Systemic inflammatory response syndrome between 24 and 48 h after ERCP predicts prolonged length of stay in patients with post-ERCP pancreatitis: a retrospective study

Amitasha Sinha; Rukshana Cader; Venkata S Akshintala; Susan M Hutfless; Atif Zaheer; Vinshi N Khan; Mouen A Khashab; Anne Marie Lennon; Anthony N Kalloo; Vikesh K Singh

doi:10.1016/j.pan.2015.02.005

Systemic inflammatory response syndrome between 24 and 48 h after ERCP predicts prolonged length of stay in patients with post-ERCP pancreatitis: a retrospective study

Pancreatology. 2015 Mar-Apr;15(2):105-10. doi: 10.1016/j.pan.2015.02.005. Epub 2015 Feb 17.

Authors

Affiliations

¹ Department of Internal Medicine, Division of Gastroenterology and Hepatology, Johns Hopkins Medical Institutions, Baltimore, MD, USA. Electronic address: amitashasinha@gmail.com.
² Department of Internal Medicine, Division of Gastroenterology and Hepatology, Johns Hopkins Medical Institutions, Baltimore, MD, USA. Electronic address: rcader@me.com.
³ Department of Internal Medicine, Division of Gastroenterology and Hepatology, Johns Hopkins Medical Institutions, Baltimore, MD, USA. Electronic address: findsandeep.amc@gmail.com.
⁴ Department of Internal Medicine, Division of Gastroenterology and Hepatology, Johns Hopkins Medical Institutions, Baltimore, MD, USA. Electronic address: shutfle1@jhmi.edu.
⁵ Pancreatitis Center, Johns Hopkins Medical Institutions, Baltimore, MD, USA; Department of Radiology and Radiological Science, Johns Hopkins Medical Institutions, Baltimore, MD, USA. Electronic address: azaheer1@jhmi.edu.
⁶ Department of Internal Medicine, Division of Gastroenterology and Hepatology, Johns Hopkins Medical Institutions, Baltimore, MD, USA. Electronic address: vinshinazkhan86@gmail.com.
⁷ Department of Internal Medicine, Division of Gastroenterology and Hepatology, Johns Hopkins Medical Institutions, Baltimore, MD, USA. Electronic address: mkhasha1@jhmi.edu.
⁸ Department of Internal Medicine, Division of Gastroenterology and Hepatology, Johns Hopkins Medical Institutions, Baltimore, MD, USA. Electronic address: amlennon@jhmi.edu.
⁹ Pancreatitis Center, Johns Hopkins Medical Institutions, Baltimore, MD, USA; Department of Internal Medicine, Division of Gastroenterology and Hepatology, Johns Hopkins Medical Institutions, Baltimore, MD, USA. Electronic address: akalloo@jhmi.edu.
¹⁰ Pancreatitis Center, Johns Hopkins Medical Institutions, Baltimore, MD, USA; Department of Internal Medicine, Division of Gastroenterology and Hepatology, Johns Hopkins Medical Institutions, Baltimore, MD, USA. Electronic address: vsingh1@jhmi.edu.

PMID: 25728146
DOI: 10.1016/j.pan.2015.02.005

Abstract

Background: Early systemic inflammatory response syndrome (SIRS) has been associated with severe non-iatrogenic acute pancreatitis. The aims of this study were to determine whether early SIRS could be used to predict severe post-ERCP pancreatitis (PEP) and to determine the effect of prophylactic-pancreatic stenting (PS) on SIRS and severe PEP.

Methods: Between 1/2000 and 6/2012, all patients admitted for PEP after an outpatient ERCP and who had ≥1 abdominal CT scan during hospitalization were retrospectively evaluated. The presence of SIRS was assessed between 0 and 24 h and 24 and 48 h after the time of ERCP completion. SIRS was evaluated as a predictor of severe PEP using area under receiver operating characteristic (AUROC) curve analysis.

Results: There were 113 patients with PEP of whom 22 (19.5%) had severe PEP. SIRS was present in 44 (38.9%) and 33 (29.2%) patients between 0 and 24 h and 24 and 48 h, respectively. SIRS between 24 and 48 h had a higher predictive accuracy for severe PEP compared to SIRS between 0 and 24 h (AUROC = 0.7 vs. 0.5, p = 0.002). The prevalence of SIRS between 24 and 48 h was significantly less among the 19 patients who underwent PS (11% vs. 37%, p = 0.03). There was no difference between the prophylactic stenting and no stenting groups with regards to acute fluid collection(s), pancreatic necrosis, organ failure or mortality during hospitalization.

Conclusions: SIRS between 24 and 48 h after ERCP is an accurate, easy to obtain, and inexpensive predictor of severe PEP. PS is associated with a decreased prevalence of SIRS between 24 and 48 h after ERCP.

Keywords: Cholangiopancreatography; Complications; Endoscopic retrograde; Pancreatitis; Stent; Systemic inflammatory response syndrome.

MeSH terms

Adult
Cholangiopancreatography, Endoscopic Retrograde / adverse effects*
Cohort Studies
Female
Humans
Length of Stay
Male
Middle Aged
Pancreatitis / etiology*
Pancreatitis / therapy
Predictive Value of Tests
Retrospective Studies
Systemic Inflammatory Response Syndrome / etiology*
Treatment Outcome