Ascitic fluid analysis in acute pancreatitis: Clinically promising but methodologically constrained prognostic indicators

Abstract

A recent single-center retrospective study by Rao et al has offered valuable insights into the prognostic utility of ascitic fluid characteristics in acute pancreatitis. Their findings, which demonstrate associations between ascitic color, turbidity, and elevated lactate dehydrogenase levels with organ failure, infected pancreatic necrosis, and in-hospital mortality provide a valuable contribution to a relatively underexplored area in pancreatology. However, the reliance on subjective visual assessment and a single time-point evaluation raises concerns regarding reproducibility and dynamic disease monitoring. Furthermore, the lack of integration with objective indicators such as polymorphonuclear cell counts, microbiological cultures, and exudative vs transudative analysis limits the interpretability of the results. Despite these limitations, the study provides a clinically relevant framework that supports further investigation and refinement through prospective, multicenter validation.

Keywords: Acute pancreatitis; Ascitic fluid; Prognosis; Infected pancreatic necrosis; Lactate dehydrogenase; Peritonitis

Core Tip: This letter provides a critical appraisal of Rao et al’s study on the prognostic value of ascitic fluid characteristics in acute pancreatitis. While their findings linking fluid color, turbidity, and lactate dehydrogenase levels with adverse outcomes are noteworthy, concerns remain regarding the subjectivity of visual assessment, absence of infection-related markers, and the limitation of single time-point analysis. We emphasize the need for objective classification using cytological, microbiological, and biochemical parameters, as well as longitudinal monitoring and integration into established severity scoring systems to improve prognostic accuracy and clinical applicability.