Rising in BUN over 24h and haematocrit ≥44% predicts severity and local complications in acute pancreatitis

Background: The aim of our study was to compare admission haematocrit ≥ 44%, blood urea nitrogen (BUN) and variations in their levels over 24 h with acute physiology and chronic health evaluation II score (APACHE II) and C-reactive protein levels ≥ 15mg/dl, in order to determine the most accurate laboratory test for predicting pancreatic necrosis and severity in acute pancreatitis (AP). Methods: Clinical data of 212 AP patients, prospectively enroled for study at our institution, were analysed. The predictive accuracy of the laboratory test was measured using area-under-thecurve receiver-operating characteristics (AUC) analysis and sensitivity and specificity tests. Results: Rising in BUN over 24h outperform other laboratory parameters and APACHE II, for severity of AP; persistent organ failure (AUC: 0.716, p=0.000), persisting multiorgan failure (AUC: 0.786, p=0.000), mortality (AUC:0.826,p=0.000), intensive care unit admission (AUC: 0.789, p=0.000) also for local complications as; infected pancreatic necrosis (AUC: 0.680, p=0.025) and needed for intervention procedures against necrosis (AUC: 0.737, p=0.001). Haematocrit ≥ 44% on admission was the only siignificant test predicting intrapancreatic necrosis (AUC: 0.64 CI: 0.547–0.732). In a composite analysis of patients with haematocrit ≥ 44% on admission and/or Rising BUN over 24 h, the rate of persistent organ failure rose compared with patients without this characteristics (20.4% vs 5.1%, OR: 4.8 CI: 1.75–13.1). Conclusion: Rising in BUN over 24h plays a role in the prediction of severity and local complications in acute pancreatitis. Haematocrit ≥ 44% on admission plays a role in the prediction of pancreatic necrosis.