Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
Department of Surgery, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
Pancreatology. 2019 Jul;19(5):646-652. doi: 10.1016/j.pan.2019.06.004. Epub 2019 Jun 9.
BACKGROUND & AIM: Ascites in patients with acute pancreatitis (AP) is understudied although recent literature hints at its evident role in the final outcome. This study was planned to study the characteristics of ascites in patients of AP and its effect on the disease course and outcome.
Consecutive patients of AP were studied and patients with or without ascites were evaluated for the baseline parameters and severity assessment. Ascites was quantified and fluid analyzed for its characteristics. Intraabdominal pressure (IAP) was monitored. The various outcome parameters were compared between the two groups of patients with and without ascites.
Of the cohort of 213 patients, 82 (38.5%) developed ascites. Ascites group had significantly higher rates of organ failure (p = 0.001), necrosis (p=<0.001) and higher severity assessment scores. The ascites group had significantly longer hospital and ICU stay and higher ventilator days compared to the non-ascites group. Mortality was also higher in the ascites group (34.1% vs 8.45; p = 0.001). Majority of patients with ascites had moderate to gross ascites (75.6%), low serum ascites albumin gradient (87.8%) with low amylase levels (71.9%). Sub-group analysis in ascites group showed that patients with fatal outcome had higher rates of moderate to gross ascites, higher baseline IAP and lower reduction in IAP after 48 h. Moderate to gross ascites and grades of intra-abdominal hypertension (IAH) were significant predictors of mortality (AUC - 0.76).
AP patients with ascites have a more severe disease with poorer outcome. Higher degrees of ascites and IAH grades are significant predictors of mortality.
尽管最近的文献表明腹水在急性胰腺炎（AP）的最终结局中具有明显作用，但患有 AP 的患者的腹水情况仍研究不足。本研究旨在研究 AP 患者腹水的特征及其对疾病过程和结局的影响。
连续研究 AP 患者，评估有无腹水的患者的基线参数和严重程度评估。对腹水进行定量并分析其特征。监测腹腔内压（IAP）。比较两组患者的各种结局参数。
在 213 例患者队列中，82 例（38.5%）出现腹水。腹水组的器官衰竭发生率（p=0.001）、坏死发生率（p<0.001）和严重程度评估评分均明显更高。腹水组的住院时间和 ICU 入住时间以及呼吸机使用天数均明显长于无腹水组。腹水组的死亡率也更高（34.1%比 8.45%；p=0.001）。大多数腹水患者的腹水为中至大量腹水（75.6%），血清腹水白蛋白梯度低（87.8%），腹水淀粉酶水平低（71.9%）。腹水组的亚组分析显示，死亡结局患者的中至大量腹水发生率更高，基线 IAP 更高，48 小时后 IAP 降低幅度更小。中至大量腹水和 IAH 分级是死亡率的显著预测因素（AUC-0.76）。
有腹水的 AP 患者病情更严重，结局更差。较高程度的腹水和 IAH 分级是死亡率的显著预测因素。
