Does the etiology influence the primary outcomes of acute pancreatitis? / Z. Dambrauskas, P. Ignatavicius, A. Vitkauskiene, J. Pundzius, G. Barauskas

Introduction: The influence of etiological factors on the course and outcomes of AP is not fully understood yet. Dominant (>80%) etiological factors of AP are gallstones and alcohol abuse. Aims & methods: In the present prospective study we aimed to compare the course and outcomes in alcoholic and biliary SAP patients. The study population consisted of 217 patients with alcoholic or biliary acute pancreatitis (AP). The severity of disease and clinical status was assessed on the day of admission and reassessed using the same prognostic tools every 7 days, or when the deterioration of clinical condition occurred. The contrast enhanced computer tomography CECT scan was performed on day 5 to 9 after the onset of disease to demonstrate the presence of pancreatic necrosis. All patients were managed according to the standard AP management protocol following the recent international guidelines. Prospectively maintained database of microbiology laboratory was used to analyze the incidence of infection and isolated pathogens. Results: Total in-hospital stay was longer in alcoholic SAP group (14 (1−68)) in comparison with biliary SAP group (8.4 (1−59), P = 0.02). Rate of complications such as multiple organ dysfunction syndrome (MODS), pulmonary or renal dysfunction was similar between both groups. Cardiac dysfunction was more often diagnosed in biliary SAP group (6 (16.2%) vs 1 (2.3%), P = 0.02). There was no significant difference in mortality rate in both groups. There was no significant difference between alcoholic and biliary SAP groups in frequency and timing of ultrasound-guided fine needle aspiration (FNA) and ultrasound-guided drainage (UGD). Open necrosectomy was more frequently performed in alcoholic SAP group (22 (50%) vs 9 (24.3%), P = 0.03). CECT had shown that there were 24 (58.5%) patients of alcoholic SAP group and 16 (51.6%) patients of biliary SAP group with pancreatic necrosis exceeding 30%. Bacterial culture analysis revealed that the overall

number of bacterial strands isolated in the alcoholic SAP group patients was higher when compared with the biliary SAP group (168 vs 68). There was no statistically significant difference in the prevalence of antibiotic resistant strands of bacteria in either of the treatment groups. Conclusion: The results of this study show more favourable course of disease in biliary SAP patients.