A PROSPECTIVE OBSERVATIONAL STUDY TO ASSESS INCIDENCE OF ACUTE KIDNEY INJURY, CLINICAL PROFILE AND OUTCOMES IN PATIENTS WITH ACUTE PANCREATITIS IN A TERTIARY CARE CENTER

Introduction:

Acute Pancreatitis (AP) is a severe disease with a 34 per 100,000 person-year incidence in high-income nations, resulting in substantial morbidity and mortality. Alcohol consumption (20%) and gallstones (45%) are major causes. Drugs like azathioprine, valproic acid, and mesalamine contribute for less than 5% of instances. 

Acute kidney injury is a long recognized common complication of acute pancreatitis, with varying occurrence of 7.9–23.5%. Various risk factors responsible include old age, higher BMI, past history of chronic kidney disease, sepsis, severe disease, delayed fluid resuscitation. 

Higher fatality rates are seen in AKI group (8.8% vs. 0.7%; p < 0.01). Assessment of risk factors holds the basis to design scores for prediction of AKI in patients with acute pancreatitis. The majority of studies done in past were retrospective and focused on severe disease.

Methods:

Study participants were adults over 18 years old admitted at Medanta Medicity, Gurugram, with a diagnosis of acute pancreatitis (defined by Revised Atlanta Classification Criteria 2012). Study design was prospective observational. Data about demography, vitals, hematological investigations, occurrence of AKI, and dialysis were noted. The AKI group was monitored for 3 months for resolution or chronicity.

Binary logistic regression was utilized for multivariate outcome analysis. Survival analyses compared survival with AKI incidence. P < 0.05 significant.

Results:

A study of 80 acute pancreatitis cases was conducted over 8 months. Study participants averaged 46.1 years old. About 87.5% of cases were male, with 40% having type 2 diabetes mellitus. Acute Pancreatitis was primarily caused by alcohol use (29.4%) and gall stone disease (11.76%). One patient had Azathioprine as underlying cause.

AKI was found in 41.25% (33 of 80) of AP cases, with 30.03% having stage 3 AKI requiring renal replacement therapy and the rest having milder forms (45.45% and 24.5% with stages 1 and 2). In 45.45% of patients, sepsis was the likely cause of AKI, while 12.1% had a history of exposure to nephrotoxic medications including antibiotics and NSAIDs. About 23.53% of cases were recurrent, with 50% developing AKI.

Those in AKI stage 3 or had death as outcome had BISAP score >2. About 5% of AKI patients show incomplete renal recovery after 3 months. The mortality rate was 15.1% in AKI versus 2.12% in non AKI group.

Conclusions:

Patients of acute pancreatitis are at high risk of development of acute kidney injury. Risk increases with higher BISAP scores and the severity of acute pancreatitis.
AKI patients holds more mortality rate than non-AKI patients, necessitating risk factor study and the development of a prediction model for AKI in acute pancreatitis.

I have no potential conflict of interest to disclose.

I did not use generative AI and AI-assisted technologies in the writing process.