Association of pleural effusion on thoracic ultrasound with severe acute pancreatitis and mortality.

BACKGROUND: Acute pancreatitis (AP) is an inflammatory condition associated with significant morbidity and mortality that often leads to thoracic complications. Timely identification of these complications, including pleural effusion (PE), is of utmost importance because it may indicate AP severity. METHODS: This prospective cohort aimed to determine the association between the presence of PE and other lung findings identified by thoracic ultrasound (TUS) and AP severity. We included patients diagnosed with AP according to the Atlanta classification. TUS was performed within the first 48 h of diagnosis, six quadrants per hemithorax were examined to assess the presence of PE and different pulmonary patterns. AP severity scales were applied, and mortality was calculated based on the presence or absence of PE or other lung findings. RESULTS: We included 107 patients with AP with a mean age of 37 (28-51) years, 66 (62%) females. TUS identified PE in 20.5% of the cases. The Atlanta classification system revealed a higher proportion of severe AP among the patients with PE (40.9% vs. 2.4%, p < 0.001). Also, patients with PE showed a higher Marshall (2 ± 2.13 vs. 1.12 ± 1.17, p = 0.0295) and APACHE II scores (8.36 ± 5.34 vs. 5.52 ± 3.62, p = 0.022). PE and Marshall score were independent factors associated with higher mortality in a multivariate model, with odds ratios of 6.89 (1.18-50.49) and 3.00 (1.42-7.90), respectively. CONCLUSIONS: Early detection of PE using TUS in patients with AP is strongly associated with disease severity and mortality.