Prevalence of cardiovascular dysfunction and its association with outcome in patients with acute pancreatitis

  • Raghavendra Prasada
  • Narendra Dhaka
  • Ajay Bahl
  • Thakur Deen Yadav
  • Rakesh Kochhar
Original Article
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Accepted:
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Abstract

Background

Organ failure (OF) is the most important predictor of outcome in severe acute pancreatitis (SAP). Cardiovascular failure (CVSF) occurs in a variable proportion of patients with SAP. We aimed to study myocardial dysfunction in acute pancreatitis (AP) and its impact on the outcome.

Methods

In this prospective study between January 2011 and July 2012, consecutive eligible patients of AP were enrolled. Myocardial function was assessed by measuring CK-MB (creatine phosphokinase isoenzyme) and echocardiography at admission. Electrocardiography (ECG) findings at admission were noted. Patients were managed in a high dependency unit using a step-up approach and followed up during hospital stay for their outcome. The outcome variables were computed tomography severity index (CTSI), the severity of AP, infection, need for intervention, length of hospital stay, and mortality.

Results

Of the 65 patients (mean age 39.55 ± 13.14 years; 67.7% males; etiology: alcohol 47.7%, gallstone disease 43.1%, and others 3%), 28 (43%) had organ failure. Respiratory failure was present in 21 (32.3%) patients, acute kidney injury (AKI) in 11 (16.9%) patients, and cardiovascular dysfunction was present in 4 (6.2%) patients. ECG changes were present in 26 (40%) patients with ST segment depression with T wave inversion being the most common (n = 22, 85%). Elevated CK-MB level (more than two times normal) was seen in 18 (27.7%) patients and was associated with increased necrosis (odds ratio = 2.44, 95% confidence interval = 0.5–12.3, p = 0.021), CTSI (7.7 ± 2.7 vs. 5.0 ± 3.0, p = 0.002), severity of AP (p = 0.05), CVSF (p = 0.005), hospital stay (19.3 ± 12.3 vs. 12.3 ± 7.0, p = 0.006), and mortality (odds ratio = 6.42, 95% confidence interval = 1.0–38.9, p = 0.045). Left ventricular systolic dysfunction (left ventricular ejection fraction [LVEF] < 55%) was seen in 9 (13.8%) patients, all of whom had mild systolic dysfunction and left ventricular diastolic dysfunction (LVDD) was seen in 17 (26.2%) patients. There was no association between poor LVEF or LVDD and necrosis, severity of AP, infection, need for intervention, duration of hospital stay, and mortality.

Conclusion

Elevated CK-MB levels were associated with increased necrosis, higher CTSI, the severity of AP, cardiovascular failure, prolonged hospital stay, LVDD, and mortality. Echocardiographic findings namely left ventricular systolic and diastolic dysfunctions were not associated with severity or outcome of AP.

Keywords

Acute pancreatitis Creatine phosphokinase Echocardiography Electrocardiography Myocardial dysfunction Organ failure 
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Notes

Compliance with ethical standards

Conflict of interest

RP, ND, AB, TDY, and RK declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.

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Copyright information

© Indian Society of Gastroenterology 2018

Authors and Affiliations

  • Raghavendra Prasada
    • 1
  • Narendra Dhaka
    • 1
  • Ajay Bahl
    • 2
  • Thakur Deen Yadav
    • 3
  • Rakesh Kochhar
    • 1
  1. 1.Department of GastroenterologyPostgraduate Institute of Medical Education and ResearchChandigarhIndia
  2. 2.Department of CardiologyPostgraduate Institute of Medical Education and ResearchChandigarhIndia
  3. 3.Department of SurgeryPostgraduate Institute of Medical Education and ResearchChandigarhIndia

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