Risk factors for critical care admission in acute pancreatitis

Reem Al Ubaidi, Asma AlQaseer, Mariam AlKooheji, Amer Alderazi


Background: Acute pancreatitis is one of the most common gastrointestinal causes of emergency hospital admissions. One in four patients will develop severe acute pancreatitis requiring critical care admission (CCA) frequently for a prolonged period leading to a considerable burden on health care resources. The main objective of this study was to analyse factors that may predict the need for CCA in patients diagnosed with acute pancreatitis.

Methods: In this study, authors analyzed the health records of all patients (154 patients) admitted to Salmaniya Medical Complex (SMC) with the diagnosis of acute pancreatitis.

Results: A total of 10 (6.5%) and 24 (15.6%) patients were admitted to the intensive care unit (ICU) and surgical high dependency unit (SHDU) respectively. There were no differences between different admission locations when it came to age, gender, comorbidities, frequency of attacks and number of computed tomography (CT) scans. After adjusting for all covariates in a multivariate binary logistic regression, the following factors were found to predict CCA: Nationality OR (95% CI): 7.64 (1.14-51.29), dyslipidaemia etiology OR (95% CI): 0.025 (0.001-0.755) and CT severity index - CTSI (95% CI): 1.463 (1.014-2.111). CCA was associated with higher length of stay (6 days vs. 9 day) OR (95% CI): 0.79 (0.015-0.413) and higher in-hospital mortality (1.7% versus 17.6%) OR (95% CI): 5.58 (3.38-7.78).

Conclusions: This study results indicate that nationality, dyslipidaemia etiology and CTSI were associated with higher CCA. ICU admission was associated with longer length of hospital stay and higher mortality rates.


Acute pancreatitis, Bahrain, Computerized tomography severity index, Critical care, Prognosis, Retrospective study

Full Text:



Gislason H, Horn A, Hoem D, Andrén-Sandberg Å, Imsland AK, Søreide O, et al. Acute pancreatitis in Bergen, Norway: a study on incidence, etiology and severity. Scand J Surg. 2004;93(1):29-33.

Krishna SG, Kamboj AK, Hart PA, Hinton A, Conwell DL. The changing epidemiology of acute pancreatitis hospitalizations: a decade of trends and the impact of chronic pancreatitis. Pancreas. 2017;46(4):482.

Sandzén B, Rosenmüller M, Haapamäki MM, Nilsson E, Stenlund HC, Öman M. First attack of acute pancreatitis in Sweden 1988-2003: incidence, aetiological classification, procedures and mortality-a register study. BMC Gastroenterol. 2009;9(1):18.

Yadav D, Lowenfels AB. Trends in the epidemiology of the first attack of acute pancreatitis: a systematic review. Pancreas. 2006;33(4):323-30.

Lilja HE, Leppäniemi A, Kemppainen E. Utilization of intensive care unit resources in severe acute pancreatitis. J Pancreas. 2008;9:179-84.

Mofidi R, Madhavan KK, Garden OJ, Parks RW. An audit of the management of patients with acute pancreatitis against national standards of practice. Br J Surg. 2007;94(7):844-8.

Mole DJ, Gungabissoon U, Johnston P, Cochrane L, Hopkins L, Wyper GM, et al. Identifying risk factors for progression to critical care admission and death among individuals with acute pancreatitis: a record linkage analysis of Scottish healthcare databases. BMJ Open. 2016;6(6):e011474.

Fenton-Lee D, Imrie CW. Pancreatic necrosis: assessment of outcome related to quality of life and cost of management. Br J Surg. 1993;80(12):1579-82.

Bell CF, Stephens JM, Botteman MF, Pashos CL, Ewing M. Trends in inpatient costs for acute pancreatitis in the United States. Value in Health. 2001;4(2):127.

Murata A, Matsuda S, Mayumi T, Okamoto K, Kuwabara K, Ichimiya Y, Fujino Y, Kubo T, Fujimori K, Horiguchi H. Multivariate analysis of factors influencing medical costs of acute pancreatitis hospitalizations based on a national administrative database. Dig Liver Dis. 2012;44(2):143-8.

Shen HN, Lu CL. Incidence, resource use, and outcome of acute pancreatitis with/without intensive care: a nationwide population-based study in Taiwan. Pancreas. 2011;40(1):10-5.

Ali MA, Shaheen JS, Khan MA. Acute pancreatitis induced thrombotic thrombocytopenic purpura. Indian J Crit Care Med. 2014;18(2):107-9.

AlQaseer A, AlHarmi RA, AbuAli N, Ahmed M. Rare case of trichobezoar causing pancreatitis in a young woman. BMJ Case Rep. 2019;12(12):e229173.

Alhindi S, Isa HM. Acute Pancreatitis due to Ascaris Lumbricoides Worm. Bahrain Med Bull, 2016;38:168-70.

Al-Saad S, Al-Shinawi HM, Malallah B. Fatal Ascaris Pancreatitis. Bahrain Med Bullet. 2011;158(686):1-3.

Bradley EL. A clinically based classification system for acute pancreatitis: summary of the International symposium on acute pancreatitis, Atlanta, Ga, September 11 through 13, 1992. Arch Surg. 1993;128(5):586-90.

