Hypophosphatemia as a Predictor of Pancreatic Necrosis in Acute Alcohol Induced Pancreatitis.

Abstract

Objective: Pancreatic necrosis is a catastrophic complication of acute pancreatitis and is associated with increased morbidity and mortality. While there is no objective means to predict pancreatic necrosis, recent studies have identified serum phosphate levels as a contributor in the disease process with worse outcomes noted in patients with low serum phosphates. We aimed to determine if there was a relationship between low serum phosphate levels and the risk of developing pancreatic necrosis in patients with acute alcoholic pancreatitis (AAP).

Methods: Health care records from patients admitted between January 2017 to December 2022 for acute alcoholic pancreatitis were retrospectively reviewed. These patients were categorized based on their phosphate levels within 48 hours of admission: normal phosphate levels (2.8-4.5 mg/dL) and hypophosphatemia (<2.8 mg/dL). Imaging findings from hospital stays were examined to identify cases of pancreatic necrosis. These cases were then compared across patients with normal and low phosphate levels.

Results: Among the 207 patients admitted for acute alcoholic pancreatitis, 67 met the inclusion and exclusion criteria. Of these, 37 patients exhibited serum phosphate levels below 2.8 mg/dL, while 30 maintained levels between 2.8 and 4.5 mg/dL within the first 48 hours of admission. Of the patients in the hypophosphatemia group 27.02% were noted to develop pancreatic necrosis during hospital stay compared to only 6.66% in the normal phosphate group (P-value: 0.029). Additionally, those that developed necrosis had an overall lower mean phosphate level of 2.13 mg/dL compared to the mean phosphate level of 2.60 mg/dL (P-value: 0.0521) in patients without necrosis. The median duration of hospital stay (P-value: 0.65) and rate of intensive care unit (ICU) admission (P-value: 0.41) were similar in both groups.

Conclusion: Early hypophosphatemia during admission for AAP was associated with increased risk of developing pancreatic necrosis, however it may not affect overall length of hospital stay or rate of ICU admission.