Prevalence of cardiovascular dysfunction and its association with outcome in patients with acute pancreatitis.
BACKGROUND
Organ failure (OF) is the most important predictor of outcome in severe acute pancreatitis (SAP). Cardiovascular failure (CVSF) occurs in a variable proportion of patients with SAP. We aimed to study myocardial dysfunction in acute pancreatitis (AP) and its impact on the outcome.


METHODS
In this prospective study between January 2011 and July 2012, consecutive eligible patients of AP were enrolled. Myocardial function was assessed by measuring CK-MB (creatine phosphokinase isoenzyme) and echocardiography at admission. Electrocardiography (ECG) findings at admission were noted. Patients were managed in a high dependency unit using a step-up approach and followed up during hospital stay for their outcome. The outcome variables were computed tomography severity index (CTSI), the severity of AP, infection, need for intervention, length of hospital stay, and mortality.


RESULTS
Of the 65 patients (mean age 39.55 ± 13.14 years; 67.7% males; etiology: alcohol 47.7%, gallstone disease 43.1%, and others 3%), 28 (43%) had organ failure. Respiratory failure was present in 21 (32.3%) patients, acute kidney injury (AKI) in 11 (16.9%) patients, and cardiovascular dysfunction was present in 4 (6.2%) patients. ECG changes were present in 26 (40%) patients with ST segment depression with T wave inversion being the most common (n = 22, 85%). Elevated CK-MB level (more than two times normal) was seen in 18 (27.7%) patients and was associated with increased necrosis (odds ratio = 2.44, 95% confidence interval = 0.5-12.3, p = 0.021), CTSI (7.7 ± 2.7 vs. 5.0 ± 3.0, p = 0.002), severity of AP (p = 0.05), CVSF (p = 0.005), hospital stay (19.3 ± 12.3 vs. 12.3 ± 7.0, p = 0.006), and mortality (odds ratio = 6.42, 95% confidence interval = 1.0-38.9, p = 0.045). Left ventricular systolic dysfunction (left ventricular ejection fraction [LVEF] < 55%) was seen in 9 (13.8%) patients, all of whom had mild systolic dysfunction and left ventricular diastolic dysfunction (LVDD) was seen in 17 (26.2%) patients. There was no association between poor LVEF or LVDD and necrosis, severity of AP, infection, need for intervention, duration of hospital stay, and mortality.


CONCLUSION
Elevated CK-MB levels were associated with increased necrosis, higher CTSI, the severity of AP, cardiovascular failure, prolonged hospital stay, LVDD, and mortality. Echocardiographic findings namely left ventricular systolic and diastolic dysfunctions were not associated with severity or outcome of AP.
['Prasada|Raghavendra|R|', 'Dhaka|Narendra|N|', 'Bahl|Ajay|A|', 'Yadav|Thakur Deen|TD|', 'Kochhar|Rakesh|R|']
D015415:Biomarkers D052279:Creatine Kinase, MB Form D004452:Echocardiography D004562:Electrocardiography D005260:Female D006333:Heart Failure D006801:Humans D007902:Length of Stay D008297:Male D008875:Middle Aged D019283:Pancreatitis, Acute Necrotizing D015995:Prevalence D011379:Prognosis D011446:Prospective Studies D012720:Severity of Illness Index D013318:Stroke Volume D013599:Systole D014057:Tomography, X-Ray Computed D018487:Ventricular Dysfunction, Left
Acute pancreatitis Organ failure Myocardial dysfunction Creatine phosphokinase Echocardiography Electrocardiography