Int J Curr Pharm Res, Vol 17, Issue 5, 129-132Original Article

TO EVALUATE THE CLINICAL PRESENTATION, ETIOLOGICAL FACTORS, SEVERITY, AND IMMEDIATE OUTCOMES OF ACUTE PANCREATITIS IN HOSPITALIZED PATIENTS

RUPINDER SINGH1, SAHIL KOHLI1, HARJAP SINGH2, YADWINDER KUMAR1*

1Department of Internal Medicine, MataGujri Memorial Medical College and Lions Seva Kendra Hospital, Kishanganj, Bihar, India. 2Government Medical College, Patiala, Punjab, India
*Corresponding author: Yadwinder Kumar; *Email: yadwinder654@gmail.com

Received: 11 Jun 2025, Revised and Accepted: 01 Aug 2025

ABSTRACT

Objective: Acute pancreatitis (AP) is a common gastrointestinal emergency with varying severity and outcomes. Understanding its clinico-pathological profile and immediate hospital outcomes is crucial for early intervention and improving prognosis. The aim of this study to evaluate the clinical presentation, etiological factors, severity, and immediate outcomes of acute pancreatitis in hospitalized patients.

Methods: A prospective observational study was conducted on 66 patients diagnosed with AP based on the Revised Atlanta Classification (2012). Demographic data, clinical features, laboratory parameters, imaging findings, and hospital outcomes were analyzed.

Results: The mean age of patients was 45.2±12.5 years, with a male predominance (63.6%). The most common etiology was gallstones (51.5%), followed by alcohol (30.3%). Abdominal pain (100%) and vomiting (72.7%) were the most frequent symptoms. According to severity, 57.6% had mild, 30.3% moderate, and 12.1% severe AP. Complications included pancreatic necrosis (9.1%), pseudocyst formation (6.1%), and acute kidney injury (7.6%). The mortality rate was 4.5%.

Conclusion: Gallstone disease remains the leading cause of AP. Early recognition of severe cases and prompt management can reduce complications and mortality.

Keywords: Acute pancreatitis, Gallstones, Revised atlanta classification, Mortality, Complications

© 2025 The Authors. Published by Innovare Academic Sciences Pvt Ltd. This is an open access article under the CC BY license (https://creativecommons.org/licenses/by/4.0/)
DOI: https://dx.doi.org/10.22159/ijcpr.2025v17i5.7073 Journal homepage: https://innovareacademics.in/journals/index.php/ijcpr

INTRODUCTION

Acute pancreatitis (AP) is a sudden inflammatory condition of the pancreas that can range from a mild, self-limiting disease to a severe, life-threatening disorder with systemic complications. It is one of the most common gastrointestinal emergencies requiring hospitalization, with an estimated global incidence of 13 to 45 cases per 100,000 individuals annually [1]. Despite significant advancements in medical care, AP continues to pose diagnostic and therapeutic challenges due to its variable clinical course and potential for rapid deterioration.

The two leading causes of AP worldwide are gallstones and excessive alcohol consumption, accounting for nearly 80% of cases [2]. Gallstone-induced pancreatitis is more prevalent in women and older adults, while alcohol-related AP predominantly affects middle-aged men. Other less common etiologies include hypertriglyceridemia, hypercalcemia, trauma, infections, drug toxicity, and genetic predispositions. In some cases, the cause remains unidentified, classified as idiopathic AP [3].

Clinically, AP presents with sudden-onset, severe epigastric pain radiating to the back, often accompanied by nausea, vomiting, and abdominal distension. Diagnosis is established using the Revised Atlanta Classification (2012), which requires at least two of the following criteria: characteristic abdominal pain, serum amylase/lipase ≥3 times the upper limit of normal or confirmatory imaging findings [4]. Early and accurate diagnosis is crucial for initiating timely treatment and preventing complications.

The severity of AP is classified into three categories: mild, moderately severe, and severe, based on the presence of organ failure and local or systemic complications. Approximately 20% of patients develop severe AP, which carries a high mortality rate of up to 30% due to complications such as pancreatic necrosis, pseudocysts, sepsis, and multi-organ failure [5]. Prognostic scoring systems like BISAP, APACHE-II, and CTSI help identify high-risk patients early, allowing for aggressive intervention and improved outcomes.

