Predictive Value Of Early Ascites For Severity And Prognosis In Acute Pancreatitis

Background: Acute pancreatitis(AP)is a common disease of the digestive system.We can see AP patients with ascites during their disease course,and the color of ascites can present in difference.However,there do not have big sample studies to investigate the relationship between the color and nature of the ascites and the prognosis of patients with AP.Objective: To compare the different color and nature of ascites in patients with acute pancreatitis in the early stage,and to determine whether the color and nature of ascites in early acute pancreatitis can predict organ failure and mortality.Methods: This was a retrospective study,which was used to analysis patients with AP developed ascites who hospitalized at the First Affiliated Hospital of Nanchang University from July 2005 to December 2019.Exclude people who had onset of symptoms more than 7 days,or pregnancy,or ascites caused by other diseases such as chronic pancreatitis,or younger than 18 years old,or more than 85 years old or data is uncomplete.Patients were divided into ascites group and noascites group for analysis.According to different ascites color and turbidity,patients were divided into four groups: light yellow transparent ascites group(n=54),dark yellow cloudy ascites group(n=293),red bloody ascites group(n=210),and dark brown cloudy ascites group(n=110).1.Rank sum test was used to compare the baseline data of age,CTSI score,SIRS score,APACHE II score and length of stay between the two groups of patients with and without ascites.Chi-square test was used to compare the differences in the occurrence of necrotizing pancreatitis,organ failure(persistent organ failure),infectious pancreatic necrosis and mortality between the two groups.2.The Cochran-Armitage test was used to compare the etiology,severity,organ failure and prognostic among the four groups of patients with ascites of different colors and turbidity.3.ROC curve was used to analyze the accuracy of prediction of ascites cell number,ascites neutrophil ratio,ascites amylase,ascites protein and ascites LDH to ACS and intra-abdominal bleeding.Result: According to the inclusion and exclusion criteria,667 patients with ascites tested were finally included,which were divided into four groups according to different ascites color: light yellow transparent ascites group(n=54),dark yellow cloudy ascites group(n=293),red bloody ascites group(n=210),and dark brown cloudy ascites group(n=110).1.During the study period,there were 7329 AP patients with an average age of50(40-63)years old,mainly male patients(57.9%).All patients were hospitalized within 2 days after onset,and the morbidity of idiopathic was 8.0%.1392(44.0%)patients MAP patients,2719(37.1%)were MSAP,1388(19%)were SAP,2116(28.9%)patients developed OF,including 1392(19.0%)patients with persistent OF.2.Compared patients with and without ascites,patients with ascites had a higher incidence of SAP(63.2% vs 12.8%),necrotizing pancreatitis(57.0% vs 16.4%),IPN(21.0% vs1.3%),and organ failure(transient or persistent organ failure)(77.3%vs 22.1%).Clinical scores(SIRS scores,BISAP scores,APACHEII score and CTSI scores)and mortality were also higher(P<0.05).3.The rate of OF(63.0% vs 73.7% vs 80.5% vs 81.8%),persistent OF(50.0% vs56.0% vs 66.7% vs 73.6%)(including persistent respiratory failure,persistent renal failure and persistent circulatory failure),and hospital length of stay(13)(7-20)vs 15(10-23)vs 17(11-27)vs 19(10-36))increased gradually when the ascites color become darker and more cloudy.Moreover,the rate of necrotizing pancreatitis(37.0% vs 44.7% vs 64.3% vs 67.3%),IPN(9.3% vs 14.3% vs 19.5% vs 30.9%)and complications of PCD drainage(5.6% vs 14.3% vs 18.6% vs 30.9%)also increased(P<0.05).4.ROC curve analysis ascites laboratory found that the LDH in ascites was more accurate in predicting the intra-abdominal bleeding and ACS,significant < 0.05.The area under ROC curve for predicting intra-abdominal bleeding and ACS were 0.77(0.65,0.90)and 0.79(0.70,0.88)respectively.And the specificity and sensitivity of predicting ACS were 79.2% and 79.3%,respectively.The prediction specificity and sensitivity of the intra-abdominal bleeding were 74%,80%,respectively.Conclusion: The incidence of organ failure,mortality and infectious pancreatic necrosis in AP patients in early stage with ascites was significantly higher than that in patients without ascites,and the incidence of SAP,organ failure and infectious pancreatic necrosis increased with the darker of ascites color and turbidity.And LDH in ascites of AP patients in the early stage has higher accuracy in predicting ACS and intra-abdominal bleeding.