Total serum calcium and corrected calcium as a predictor of severity in acute pancreatitis

Authors

  • Kemparaj T. Department of General Surgery, Bangalore Medical College and Research Institute, Bangalore, India
  • Narasimhamurthy K. N. Department of General Surgery, Bangalore Medical College and Research Institute, Bangalore, India
  • Archit Muralidhar Department of General Surgery, Bangalore Medical College and Research Institute, Bangalore, India

DOI:

https://doi.org/10.18203/2349-2902.isj20184622

Keywords:

Acute pancreatitis, Albumin corrected calcium, Predictor of severity, Serum total calcium

Abstract

Background: Acute pancreatitis is an acute inflammatory process of the pancreas. The Ranson and the modified Glasgow scores require 48 hours of data collection to asses’ severity. Hypocalcaemia is one of the components of Ranson's scoring system done to assess the severity of pancreatitis. Albumin-corrected calcium (ACC) has also been associated with severity, but no study has evaluated it as a prognostic severity factor within the first 24 h of the patient’s hospital admission. This study tries to evaluate total calcium and albumin corrected calcium as prognostic severity markers in acute pancreatitis within first 24 hour of admission.

Methods: This prospective study was conducted in Bowring and Lady Curzon hospital, a tertiary care centre from June 2016 to May 2018. Inclusion criteria included all patients above 18 years of age, who presented within 72 hours of onset of epigastric pain. The clinical and demographic data with respect to gender, age, previous history of pancreatitis, total calcium taken 24 h after admission. In order to evaluate total calcium and albumin corrected calcium as prognostic factors of severity, the lowest total calcium values were collected within the first 24 h of hospital admission. These values were then corrected according to the serum albumin level.

Results: A total of ninety-four patients were included in the study. There was no significant difference in the age of patients in each severity grade (p value: 0.242). No difference was observed in gender distribution of three groups. (P >0.05). As compared to total calcium, mean values of albumin corrected calcium were 8.03, 7.18 and 6.28 for mild, moderate and severe acute pancreatitis respectively, which were also significant at 0.05.

Conclusions: Total calcium and albumin-corrected calcium obtained within the first 24 hours of hospital admission are useful predictors of severity in acute pancreatitis.

References

Bradley EL. A clinically based classification system for acute pancreatitis: summary of the International Symposium on Acute Pancreatitis, Atlanta, Ga, September 11 through 13, 1992. Archives Surgery. 1993;128(5):586-90.

Vonlaufen A, Wilson JS, Apte MV. Molecular mechanisms of pancreatitis: Current opinion. J Gastroenterol Hepatol. 2008;23:1339-48.

Banks PA, Bollen TL, Dervenis C, Gooszen HG, Johnson CD, Sarr MG. Classification of acute pancreatitis: revision of the Atlanta classification and definitions by international consensus. Gut. 2013;62:102-11.

Yeung YP, Lam BY, Yip AW. APACHE system is better than Ranson system in the prediction of severity of acute pancreatitis. Hepatobiliary Pancreat Dis Int. 2006;5:294-9.

Otsuki M, Takeda K, Matsuno S, Kihara Y, Koizumi M, Hirota M. Criteria for the diagnosis and severity stratification of acute pancreatitis. World J Gastroenterol. WJG. 2013;19(35):5798.

Papachristou GI, Clermont G, Sharma A. Risk and markers of severe acute pancreatitis. Gastroenterol Clin North Am. 2007;36:277-96.

Gutiérrez-Jiménez AA, Castro-Jiménez E, Lagunes-Córdoba R. Total serum calcium and calcium corrected as predictors of severity in acute pancreatitis. J Gastroenterol of Mexico. 2014;79(1):13-21.

Bhatia M, Wong FL, Cao Y, Lau HY, Huang J, Puneet P, Chevali L. Pathophysiology of acute pancreatitis. Pancreatol. 2005;5(2-3):132-44.

Ranson JHC, Rifkind KM, Roses DF, Fink SD, Eng K and Localio SA. Objective early identification of severe acute pancreatitis. Am J Gastroenterol. 1974:61(6):443-51.

Kaya E, Dervişoǧlu A, Polat C. Evaluation of diagnostic findings and scoring systems in outcome prediction in acute pancreatitis. World J Gastroenterol. 2007:13(22):3090-4.

Ammori BJ, Barclay GR, Larvin M, McMahon MJ. Hypocalcemia in patients with acute pancreatitis: a putative role for systemic endotoxin exposure. Pancreas. 2003:26(3):213-7.

Zaloga GP. Hypocalcemia in critically ill patients. Critical Care Medicine. 1992:20(2):251-62.

Zivin JR, Gooley T, Zager RA, Ryan MJ. Hypocalcemia: a pervasive metabolic abnormality in the critically ill. Am J Kidney Diseases. 2001:37(4):689-98.

Condon JR, Ives D, Knight MJ, Day J. The aetiology of hypocalcaemia in acute pancreatitis. Br J Surg. 1975:62(2):115-8.

McMahon MJ, Woodhead JS, Hayward RD. The nature of hypocalcaemia in acute pancreatitis. Br J Surg. 1978:65(3):216-8.

Ryzen E, Rude RK. Low intracellular magnesium in patients with acute pancreatitis and hypocalcemia. Western J Med. 1990:152(20):145-8.

Whitted AD, Stanifer JW, Dube P. A dyshomeostasis of electrolytes and trace elements in acute stressor states: impact on the heart. Am J Med Sci. 2010:340(1):48-53.

Egi M, Kim I, Nichol A. Ionized calcium concentration and outcome in critical illness. Critical Care Med. 2011:39(2):314-21.

Steele T, Kolamunnage-Dona R, Downey C, Toh CH, Welters I. Assessment and clinical course of hypocalcemia in critical illness. Critical Care. 2013;17(3):R106.

Downloads

Published

2018-10-26

Issue

Section

Original Research Articles