Assessment of efficacy of IV ω-3 PUFA supplementation in patients of predicted severe acute pancreatitis using the positive predictive value of Balthazar score within 48 hours of onset
Abstract
Introduction: Since 50% of the mortalities in acute pancreatitis (AP) occur within the first week, early prediction of its outcomes is vital. The CT severity index (CTSI) reliably predicts outcomes when calculated 4-7 days after onset. However, a therapeutic window for early aggressive intervention is lost. The Balthazar score can be calculated within 48 hours of onset, thus being a diagnostic as well as a prognostic investigation. Omega-3 polyunsaturated fatty acids (ω-3 PUFA) have a beneficial immunomodulatory effect and improve outcomes in AP.
Materials and Methods: 80 patients of clinically predicted severe acute pancreatitis were included. Treatment group received IV ω-3 PUFA supplementation. Balthazar scores were calculated for all patients within 48 hours of onset. Positive predictive value (PPV) for progression to severe acute pancreatitis (SAP) was calculated from the control group. The number of patients predicted to progress to SAP was compared those actually progressing to SAP in the ω-3 PUFA group.
Results: PPV for Balthazar score of D and above for predicting progression to SAP was 87.5% in the control group. 35 (87.5%) patients were predicted to progress to SAP in the ω-3 PUFA group, but only 28 (70%) patients progressed to SAP (p=0.0315).
Conclusion: Balthazar grade of D and above on a CT scan done within 48 hours of onset of acute pancreatitis can accurately predict the progression of clinically suspected severe acute pancreatitis to severe acute pancreatitis. IV ω-3 PUFA supplementation early in the course of acute pancreatitis significantly improves early clinical outcomes.
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References
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