Background - This study tested the hypothesis that gastric intramucosal pH (pHi) can predict death in severe acute pancreatitis. Methods - Seventeen consecutive patients with predicted severe acute pancreatitis were studied 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 non-survivors 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). Conclusion - These results suggest that splanchnic ischaemia may be an important determinant of outcome in patients with severe acute pancreatitis.
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