necrotising (Mild) and Necrotising (Severe) at 24 Hrs
Aswini K Pujahari*
Department of Surgery (GI Surgery), AFMC, Pune and Command Hospital, AF and Professor, Department of Surgical gastroenterology, SIMS and RC, Bangalore, India
*Corresponding Author: Aswini K Pujahari, Department of Surgery (GI Surgery), AFMC, Pune and Command Hospital, AF and Professor, Department of Surgical gastroenterology, SIMS and RC, Bangalore, India.
Received: July 28, 2021; Published: September 14, 2021


Hypothesis: Intravenous fluid therapy is established in skin burn and acute pancreatitis. Surface area and depth decide the fluid volume in burn. Acute pancreatitis is a chemical burn of pancreas and retroperitoneum, can the volume of fluid therapy determine the severity?

Introduction: Acute pancreatitis can be mild to Severe. Currently available methods to predict severe pancreatitis are complex, cumbersome and inaccurate. A simple way is required.

Materials and Methods: Patients presenting clinically as acute pancreatitis with elevated serum amylase/lipase thrice than normal were managed by intravenous fluid similar to skin burnt injury, so as to have urine output of 0.5 - 1 mL per Kg. Based on the difference between the intake and output, they were predicted as necrotising/non-necrotising at 24 hrs. Confirmation was done on CT scan after 72 hrs or at autopsy.

Results: There was 63 patients with 9 females and 54 males, age ranging from 19 - 59 years. 38 were predicted mild and 25 as severe based on the fluid deficit ranged from 0.4 lit to 9.9L after 24 hrs. the prediction was accurate in 84.126% (severe 85.185% and non-severe 83.333%) cases and inaccurate in 15.873% of cases. And on ROC the area under the curve came out to be 88% at a confidence interval of 95% with a sensitivity and specificity of 88.416 and 82.857% respectively. Patients with fluid deficit > 8.7L died.

Conclusion: Fluid deficit at 24 hrs can predict severe AP 85.2%. Fluid deficit > 8.7 L at 24 hours were fatal.


Keywords: Acute Pancreatitis; Predicting Severe; 24 Hrs Fluid Deficit; Non-Necrotising; Sterile Necrosis; Infected Necrosis


