Acute pancreatitis: prognostic role of the hemoconcentration.

Background Studies that associate the hemoconcentration with the development of necrotizing acute pancreatitis, are present in literature. Aim To evaluate if the hemoconcentration is an early marker of necrotizing pancreatitis. Methods The study was executed in patients admitted in the Division of General Surgery of Foggia University with diagnosis of acute pancreatitis in the period from January 1998 to June 2005. The prognostic Ranson’s criteria were applied in all patients. Among the 60 patients admitted with diagnosis of acute pancreatitis (biliary pancreatitis in almost all patients), 24 were submitted to a CT-scan within 36-72 hours. Seven of the 24 patients had a necrotizing pancreatitis (Balthazar’s score). The hematocrit (Hct) was retrospectively evaluated and associated with the CT-scan morphological data, as an early marker of pancreatitis severity. Results The regression analysis showed an association between pancreatic necrosis, by means of CT evaluation, and the hemoconcentration. Hematocrit more than 43% in the males and more than 39% in the females and/or a reduction of the Hct within the first 24 hours from the admission, were markers of severity and pancreatic necrosis (and organ failure). In 6 of the 7 patients with necrotizing pancreatitis there was critical value of Hct and only in 4 of the 17 patients with edematous pancreatitis there was a high value of Hct, showing the statistical significativity of the proposed criteria (P<0.01). The negative predictive value of the hemoconcentration was 94.7% for the evolution in pancreatic necrosis. Conclusions The prognostic value of the hemoconcentration is comparable with the score of Ranson (48 hours of observation). So, it is an early and simple marker of the necrotizing evolution of the acute pancreatitis, because of its high negative predictive value: the patients with acute pancreatitis without hemoconcentration will rarely develop a necrotizing pancreatitis