Prevalence of cardiovascular dysfunction and its association with outcome in patients with acute pancreatitis
- 89 Downloads
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.
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.
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.
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.
KeywordsAcute pancreatitis Creatine phosphokinase Echocardiography Electrocardiography Myocardial dysfunction Organ failure
Compliance with ethical standards
Conflict of interest
RP, ND, AB, TDY, and RK declare that they have no conflict of interest.
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 was obtained from all individual participants included in the study.
- 3.Wilson PG, Manji M, Neoptolemos JP. Acute pancreatitis as a model of sepsis. J Antimicrob Chemother. 1998;41Suppl A:51–63.Google Scholar
- 7.Jambrik Z, Gyongyosi M, Hegyi P, et al. Plasma levels of IL-6 correlate with hemodynamic abnormalities in acute pancreatitis in rabbits. Intensive Care Med. 2002;28:1810–8.Google Scholar
- 8.Meyer A, Kubrusly MS, Salemi VM, et al. Severe acute pancreatitis: a possible role of intramyocardial cytokine production. JOP. 2014;15:237–42.Google Scholar
- 9.Malmstrom ML, Hansen MB, Andersen AM, et al. Cytokines and organ failure in acute pancreatitis: inflammatory response in acute pancreatitis. Pancreas. 2012;41:271–7.Google Scholar
- 18.Nadkarni N, Bhasin DK, Rana SS, et al. Diastolic dysfunction, prolonged QTc interval and pericardial effusion as predictors of mortality in acute pancreatitis. J Gastroenterol Hepatol. 2012;27:1576–80.Google Scholar
- 26.Kleiman NS, Lakkis N, Cannon CP, et al. Prospective analysis of creatine kinase muscle-brain fraction and comparison with troponin T to predict cardiac risk and benefit of an invasive strategy in patients with non-ST-elevation acute coronary syndromes. J Am Coll Cardiol. 2002;40:1044–50.CrossRefPubMedGoogle Scholar
- 28.Paulus WJ, Tschope C, Sanderson JE, et al. How to diagnose diastolic heart failure: a consensus statement on the diagnosis of heart failure with normal left ventricular ejection fraction by the Heart Failure and Echocardiography Associations of the European Society of Cardiology. Eur Heart J. 2007;28:2539–50.CrossRefPubMedGoogle Scholar
- 29.Lang RM, Bierig M, Devereux RB, et al. Recommendations for chamber quantification: a report from the American Society of Echocardiography’s Guidelines and Standards Committee and the Chamber Quantification Writing Group, developed in conjunction with the European Association of Echocardiography, a branch of the European Society of Cardiology. J Am Soc Echocardiogr. 2005;18:1440–63.CrossRefPubMedGoogle Scholar
- 37.Kellner A, Robertson T. Selective necrosis of cardiac and skeletal muscle induced experimentally by means of proteolytic enzyme solutions given intravenously. J Exp Med. 1954;99:387–404.Google Scholar
- 38.Aundhakar S, Mahajan S, Agarwal A, Mhaskar D. Acute pancreatitis associated with elevated troponin levels: whether to thrombolyse or not? Ann Med Health Sci Res. 2013;3Suppl 1:S50–2.Google Scholar
- 40.Landesberg G, Levin PD, Gilon D, et al. Myocardial dysfunction in severe sepsis and septic shock: no correlation with inflammatory cytokines in real-life clinical setting. Chest. 2015;148:93–102.Google Scholar