Pediatric Gastroenterology, Hepatology & Nutrition

The Korean Society of Pediatric Gastroenterology, Hepatology and Nutrition (대한소아소화기영양학회)
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Impact of Clinical, Laboratory and Fluid Therapy Variables on Hospital Length of Stay for Children with Acute Pancreatitis

  • Shahein, Abdul R. (Division of Pediatric Gastroenterology and Nutrition, Children's Hospital of Arkansas) ;
  • Quiros, J. Antonio (Division of Pediatric Gastroenterology and Nutrition, Medical University of South Carolina Children's Hospital) ;
  • Arbizu, Ricardo A. (Division of Pediatric Gastroenterology and Nutrition, Medical University of South Carolina Children's Hospital) ;
  • Jump, Candi (Division of Pediatric Gastroenterology and Nutrition, Medical University of South Carolina Children's Hospital) ;
  • Lauzon, Steven D. (Department of Public Health Sciences, Medical University of South Carolina) ;
  • Baker, Susan S. (Department of Pediatrics, University at Buffalo)
  • Received : 2019.11.16
  • Accepted : 2020.03.08
  • Published : 2020.07.15
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Abstract

Purpose: There have been many efforts to develop generalizable severity markers in children with acute pancreatitis (AP). Expert opinion panels have developed consensus guidelines on management but it is unclear if these are sufficient or valid. Our study aims to assess the effect of clinical and laboratory variables, in addition to treatment modality on hospital length of stay (LOS) as a proxy variable for severity in pediatric patients admitted with AP. Methods: We conducted a retrospective chart review of patients between ages of 0-18 years, who were admitted with AP at 2 institutions between 2013-2018, John R. Oishei Children's Hospital (Buffalo, NY, USA) and Medical University of South Carolina Children's Hospital (Charleston, SC, USA). We constructed three linear regression models to analyze the effect of clinical signs of organ dysfunction, laboratory markers and fluid intake on hospital LOS. Results: Ninety-two patients were included in the study. The mean age was 12 years (range, 7.6-17.4 years), 55% were females, and median LOS was 3 days. The most frequent cause of AP was idiopathic. Our study showed that elevated blood urea nitrogen (BUN) on admission (p<0.005), tachycardia that lasted for ≥48 hours (p<0.001) and need for fluid resuscitation were associated with increase LOS. Total daily fluid intake above maintenance did not have a significant effect on the primary outcome (p=0.49). Conclusion: Elevated serum BUN on admission, persistent tachycardia and need for fluid resuscitation were associated with increase LOS in pediatric AP. Daily total fluid intake above recommended maintenance did not reduce LOS.

