Objective: To investigate the clinical characteristics, prognosis effects and management of different admission serum glucose levels in patients with severe acute pancreatitis (SAP).
Methods: A retrospective analysis involving a total of 218 patients with SAP and have serum glucose > or = 6.1 mmol/L at admission during the period from August 1, 2005 to December 31, 2007 was enrolled based on the coding data in West China hospital. They were divided into 3 groups according to admission glucose levels of 6.1-11.1 mmol/L (n = 115), 11.2-16.7 mmol/L (n = 71), and > 16.7 mmol/L (n = 32) respectively. Patients' demographic characteristics, clinical parameters, various scoring systems, the ICU transfer rate during early phase and the mortality, infection rate and operation transfer rate during later phase were obtained and calculated.
Results: The pulse and respire frequency, the levels of serum lactate dehydrogenase (LDH), blood urea nitrogen (BUN), creatinine (Crea) and scores on the Ranson Criteria, Acute Physiology and Chronic Health Evaluation II (APACHE II) at admission, APACHE II and Balthazar's Computed Tomography Severity Index (CTSI) within 72 hours increased in sequence according to mild, moderate and severe hyperglycemic group (P < 0.01). Whereas the concentration of serum Ca2+ was lower than that in the mild elevated serum glucose group (P < 0.01). In the 3 groups, the early single organ failure rates were elevated in turn (P < 0.01) and the multi-organ failure rates were 16.5%, 45.1% and 50.0% (P < 0.01) respectively. Simultaneously, the ICU transfer rates were 10.4%, 26.8% and 34.4%, while the mortality in the 3 groups were 7.8%, 16.9% and 40.6% respectively, which were statistically significant (P < 0.01).
Conclusion: The findings of the study suggest that admission elevated glucose is an indicator of organ failure and poor prognosis of SAP.