Development of disturbance of consciousness is associated with increased severity in acute pancreatitis

Hágendorn, Roland and Vincze, Áron and Izbéki, Ferenc and Gajdán, László and Gódi, Szilárd and Illés, Anita and Sarlós, Patrícia and Farkas, Nelli and Erőss, Bálint and Lillik, Veronika and Illés, Dóra and Varjú, Péter and Márta, Katalin and Török, Imola and Papp, Mária and Vitális, Zsuzsanna and Bod, Barnabás and Hamvas, József and Szepes, Zoltán and Takács, Tamás and Czakó, László and Márton, Zsolt and Szentesi, Andrea and Párniczky, Andrea and Hegyi, Péter and Mikó, Alexandra (2020) Development of disturbance of consciousness is associated with increased severity in acute pancreatitis. PANCREATOLOGY, 20 (5). pp. 806-812. ISSN 1424-3903 (print); 1424-3911 (online)

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Abstract

Background Disturbance of consciousness (DOC) may develop in acute pancreatitis (AP). In clinical practice, it is known that DOC may worsen the patient's condition, but we have no exact data on how DOC affects the outcome of AP. Methods From the Hungarian Pancreatic Study Groups' AP registry, 1220 prospectively collected cases were analysed, which contained exact data on DOC, included patients with confusion, delirium, convulsion, and alcohol withdrawal, answering a post hoc defined research question. Patients were separated to Non-DOC and DOC, whereas DOC was further divided into non-alcohol related DOC (Non-ALC DOC) and ALC DOC groups. For statistical analysis, independent sample t-test, Mann-Whitney, Chi-squared, or Fisher exact test were used. Results From the 1220 patients, 47 (3.9%) developed DOC, 23 (48.9%) cases were ALC DOC vs. 24 (51.1%) Non-ALC DOC. Analysis between the DOC and Non-DOC groups showed a higher incidence of severe AP (19.2% vs. 5.3%, p<0.001), higher mortality (14.9% vs. 1.7%, p<0.001), and a longer length of hospitalization (LOH) (Me=11; IQR: 8-17 days vs. Me=9; IQR: 6-13 days, p=0.049) respectively. Patients with ALC DOC developed more frequently moderate AP vs. Non-ALC DOC (43.5% vs. 12.5%), while the incidence of severe AP was higher in Non-ALC vs. ALC DOC group (33.3% vs. 4.4%) (p<0.001). LOH showed a tendency to be longer in Non-ALC DOC compared to ALC DOC, respectively (Me:13; IQR:7-20 days vs. Me:9.5; IQR:8-15.5 days, p=0.119). Conclusion DOC during AP is associated with a higher rate of moderate and severe AP and increases the risk of mortality.

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