  1. Delrue LJ., et al. “Acute pancreatitis: radiologic scores in predicting severity and outcome”. Abdom Imaging 35 (2010): 349-361.
  2. Zhi Zheng., et al. “A narrative review of acute pancreatitis and its diagnosis, pathogenetic mechanism, and management Affiliations expand”. The Annals of Translational Medicine's 9 (2021): 69.
  3. Ricardo Ruiz Ch. “Acute Pancreatitis”. Revista de Gastroenterología del Perú 1 (1998): 99-107.
  4. Ashok Saluja., et al. “Early Intra-Acinar Events in Pathogenesis of Pancreatitis”. Gastroenterology 156 (2019): 1979-1993.
  5. Ozan Ozcan., et al. “Protective effect of Myrtle (Myrtus communis) on burn induced skin injury”. Burns 45 (2019): 1856-1863.
  6. Göksel Sener., et al. “Leukotriene receptor blocker montelukast protects against burn-induced oxidative injury of the skin and remote organs”. Burns 31 (2005): 587-596.
  7. Levent Kabasakal., et al. “Burn-induced oxidative injury of the gut is ameliorated by the leukotriene receptor blocker montelukast”. Prostaglandins, Leukotrienes and Essential Fatty Acids - Journals 72 (2005): 431-440.
  8. Bailey and Love’s, Chapter 30, 26th Edited by Norman S. Williams, Christopher J.K. Bulstrode, P. Ronan O’Connell, CRC press (2013).
  9. Mitali Mehta and Gregory J. “Tudor Parkland Formula”. In: Stat Pearls [Internet]. Treasure Island (FL): Stat Pearls Publishing (2021).
  10. Bechien U Wu. “Editorial: fluid resuscitation in acute pancreatitis: striking the right balance”. The American Journal of Gastroenterology 106 (2011): 1851-1852.
  11. DiZerega GS. “Peritoneum, Peritoneal Healing, and Adhesion Formation”. In: diZerega G.S. (editions) Peritoneal Surgery. Springer, New York, NY (2000).
  12. Takeshi Tomoda., et al. “Combination of Diclofenac and Sublingual Nitrates Is Superior to Diclofenac Alone in Preventing Pancreatitis After Endoscopic Retrograde Cholangiopancreatography”. Gastroenterology 156 (2019): 1753-1760.e1.
  13. EJ Balthazar., et al. “Acute pancreatitis: value of CT in establishing prognosis”. Radiology2 (1990): 331-336.
  14. Emil J Balthazar. “Acute pancreatitis: assessment of severity with clinical and CT evaluation”. Radiology 223 (2002): 603-613.
  15. Sarr MG. “2012 revision of the Atlanta classification of acute pancreatitis”. Polish Archives of Internal Medicine - Medycyna Praktyczna 123 (2013): 118-124.
  16. Todd H Baron., et al. “American Gastroenterological Association Clinical Practice Update: Management of Pancreatic Necrosis Gastroenterology 158 (2020): 67-75.e1.
  17. Tyler Stevens., et al. “Acute pancreatitis: Problems in adherence to guidelines”. Cleveland Clinic Journal of Medicine 12 (2009): 697-704.
  18. Aoun E., et al. “Diagnostic accuracy of interleukin-6 and interleukin-8 in predicting severe acute pancreatitis: a meta-analysis”. Pancreatology 9 (2009): 777-785.
  19. Theodore W James and Seth D Crockett. “Management of acute pancreatitis in the first 72 hours”. Current Opinion in Gastroenterology5 (2018): 330-335.
  20. Bechien U Wu. “Editorial: fluid resuscitation in acute pancreatitis: striking the right balance”. The American Journal of Gastroenterology 106 (2011): 1851-1852.
  21. John Y Nasr., et al. “Early fluid resuscitation in acute pancreatitis: a lot more than just fluids”. Clinical Gastroenterology and Hepatology 9 (2011): 633-634.
  22. Trikudanathan G., et al. “Current controversies in fluid resuscitation in acute pancreatitis: a systematic review”. Pancreas 41 (2012): 827-834.
  23. Bechien U Wu., et al. “Lactated Ringer's solution reduces systemic inflammation compared with saline in patients with acute pancreatitis”. Clinical Gastroenterology and Hepatology 9 (2011): 710-717.e1.
  24. Mao EQ., et al. “Fluid therapy for severe acute pancreatitis in acute response stage”. Chinese Medical Journal 122 (2009): 169-173.
  25. Wu BU., et al. “Lactated Ringer’s solution reduces systemic inflammation compared with saline in patients with acute pancreatitis”. Clinical Gastroenterology and Hepatology 9 (2011): 710-717.
  26. Haydock MD., et al. “National survey of fluid therapy in acute pancreatitis: current practice lacks a sound evidence base”. World Journal of Surgery 37 (2013): 2428-2435.