Despite extensive research, AP remains a significant cause of morbidity and mortality, particularly in low-resource settings where delays in diagnosis and treatment are common. Regional variations in etiology, clinical presentation, and outcomes highlight the need for localized studies to guide management strategies. This study aims to evaluate the clinico-pathological profile and immediate hospital outcomes patients with AP, providing insights into disease patterns, complications, and prognostic factors in our population.

MATERIALS AND METHODS

This study employed a prospective observational design to evaluate the clinico-pathological characteristics and immediate hospital outcomes of patients diagnosed with acute pancreatitis (AP). The study was conducted in the Department of Internal Medicine in MataGujri Memorial Medical College and Lions Seva Kendra, a tertiary care referral center with specialized facilities for managing pancreatic disorders.

The target population included adult patients (age ≥18 y) admitted to the hospital with a confirmed diagnosis of acute pancreatitis based on the Revised Atlanta Classification (2012). Patients with pre-existing chronic pancreatitis, pancreatic malignancies, or incomplete medical records were excluded.

Inclusion and exclusion criteria

Inclusion criteria

Exclusion criteria

Sample size calculation

The sample size was determined based on convenience sampling due to time and resource constraints. A total of 66 patients were enrolled over the period of 1 y, ensuring adequate representation of different AP etiologies and severity levels. Previous studies in similar settings have used comparable sample sizes (range: 50–100) for preliminary analyses.

Procedure for data collection

Statistical analysis

Software

SPSS v26 (IBM Corp.) for analysis. Descriptive statistics (mean±SD, percentages). Chi-square/Fisher’s exact test for categorical variables. Student’s t-test/Mann-Whitney U test for continuous variables. Multivariate regression for predictors of severe AP (p<0.05 significant).

Table 1: Demographic and clinical characteristics of patients with acute pancreatitis

Variable Category Number (%)/Mean±SD
Age (years) Mean±SD 45.2±12.5
Sex Male 42 (63.6%)
Female 24 (36.4%)
Clinical presentation Abdominal pain 66 (100%)
Vomiting 48 (72.7%)
Fever 19 (28.8%)
Etiology Gallstones 34 (51.5%)
Alcohol 20 (30.3%)
Hypertriglyceridemia 4 (6.1%)
Idiopathic 8 (12.1%)

The mean age of patients was 45.2±12.5 y, with a male predominance (63.6%). All patients (100%) presented with abdominal pain, while vomiting (72.7%) and fever (28.8%) were common associated symptoms. The leading etiology was gallstones (51.5%), followed by alcohol (30.3%), hypertriglyceridemia (6.1%), and idiopathic causes (12.1%).

Table 2: Severity classification and complications (N=66)

Variable Category Number (%)
Severity (Revised atlanta criteria) Mild AP 38 (57.6%)
Moderately Severe AP 20 (30.3%)
Severe AP 8 (12.1%)
Complications Pancreatic necrosis 6 (9.1%)
Pseudocyst formation 4 (6.1%)
Acute kidney injury (AKI) 5 (7.6%)
Respiratory failure 3 (4.5%)
Mortality Deaths 3 (4.5%)

Based on the Revised Atlanta Classification, 57.6% of cases were mild AP, 30.3% moderately severe and 12.1% severe. Complications included pancreatic necrosis (9.1%), pseudocyst formation (6.1%), and acute kidney injury (AKI) (7.6%). Mortality was 4.5%, occurring exclusively in severe AP cases.

Table 3: Laboratory and imaging findings (N=66)

Parameter Mean±SD/Number (%) Reference range
Serum amylase (U/l) 980±420 30–110 U/l
Serum lipase (U/l) 850±380 10–140 U/l
CRP (mg/l) 45.6±22.3 <10 mg/l
CT severity index (CTSI) Mild (0–3) 32 (48.5%)
Moderate (4–6) 25 (37.9%)
Severe (7–10) 9 (13.6%)

Serum amylase (980±420 U/l) and lipase (850±380 U/l) were significantly elevated. CRP levels (45.6±22.3 mg/l) indicated systemic inflammation. CT Severity Index (CTSI) revealed 48.5% mild, 37.9% moderate, and 13.6% severe cases, correlating with clinical severity.

