ology 13 (2013) S1–S80

[P-015].

Comparison of scoring systems in predicting severity of acutepancreatitis

Hyun Hee Chung, Kook Hyun Kim, Tae Nyeun Kim

Internal Medicine, Yeungnam University College of Medicine, Daegu,South Korea

Background/aim: Severe acute pancreatitis (AP) occurs in about 20% ofthe patients with AP and associated with multiple organ failure and mayadditionally include local complications. The early prediction of theseverity and identification of patients at risk has important implicationsfor early intensive therapy.

This study was designed to evaluate the prognostic usefulness ofRanson’s, Acute Physiology and Chronic Health Evaluation (APCHE)-IIscoring systems, bedside index for severity in acute pancreatitis (BISAP),CT severity index(CTSI) and C-reactive protein(CRP) in predicting theseverity of AP.

Methods: We analyzed the prospectively collected clinical database of161 patients diagnosed with AP between 2009 and 2012, retrospectively.The Ranson’s, APACHE-II score, BISAP and CTSI were calculated. Severe APwas defined by persistent organ failure for more than 48 hr according tomost recently revised Atlanta classification. Predictive accuracy of thescoring systems was measured by the area under the receiver-operatingcurve (AUC).

Results: Twenty-one patients (13%) were classified as severe AP and140 were classified as mild to moderately severe AP according to theAtlanta classification. The mortality rate was 1.9%(n¼3). AUCs for Ranson’s,BISAP, APACHE-II, CT index, and CRP (24 hours after admission) in pre-dicting severe AP are 0.69(CI 0.62w0.76), 0.74(CI 0.66w0.80), 0.78(CI0.7w0.84), 0.69(CI 0.61w0.76) and 0.68(0.57w0.78), respectively.Although APACH-II demonstrated the highest accuracy for predicting se-vere AP, no statistically significant pairwise differences were observedbetween APACHE-II and the other score systems including CRP.

Conclusions: In this study, various score systems and CRP had similarpredictive accuracy for severity of AP. APACH-II seems to be the highestaccuracy for severe AP. However, no simple scoring systems are available toreach maximal utility and unique models are needed to further improvepredictive accuracy.

Keywords: Severe acute pancreatitis

[P-016].

Visceral fat and acute pancreatitis

Serge Chooklin, Mariya Shavarova

Department of Surgery, Medical University, Lviv, Ukraine

Background/aim: Obesity plays an important role in acute pancreatitis(AP). Increased visceral fat has been shown to exacerbate the pro-in-flammatory milieu experienced by patients. Volume of visceral adiposetissue directly influences the severity of acute pancreatitis.

Methods: Medical records of 55 patients with acute pancreatitis werereviewed. General data, acute pancreatitis etiology, admission prognosticcriteria, and occurrence of complications were recorded. Patients wereclassified according to body mass index (BMI) as obese (BMI > 30) andnon-obese (BMI � 30). We examine the association between waistcircumference and body mass index and the risk of acute pancreatitis. Wecalculate individual abdominal fat distribution parameters from CT scansby segmentation of abdominal tissues.

Results: The risk for severe AP increased according to the degree ofobesity. The risk of acute pancreatitis among those with a waist circum-ference of>105 cmwas twofold increased comparedwith individuals witha waist circumference of 80.0–90.0 cm, when adjusted for confounders.Pancreatic and peripancreatic necrosis was more common in obese pa-tients, as was the incidence of infectious complications. Visceral fat volumewas the volumetric fat parameter that had the most significant associationwith severe acute pancreatitis. There was a significant association between

Abstracts / PancreatS20

visceral fat volume and subsequent development of systemic complica-tions of severe acute pancreatitis.

Conclusions: Obesity may predispose to a complicated course of AP.Abdominal adiposity is an independent risk factor for the development ofacute pancreatitis. Visceral fat volume should be incorporated into futurepredictive scoring systems.

Keywords: Acute pancreatitis, Obesity, Visceral fat

[P-017].

The effect of early enteral nutrition on severe acute pancreatitis

Yu Wang, Hong Zhang

Department of EICU, 1st Affiliated Hospital of Anhui MedicalUniversity, Hefei, Anhui, China

Background/aim: Early enteral nutrition (EEN) has already beenhighlighted for the treatment of severe acute pancreatitis (SAP), but thereis no strong evidence to suggest the appropriate time to start EEN.

Methods: A clinical retrospective study was carried out on 60 patientswith SAP in our hospital from Jan 2010 to Dec 2012. The patients weredivided into early enteral nutrition group (EEN group, n¼20) whichreceived nasojejunal enteral nutrition within 48 hours after admission,parenteral and enteral nutrition combined group (PNþEN group, n¼20)and total parenteral nutrition group (TPN group, n¼20). After 2-weektreatment, the levels of serum C-reactive protein, albumin, prealbumin,hemoglobin, incidence of infections, incidence of MODS, duration of hos-pital stay, APACHE II score and SOFA score were evaluated.

Results: The levels of albumin, prealbumin, C-reactive protein, APACHEII score and SOFA score in EEN group were (39.68�10.81)g/L,(244.23�102.02)g/L, (29.21�23.51)mmol/L, (7.45�3.69) and (2.39�1.57)respectively, which were significantly improved compared with PNþENgroup and TPN group (P<0.05); The hemoglobin decline in EEN group wassignificantly lower than those in PNþEN group and TPN group (P<0.05);The infection rate in EEN group (25%) was significantly lower than those inPNþEN group (60%) and TPN group (60%) (P<0.05); The incidence ofMODS in EEN group was significantly lower than that in TPN group (15% vs55%, P<0.05); The mean length of hospital stay in EEN group was signifi-cantly less than that in PNþEN group [(29.65�16.80)d vs (31.73�20.60)d,P<0.05)].

Conclusions: Start of enteral nutritionwithin 48 hours after admissioncan improve the nutrition status of the patients, and decrease the systemicinflammatory response and secondary infection.

Keywords: Severe acute pancreatitis, Early enteral nutrition, Parenteralnutrition, C reactive protein, APACHE II

[P-018].

Outcome of critically ill patients and severity of acute pancreatitis andacute kidney injury

Maxim Ilynskiy, Irina Aleksandrova, Sergey Rei,Vladimir Kiselev, Gennadiy Berdnikov, Ludmila Marchenkova

Acute Endotoxicosis, Hospital Research Institute for EmergencyMedicine Named after N.v. Sklifosovsky, Moscow, Russian Federation

Background/aim: The systemic determinant of severity in a newclassification of acute pancreatitis (AP) is based on identification of pa-tients with persistent organ failure (OF). Development of acute kidneyinjury (AKI) in critically ill patients is associated with significant mortalityand in fatal AP renal dysfunction is one of the most frequently occurringcomplications, along with pulmonary and cardiovascular dysfunction.

The aim of the current retrospective study was to examine the asso-ciation between severity of AKI and outcome in ICU patients with AP.

Methods: This study included 152 patients who were admitted to theICU between 2002 and 2009. Admissions transferred from other hospitals