Predictors of Surgery in Patients with Severe Acute Pancreatitis Managed by Step up Approach

Abstract

Background: Severe acute pancreatitis (SAP) is initially treated conservatively. Saline irrigation combined with percutaneous catheter drainage (PCD) is reportedly a successful step-up strategy. It's uncertain what causes surgery. Methods: Seventy consecutive SAP patients were chosen for this ongoing prospective investigation. Using a step-up strategy, every patient was first treated medically before having PCD and surgery performed when necessary. Findings: Of the 70 consecutive SAP patients, 14 were treated medically, 29 were treated only with PCD, and 27 needed surgery in addition to PCD at the beginning. Sixty-two percent of patients had sepsis reversal with PCD monotherapy. In 27 patients (48%), PCD alone proved to be a curative therapy. The group's overall mortality rate was 24 percent. The starting acute physiology and chronic health assessment (APACHE) II score, the APACHE II score at first intervention, sepsis reversal by PCD within one week, the amount of organs failed, organ failure within a week of the illness beginning, the number of bacteria isolated per patient, renal failure, respiratory failure, Escherichia coli, the computerised tomography extent index score at admission, the need for parenteral nutrition before or after radiological action, the greatest degree of necrosis of more than 50% of the pancreas, and extrapancreatic necrosis were among the factors that significantly affected surgical intervention in univariate analysis. Renal failure (P -0.03), the APACHE II score at the time of the first intervention (P -0.006), and the total number of of bacteria isolated per patient (P –0.01) remained independent predictors of surgery. An APACHE II score of more than 7.5 at first intervention (PCD) had the ability to predict surgery with a sensitivity of 88.9% and a specificity of 69%. Conclusions: In 62% of patients, PCD prevented surgery whereas in 48% of cases, it reversed sepsis. Early disease progression may require surgery if sepsis is reversed within a week of PCD, if the APACHE II score is high at the time of initial intervention (PCD), and if organ failure occurs within a week of the commencement of the illness.