Viswanathan Stalin, Jain Dheeraj, Vinayagamoorthi R, Gayathri Murugesan S
General Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry, IND.
General Medicine, Indira Gandhi Medical College & Research Institute, Pondicherry, IND.
Cureus. 2020 Nov 28;12(11):e11737. doi: 10.7759/cureus.11737.
Background The severity of acute alcohol-related pancreatitis (AAP) with alcohol withdrawal syndrome (AWS) has not been studied. Electrocardiogram (ECG) has not been used as a predictor of severity in patients with AWS and acute pancreatitis. Objectives The study aimed to determine whether the ECG heart rate (HR) could predict the severity of AAP; secondarily, whether AWS influenced the severity of AAP based on Acute Physiology and Chronic Health Evaluation (APACHE) II and Bedside Index for Severity in Acute Pancreatitis (BISAP). Methods Demographics, comorbid illnesses, AWS, biochemistry, ECG, arterial blood gases, and CT findings were noted in patients with AAP. The severity of pancreatitis was scored into mild, moderate, and severe based on CT. BISAP, APACHE II, and ECG heart rate-APACHE (E-APACHE) were compared in patients with and without AWS. A receiver operating characteristic curve was used to find the best predictor of severity. Results Among 138 patients (M=128), 94 had AWS. ECG changes (≥1) were seen in 50%. Patients with AWS were younger, had consumed alcohol for a shorter duration, had higher systemic inflammatory response syndrome (SIRS), APACHE II, and E-APACHE II scores. APACHE II and E-APACHE II correlated significantly with severity grading, HR, alcohol duration, and AWS. HR was the best predictor of severe pancreatitis; E-APACHE was the best predictor for moderately severe pancreatitis. Conclusions Mostly, AAP appears to be mild; >2/3 have AWS. ECG findings were seen in 50%. HR has not been previously studied in patients with both AAP and AWS and is an easy and inexpensive test to predict the severity of pancreatitis in this cohort.
急性酒精相关性胰腺炎（AAP）合并酒精戒断综合征（AWS）的严重程度尚未得到研究。心电图（ECG）尚未被用作AWS和急性胰腺炎患者严重程度的预测指标。目的：本研究旨在确定心电图心率（HR）是否能预测AAP的严重程度；其次，基于急性生理与慢性健康状况评分系统（APACHE）Ⅱ和急性胰腺炎严重程度床边指数（BISAP），探讨AWS是否会影响AAP的严重程度。方法：记录AAP患者的人口统计学资料、合并疾病、AWS、生化指标、心电图、动脉血气分析和CT检查结果。根据CT将胰腺炎的严重程度分为轻度、中度和重度。比较有或无AWS患者的BISAP、APACHEⅡ和心电图心率-APACHE（E-APACHE）。采用受试者工作特征曲线寻找最佳严重程度预测指标。结果：138例患者（男性128例）中，94例有AWS。50%的患者出现心电图改变（≥1项）。有AWS的患者更年轻，饮酒时间更短，全身炎症反应综合征（SIRS）、APACHEⅡ和E-APACHEⅡ评分更高。APACHEⅡ和E-APACHEⅡ与严重程度分级、心率、饮酒时间和AWS显著相关。心率是重症胰腺炎的最佳预测指标；E-APACHE是中度重症胰腺炎的最佳预测指标。结论：大多数情况下，AAP似乎为轻症；超过2/3的患者有AWS。50%的患者有心电图表现。此前尚未对同时患有AAP和AWS的患者进行心率研究，心率是预测该队列胰腺炎严重程度的一种简便且廉价的检查方法。
