Prevalence and predictors of severe acute pancreatitis in patients with acquired immune deficiency syndrome (AIDS)

OBJECTIVE: Recent case control data suggested that a severe course of acute pancreatitis in HIV+ patients was 1) common (50% of cases), 2) poorly pred icted by Ranson's criteria (sensitivity 41%), and 3) accurately predicted b y a diagnosis of AIDS (positive predictive value 67%). However, the definit ion of severity included length of stay in hospital and excluded commonly a ccepted markers (local complications, systemic complications, and need for surgery). The aim of this study was to determine 1) the prevalence of sever ity and 2) the value of these predictors with regard to severity, as define d by commonly accepted standardized criteria in patients with AIDS and acut e pancreatitis. METHODS: A retrospective review identified 50 patients with AIDS exhibiting clinical, laboratory, and/or radiological features of acute pancreatitis. RESULTS: Only five patients followed a severe course as defined by accepted markers. Of these patients, 29 had values available for at least nine of 1 1 of Ranson's criteria (sensitivity 80%, specificity 54%). Points were awar ded most commonly for decreased serum Ca2+ (n = 14) and elevated serum LDH (n = 7). CONCLUSIONS: In patients with AIDS and acute pancreatitis at our institutio ns, 1) the prevalence of severity and 2) the sensitivity of Ranson's criter ia with regard to severity is comparable to that reported in large historic al case series of immunocompetent patients. Pseudohypocalcemia and/or eleva tion in LDH are frequent, likely due to the catabolic infectious disease st ate. (Am J Gastroenterol 1999;94 : 784-789. (C) 1999 by Am. Coll. of Gastro enterology).