  27. Elisabeth De Waele., et al. “How to deal with severe acute pancreatitis in the critically ill”. Current Opinion in Critical Care 25 (2019): 150-156.
  28. Enver Zerem. “Treatment of severe acute pancreatitis and its complications”. World Journal of Gastroenterology 38 (2014): 13879-13892.
  29. GV Rodoman., et al. “[DIC-syndrome-related mortality in acute necrotic pancreatitis]”. Khirurgiia 5 (2018): 19-27.
  30. Mohammad Shafi Kuchay., et al. “Heparin and insulin in the management of hypertriglyceridemia-associated pancreatitis: case series and literature review”. Archives of Endocrinology and Metabolism 61 (2017): 198-201.
  31. Rajat Garg and Tarun Rustagi. “Management of Hypertriglyceridemia Induced Acute Pancreatitis”. BioMed Research International (2018): 4721357.
  32. Quentin M Nunes., et al. “The heparin-binding proteome in normal pancreas and murine experimental acute pancreatitis”. PLoS One 14 (2019): e0217633.
  33. Qiu Qiu., et al. “The efficacy of low molecular weight heparin in severe acute pancreatitis: A systematic review and meta-analysis of randomized controlled trials”. Journal of Digestive Diseases 20 (2019): 512-522.
  34. Enrique de-Madaria. “[Latest advances in acute pancreatitis]”. Clinical Gastroenterology and Hepatology 1 (2015): 100-105.
  35. FG Brivet., et al. “Pro- and anti-inflammatory cytokines during acute severe pancreatitis: an early and sustained response, although unpredictable of death. Parisian Study Group on Acute”. Pancreatiti Critical Care Medicine 27 (1999): 749-755.
  36. Allison L Yang. “Nutrition and Acute Pancreatitis”. Journal of Clinical Medicine 10 (2021): 836.
  37. Attila Oláh and Laszlo Romics Jr. “Enteral nutrition in acute pancreatitis: a review of the current evidence”. World Journal of Gastroenterology 20 (2014): 16123-16131.
  38. Jianbo Song., et al. “Enteral nutrition provided within 48 hours after admission in severe acute pancreatitis: A systematic review and meta-analysis”. Medicine 97 (2018): e11871.
  39. Piet J Lodewijkx., et al. “Nutrition in acute pancreatitis: a critical review”. Expert Review of Gastroenterology and Hepatology 10 (2016): 571-580.
  40. Beata Jabłońska and Sławomir Mrowiec. “Nutritional Support in Patients with Severe”. Acute Pancreatitis-Current Standards Nutrients 5 (2021): 1498.
  41. Hideto Yasuda., et al. “Etiology and mortality in severe acute pancreatitis: A multicenter study in Japan”. Pancreatology3 (2020): 307-317.
  42. JJ Powell., et al. “Survey of antibiotic prophylaxis in acute pancreatitis in the UK and Ireland”. British Journal of Surgery 86 (1999): 320-322.
  43. C Bassi., et al. “Antibiotic therapy for prophylaxis against infection of pancreatic necrosis in acute pancreatitis”. Cochrane Database of Systematic Reviews 4 (2003): CD002941.
  44. Villatoro E., et al. “Antibiotic therapy for prophylaxis against infection of pancreatic necrosis in acute pancreatitis”. Cochrane Database of Systematic Reviews4 (2006): CD002941.
  45. Eduardo Villatoro., et al. “Antibiotic therapy for prophylaxis against infection of pancreatic necrosis in acute pancreatitis”. Cochrane Database of Systematic Reviews 5 (2010): CD002941.
  46. Cheng Zhu., et al. “Intra-abdominal infection in acute pancreatitis in eastern China: microbiological features and a prediction model”. Annals of Translational Medicine 9 (2021): 477.
  47. Mark C van Baal., et al. “Dutch Pancreatitis Study Group) The role of routine fine-needle aspiration in the diagnosis of infected necrotizing pancreatitis”. Surgery 155 (2014): 442-448.
  48. Pramod Kumar Garg., et al. “Association of extent and infection of pancreatic necrosis with organ failure and death in acute necrotizing pancreatitis”. Clinical Gastroenterology and Hepatology 3 (2005): 159-166.
  49. Antonio Carnovale., et al. “Mortality in Acute Pancreatitis: Is It an Early or a Late Event? Antonio Carnovale1 JOP”. JOP Journal of the Pancreas5 (2005): 438-444.
Citation: Aswini K Pujahari. “Therapeutic Way to Predicting Acute Pancreatitis Non-Necrotising (Mild) and Necrotising (Severe) at 24 Hrs”. EC Gastroenterology and Digestive System 8.10 (2021): 25-39.

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