Systemic Inflammatory Response Syndrome (SIRS) as a Simple Predictor of Severity in Acute Pancreatitis

Study results show that SIRS on admission and at 72 hours after is associated with a higher incidence of pancreatic necrosis, an important risk factor contributing to death in patients with severe acute pancreatitis.

A retrospective study of the Systemic Inflammatory Response Syndrome (SIRS) found that it is in an important predictive marker for clinical outcomes in patients with acute pancreatitis on admission up to 3 days, according to findings presented at the 2013 American College of Gastroenterology annual meeting in San Diego.

The aim of the study was to determine what role SIRS, which provokes an acute inflammatory reaction throughout the body, plays in predicting outcomes in acute pancreatitis compared with other simple markers of severity, said Brooke Hill, MD, who presented the findings during a poster session.

Researchers identified 280 non-transfer patients with acute pancreatitis admitted to Dartmouth-Hitchcock Medical Center, Lebanon, NH, over a 24-year period between 1985 and 2009. Most of the patients included in the study were first seen in the center’s emergency department.

“We wanted to get their labs and data on presentation and if they were transferred from an outside hospital, that window is missed,” said Hill.

Patients were grouped based on whether they had SIRS at 24, 48, or 72 hours after admission. The study’s primary outcomes were pancreatic necrosis, persistent organ failure (POF), admission to the intensive care unit (ICU), length of stay, and mortality.

Results showed that SIRS on admission and at 72 hours after was associated with a higher incidence of pancreatic necrosis, an important risk factor contributing to death in patients with severe acute pancreatitis. SIRS was associated with increased incidence of POF from admission and at 24, 48, and 72-hour timepoints. There also was a correlation between transfer to the ICU and SIRS at admission. Hospital stays greater than 7 days and mortality correlated with SIRS at admission, and at all three measured timepoints.

Hill noted that the results indicate that SIRS can be a simple and useful marker in identifying the severity of patients with acute pancreatitis.

“You can look at SIRS, and if a patient still has it at 24 hours, they have higher risk of having a bad outcome. If they still have it at 48 hours, the risk is even greater. So with those patients, just by looking at the presence of SIRS you could be more aggressive in their care.”

Researchers compared the SIRS data to levels of blood urea nitrogen (BUN), a test for the kidneys and liver that measures the amount of nitrogen in the blood. A BUN of greater than 25 at admission was associated with POF, transfer to the ICU, prolonged hospital stays, and death.

There was no clinically significant correlation between elevated hematocrit and the primary outcomes. Advanced age over 60 was associated with POF but was not clinically significant for other outcomes, Hill said.

Researchers concluded that as a predictive marker of important clinical outcomes, SIRS outperformed hematocrit and BUN as a marker of severity in acute pancreatitis.