Working GI, APA AP. IAP/APA evidence-based guidelines for the management of acute pancreatitis. J Int Associat Pancreatol (IAP). 2013;13(4 Suppl 2):e1.

Charlson ME, Pompei P, Ales KL, MacKenzie CR. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Clin Epidemiol. 1987;40(5):373-83.

Charlson M, Szatrowski TP, Peterson J, Gold J. Validation of a combined comorbidity index. J Clin Epidemiol. 1994;47(11):1245-51.

Frenkel WJ, Jongerius EJ, Mandjes‐van Uitert MJ, van Munster BC, de Rooij SE. Validation of the Charlson Comorbidity Index in acutely hospitalized elderly adults: a prospective cohort study. J Am Geriatr Soc. 2014;62(2):342-6.

Balthazar EJ, Robinson DL, Megibow AJ, Ranson JH. Acute pancreatitis: value of CT in establishing prognosis. Radiol. 1990;174(2):331-6.

Balthazar EJ. Acute pancreatitis: assessment of severity with clinical and CT evaluation. Radiol. 2002;223(3):603-13.

Dale J, Omdal T, Lie SA, Iversen K, Flaaten H, Ovrebo KK. The risk factors of intensive care unit admittance during first attack of acute pancreatitis.. Surg Sci. 2012;3(12):603-13.

Beger HG, Rau B, Mayer J, Pralle U. Natural course of acute pancreatitis. World J Surg. 1997;21(2):130-5.

Lankisch PG, Assmus C, Pflichthofer D, Struckmann K, Lehnick D. Which etiology causes the most severe acute pancreatitis?. Int J Pancreatol. 1999;26(2):55-7.

Ventre C, Nowell S, Graham C, Kidd D, Skouras C, Mole DJ. Survival and new-onset morbidity after critical care admission for acute pancreatitis in Scotland: a national electronic healthcare record linkage cohort study. BMJ Open. 2018;8(12):e023853.

Vriens PW, van de Linde P, Slotema ET, Warmerdam PE, Breslau PJ. Computed tomography severity index is an early prognostic tool for acute pancreatitis. J Am Coll Surg. 2005;201(4):497-502.

Pavlidis P, Crichton S, Lemmich Smith J, Morrison D, Atkinson S, Wyncoll D, et al. Improved outcome of severe acute pancreatitis in the intensive care unit. Crit Care Res Pract. 2013;2013:897107.

Ribeiro MD, Paiva JA, Landeiro N, Duarte J. Patients with severe acute pancreatitis should be more often treated in an Intensive Care Department. Rev Esp Enferm Dig. 2002;94(9):523-32.

Soran A, Chelluri L, Lee KK, Tisherman SA. Outcome and quality of life of patients with acute pancreatitis requiring intensive care. J Surg Res. 2000;91(1):89-94.

Wadhwa V, Garg SK, Issa D, Sanaka MR. Mo1364 inpatient burden of acute pancreatitis: an analysis of national trends in the United States From 1997 to 2012. Gastroenterol. 2015;148(4):S-683.

McMahon MJ, Playforth MJ, Pickford IR. A comparative study of methods for the prediction of severity of attacks of acute pancreatitis. Br J Surg. 1980;67(1):22-5.

Wilson C, Imrie CW. Prediction of outcome in acute pancreatitis: a comparative study of APACHE II, clinical assessment and multiple factor scoring systems. Br J Surg. 1990;77(11):1260-4.

Corfield AP, Williamson RC, McMahon MJ, Shearer MG, Cooper MJ, Mayer AD, et al. Prediction of severity in acute pancreatitis: prospective comparison of three prognostic indices. Lancet. 1985;2(8452):403-7.

Bollen TL, Singh VK, Maurer R, Repas K, Van Es HW, Banks PA, et al. A comparative evaluation of radiologic and clinical scoring systems in the early prediction of severity in acute pancreatitis. Am J Gastroenterol. 2012;107(4):612-9.

Chatzicostas C, Roussomoustakaki M, Vardas E, Romanos J, Kouroumalis EA. Balthazar computed tomography severity index is superior to Ranson criteria and APACHE II and III scoring systems in predicting acute pancreatitis outcome. J Clin Gastroenterol. 2003;36(3):253-60.

Leung TK, Lee CM, Lin SY, Chen HC, Wang HJ, Shen LK, et al. Balthazar computed tomography severity index is superior to Ranson criteria and APACHE II scoring system in predicting acute pancreatitis outcome. World J Gastroenterol. 2005;11(38):6049-52.

Van den Biezenbos AR, Kruyt PM, Bosscha K, Van Leeuwen MS, Feldberg MA, Van der Schouw YT, et al. Added value of CT criteria compared to the clinical SAP score in patients with acute pancreatitis. Abdom Imaging. 1998;23(6):622-6.

Dauphine C, Kovar J, Stabile BE, Haukoos JS, de Virgilio C. Identification of admission values predictive of complicated acute alcoholic pancreatitis. Arch Surg. 2004;139(9):978-82.

Sauerland S, Lefering R, Neugebauer EA. Retrospective clinical studies in surgery: potentials and pitfalls. J Hand Surg. 2002;27(2):117-21.