The role of phosphorus-calcium homeostasis and vitamin D in the pathogenesis of acute pancreatitis and assessment of its severity

Abstract

The aim of the study was to determine the role of phosphorus-calcium homeostasis and vitamin D in the pathogenesis of acute pancreatitis and assess the severity of its course. We examined 72 people, who were divided into two groups: the first group (comparison group) - men and women without pathology of the gastrointestinal tract and any other conditions or diseases that could affect the state of calcium-phosphorus metabolism (n = 36) and the second group (main group) - patients with acute pancreatitis (n = 36). Additionally, patients in the main group were divided into two subgroups: the first subgroup included patients with severe disease (n = 18), and the second (n = 18) - with mild and moderate disease. In patients with acute pancreatitis, the incidence of vitamin D deficiency (<20 ng/ml) was significantly higher than in the comparison group and was 72.2 and 5.6%, respectively (χ2 = 33.1, 95% CI 46.1-79.2). The incidence of severe vitamin D deficiency (<10 ng/ml) in patients with severe acute pancreatitis was significantly higher than in patients with mild to moderate disease and was 55.6 and 5.6% respectively (χ2 = 10.3, 95% CI 20.2- 70.4). Hypocalcemia in terms of total calcium was registered probably more often in patients with severe acute pancreatitis - 61.1% than in patients with mild and moderate - 16.7% (χ2 = 7.3, 95% CI 12.5-65.9). Patients with the lowest quartile of vitamin D and total calcium had a significantly more severe course of acute pancreatitis than those with the highest quartile. Thus, the content of vitamin D levels ≤13.28 ng/ml for patients with acute pancreatitis can be considered as a threshold at which severe disease is predicted is predicted, at the same time the level of calcium decrease correlates with an increase in the severity of acute pancreatitis, which can be considered a reliable criterion for the severity of the disease, however, significant changes in phosphorus metabolism are not identified.

Modern Aspects of Pathogenesis and Diagnosis of Acute Pancreatitis

“…Було встановлено, що у хворих на ГП частота дефіциту вітаміну D (<20 нг/мл) була вірогідно вищою, ніж у здорових осіб, при цьому частота вираженого дефіциту вітаміну D (<10 нг/мл) у пацієнтів з тяжким перебігом ГП була вірогідно вищою порівняно з легким та середньої тяжкості перебігом захворювання і становила 55,6 та 5,6% відповідно. Для пацієнтів на ГП вміст вітаміну D у сироватці крові ≤13,28 нг/мл можна розглядати як вірогідний предиктор тяжкого перебігу захворювання (чутливість тесту -83,3%, специфічність -94,4%) [61].…”

Intra-Abdominal Hypertension as a Complication of Acute Pancreatitis

“…Згідно з класифікацією ГП, що була запропонована у Атланті в 2012 р., виділяють три ступені тяжкості перебігу захворювання. При цьому тяжкий перебіг пов'язаний з розвитком поліорганної недостатності тривалістю понад 48 год, враховуючи респіраторну, серцево-судинну та ниркову дисфункції [2].…”