ETIOLOGICAL SPECTRUM AND CLINICAL PROFILE OF ACUTE PANCREATITIS IN A TERTIARY CARE HOSPITAL IN PESHAWAR

Abstract

Background:Acute pancreatitis (AP) is a major cause of emergency hospitalization worldwide, with etiologic patterns varying across regions. In low. and middle. Income countries such as Pakistan, gallstone disease and metabolic factors predominate, while alcohol. and parasite. Related etiologies are less frequent. This study aimed to evaluate the etiological spectrum, clinical profile, severity distribution, and outcomes of AP in a tertiary. Care center in northwest Pakistan.

Methods:This prospective observational study enrolled consecutive adults (≥18 years) with new. Onset AP admitted to Hayatabad Medical Complex, Peshawar, between February 2024 and April 2025. AP was diagnosed using revised Atlanta criteria. Etiology was determined using standardized clinical, laboratory, and imaging protocols. Disease severity was classified as mild, moderately severe, or severe, and BISAP, Ranson, and APACHE II scores were calculated at admission. Multivariable logistic regression was performed to identify independent predictors of severe AP.

Results:A total of 162 patients were included (mean age 49.4 ± 18.9 years; 54.9% male). Biliary disease was the most common etiology (52.5%), followed by alcohol. Related AP (25.9%), hypertriglyceridemia (7.4%), parasitic infestation (3.1%), drug. Induced (2.5%), post. ERCP (1.9%), and idiopathic causes (4.9%). According to revised Atlanta classification, 69.1% had mild AP, 20.4% moderately severe, and 10.5% severe disease. Mean admission scores were BISAP 1.8 ± 1.1, Ranson 2.4 ± 1.5, and APACHE II 7.6 ± 5.2. ICU admission was required in 15.4% of patients, and overall in. hospital mortality was 4.9%. On multivariable analysis, hypertriglyceridemia etiology (aOR 2.40, 95% CI 1.02–5.65), elevated admission serum creatinine (aOR 2.60 per mg/dL, 95% CI 1.40–4.85), and higher BISAP score (aOR 2.40 per point, 95% CI 1.75–3.30) were independent predictors of severe AP.

Conclusion:Gallstones remain the leading cause of acute pancreatitis in northwest Pakistan, while alcohol. and parasite. Associated AP are relatively uncommon. Disease severity and outcomes are primarily influenced by metabolic factors, renal dysfunction, and early severity scores. Region. Specific preventive strategies, early risk stratification, and improved diagnostic capacity are essential to optimize outcomes in resource. Limited settings.