Calcium and pH value might predict persistent renal failure in acute pancreatitis in the early phase

Abstract

Objectives

Persistent renal failure (PRF) increases morbidity and mortality in acute pancreatitis (AP). Traditional scoring systems achieve good diagnostic value of AP but not PRF alone. Our study aimed to determine PRF predictors in AP patients for early intervention in the disease development.

Methods

In the prospective observational study, we consecutively recruited AP patients from October 2013 to October 2016. Complete clinical characteristics on admission were collected. The 2012 revision of the Atlanta classification diagnosed AP, and the Modified Marshall scoring system defined organ failures. We used univariate and multivariate analyses to select risk factors, and plotted survival curves of different groups and ROC curves of parameters to analyze PRF predictors in AP.

Results

A total of 29 AP patients with PRF and 280 AP patients without PRF were included. Severity scoring and ICU admission rate were higher in the former group. The PRF group’s mortality was 10-fold higher than without PRF (20.7% versus 2.1%, p < .001). Most relevant kidney metabolism indicators and excretion have significant differences (p < .05) between the two groups. Serum calcium (Ca) and pH value (pH) were independent risk factors of PRF (p < .05). ROC curve analysis indicated Ca and pH might predict PRF in AP with areas under the curves (AUCs) of 0.758 and 0.809.

Conclusions

AP patients with PRF had higher morbidity and mortality rate. Our study showed that Ca < 1.94 mmol/L and pH < 7.37 when patients on admission could be used to predict PRF in AP.

Keywords:

• Acute pancreatitis
• persistent renal failure
• predictive factors

Transparency

Declaration of funding

This study was supported by the Health Research and Special Projects Grant of China (No. 201002020, No. 201502005), the Science Foundation for Excellent Young Scholars of the Ministry of Education of China (No. 20101106120059), the 2010 National Clinical Specialty Projects, and the CAMS Innovation Fund for Medical Sciences (CIFMS, 2016-12 M-3-001).

Declaration of financial/other relationships

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

CMRO peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Author contributions

X.C. wrote the manuscript and assisted M.J. in analyzing the data. H.L. and H.Y. designed the study. H.Y. helped revise the main text. All authors reviewed the manuscript.

Acknowledgements

We would like to acknowledge the staff in PUMCH who participated in this study for their support. We would also like to express our sincere gratitude to the patients who participated in this study.