Corelation among clinical, biochemical and tomographic criteria in order to evaluate the severity in acute pancreatitis

Abstract

Background: the acute pancreatitis is an inflammatory process that may involve peripancreatic tissue and distant organs. According to the Atlanta criteria, in 10 to 20% of the patients the disease is severe. Nowadays there are different clinical and biochemical severity scales such as the Ranson, APACHE-II (Acute Physiology and Chronic Health Evaluation) and hematocrit, which have discrepancies when being compared to tomographic scales such as the Balthazar. There exist few studies that correlate these parameters. Objective: to evaluate the severity of the acute pancreatitis according to the Ranson, APACHE-II and serous hematocrit criteria at the moment of admission of the patient and correlate these scales with the local pancreatic complications according to the Balthazar classification. Patients and method: retrospective, observational and analytic study. There were included patients of any gender above the age of 18, with diagnosis of acute pancreatitis of any etiology, who had performed an abdominal tomography 72 hours after the beginning of the clinical condition in order to stage the pancreatic damage. The diagnosis of acute pancreatitis was established with 2 of the 3 following criteria: a) characteristic abdominal pain; b) uprising of the amylase and/or lipase more than 3 times above the superior normal limit; and c) characteristic finds of acute pancreatitis in the computed tomography. In order to make the correlation, the Pearson or the Spearman tests were used according to the distribution of the variables. Results: there were included 28 patients (21 masculine, 75%). The most frequent etiology was due to alcohol (53.6%, bile (21.4%) and hypertriglyceridemia (17.9%). The age average was 38.1 years old. Fifty per cent of the patients had acute severe pancreatitis according to the Atlanta criteria. Of the patients with APACHE-II less than 8 points, 62.5% were classified according to the Balthazar tomographic scale as D or E degree. Ninety-two point nine per cent of the patients had less than 3 Ranson criteria of which 57.6% got D or E degree. Fifty-seven per cent of the patients with hematocrit value lower than 44% got D and E Balthazar degree, and 64.2% of the patients with hematocrit above 44% got D and E degree.

Malondialdehyde in early phase of acute pancreatitis

“…The accuracy of the current severity criteria is not optimal, and it has been described that the corelation between clinical-analytical criteria and radiologic severity is low (31). Some authors have proposed MDAc as a predictive parameter of severity (8,10).…”

Hafif Dereceli Pankreatit Olgularının Tanısında Lipaz/Amilaz Oranı Ve Ortalama Platelet Hacmi Ne Kadar Güvenilirdir?

“…Amylase and lipase were studied as a marker of the severity of pancreatitis but no correlation was reported (15,16). Gomez et al suggested to use lipase alone rather than using with amylase to reduce costs, but amylase is still a very widely accepted marker in the diagnosis of pancreatitis (17,18).…”

Cholecystectomy in mild acute biliary pancreatitis: The sooner; the better

“…Between 25% and 60% of patients manifest a systemic inflammatory response syndrome (SIRS), although in the majority this resolves in the first 24 hours with appropriate fluid replacement therapy (17)(18)(19)(20).…”