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Evaluation of Respiratory Parameters in 189 Patients With Acute Pancreatitis in a Single Center: How to Detect a Fire?
Tercio De Campos*, Aline Celeghini Rosa Vicente, Victor Minari Campos, Angelo C. Duarte, Rodrigo Mastrorosa, Bruna Nascimento Santos
Surgery, Santa Casa School of Medical Sciences - Sao Paulo, Brazil, Sao Paulo, Brazil
Introduction: Acute Pancreatitis (AP) is a common disease with highly variable presentation depending on the intensity and extension of pancreatic injury and systemic inflammatory response. About 10 to 15% of cases are severe or critical with up to 50 % mortality rate. It has been observed that 60% of deaths in the first week of the disease are accompanied by lung disorders. Thus, the aim of the study is to evaluate the respiratory parameters in patients with AP and to detect early changes that are related with greater severity and mortality.
Methods: Prospective data collection of patients admitted to the Emergency Unit of Santa Casa in São Paulo with AP diagnosis. Respiratory assessment was made by laboratory evaluation of blood gases as well as the spirometry test muscle strength and chest X-ray, performed on admission, day two and day seven. Data were evaluated and compared with the severity of the AP according to the Revised Atlanta Classification to assess possible factors involved in respiratory disorders. Statistical analysis was performed using the Student's t test, chi square test (p <0.05) and Oddis Ratio.
Results: We evaluated 189 patients, whose mean age was 45.4 years, 61.4% were females and 19.4% of patients were smokers. Mild AP was diagnosed in 56.5% of patients, moderate in 23.8%, 16.6% were severe and 3.3% were critical. Systemic severity was calculated using the scores: APACHE II, with an average of 5,95 (+3.38); SOFA, an average of 1.80 (+1.35) and Marshall, average 0.63 (+0.95). Analyzing respiratory function of these patients on admission, we found that 33.3% of these patients had hypoxemia and this was associated with greater severity (p = 0.043), increasing also the risk of death (OR = 2.67). With regard to parameters used to assess lung function, the x-ray was related to greater severity on admission (D0) (p = 0.0023), D2 (p = 0.0032) and D7 (p = 0.0105), with 6.5 times more likely more severe in D0. Moreover, their modification in D0 was related to mortality (p = 0.0061), and bilateral infiltrates this time increased the risk of death by 75 times, thus correlating with severity (p < 0.0001). Metabolic acidosis on admission was related to mortality (p <0.0001), an increase of 53.25 times the number of deaths. The changes in spirometry and muscle strength testing did not correlate with the severity or mortality, as well as with smoking.
Conclusion: The presence of hypoxemia and x-ray with bilateral infiltrates on admission were a factor related to severity and risk of death, as well as metabolic acidosis was related to higher mortality. Changes in X-ray and blood gases were related to greater severity of patients in all periods analyzed.
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