INTRA-ABDOMINAL HYPERTENSION IS A STRONG PREDICTOR OF MORTALITY AND POOR CLINICAL OUTCOME IN SEVERE ACUTE PANCREATITIS

in our department with AP in between 01.01.2006 and 31.12.2016.Data collected at admission (demographic data, abdominal ultrasound, common biological tests) were used to search for significant correlation with biliary etiology.Multiple regression analysis was performed to calculate a predictive score for the biliary etiology of AP.Results: Out of 1202 patients admitted with acute pancreatitis, 50% (603) patients had gallstone disease as etiology, the mean age was 58 years.In univariate analysis, the following [RS1] factors were significantly associated with biliary etiology of AP: evidence of gallstones disease (calculi or sludge present in the gallbladder or previous cholecystectomy for gallstones) -Pearson correlation [RS2] coefficient r of 0.7 (p<0.0001),AUC: 0.85; female gender, r: 0.39 (p<0.0001),AUC: 0.69; ALT higher than 104 UI/ml (AUC 0.7), r: 0.56.Following multiple regression analysis, the following score was obtained : SCORE = 0.5 points (if ALT>104) + 1 point (if the patient is a woman) + 3 points (if evidence of gallstones disease).This score has an AUC of 0.9 p<0.001 to predict the biliary etiology of AP.The optimal cut-off was 1 point (91.7%Se, 81.6% Sp).The specificity is increasing with the number of points > 3 points -90%, > 3.5 points -94%, > 4 points -97%.Conclusion: In biliary AP the timing of ERCP is key.Selecting the right candidates based on simple clinical and paraclinical findings is not only cost effective but it is also the easiest.