Pleuropulmonary pathologies in the early phase of acute pancreatitis correlate with disease severity

Background Acute pancreatitis (AP) is a common disease with high morbidity and mortality. Respiratory failure worsens outcome and underlying factors might be early detectable.

Objective This study aimed to analyse the relevance of early pleuropulmonary pathologies and pre-existing chronic lung diseases (CLD) in AP patients.

Methods Patients with a first AP attack from 2010-2018 were retrospectively enrolled from seven European centres. Caudal sections of the thorax derived from abdominal contrast enhanced computed tomography (CECT) of the early AP phase were assessed for pleuropulmonary pathologies. Clinical data were retrieved from patient files. Independent predictors of severe AP were identified by binary logistic regression analysis. A one-year survival analysis using Kaplan-Meier curves and log rank test was performed.

Results Of 395 screened patients, 358 met the eligibility criteria. CECTs were performed with a median of 2 days (IQR 1 - 3) after admission. Overall, 81% of patients showed pleuropulmonary pathologies comprising dystelectases, pleural effusions (PEs), pleural contrast enhancement and elevated left diaphragm in 76%, 55%, 12% and 10% of the cases, respectively. Multivariable analysis identified pre-existing CLD (OR=2.93, 95%CI 1.17-7.32, p=0.022) and moderate to severe or bilateral PEs (OR=4.16, 95%CI 2.05-8.45, p< 0.001) as independent predictors of severe AP. Log rank test showed a significantly worse one-year survival in patients with bilateral compared to unilateral PEs (p=0.04, n=90).

Conclusions Increasing awareness of the prognostic impact of large and bilateral PE’s and pre-existing CLD could facilitate the identification of patients at high risk for severe AP in the early phase and thus improve their prognosis.

Publication History

Article published online:
07 September 2021