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References

  1. Morinville VD, Barmada MM, Lowe ME. Increasing incidence of acute pancreatitis at an American pediatric tertiary care center: is greater awareness among physicians responsible? Pancreas 2010;39:5-8. https://doi.org/10.1097/MPA.0b013e3181baac47
  2. Nydegger A, Heine RG, Ranuh R, Gegati-Levy R, Crameri J, Oliver MR. Changing incidence of acute pancreatitis: 10-year experience at the Royal Children's Hospital, Melbourne. J Gastroenterol Hepatol 2007;22:1313-6. https://doi.org/10.1111/j.1440-1746.2007.04936.x
  3. Park A, Latif SU, Shah AU, Tian J, Werlin S, Hsiao A, et al. Changing referral trends of acute pancreatitis in children: a 12-year single-center analysis. J Pediatr Gastroenterol Nutr 2009;49:316-22. https://doi.org/10.1097/MPG.0b013e31818d7db3
  4. Pant C, Deshpande A, Olyaee M, Anderson MP, Bitar A, Steele MI, et al. Epidemiology of acute pancreatitis in hospitalized children in the United States from 2000-2009. PLoS One 2014;9:e95552. https://doi.org/10.1371/journal.pone.0095552
  5. Abu-El-Haija M, El-Dika S, Hinton A, Conwell DL. Acute pancreatitis admission trends: a national estimate through the Kids' Inpatient Database. J Pediatr 2018;194:147-51.e1. https://doi.org/10.1016/j.jpeds.2017.09.061
  6. Kumar S, Ooi CY, Werlin S, Abu-El-Haija M, Barth B, Bellin MD, et al. Risk factors associated with pediatric acute recurrent and chronic pancreatitis: lessons from INSPPIRE. JAMA Pediatr 2016;170:562-9. https://doi.org/10.1001/jamapediatrics.2015.4955
  7. Morinville VD, Husain SZ, Bai H, Barth B, Alhosh R, Durie PR, et al. Definitions of pediatric pancreatitis and survey of present clinical practices. J Pediatr Gastroenterol Nutr 2012;55:261-5. https://doi.org/10.1097/mpg.0b013e31824f1516
  8. Abu-El-Haija M, Lin TK, Palermo J. Update to the management of pediatric acute pancreatitis: highlighting areas in need of research. J Pediatr Gastroenterol Nutr 2014;58:689-93. https://doi.org/10.1097/mpg.0000000000000360
  9. Abu-El-Haija M, Kumar S, Szabo F, Werlin S, Conwell D, Banks P, et al. Classification of acute pancreatitis in the pediatric population: clinical report from the NASPGHAN pancreas committee. J Pediatr Gastroenterol Nutr 2017;64:984-90. https://doi.org/10.1097/MPG.0000000000001583
  10. Bai HX, Lowe ME, Husain SZ. What have we learned about acute pancreatitis in children? J Pediatr Gastroenterol Nutr 2011;52:262-70. https://doi.org/10.1097/MPG.0b013e3182061d75
  11. Pant C, Sferra TJ, Lee BR, Cocjin JT, Olyaee M. Acute recurrent pancreatitis in children: a study from the Pediatric Health Information System. J Pediatr Gastroenterol Nutr 2016;62:450-2. https://doi.org/10.1097/MPG.0000000000001058
  12. Gay AC, Barreto NB, Schrager SM, Russell CJ. Factors associated with length of stay and 30-day revisits in pediatric acute pancreatitis. J Pediatr Gastroenterol Nutr 2018;67:e30-5. https://doi.org/10.1097/MPG.0000000000002033
  13. Aggarwal A, Manrai M, Kochhar R. Fluid resuscitation in acute pancreatitis. World J Gastroenterol 2014;20:18092-103. https://doi.org/10.3748/wjg.v20.i48.18092
  14. Mayer J, Rau B, Gansauge F, Beger HG. Inflammatory mediators in human acute pancreatitis: clinical and pathophysiological implications. Gut 2000;47:546-52. https://doi.org/10.1136/gut.47.4.546
  15. Hack CE, Zeerleder S. The endothelium in sepsis: source of and a target for inflammation. Crit Care Med 2001;29(7 Suppl):S21-7. https://doi.org/10.1097/00003246-200107001-00011
  16. de-Madaria E, Soler-Sala G, Sanchez-Paya J, Lopez-Font I, Martinez J, Gomez-Escolar L, et al. Influence of fluid therapy on the prognosis of acute pancreatitis: a prospective cohort study. Am J Gastroenterol 2011;106:1843-50. https://doi.org/10.1038/ajg.2011.236
  17. Eckerwall G, Olin H, Andersson B, Andersson R. Fluid resuscitation and nutritional support during severe acute pancreatitis in the past: what have we learned and how can we do better? Clin Nutr 2006;25:497-504. https://doi.org/10.1016/j.clnu.2005.10.012
