Deaprtment of Gastrointestinal, Hepatobiliary and Pancreatic Disorder,BIRDEM General Hospital,Shahbag, Dhaka, Bangladesh
Department of Medicine,Sirajul Islam Medical College,Moghbazar, Dhaka, Bangladesh
and objectives: Acute pancreatitis is
a common condition for hospital admission. In Bangladesh, no study has yet
investigated the clinical profile, degree of severity and underlying factors of
acute pancreatitis. The aim of the present study was to
determine the clinical profile, degree of severity and underlying factors of
acute pancreatitis in a cohort of Bangladeshi patients.
Methods: This prospective
study was conducted from April 2016 to March 2017 on patients admitted with
acute pancreatitis at Bangladesh
Institute of Research and Rehabilitation in Diabetes, Endocrine and Metabolic
Disorders (BIRDEM) General Hospital, Dhaka,
Bangladesh. History and clinical features of each patient was systematically
of acute pancreatitis was made by clinical findings, serum amylase and lipase
levels (> 3 times the upper limit of normal values), evidences of acute
pancreatitis by ultrasonography and computed tomography (CT). Severity of acute
pancreatitis was classified according to the revised version of Atlanta
Results: A total of 40
patients with acute pancreatitis were enrolled in the study. Male and female
were equally distributed. The mean age was 44.3±2.7 years. Among 40
cases, 26 (65.0%) and 14 (35%) had moderate and severe acute pancreatitis
respectively. No specific clinical feature including ascites or pleural
effusion was found significantly related to severity of the disease. Gall stone
and metabolic (hypertriglyceridaemia/hypercalcemia) causes were present in
62.5% cases, but none had significant association with the severity of the
Conclusion: The present study has
demonstrated that no specific observed clinical feature or underlying factor
was related to the degree of severity of acute pancreatitis in a cohort of
IMC J Med Sci 2018; 12(1): 06-10
pancreatitis is a medical emergency and is one of the most common
gastrointestinal conditions for hospital admission. The reported annual
incidence of acute pancreatitis is 13 to 45 per 100,000 populations in
different countries of the world . The risk, clinical features and severity
of acute pancreatitis differ with age, sex, life style and presence of co-morbidities.
Of the many complications, ascites and pleural effusion are important
complications related to the severity of the disease [2,3,4]. So far, no systematic
study has investigated the clinical profile, degree of severity and underlying
factors of acute pancreatitis among Bangladeshi patients. Therefore, the
present study has attempted to determine the rate of different grades of
severity of acute pancreatitis and their associated clinical features in a
group of Bangladeshi patients.
Materials and Methods
The present prospective study was performed from April 2016
to March 2017 at the BIRDEM General Hospital, Dhaka, Bangladesh. All patients aged 18
years or more, diagnosed as a case of acute pancreatitis, were included in
study. Informed consent was obtained from each participant.
of acute pancreatitis was made by clinical findings, serum amylase and lipase
levels more than 3 times the upper limit of normal value as well as by evidences
of acute pancreatitis by ultrasonography and computed tomography (CT).
Ultrasonography and CT scan were performed in all patients within 3 and 4 days
of admission respectively. Abdominal ultrasonography was repeated when clinically
indicated during hospitalization and 1 month after leaving the hospital. X-ray
chest was done in all patients. Ascites and pleural effusion were diagnosed
accordingly. Organ failure was diagnosed when shock, pulmonary insufficiency,
renal failure and gastrointestinal bleeding were present. Presence of pancreatic
necrosis, abscess and pseudocyst were recorded. Severity of acute pancreatitis
was classified according to the revised version of Atlanta classification .
Moderately severe acute pancreatitis was diagnosed based on the presence of
local complication and/or transient organ failure (<48 hours). Severe acute
pancreatitis was defined as patients having persistent single or multiple organ
failure for >48 hours – systolic blood pressure ≤ 90 mmHg or PaO2<60%
or serum creatinine ≥2mg/dl . Patients having ascites and pleural effusion
due to cardiac, pulmonary and liver diseases and having other severe co-morbid
condition were excluded from this study. Detailed history and biochemical
parameters were recorded in a predesigned data sheet for determining possible
etiological factors of acute pancreatitis. Gall stone pancreatitis was diagnosed
if serum alanine aminotransferase level was more than 3 times the upper limit
of normal value and/presence of gall stone in gallbladder or bile duct.
