The predictive value of proteinuria in acute pancreatitis

• Published in: Pancreatology : official journal of the International Association of Pancreatology (IAP) ... [et al.] 2014-11, Vol.14 (6), p.484-489
• Main Authors: Zuidema, M.J, van Santvoort, H.C, Besselink, M.G, van Ramshorst, B, Boerma, D, Timmer, R, Bollen, T.L, Weusten, B.L.A.M
• Format: Article
• Language: English
• Subjects: Acute Disease; Aged; APACHE; Catheters; Chronic obstructive pulmonary disease; Confidence intervals; Creatinine; Databases, Factual; Endocrinology & Metabolism; Endpoint Determination; Enzymes; Female; Gastroenterology and Hepatology; Hospital Mortality; Humans; Kidney diseases; Male; Middle Aged; Mortality; Netherlands - epidemiology; Pancreas; Pancreatitis; Pancreatitis - diagnosis; Pancreatitis - mortality; Physiology; Predictive Value of Tests; Prognosis; Prospective Studies; Proteins; Proteinuria; Proteinuria - diagnosis; Proteinuria - therapy; Severity; Treatment Outcome; Urine
• ISSN: 1424-3903; 1424-3911
• DOI: 10.1016/j.pan.2014.09.004

Abstract Background/objectives Acute pancreatitis has a highly variable clinical course. Early and reliable predictors for the severity of acute pancreatitis are lacking. Proteinuria appears to be a useful predictor of disease severity and outcome in a variety of clinical conditions. This study aims to investigate the predictive value of proteinuria on admission for the severity of acute pancreatitis compared with other commonly used predictors; the APACHE II score, Modified Glasgow score and C-reactive protein (CRP). Methods This is a post-hoc analysis of 64 patients admitted with acute pancreatitis treated in one teaching hospital, who participated in a previous randomized trial. Proteinuria was defined as a Protein/Creatinine ( P / C ) ratio >23 mg/mmol. The primary endpoint was severe acute pancreatitis. Secondary endpoints included infectious complications, need for invasive intervention, ICU stay and in-hospital mortality. Results Proteinuria was present in 30/64 patients (47%). Eleven patients (17%) had severe acute pancreatitis. There was no difference in incidence of severe acute pancreatitis between patients with and without proteinuria: 6/30 patients (20%) versus 5/34 patients (15%) respectively ( p  = 0.58). Likewise, the occurrence of infectious complications, need for intervention and ICU stay and mortality did not differ significantly ( p  = 0.58, p  = 0.99, p  = 0.33 and p  = 0.60 respectively). The diagnostic performance of the P / C ratio for the prediction of severe pancreatitis was inferior to the Modified Glasgow score ( p  = 0.04) and CRP ( p  = 0.03). Conclusion Proteinuria on admission does not seem to be a reliable predictor for disease severity in acute pancreatitis. The diagnostic performance of the P / C ratio is inferior to the Modified Glasgow score and CRP.