Early prognosis of outcomes of acute pancreatitis with different etiologies: A retrospective observational study

Background. Acute pancreatitis remains a global health problem associated with high mortality and significant financial costs. Although up to 80% of cases are mild, the remainder may progress to severe conditions requiring active treatment, the effectiveness of which depends largely on the accuracy of early risk assessment. Conducted studies have revealed no reliable method predicting an adverse outcome of acute pancreatitis, taking into account its pathogenesis, and being equally effective for all etiologic forms. This emphasizes the need for further research to improve prognostic methods.
Objectives. To determine the prognostic value of tools (scales and criteria) for assessing the risk of adverse outcomes of acute pancreatitis with different etiologies.
Methods. A retrospective observational study was conducted on the basis of the Regional Clinical Hospital No. 2, Krasnodar Krai in the period from 01.01.2023 to 01.11.2023. 541 patients were evaluated according to the inclusion criteria. 512 patients aged 18 years and above were included in the study. Patients were divided into groups according to etiologic factors. The statistical significance of the available methods for predicting adverse outcomes (quick Sepsis-related Organ Failure Assessment (qSOFA), Bedside Index of Severity in Acute Pancreatitis (BISAP), Systemic Inflammatory Response Syndrome (SIRS) criteria, the level of C-reactive protein in the blood) for the total cohort and in groups divided by etiology was assessed by using ROC analysis and comparing their prognostic value. Statistical data processing was performed using MedCalc v22.020 (MedCalc Software Ltd., Belgium) and Microsoft Office Excel 2016 (Microsoft Corporation, USA) software packages.
Results. In 309 (60.3%) of 512 cases, the etiologic structure was dominated by alcohol and alimentary factors. Biliary pancreatitis was observed in 176 cases (34.4%) and traumatic pancreatitis was observed in 27 cases (5.3%). In 35.2% of patients, acute pancreatitis occurred in severe form. The overall mortality in the studied cohort amounted to 10.5% (54 patients). At the same time, mortality was different in groups divided by etiology: 15.3% in the group of patients with biliary pancreatitis (the highest mortality among all groups); 8.1% in the group of patients with alcoholic-alimentary pancreatitis; 7.4% in the group of patients with traumatic pancreatitis. When analyzing patients’ survival in subgroups, a statistically significant difference in the share of fatal cases was observed. In the follow-up period, the risk of mortality in patients with biliary pancreatitis was 2.3 times higher than in patients with alcoholic-alimentary pancreatitis and 4.3 times higher than in patients with traumatic acute pancreatitis. The analysis of the cohort revealed the SIRS criteria (AUC 0.831) to be the most effective in predicting adverse outcomes. However, when analyzing subgroups, other data were obtained. For the alcohol-alimentary etiology of acute pancreatitis, the qSOFA scale showed the greatest prognostic value (AUC 0.874, confidence interval of 95% 0.831–0.909; p < 0.001). For biliary pancreatitis, the SIRS criteria provided a more accurate prognosis (AUC 0.857, confidence interval of 95% 0.796–0.905; p < 0.001). For traumatic pancreatitis, only the SIRS criteria produced valuable prognostic results (AUC 0.700, confidence interval of 95% 0.494–0.860; p = 0.014). At the same time, BISAP, qSOFA, and the level of C-reactive protein showed no prognostic value.
Conclusion. Available tools for assessing the risk of adverse outcomes in patients with acute pancreatitis demonstrate different effectiveness depending on the etiology of acute pancreatitis, which emphasizes the need for large-scale studies to develop universal multifactorial scales and/or biomarkers capable of accurately predicting disease progression.

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