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Abstract
Objective: To compare the complications and clinical outcomes of gallstone and non-gallstone severe acute pancreatitis (SAP) among patients admitted in a tertiary care hospital in Karachi, Pakistan.
Methods: This was a retrospective comparative study that was carried out in the Surgical Wards of Jinnah Postgraduate Medical Centre (JPMC), Karachi, between January 2024 and December 2024. Medical records of 300 patients with SAP were analyzed following the IRB approval, comprising of 180 patients with gallstones and 120 patients without gallstones. Demographic, etiological, local and systemic complications, interventions, ICU admission, length of stay and mortality data were obtained. The SPSS version 26 was used to conduct the statistical analysis and p < 0.05 was regarded as significant.
Results: Non-gallstone SAP had much higher pancreatic necrosis rates (30.0% vs. 16.7%, p = 0.003), organ failure rates (37.5% vs. 19.4%, p < 0.001), sepsis or infected necrosis rates (20.0% vs. 8.3%, p = 0.001) and ICU admission rates (25.0% vs. 13.9%, p = 0.0 Non-gallstone patients had longer median hospital stay (12 vs. 8 days, p < 0.001). The rate of mortality was considerably greater in non-gallstone group (15.0% vs. 6.7% p = 0.02). Independent predictors of mortality were non-gallstone etiology (OR 2.4), advancing age, and organ failure.
Conclusion: Compared to gallstone SAP, non-gallstone SAP was associated with a greater number of severe complications, increased ICU stay, and hospitalization and mortality. Unfamiliar etiologies of non-gallstones should be recognized and actively managed in the tertiary care to enhance patient outcomes in Pakistan.