ELEVATED SERUM LACTATE LEVELS AS INDEPENDENT PREDICTOR OF POOR OUTCOMES IN SEVERE ACUTE BILIARY PANCREATITIS

Abstract

Objective: To evaluate the association between elevated admission serum lactate and poor clinical outcomes in patients with severe acute biliary pancreatitis (SABP).

Study Design: Prospective observational cohort study.

Place and Duration of Study: Department of Surgery, Combined Military Hospital Kohat from Jun 2023 to Jun 2025.

Methodology: Sixty-four consecutive patients with SABP were enrolled and grouped by admission serum lactate: normal (<2 mmol/L, n=22) and elevated (≥2 mmol/L, n=42). The primary endpoint was composite poor outcome, defined as death, septic shock, or pancreatic infection. Clinical parameters, severity scores, and outcomes were compared. Binary logistic regression and receiver operating characteristic (ROC) curve analyses assessed the predictive value of serum lactate.

Results: Composite poor outcome occurred in 21/42 (50.0%) patients with elevated lactate versus 4/22 (18.2%) with normal lactate (p=0.016). The elevated lactate group showed higher rates of multiple organ failure (38.1% vs 9.1%, p=0.019), pancreatic necrosis (73.8% vs 40.9%, p=0.021), and longer hospital stay (median 19.5 vs 10.5 days, p<0.001). Elevated lactate was a significant univariate predictor of poor outcome (OR 4.5, 95% CI 1.3–15.6, p=0.018). The area under the ROC curve was 0.72.

Conclusion: Elevated admission serum lactate is significantly associated with adverse outcomes in SABP and can serve as a practical bedside marker for early risk stratification.