Table 4: Hospital outcomes (N=66)

Outcome Number (%)/Mean±SD
Length of hospital stay (days) 7.2±3.8
ICU admission 10 (15.2%)
Need for intervention
ERCP 8 (12.1%)
Surgical drainage 2 (3.0%)
Disposition at discharge
Home 60 (90.9%)
Referral to higher center 3 (4.5%)

The mean hospital stay was 7.2±3.8 d.15.2% required ICU admission, primarily severe AP patients. ERCP was performed in 12.1% (mostly gallstone-related cases). Surgical drainage (3.0%) was needed for infected necrosis.90.9% were discharged home, while 4.5% required referral to higher centers.

DISCUSSION

The findings of our study provide important insights into the contemporary clinico-pathological profile and outcomes of acute pancreatitis in a tertiary care setting. Our results demonstrate several key observations that warrant further discussion in the context of existing literature and clinical practice.

The predominance of gallstone-related pancreatitis (51.5%) in our study is consistent with epidemiological data from other developing countries, where biliary stones account for 40-70% of AP cases [6]. This contrasts sharply with Western populations, where alcohol-induced pancreatitis is more prevalent, particularly in Northern Europe and North America [7]. The high proportion of biliary pancreatitis in our cohort may reflect regional variations in gallstone prevalence, dietary habits, and possibly genetic predisposition. Interestingly, our finding of 30.3% alcohol-related cases suggests an emerging trend of increasing alcohol consumption in our population, mirroring observations from recent Indian studies [8].

The demographic profile of our patients, with a mean age of 45.2 y and male predominance (63.6%), aligns with global patterns of AP epidemiology. However, we observed a slightly younger age distribution compared to Western cohorts, where the peak incidence typically occurs in the sixth decade [7]. This difference may be attributable to earlier onset of gallstone disease in our population or variations in alcohol consumption patterns.

The distribution of disease severity in our study (57.6% mild, 30.3% moderately severe, and 12.1% severe) closely matches the expected proportions based on the Revised Atlanta Classification [9]. However, our observed mortality rate of 4.5% was notably lower than the 10-20% typically reported for severe AP in international studies [10]. This improved outcome may reflect several factors:

The strong correlation between elevated CRP levels (45.6±22.3 mg/l) and disease severity supports the growing body of evidence that inflammatory markers are valuable for early risk stratification [11]. Our findings reinforce the utility of CRP as a simple, cost-effective prognostic tool, particularly in resource-limited settings where more sophisticated scoring systems may be less accessible.

The complication profile in our cohort, with pancreatic necrosis (9.1%) and AKI (7.6%) being most common, is consistent with global patterns of AP-related morbidity. However, the relatively low incidence of infected necrosis (3.0%) compared to Western series (10-15%) [12] may reflect differences in microbial flora, antibiotic protocols, or possibly genetic factors influencing the inflammatory response.

Our therapeutic outcomes deserve particular attention. The mean hospital stay of 7.2 d compares favorably with international benchmarks, suggesting efficient management of mild to moderate cases. The 15.2% ICU admission rate and 12.1% ERCP utilization rate both fall within expected ranges for a tertiary referral center managing complex cases. The low mortality in severe AP (4.5% vs expected 20%) may reflect our center's protocol-driven approach, including:

When compared with the landmark multinational AP registry data¹⁰, our findings show both similarities and important differences. While the overall severity distribution aligns with global patterns, our better-than-expected outcomes in severe cases suggest that protocolized care can significantly impact prognosis even in resource-constrained settings.

The Indian PANCREAS study6 reported similar etiological patterns but higher mortality (8.2%), possibly reflecting inclusion of more rural centers with delayed presentation. Our single-center experience at a tertiary facility likely represents optimal outcomes achievable with timely referral and standardized management.

CONCLUSION

This prospective study provides contemporary data on the clinico-pathological profile and outcomes of acute pancreatitis in a tertiary care setting. Our findings confirm gallstones as the predominant etiology while demonstrating that protocolized management can achieve excellent outcomes even in severe cases. The results underscore the importance of early risk stratification, aggressive fluid resuscitation, and multidisciplinary care in optimizing AP outcomes. Future multicenter studies with larger cohorts are needed to validate these findings and establish comprehensive management guidelines tailored to regional epidemiological patterns.

FUNDING

Nil

AUTHORS CONTRIBUTIONS

All authors have contributed equally

CONFLICT OF INTERESTS

Declared none

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