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Christine Dauphine, MD; Jeffrey Kovar, BS; Bruce E. Stabile, MD; Jason S. Haukoos, MD, MS; Christian de Virgilio, MD

Arch Surg. 2004;139:978-982.

Background  Hospital admission indexes (serum urea nitrogen level, serum glucose level, heart rate, and white blood cell count) have been previously identified as useful predictors for the development of both severe systemic complications and death in patients with gallstone pancreatitis.

Hypothesis  We hypothesized that (1) these same 4 indexes would predict complications and/or death in first-time acute alcoholic pancreatitis and (2) these indexes would compare favorably with an admission Ranson score.

Design  Retrospective cohort study.

Setting  A university-affiliated, urban, public teaching hospital.

Patients  One hundred five patients who experienced first episodes of alcoholic pancreatitis treated between January 1, 1992, and June 30, 2003.

Main Outcome Measures  Major systemic complications (pulmonary, cardiac, renal, infectious) requiring intensive care unit admission and/or death.

Results  A total of 105 patients were identified. Twenty-six patients (25%) (95% confidence interval [CI], 17%-34%) had a major systemic complication, and 6 patients (6%) (95% CI, 2%-12%) died. A serum glucose level of 160 mg/dL (8.9 mmol/L) or higher combined with a white blood cell count of 17 x 10³/µL or more had a positive predictive value of 80% (95% CI, 44%-98%), and an admission Ranson score of 3 or higher had a positive predictive value of 100% (95% CI, 48%-100%) for determining the likelihood of a systemic complication. Both an admission Ranson score of 1 or more and a white blood cell count of 17 x 10³/µL or more, independent of each other, had equally high negative predictive values (100% [95% CI, 94%-100%] and 99% [95% CI, 94%-100%], respectively) with respect to mortality.

Conclusions  Two simple admission laboratory values—white blood cell count and serum glucose level—are useful predictors for development of major systemic complications and/or mortality in patients with first-time alcoholic pancreatitis. The predictive values of leukocytosis and hyperglycemia compare favorably with those of the admission Ranson score.

From the Department of Surgery, Harbor–UCLA Medical Center, Torrance, Calif (Drs Dauphine, Stabile, and de Virgilio and Mr Kovar); and the Department of Emergency Medicine, Denver Health Medical Center, Denver, Colo (Dr Haukoos).