Original article Early changes in serum creatinine level and estimated glomerular filtration rate predict pancreatic necrosis and mortality in acute pancreatitis Creatinine and eGFR in acute pancreatitis Michal Lipinski a, * , A. Rydzewski b, c , G. Rydzewska a, c a Department of Gastroenterology, Central Clinical Hospital of The Ministry of Interior, Woloska 137, 02-507 Warsaw, Poland b Department of Internal Medicine and Nephrology, Central Clinical Hospital of The Ministry of Interior, 02-507 Warsaw, Poland c The Jan Kochanowski University Humanities and Sciences, Kielce, Poland article info Article history: Received 14 December 2012 Accepted 12 February 2013 Keywords: Pancreatitis Creatinine Glomerular filtration rate eGFR Prediction Pancreatic necrosis Mortality abstract Aim: The aim of the study was to evaluate the significance of serum creatinine level (SCL) and estimated glomerular filtration rate (eGFR) measured in an early phase of acute pancreatitis (AP) for prediction of pancreatic necrosis (PNec) and mortality. Methods: One hundred and forty-seven patients with AP were retrospectively reviewed in the study. Serum creatinine level and estimated glomerular filtration rate (calculated using the abbreviated Modification of Diet in Renal Disease equation) on admission and 48 h thereafter were analyzed for each patient. These parameters were compared with contrast-enhanced computed tomography images per- formed within 96 h from admission (n ¼ 103). Usefulness of SCL and eGFR for prediction of PNec and fatal outcome of AP was evaluated using a receiver operator characteristic curve analysis and comparison of average parameter values. Results: We confirmed pancreatic necrosis in 41 (39.8%) of 103 patients using computed tomography examination. Both creatinine and estimated glomerular filtration rate measured on admission (p < 0.001, p < 0.001 respectively) and 48 h later (p ¼ 0.001, p < 0.001 respectively) were significantly associated with the presence of pancreatic necrosis. Moreover, serum creatinine level and eGFR measured on the 1st day proved to be a good predictor of fatal outcome. Both, mortality and presence of pancreatic necrosis were significantly higher in the group with elevated serum creatinine level and low eGFR values. Conclusions: SCL and eGFR on admission are useful indicators of PNec and mortality. Copyright Ó 2013, IAP and EPC. Published by Elsevier India, a division of Reed Elsevier India Pvt. Ltd. All rights reserved. 1. Introduction Acute pancreatitis is a common, and potentially lethal acute inflammatory process with diverse clinical course. The incidence of AP is about 30e40 cases per 100 000 individuals. Severe clinical course (20%), accompanied by development of a systemic inflam- matory response syndrome (SIRS) and multiple organ failure (MOF) constitute main reasons of complications and on occasion death (10e20%) [1,2]. It is uncertain why some cases of AP result in organ failure and others do not, or at which point in the inflammatory process would an intervention influence disease progression. Early prediction of acute pancreatitis severity using a simple, single laboratory test would be very helpful for guiding disease management from the very beginning and potentially improving the outcome. Many biochemical parameters (including C-reactive protein (CRP), procalcitonin, trypsinogen-activation peptide (TAP)) were evaluated with regard to their value for assessment of AP severity [3e5]. C-reactive protein, one of the most valuable parameters, is not specific for pancreatitis, and its elevation is observed 48 h after the onset of the disease. Therefore, it is desir- able to find a rapid and inexpensive marker, which would effec- tively predict the outcome at an early stage of the disease. Hypoperfusion plays a major role in the pathogenesis not only of pancreatic necrosis (PNec) but also of MOF, which are the main causes of death in severe acute pancreatitis. Knowledge of body water balance disruption (which is the primary cause of hypo- perfusion) in AP and resulting deviations in laboratory tests is potentially useful for clinical purposes, both diagnostic and thera- peutic [6]. * Corresponding author. Tel.: þ48 22 508 12 40; fax: þ48 22 508 10 40. E-mail address: michal7lipinski@yahoo.com (M. Lipinski). Contents lists available at SciVerse ScienceDirect Pancreatology journal homepage: www.elsevier.com/locate/pan 1424-3903/$ e see front matter Copyright Ó 2013, IAP and EPC. Published by Elsevier India, a division of Reed Elsevier India Pvt. Ltd. All rights reserved. http://dx.doi.org/10.1016/j.pan.2013.02.002 Pancreatology 13 (2013) 207e211