Metabolic pancreatitis was diagnosed if serum triglyceride level was more than
1000 mg/dl or hypercalcemia was present . The significance of association of
clinical features with severity of pancreatitis was tested by chi-square and
other appropriate statistical tests.
of 40 acute pancreatitis patients were enrolled in the study. Of the 40 cases,
19 (47.5%) and 21 (52.5%) were male and female respectively and the mean age
was 44.25±2.7 years. Among them, 26 (65.0%) and 14 (35%) had moderate and
severe acute pancreatitis respectively. The mean age of patients with severe
acute pancreatitis (59.1±16.2 years) was significantly higher (p<0.01) than
that of cases with moderately severe pancreatitis (36.2±11.5 years). Duration
of hospital stay of patients with moderately severe acute pancreatitis cases
(6.5±2.0 days; 95% CI: 5.6-7.3) was significantly (p<0.01) less compared to
those with severe pancreatitis (9.4±5.1 days; 95% CI: 6.5 - 12.3).The overall
mean hospital stay for all acute pancreatitis cases was 7.5±.6 days.
clinical profile of study population is shown in Table-1. The most common
presentations of both moderate and severe acute pancreatitis were upper abdominal
pain (100%) and vomiting (84.6% and 92.8%). Among the patients, ascites and
pleural effusion were present in 30% (12/40) and 32.5% (13/40) respectively. Pleural
effusions was bilateral in 7 (53.8%), left sided in 5 (38.46%) and right sided
in 1 (7.69%). Bilateral pleural effusion was present in 21.4% and 15.4% cases
with severe and moderately severe pancreatitis cases. No significant
differences (p>0.05) were observed regarding occurrence of either ascites or
pleural effusion in moderately severe and severe acute pancreatitis cases (ascites:
23% vs. 42.8%; pleural effusion: 23% vs. 50%). Both ascites and pleural
effusion were together present in 11.5% and 35.5% patients with moderate and severe
acute pancreatitis respectively (p=0.06). Ascites disappeared in all surviving
patients before they were released from the hospital. Two patients were
discharged from the hospital with pleural effusion but the effusion disappeared
within one month. Leukocytosis was present in 19.2% and 57.1% cases with
moderate and severe acute pancreatitis respectively. Only one patient died due
to pancreatic necrosis and respiratory distress syndrome.
Table-1: Demographic and clinical profile of patients with moderate (n=26) and
severe (n=14) acute pancreatitis
study, gallstones was associated with 15.3% and 42.8% patients with moderate and
severe acute pancreatitis respectively; while metabolic syndrome was present in
46.1% and 21.4% cases respectively (Table-2). History of alcohol consumption
was present in 15.3% patient with moderate acute pancreatitis and 7.1% in
severe acute pancreatitis. No underlying cause was found (idiopathic) in 23%
and 28.5% cases in both groups. None of the underlying factors were found significantly
associated with the severity of acute pancreatitis.
Table-2: Etiology or underlying factor in cases with moderate and severe acute
present study has attempted to determine the rate of different grades of severity
of acute pancreatitis and their associated clinical features in a group of
Bangladeshi patients. In this study, 65% of patients had a moderately severe
and 35% had severe acute pancreatitis. Other studies reported the rate of
severe acute pancreatitis as 21% to 25% [7,8]. The higher rate of severe
pancreatitis in our patients could be due to delay in early intervention, food
habits and underlying predisposing factors like diabetes mellitus. About 80% of
our cases had diabetes mellitus of different duration.
our 40 cases, male and female were equally affected. Similar observation has
also been reported by other investigators [9,10,11]. As reported by others ,
upper abdominal pain (100%) and vomiting (87.5%) were the most common clinical
features. Ascites is a well known complication of acute pancreatitis. In our
study, there was no significant difference of occurrence of ascites among
moderate and severe acute pancreatitis cases though 42% severe cases had ascites
compared to 23% in moderately severe cases. Studies elsewhere have reported the
rate of ascites in severe pancreatitis cases from 18% to 60% [13,14]. Similarly,
in the present study, we were unable to find any significant association of
pleural effusion with the severity of acute pancreatitis though the rate of
pleural effusion was much higher (23% and 50%) in our study than those (4% to
17%) reported by other studies [15,16]. In both moderate and severe disease,
the majority of effusions were bilateral. Thus the site of pleural effusion
offers no additional diagnostic information . Perhaps studies large number
of cases with stringent case selection criteria is needed to ascertain whether
ascites and pleural effusion can be used as diagnostic criteria for severe
to determine the underlying predisposing factors of acute pancreatitis in our
cases. In the present study, metabolic cause was found to be the most common
cause of acute pancreatitis (37.5%), followed by gallstone disease. Among the
severe acute pancreatitis cases, we found gallstone disease as the most common
cause (42.8%). One fourth of our cases were idiopathic. However, it is to be
noted that over 80% of our cases had diabetes mellitus of different duration
and, therefore, the presence of such co-morbid condition and use of certain
anti-diabetic drugs might play a role in its pathogenesis . However, we
could not find any significant association of these factors with severity of
present study has demonstrated the frequency of severity and the clinical
profiles of moderately severe and severe variety of acute pancreatitis among a
cohort of Bangladeshi patients. Study with larger number of cases may be
required to determine the specific underlying factor(s), predictive or
prognostic criteria for different grades of acute pancreatitis in our
IKD was involved in case enrollment, management and
manuscript writing; MNH and TMB did overall supervision.
Authors declare no conflict of interest.
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