Peripheral venous bicarbonate levels as a marker of predicting severity in acute pancreatitis: a retrospective study

Introduction
Acute pancreatitis is an inflammatory process of the pancreas, which can range from mild, self-limited disease to severe disease potentially resulting in death. Although overall mortality has decreased, the incidence of acute pancreatitis is increasing. Severe episodes of acute pancreatitis are more likely to result in prolonged hospitalisation and increased mortality. Reliable means of early detection and indicators of severity in acute pancreatitis remain a challenge, hence the continued efforts of the medical community toward developing improved prognostic tools. There are various scoring systems available that are aimed at classifying severity of acute pancreatitis; however, many of these scores are cumbersome and remain underutilised. As a result, the investigation of biological markers with potential to predict prognosis of acute pancreatitis has been a topic of interest.

Aim
To investigate the utility of peripheral venous bicarbonate levels as a biomarker in predicting severity of acute pancreatitis, defined as increased length of stay, organ failure, need for intervention, and/or mortality.

Material and methods
Patients between the ages of 18 and 80 who were admitted from September 2015 to August 2017 with acute pancreatitis were selected via chart review. The associations between peripheral venous bicarbonate level obtained on admission and length of stay, encounter type, organ failure and need for intervention were analyzed.

Results
There was a significant association between bicarbonate levels and both discharge type and organ failure. Expired patients and patients with more incidences of organ failure during their hospitalization were found to have lower peripheral venous bicarbonate levels on admission. There was no significant association found between bicarbonate level and length of stay or need for intervention.

Conclusions
Our retrospective study found that lower peripheral venous bicarbonate levels were significantly associated with increased incidence of organ failure and mortality in acute pancreatitis. Peripheral venous sampling can be promptly and easily obtained in most clinical settings, making this biological marker worthy of further investigation.