Gastric intramucosal pH predicts death in severe acute pancreatitis

severe acute pancreatitis. prospectively. Four died from complications related to pancreatitis. Gastric pHi was measured by nasogastric tonometry at least every 12 h for the first 48 h after admission and then on a daily basis during the first week. Results The lowest pHi recorded during the first 48 h was significantly less in those admitted to the intensive care unit than that in those who remained on the surgical ward (P = 0.0015) and in nonsurvivors compared with the survivors (P = 0.009). A receiver-operator characteristic curve defined a pHi of 7.25 as the optimal cut-off point to predict death (sensitivity 100 per cent, specificity 77 per cent, overall predictive value 82 per cent). outcome in patients with severe acute pancreatitis. Conclusion These results suggest that splanchnic ischaemia may be an important determinant of The mortality rate associated with severe acute pancreatitis remains high' and any further improvement in outcome will only occur when the pathogenesis of acute pancreatitis is better defined and is used to develop specific interventions. There is evidence to suggest that ischaemia-reperfusion injury with its associated oxidative stress plays a major role in the pathogenesis of acute pan~reatitis*-~. The susceptibility of the pancreas to ischaemic injury has been demonstrated in both experimental and clinical ~tudie?~. Patients with pancreatitis often have clinical signs of hypovolaemia at the time of admission, resulting from a significant retroperitoneal 'third space' loss of fluid. Because the splanchnic vasoconstriction that occurs in response to this hypovolaemia may persist despite seemingly adequate resuscitationlo.", it is not unreasonable to suggest that the pancreas may be subject to continuing ischaemic injury. An indirect measure of splanchnic ischaemia is now possible with nasogastric tonometry'2,13. Anaerobic metabolism within the gastric mucosal cells results in a low intramucosal pH (pHi); the indirect measurement of this via tonometry has been validated in low-flow states I4.I5 and has been shown to be reliably and linearly related to indices of splanchnic tissue oxygenation as measured in the hepatic vein16. In clinical studies of patients with severe sepsis and critical illness, pHi has been shown to predict The aim of this study was to test the hypothesis that pHi predicts death in patients with severe acute pancreatitis.