The Usefulness of Laboratory Tests in the Early Assessment of Severity of Acute Pancreatitis

Abstract

Acute pancreatitis is a disorder that affects approximately 200,000 individuals in the U.S. annually. While most cases are mild, up to 30% of patients will have a complicated course with prolonged hospitalization and significant morbidity and mortality. Early institution of several therapeutic interventions, such as enteral nutrition, prophylactic antibiotics, endoscopic retrograde cholangiopancreatography (ERCP) and intensive care monitoring, have been shown to decrease the morbidity associated with severe acute pancreatitis. However, the ability of clinicians to predict, upon presentation, which patient will have mild or severe pancreatitis has remained poor over the years, thus leading to a delay in the institution of such treatments. Researchers have focused on markers that might improve upon clinical prediction alone. While data have shown the predictive value of tools such as Ranson's and Glasgow's criteria, C-reactive protein (CRP) and the APACHE score, their application in clinical practice has been limited by a time delay of at least 48 h in the former two and by being cumbersome in the latter. Thus, our focus is to critically appraise the evidence available for various biochemical markers in their ability to distinguish mild and severe acute pancreatitis early and more accurately than currently available tools.

Fractalkine as a marker for assessment of severe acute pancreatitis

“…TNF‐α may lead to injury of pancreatic duct cells, pancreatic acinus ischemia, necrosis and inflammation 15 . Mononuclear macrophages and endothelial cells in the presence of activated neutrophils can release IL‐8 16–19 . IL‐8 acts as the main secondary mediator of TNF‐α‐induced neutrophil activation 20 .…”

“…15 Mononuclear macrophages and endothelial cells in the presence of activated neutrophils can release IL-8. [16][17][18][19] IL-8 acts as the main secondary mediator of TNF-a-induced neutrophil activation. 20 Related studies indicate that during SAP the levels of IL-8 increased, which might be correlated with the status of SAP.…”

Co-morbidity is a Strong Predictor of Early Death and Multi-organ System Failure among Patients with Acute Pancreatitis

“…The goal has been to identify patients at high risk for early multiorgan system dysfunction and death. 14 These studies have analyzed an array of clinical parameters collected at the time of admission or during the first 48 h, such as APACHE II parameters score, 15,16 or Ranson score, 17 or Imrie (Glasgow) score, 14,17,18 and laboratory test findings, [19][20][21] with the goal of accurately determining not only the severity of the pancreatitis, but also short-term prognosis. Unfortunately, researchers have not been able to develop and validate a prediction tool that is useful in individual patients.…”

Treatment of severe acute pancreatitis through retroperitoneal laparoscopic drainage

“…We think that as long as an obvious exudation around the pancreas can be detected by imaging, drainage via retroperitoneal laparoscopy can be adopted. If the inflammatory exudation of the pancreatitis cannot be drained in time, the probability of a secondary infection is increased to 40%-70% [12]. For a patient who receives surgery during the acute reaction period, especially within one to two weeks after the incidence, a surgical operation is easier to accomplish, the surgical time is short, and the patient's postoperative recovery is quite smooth.…”