Acute Pancreatitis Gravity Predictive Factors: Which and When to Use Them?

Abstract

Introduction: Acute pancreatitis has as its main causes lithiasic biliary disease and alcohol abuse. Most of the time, the disease shows a self-limiting course, with a rapid recovery, only with supportive treatment. However, in a significant percentage of cases, it runs with important local and systemic complications associated with high mortality rates. Aim: To present the current state of the use of these prognostic factors (predictive scores) of gravity, as the time of application, complexity and specificity. Method: A non-systematic literature review through 28 papers, with emphasis on 13 articles published in indexed journals between 2008 and 2013 using Lilacs, Medline, Pubmed. Results: Several clinical, laboratory analysis, molecular and image variables can predict the development of severe acute pancreatitis. Some of them by themselves can be determinant to the progression of the disease to a more severe form, such as obesity, hematocrit, age and smoking. Hematocrit with a value lower than 44% and serum urea lower than 20 mg/dl, both at admission, appear as risk factors for pancreatic necrosis. But the PCR differentiates mild cases of serious ones in the first 24 h. Multifactorial scores measured on admission and during the first 48 h of hospitalization have been used in intensive care units, being the most ones used: Ranson, Apache II, Glasgow, Iget and Saps II. Conclusion: Acute pancreatitis is a disease in which several prognostic factors are employed being useful in predicting mortality and on the development of the severe form. It is suggested that the association of a multifactorial score, especially the Saps II associated with Iget, may increase the prognosis accuracy. However, the professional's preferences, the experience on the service as well as the available tools, are factors that have determined the choice of the most suitable predictive score.

Early prediction of infected pancreatic necrosis secondary to necrotizing pancreatitis

“…Even with its delayed increase and peak, CRP remains useful and widely available. [ 42 , 45 ] Ferreira et al [ 46 ] suggested that although the maximum serum concentration of CRP is achieved after 72 hours, it is able to discriminate severe cases from mild cases of AP within the first 24 hours. Second, the highest PCT value from serial daily measurements over a long time period better identifies IPN than intermittent measurements.…”

Nutrición enteral temprana en pacientes con pancreatitis agudas leves: estudio clínico randomizado

“…No obstante, el rango de intolerancia para este tipo de dieta alcanza el 12.4% (17,22) . De acuerdo con Ferreira y cols, la PAL es aquella en la cual el páncreas se encuentra edematizado, la respuesta inflamatoria sistémica es leve y, limitada localmente (11) . Los cambios en el manejo de pacientes con pancreatitis aguda grave, tales como la nutrición enteral, el uso racional de los antibióticos y los cuidados intensivos, han contribuido de manera significativa a la reducción del tiempo de hospitalización y mortalidad (1) .…”

“…Criterios pronósticos de APACHE II al ingreso (basal), a las 48 hs y prequirúrgico (para PAL litiásicas), o al alta (para PAL alitiásicas): variable cuantitativa continua. El Score de APACHE II puede ser utilizado al ingreso y diariamente en las primeras 72 hs de internación (11) . Albuminemia al ingreso (basal), a las 48 hs y prequirúrgica o al alta: variable cuantitativa continua.…”

Fisiopatologia e tratamento da pancreatite aguda

“…A pancreatite aguda é caracterizada como uma doença inflamatória decorrente da ativação anormal de enzimas pancreáticas e liberação de uma série de mediadores inflamatórios, atingindo, além do pâncreas, os tecidos peripancreáticos, podendo inclusive afetar outros órgãos 1 .…”