Serum Creatinine: A Reliable Indicator for Pancreatic Necrosis in Acute Pancreatitis.

ABSTRACT

Background: Necrotizing pancreatitis is one of the severe complications associated with acute pancreatitis. Serum creatinine has recently emerged as a reliable predictor of this severe complication associated with acute pancreatitis. Aims and objectives: The aim of this study is to evaluate the sensitivity and specificity of this simple biochemical marker in predicting the likelihood of developing pancreatic necrosis in any case of acute pancreatitis. Methods: A prospective study was carried out in Victoria Hospital, Bangalore over a period of two years and a total of 200 patients who presented with features suggestive of acute pancreatitis and further confirmed by computerized tomographic evaluation carried out within 96 hours of admission. Serum creatinine levels were documented at the time of admission, 24hrs and 48hrs after admission to notice if an elevation in serum creatinine corresponded with the development of pancreatic necrosis. Results: Out of the 200 test subjects, 26 (13%) patients developed pancreatic necrosis, which was confirmed by a contrast enhanced CT scan performed within 96 hours of admission into our centre. The sensitivity of serum creatinine alone in predicting the development of necrotizing pancreatitis was found to range between 75%-83% and the specificity varied between 71%-79% in our study. The positive predictive value ranges between 11%-23% with a negative predictive value ranging between 98%-99%. Conclusion: Serum creatinine though not highly sensitive is more specific and hence is a valuable simple and inexpensive biochemical parameter for predicting the development of pancreatic necrosis in cases of acute pancreatitis.