Morbidity and Mortality Predictors of Acute Respiratory Failure in Acute Pancreatitis: A Cohort Study Conducted in Vietnam.

BACKGROUND AND AIM: Acute pancreatitis (AP) can result in severe complications, with acute respiratory failure (ARF) being among the most critical. Research on ARF in AP remains limited. This study aims to investigate the occurrence, outcomes, and predictors of ARF in AP patients at Cho Ray Hospital, a tertiary care center in Vietnam.

METHOD: A prospective cohort study was conducted with 230 AP patients at a national hospital in Ho Chi Minh City, Vietnam. Patients were divided into ARF and non-ARF groups, and clinical characteristics were compared. Key outcomes included invasive mechanical ventilation, in-hospital mortality, and length of hospital stay.

RESULTS

ARF developed in 26.1% of patients, with a mortality rate of 25.0% in the ARF group versus 1.2% in the non-ARF group. Mechanical ventilation was required in 48.3% of ARF patients. Significant predictors of ARF were abnormal body mass index (BMI) (p = 0.021), prolonged systemic inflammatory response syndrome (SIRS) (p < 0.001), modified computed tomography severity index (mCTSI) (p = 0.041), and a high bedside index for severity in acute pancreatitis (BISAP) score (p < 0.001). BISAP scores ≥ 2 had a sensitivity of 90.0%, specificity of 73.5%, and AUC of 0.878 (95% CI 0.829-0.921) for predicting ARF. Predictors of mortality in ARF patients included cardiovascular failure (HR 15.83, p = 0.001), prolonged SIRS (HR 4.76, p = 0.038), and high BISAP scores (HR 3.41, p = 0.015).

CONCLUSION

ARF significantly worsens outcomes in AP patients. Early identification of key predictors, like abnormal BMI, prolonged SIRS, mCTSI, and BISAP scores, could improve interventions and patient prognosis.