Early measures of hemoconcentration and inflammation are predictive of prolonged hospitalization from post - Endoscopic retrograde cholangiopancreatography pancreatitis

Gregory A. Coté, Sashidhar V. Sagi, Suzette E. Schmidt, Glen Lehman, Lee McHenry, Evan Fogel, James Watkins, Stuart Sherman

Research output: Contribution to journalArticle

6 Citations (Scopus)

Abstract

Objectives: Hemoconcentration markers are predictors of severe acute pancreatitis but have not been specifically evaluated in post-endoscopic retrograde cholangiopancreatography pancreatitis (PEP). Methods: Case-control study of patients undergoing ERCP for suspected sphincter of Oddi dysfunction. We identified patients with PEP (PEP positive) and controls (PEP negative) in a 1:2 ratio. blood urea nitrogen (BUN) and hematocrit (Hct) were measured before procedure, upon admission, and 24 hours later. Preprocedure levels of BUN and Hct were analyzed to control for confounders. Among the PEP-positive patients, BUN level, Hct level, and systemic inflammatory response syndrome are compared between severe and mild/moderate cases. Results: There were 149 PEP-positive patients, including 18 patients (12.1%) with severe PEP and 301 PEP-negative controls. After adjusting, higher preprocedure BUN level (odds ratio [OR], 1.05 [1.01, 1.10]; P G 0.02) and pancreatic sphincterotomy (OR, 1.60 [1.01, 2.55]; P G 0.05) were associated with PEP, whereas older age (OR, 0.98 [0.96, 0.99]; P G 0.02) and a greater body mass index (OR, 0.97 [0.94, 0.99]; P G 0.03) with a lower rate. Difference in BUN level of 0.0 or greater (failure to decline) had a sensitivity of 71% and a specificity of 79% for differentiating severe from mild/moderate PEP. Patients with severe PEP were more likely to have systemic inflammatory response syndrome upon admission (44.4% [21.5, 67.4]) and after 24 hours (61.1% [38.6, 83.6] versus mild/moderate (9.2% [4.2, 14.1], 10.6% [5.4,16.0]; P G 0.0001 for each). Conclusions: Preprocedure BUN level is associated with the development of PEP. The preprocedure BUN level and failure of the BUN level to decline during the first 24 hours are associated with prolonged hospitalization.

Original languageEnglish
Pages (from-to)850-854
Number of pages5
JournalPancreas
Volume42
Issue number5
DOIs
StatePublished - Jul 2013

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Endoscopic Retrograde Cholangiopancreatography
Pancreatitis
Hospitalization
Blood Urea Nitrogen
Inflammation
Odds Ratio
Hematocrit
Systemic Inflammatory Response Syndrome
Peptamen
Sphincter of Oddi Dysfunction
Case-Control Studies
Body Mass Index

Keywords

  • Cholangiopancreatography
  • Endoscopic retrograde
  • Pancreatitis
  • Serum urea nitrogen
  • Sphincter of Oddi dysfunction

ASJC Scopus subject areas

  • Hepatology
  • Internal Medicine
  • Endocrinology
  • Endocrinology, Diabetes and Metabolism

Cite this

Early measures of hemoconcentration and inflammation are predictive of prolonged hospitalization from post - Endoscopic retrograde cholangiopancreatography pancreatitis. / Coté, Gregory A.; Sagi, Sashidhar V.; Schmidt, Suzette E.; Lehman, Glen; McHenry, Lee; Fogel, Evan; Watkins, James; Sherman, Stuart.

In: Pancreas, Vol. 42, No. 5, 07.2013, p. 850-854.

Research output: Contribution to journalArticle

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abstract = "Objectives: Hemoconcentration markers are predictors of severe acute pancreatitis but have not been specifically evaluated in post-endoscopic retrograde cholangiopancreatography pancreatitis (PEP). Methods: Case-control study of patients undergoing ERCP for suspected sphincter of Oddi dysfunction. We identified patients with PEP (PEP positive) and controls (PEP negative) in a 1:2 ratio. blood urea nitrogen (BUN) and hematocrit (Hct) were measured before procedure, upon admission, and 24 hours later. Preprocedure levels of BUN and Hct were analyzed to control for confounders. Among the PEP-positive patients, BUN level, Hct level, and systemic inflammatory response syndrome are compared between severe and mild/moderate cases. Results: There were 149 PEP-positive patients, including 18 patients (12.1{\%}) with severe PEP and 301 PEP-negative controls. After adjusting, higher preprocedure BUN level (odds ratio [OR], 1.05 [1.01, 1.10]; P G 0.02) and pancreatic sphincterotomy (OR, 1.60 [1.01, 2.55]; P G 0.05) were associated with PEP, whereas older age (OR, 0.98 [0.96, 0.99]; P G 0.02) and a greater body mass index (OR, 0.97 [0.94, 0.99]; P G 0.03) with a lower rate. Difference in BUN level of 0.0 or greater (failure to decline) had a sensitivity of 71{\%} and a specificity of 79{\%} for differentiating severe from mild/moderate PEP. Patients with severe PEP were more likely to have systemic inflammatory response syndrome upon admission (44.4{\%} [21.5, 67.4]) and after 24 hours (61.1{\%} [38.6, 83.6] versus mild/moderate (9.2{\%} [4.2, 14.1], 10.6{\%} [5.4,16.0]; P G 0.0001 for each). Conclusions: Preprocedure BUN level is associated with the development of PEP. The preprocedure BUN level and failure of the BUN level to decline during the first 24 hours are associated with prolonged hospitalization.",
keywords = "Cholangiopancreatography, Endoscopic retrograde, Pancreatitis, Serum urea nitrogen, Sphincter of Oddi dysfunction",
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T1 - Early measures of hemoconcentration and inflammation are predictive of prolonged hospitalization from post - Endoscopic retrograde cholangiopancreatography pancreatitis

