Hemoconcentration is an early marker for organ failure and necrotizing pancreatitis

In a previous retrospective case-control study, hemoconcentration was assoc iated with the development of pancreatic necrosis. The aim of the present s tudy was to determine in a cohort study whether hemoconcentration is a mark er for both organ failure and necrotizing pancreatitis. A cohort study was performed on patients admitted with acute pancreatitis from February 1996 t o April 1997. Pancreatic necrosis was defined by findings on dynamic contra st-enhanced computed tomography scan or magnetic resonance imaging. Of 128 total patients with acute pancreatitis, 53 underwent computed tomography or magnetic resonance imaging. Eighteen of 53 had necrotizing pancreatitis. L ogistic regression identified an admission hematocrit greater than or equal to 44% and a failure of admission hematocrit to decrease at 24 hours as th e best binary predictors of necrotizing pancreatitis and organ failure. By 24 hours, 17 of 18 patients with necrotizing pancreatitis versus 11 of 35 w ith interstitial pancreatitis met one or the other criterion for necrosis p < 0,001). By 24 hours, 13 of 15 with organ failure versus 36 of 104 withou t organ failure met one or the other criterion (p < 0.001). The negative pr edictive value by 24 hours was 96% for necrotizing pancreatitis and 97% for organ failure. Hemoconcentration with an admission hematocrit greater than or equal to 44% and/or failure of admission hematocrit to decrease at appr oximately 24 hours was associated with the development of necrotizing pancr eatitis and organ failure. Patients who did not experience hemoconcentratio n were very unlikely to develop pancreatic necrosis or organ failure.