A Study of Acute Kidney Injury in Severe Acute Pancreatitis in a Tertiary Care Hospital from South India
Journal Title: IOSR Journal of Dental and Medical Sciences (IOSR-JDMS) - Year 2018, Vol 17, Issue 3
Abstract
Acute kidney injury (AKI) is one of the serious complications in patients with severe acute pancreatitis (SAP). Severe acute pancreatitis is associated with a higher incidence of mortality ranging from 7% to 47% [1]. A tenfold increase in mortality has been shown to be observed in AP associated with acute renal failure [2]. Objectives (i) To identify the incidence of acute kidney injury in patients admitted with severe acute pancreatitis (based on revised Atlanta criteria-2012), (ii) To determine the severity of AKI in these patients based on the KDIGO-AKI-2012 criteria, based on urine output and serum creatinine elevation, (iii) To assess the mode of management and outcome of the renal dysfunction in these patients. Methods: This is a prospective cross sectional study of 100 patients, who were admitted in Govt. Stanley Medical College with severe acute pancreatitis diagnosed based on the Revised Atlanta classification (2012). The patients are followed up throughout the hospital stay and at least six months after discharge. The mode of management and the outcome of acute kidney injury were assessed. Results: Acute kidney injury occurred in 32 patients (32%). Majority of the Patients who developed AKI were alcoholic (78.13%). Mortality rate in our study was 12.5%. Mean age of patients who had acute pancreatitis was 42.92 ±12.60 years. There were higher proportion of diabetics in AKI group when compared to non-AKI group (40.63% vs 14.71%: p- 0.004). Stage 1 AKI was in 26 patients (81.25%), followed by stage 2 (n=4, 12.50%) and stage 3(n=2, 6.28%). Majority of the Acute Kidney Injury group patients were treated conservatively with fluids and antibiotics (n=30, 93.75%) and only 2 patients required hemodialysis (6.25%). Four patients expired (12.5%) in AKI group, while only one patient expired in non-AKI group (p- 0.018). The risk of death in SAP with AKI patients with Diabetics is 1.62 times significantly more than patients with non-diabetics (p- 0.0074). In SAP with AKI patients the risk of death significantly increases with alcohol intake, serum amylase >200 IU/L, serum creatinine >2.4mg/dl at admission and when AKI stage >1 at admission (odds ratio: 3.04; 3.58; 4.29; 3.59). Conclusions: In our study, the incidence of AKI in severe acute pancreatitis patients was 32%. Based on the KDIGO staging of acute kidney injury, majority of the patients were in stage-1. Diabetes mellitus and ethanol use were significantly related with the development of AKI. Most of them recovered with conservative management and only 2 patients required dialysis support. An early recognition of AKI in acute pancreatitis and timely management can improve the outcome and reduces mortality.
Authors and Affiliations
Manokaran S1, Edwin Fernando M, Srinivasaprasad ND, Sujit Suren
Keywords
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- EP ID EP369696
- DOI 10.9790/0853-1703114548.
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