ENDOTOXEMIA PREDICTS OUTCOME IN ACUTE-PANCREATITIS

The incidence of complications of acute pancreatitis is high in patien ts with endotoxemia, and so we determined the endotoxin levels in the blood and peritoneal fluid of patients with acute severe pancreatitis to correlate the levels with any sequelae. Fourteen patients with acut e severe pancreatitis were examined with regard to clinical features, biochemical tests, and laparotomy (n = 9). In all coagulation profiles , blood gas analysis, chest and abdominal x-rays, ultrasound, and abdo minal computed tomography scan (n = 10) were performed. Qualitative es timation of endotoxin levels was done in peripheral blood and peritone al and peripancreatic fluid. Ten (71.42%) of 14 patients had endotoxin in the blood, and 9 (64.28%) had it in the peritoneal fluid. Twelve ( 85.7%) had pulmonary involvement, with hypoxia being the most common ( 85.7%); among them endotoxin was found in the blood of 10 (83.32%) and in the peritoneal fluid of 8 (66.66%) patients. Renal dysfunction was found in 4 (28.57%) patients; endotoxin was present in the blood of a ll 4 patients and in the peritoneal fluid of 3 (75%) patients. Cardiov ascular abnormality was detected in 8 (57.14%) patients, and endotoxin was present in the blood and peritoneal fluid of all patients. Metabo lic abnormality was present in 8 (57.14%) patients; endotoxin was pres ent in the blood of all 8 patients and in the peritoneal fluid of 7 (8 7.6%) patients. Eight (88.88%) of the 9 patients who required surgery had endotoxemia. Three (30%) patients with endotoxemia survived, where as all 4 patients without endotoxemia survived. Mean hospital stay was 61.2 days and 46.7 days for endotoxin-positive and endotoxin-negative patients, respectively. We conclude that the presence of endotoxin in blood and peritoneal fluid correlates with the severity, systemic com plications, and mortality rates of acute pancreatitis. Endotoxin estim ation can identify patients at risk in the early stages of acute pancr eatitis.