ROSH Gastrointestinal Practice Exam

Which lab value indicates a poor prognosis in a patient with suspected pancreatitis?

1. Aspartate aminotransferase 200 units/L

2. Glucose 172 mg/dL

3. Serum lactate dehydrogenase 300 units/L

4. White blood cell count 18,000

The correct answer is: White blood cell count 18,000

In the context of pancreatitis, an elevated white blood cell count is a significant indicator of a poor prognosis. It typically reflects an inflammatory response to the disease, which can be severe and lead to complications. A white blood cell count of 18,000 suggests a heightened inflammatory process, which is often associated with a more severe form of pancreatitis, potentially indicating the presence of complications such as infection, necrosis, or systemic inflammatory response syndrome (SIRS). While other values like aspartate aminotransferase, glucose, or serum lactate dehydrogenase may provide important information about the patient's condition, they do not carry the same weight in indicating prognosis as an elevated white blood cell count does. For instance, elevated liver enzymes or glucose levels might be observed in many conditions and do not specifically correlate with the severity of pancreatitis. Similarly, lactate dehydrogenase levels can be elevated in various other diseases, and while they may indicate tissue damage, they are not as direct a marker of pancreatitis severity as leukocytosis. Therefore, in the context of suspected pancreatitis, an elevated white blood cell count serves as a more reliable prognostic indicator.