AU - Coté, Gregory A.

AU - Sagi, Sashidhar V.

AU - Schmidt, Suzette E.

AU - Lehman, Glen

AU - McHenry, Lee

AU - Fogel, Evan

AU - Watkins, James

AU - Sherman, Stuart

PY - 2013/7

Y1 - 2013/7

N2 - Objectives: Hemoconcentration markers are predictors of severe acute pancreatitis but have not been specifically evaluated in post-endoscopic retrograde cholangiopancreatography pancreatitis (PEP). Methods: Case-control study of patients undergoing ERCP for suspected sphincter of Oddi dysfunction. We identified patients with PEP (PEP positive) and controls (PEP negative) in a 1:2 ratio. blood urea nitrogen (BUN) and hematocrit (Hct) were measured before procedure, upon admission, and 24 hours later. Preprocedure levels of BUN and Hct were analyzed to control for confounders. Among the PEP-positive patients, BUN level, Hct level, and systemic inflammatory response syndrome are compared between severe and mild/moderate cases. Results: There were 149 PEP-positive patients, including 18 patients (12.1%) with severe PEP and 301 PEP-negative controls. After adjusting, higher preprocedure BUN level (odds ratio [OR], 1.05 [1.01, 1.10]; P G 0.02) and pancreatic sphincterotomy (OR, 1.60 [1.01, 2.55]; P G 0.05) were associated with PEP, whereas older age (OR, 0.98 [0.96, 0.99]; P G 0.02) and a greater body mass index (OR, 0.97 [0.94, 0.99]; P G 0.03) with a lower rate. Difference in BUN level of 0.0 or greater (failure to decline) had a sensitivity of 71% and a specificity of 79% for differentiating severe from mild/moderate PEP. Patients with severe PEP were more likely to have systemic inflammatory response syndrome upon admission (44.4% [21.5, 67.4]) and after 24 hours (61.1% [38.6, 83.6] versus mild/moderate (9.2% [4.2, 14.1], 10.6% [5.4,16.0]; P G 0.0001 for each). Conclusions: Preprocedure BUN level is associated with the development of PEP. The preprocedure BUN level and failure of the BUN level to decline during the first 24 hours are associated with prolonged hospitalization.

AB - Objectives: Hemoconcentration markers are predictors of severe acute pancreatitis but have not been specifically evaluated in post-endoscopic retrograde cholangiopancreatography pancreatitis (PEP). Methods: Case-control study of patients undergoing ERCP for suspected sphincter of Oddi dysfunction. We identified patients with PEP (PEP positive) and controls (PEP negative) in a 1:2 ratio. blood urea nitrogen (BUN) and hematocrit (Hct) were measured before procedure, upon admission, and 24 hours later. Preprocedure levels of BUN and Hct were analyzed to control for confounders. Among the PEP-positive patients, BUN level, Hct level, and systemic inflammatory response syndrome are compared between severe and mild/moderate cases. Results: There were 149 PEP-positive patients, including 18 patients (12.1%) with severe PEP and 301 PEP-negative controls. After adjusting, higher preprocedure BUN level (odds ratio [OR], 1.05 [1.01, 1.10]; P G 0.02) and pancreatic sphincterotomy (OR, 1.60 [1.01, 2.55]; P G 0.05) were associated with PEP, whereas older age (OR, 0.98 [0.96, 0.99]; P G 0.02) and a greater body mass index (OR, 0.97 [0.94, 0.99]; P G 0.03) with a lower rate. Difference in BUN level of 0.0 or greater (failure to decline) had a sensitivity of 71% and a specificity of 79% for differentiating severe from mild/moderate PEP. Patients with severe PEP were more likely to have systemic inflammatory response syndrome upon admission (44.4% [21.5, 67.4]) and after 24 hours (61.1% [38.6, 83.6] versus mild/moderate (9.2% [4.2, 14.1], 10.6% [5.4,16.0]; P G 0.0001 for each). Conclusions: Preprocedure BUN level is associated with the development of PEP. The preprocedure BUN level and failure of the BUN level to decline during the first 24 hours are associated with prolonged hospitalization.

KW - Cholangiopancreatography

KW - Endoscopic retrograde

KW - Pancreatitis

KW - Serum urea nitrogen

KW - Sphincter of Oddi dysfunction

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