Biochemical Findings and outcomes of the treatment of the Patients with pancreatitis admitted in Nobel Medical College Teaching Hospial , Biratnagar , Nepal

Background Pancreatitis is well known for its painful state of illness causing a severe impact on the quality of life which can be followed by life-threatening long-term sequelae of diabetes mellitus and pancreatic cancer as its complications. The present study was conducted to evaluate biochemical findings and outcomes following treatment of ICU admitted patients suffering from pancreatitis in Nobel Medical College Teaching Hospital (NMCTH). Materials and Methods All the patients admitted in the ICU of NMCTH from 15 January 2017 to 14 January 2018 having been diagnosed as suffering from pancreatitis were enrolled in this study. Age, sex, differential diagnosis, blood amylase, lipase level and outcomes of the treatment of the patients were measured as major variables. Blood amylase and lipase level of these patients were estimated in the department of Biochemistry, NMCTH by the standard protocols using Randox kits, provided by the manufacturer. The study was carried out after getting the approval from Institutional review committee (IRC). Statistical significance was compared using Student's two-tailed t-test. Results were considered significant if p ≤ 0.05. Results The number of patients admitted in ICU and suffering from pancreatitis was 136 out of 2204 total admission in ICU within a period of 1 year. Out of 136 pancreatitis patients, 44 were of biliary pancreatitis, 40 of alcoholic and 52 were patients of pancreatitis suffered from some other unknown factors. The mean age of the patients was 41.5±14.2 year. While analyzing the pancreatitis cases gender wise, it was found that male (N=80) were more sufferers than females (N=56). The mean ±SD value of blood amylase and lipase of these patients with pancreatitis were 1040±1062 IU/L & 442±425 IU/L respectively, which was significantly higher than the normal range. The maximum numbers of pancreatitis cases were seen in age group (30-39), (44 patients). It was found in our study that male patients were more sufferers of alcoholic pancreatitis than females; where as female patients were more in number among patients with biliary pancreatitis than males. The patients after getting the proper line of treatment,88 of them recovered completely without any complication, 38 patients developed some complication, in which 26 got recovered fully and 12 were referred. Mortality was seen in 10 patients. Conclusion The results shows a very high prevalence rate of pancreatitis, the highest number being shared by those suffering from unknown factors followed by biliary pancreatitis and Rupesh Kumar Shreewastav, Journal of Nobel Medical College *Corresponding Author: Rupesh Kumar Shreewastav, Assistant Professor | E-mail: rupeshaiims4@gmail.com 10 alcoholic pancreatitis in the descending order. In biliary pancreatitis, female patients are more whereas, the males are taking the major share among alcoholic pancreatitis. The level of the marker enzymes (amylase & lipase) are significantly higher than the normal confirming the cases to be of pancreatitis. Out of 136 patients, except for 12 cases referred and 10 patients died, all are fully recovered and discharged.


Introduction
Pancreatitis is the inflammatory disease of pancreas.
The most frequent gastrointestinal cause for getting admitted into hospital is acute pancreatitis.The incidence of pancreatitis is increasing day by day.The annual global rate of incidence of pancreatitis is 13-45 per 1,00,000 person [1][2].Elevation of pancreatic enzymes in the blood and abrupt onslaught of abdominal pain are the clinical characteristics of the disease [3].The overall mortality rate of acute pancreatitis is 3.8% [4] whereas for severe acute pancreatitis,the rate may go upto 20% [5].Pancreatitis occurs due to different reasons like gallstones, alcohol consumption, cigarette smoking, elevated triglyceride, drug induced etc.The most common cause of acute pancreatitis is found to be due to gallstones worldwide.Gall stones, are made up of either cholesterol or other bile component in the gall bladder, which obstruct pancreatic duct causing pancreatitis.Alcohol abuse induced acute pancreatitis is the next common cause.The toxic and metabolic effects of alcohol on pancreatic acinar cells [6] cause small duct obstruction and hence pancreatitis.The risk of pancreatitis increases with the amount of alcohol consumed.Alcoholic pancreatitis is more likely in middle age population, with a peak incidence at 45-55 years [7].The present piece of study is aimed at evaluating biochemical findings and final outcome of the treatment of the patients admitted in ICU with pancreatitis.

Materials and Methods
It is a descriptive cross-sectional study which was carried out on all the patients diagnosed as suffering from pancreatitis and admitted in the ICU from 15 th January 2017 to 14

Results
The total number of patients admitted in ICU within a period of 1 year was 2204.Out of this, 136 patients were of pancreatitis as shown in figure 1.While analyzing the differential diagnosis of the patients suffering with pancreatitis, it was found that there were three types of patients suffering with different types of pancreatitis.Out of 136, 44 patients were of biliary pancreatitis, whereas the number of patients suffering from alcoholic pancreatitis and other pancreatitis caused by other factorswere 40 and 52 respectively as shown in figure 2.

Figure 1 : The total number and percentage of patients in ICU with and without pancreatitis Figure 2 : Number of patients suffering with different types of pancreatitis
The mean age of the patients was 41.5±14.2.We have analyzed our study according to gender and in different age group also.It was seen in our analysis that the total number of male patients suffering from all types of pancreatitis was 80, whereas that of the female patients was 56 as shown in figure 3.

Figure 3 : Number and percentage of male and female suffering from pancreatitis
We The number of male and female patients of pancreatitis (all types combined) in different age group was also found out and is shown in figure 4.

Figure 4 : Number of male and female patients with pancreatitis in different age group
While analyzing the number of male and female patients with different types of pancreatitis in our study, it was found that 36 male and 4 female were of alcoholic pancreatitis, 16 male and 28 female patients were with biliary pancreatitis and 28 male and 24 female patients were of   female patients (all type combined) was 80 and 56 respectively.Our finding is slightly different from that of the study carried out in Jamaica, which revealed that out of 91 patients, 70 were females and 21 were males [13].We have extended our study by analyzing the occurrence of pancreatitis in different age groups and found that the maximum number of patients (both male and female) was in the age group of 30-39 years.including lifestyle, socioeconomic status and food habit etc may be required just to know the actual cause.Out of 40 cases of alcoholic pancreatitis, 36 are males whereas the females are sharing higher (28 out of 44) in the case of biliary pancreatitis.Many of the male members of a family in Nepal, maintain a habit of visiting hotels every evening where alcohol is available and most of the young housewives from well to do families are overweight.Maximum number of operations in NMCTH is cause of Cholecystitis of females.So, a well regulated awareness program through NGOs or Health department may be initiated so that consumption of alcohol may be reduced among males.Proper dieting along with regular exercise for young ladies may also be encouraged for maintenance of normal weight.
the other pancreatitis as shown in figure5.The serum amylase and lipase level of the all the patients with pancreatitis were estimated.The Mean±SD value of serum amylase and lipase of all patients with pancreatitis were 1040±1062 IU/L & 442±425 IU/L respectively, which was significantly higher when compared to the control group (figure6).

Figure 5 :Figure 6 :
Figure 5: Number of male and female patients with different types of pancreatitis

Figure 7 :
Figure 7: Outcome of the treatment of the patients with pancreatitis