  18. Mao EQ, Tang YQ, Li L, Qin S, Wu J, Liu W, et al. [Strategy of controlling fluid resuscitation for severe acute pancreatitis in acute phase]. Zhonghua Wai Ke Za Zhi 2007;45:1331-4. Chinese.
  19. Ranson JH, Rifkind KM, Roses DF, Fink SD, Eng K, Spencer FC. Prognostic signs and the role of operative management in acute pancreatitis. Surg Gynecol Obstet 1974;139:69-81.
  20. Ceneviva G, Paschall JA, Maffei F, Carcillo JA. Hemodynamic support in fluid-refractory pediatric septic shock. Pediatrics 1998;102:e19. https://doi.org/10.1542/peds.102.2.e19
  21. Goldstein B, Giroir B, Randolph A; International Consensus Conference on Pediatric Sepsis. International pediatric sepsis consensus conference: definitions for sepsis and organ dysfunction in pediatrics. Pediatr Crit Care Med 2005;6:2-8. https://doi.org/10.1097/01.pcc.0000149131.72248.e6
  22. Lin S, Hong W, Basharat Z, Wang Q, Pan J, Zhou M. Blood urea nitrogen as a predictor of severe acute pancreatitis based on the revised Atlanta criteria: timing of measurement and cutoff points. Can J Gastroenterol Hepatol 2017;2017:9592831.
  23. Granger J, Remick D. Acute pancreatitis: models, markers, and mediators. Shock 2005;24 Suppl 1:45-51. https://doi.org/10.1097/01.shk.0000191413.94461.b0
  24. Vitale DS, Hornung L, Lin TK, Nathan JD, Prasad S, Thompson T, et al. Blood urea nitrogen elevation is a marker for pediatric severe acute pancreatitis. Pancreas 2019;48:363-6. https://doi.org/10.1097/mpa.0000000000001265
  25. DeBanto JR, Goday PS, Pedroso MR, Iftikhar R, Fazel A, Nayyar S, et al. Acute pancreatitis in children. Am J Gastroenterol 2002;97:1726-31. https://doi.org/10.1016/S0002-9270(02)04189-8
  26. Szabo FK, Hornung L, Oparaji JA, Alhosh R, Husain SZ, Liu QY, et al. A prognostic tool to predict severe acute pancreatitis in pediatrics. Pancreatology 2016;16:358-64. https://doi.org/10.1016/j.pan.2016.03.002
  27. Banks PA. Practice guidelines in acute pancreatitis. Am J Gastroenterol 1997;92:377-86.
  28. Nathens AB, Curtis JR, Beale RJ, Cook DJ, Moreno RP, Romand JA, et al. Management of the critically ill patient with severe acute pancreatitis. Crit Care Med 2004;32:2524-36. https://doi.org/10.1097/01.CCM.0000148222.09869.92
  29. Martinez J, Sanchez-Paya J, Palazon JM, Suazo-Barahona J, Robles-Diaz G, Perez-Mateo M. Is obesity a risk factor in acute pancreatitis? A meta-analysis. Pancreatology 2004;4:42-8. https://doi.org/10.1159/000077025
  30. Johnson CD, Toh SK, Campbell MJ. Combination of APACHE-II score and an obesity score (APACHE-O) for the prediction of severe acute pancreatitis. Pancreatology 2004;4:1-6. https://doi.org/10.1159/000077021
  31. Gloor B, Muller CA, Worni M, Martignoni ME, Uhl W, Buchler MW. Late mortality in patients with severe acute pancreatitis. Br J Surg 2001;88:975-9. https://doi.org/10.1046/j.0007-1323.2001.01813.x
  32. Halonen KI, Leppaniemi AK, Puolakkainen PA, Lundin JE, Kemppainen EA, Hietaranta AJ, et al. Severe acute pancreatitis: prognostic factors in 270 consecutive patients. Pancreas 2000;21:266-71. https://doi.org/10.1097/00006676-200010000-00008
  33. Brotanek JM, Gosz J, Weitzman M, Flores G. Iron deficiency in early childhood in the United States: risk factors and racial/ethnic disparities. Pediatrics 2007;120:568-75. https://doi.org/10.1542/peds.2007-0572
  34. Perel P, Roberts I, Ker K. Colloids versus crystalloids for fluid resuscitation in critically ill patients. Cochrane Database Syst Rev 2013;(2):CD000567.
  35. Quiros JA, Marcin JP, Kuppermann N, Nasrollahzadeh F, Rewers A, DiCarlo J, et al. Elevated serum amylase and lipase in pediatric diabetic ketoacidosis. Pediatr Crit Care Med 2008;9:418-22. https://doi.org/10.1097/pcc.0b013e318172e99b
  36. Abu-El-Haija M, Kumar S, Quiros JA, Balakrishnan K, Barth B, Bitton S, et al. Management of acute pancreatitis in the pediatric population: a clinical report from the North American Society for Pediatric Gastroenterology, Hepatology and Nutrition Pancreas committee. J Pediatr Gastroenterol Nutr 2018;66:159-76. https://doi.org/10.1097/MPG.0000000000001715

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