Patients with acute pancreatitis who have SIRS and hypoxemia at presentation have evidence of severe systemic and pancreatic inflammation
Bruen C, Miller J, Mackey C, Dunn M, Stauderman K, and Hebbar S. Patients with acute pancreatitis who have SIRS and hypoxemia at presentation have evidence of severe systemic and pancreatic inflammation. Crit Care 2019; 23.
Introduction: Clinical scoring systems used to prognosticate the severity of acute pancreatitis (AP), such as APACHE II, are cumbersome and usually require 24 hours or more after presentation to become accurate, at which time the window for early therapeutic intervention has likely passed. SIRS at presentation is sensitive but poorly specific for severe AP. We postulated that SIRS and accompanying hypoxemia would specify at presentation patients with AP who have severe inflammation and are at risk for clinically severe disease. Methods: Patients with AP who had SIRS and hypoxemia at presentation were enrolled in an open-label study evaluating the safety and efficacy of CM4620-IE, a Calcium Release-Activated Calcium (CRAC) channel inhibitor (NCT03401190). Hypoxemia was defined as an estimated PaO2 <75 mm Hg calculated using a log-linear equation and the SpO2 on room air at the time of presentation. A contrastenhanced computed tomography (CECT) was performed at presentation and a CBC with differential, D-dimer and CRP were analyzed daily. The CECT was read by a blinded central reader who assessed the degree of inflammation using the Balthazar scoring system (Table 1). Results: 13 patients, seven men and six women, have been randomized in the study. The mean estimated PaO2 at presentation was 74 mm Hg. 10 patients had 2 SIRS criteria present and the other 3 patients had 3 SIRS criteria present. The median value for age was 53.5 (IQR 48-56), initial neutrophil-lymphocyte ratio (NLR) 10.6 (6.3-13.1), D-Dimer at 24 hours 3670 ng/mL (1440-4840), and CRP at 48 hours 230 mg/L (93-367). In 7 of 13 patients the Balthazar score was 4. Conclusions: In patients with AP who have SIRS and hypoxemia at presentation, there was evidence of severe systemic inflammation as assessed by NLR, D-Dimer and CRP. The majority of patients also had CECT evidence of severe pancreatic inflammation. SIRS and SpO2 do not have the limitations of clinical scoring systems and identify AP patients at presentation who would benefit from early intervention.