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Akut pankreatitte şiddeti belirlemede biyokimyasal belirteçlerin yeri

Yıl 2026, Cilt: 25 Sayı: 1 , 37 - 44 , 21.04.2026

Mehmet Kasım Aydın Zekiye Nur Harput , Oktay Bayraktar , Elif Ertaş , Orhan Sezgin , Engin Altintas

https://doi.org/10.17941/agd.1916118
https://izlik.org/JA59HS44RN

Öz

Giriş ve Amaç: Akut pankreatit şiddetinin öngörülmesi, mortaliteyi düşürmek için kritik öneme sahiptir. Bu çalışmanın amacı, akut pankreatit hastalarında hastalık şiddeti ve prognozunun değerlendirilmesinde kreatinin, kreatinin/albümin, C-reaktif protein/trombosit ve lökosit/trombosit gibi yeni birleşik oranların prediktif değerini araştırmak ve bu parametrelerin Akut Pankreatitte Yatak Başı Şiddet İndeksi, Zararsız Akut Pankreatit Skoru ve Pankreatit Aktivite Skorlama Sistemleriyle olan korelasyonunu ortaya koymaktır. Gereç ve Yöntem: Bu retrospektif çalışma, Ocak 2018-Kasım 2023 tarihleri arasında yatarak tedavi gören 325 akut pankreatit hastasının klinik verilerini içermektedir. Çalışmada kreatinin, kreatinin/albümin, albümin/non-albümin protein, hematokrit/albümin, C-reaktif protein/trombosit, eozinofil/trombosit, lökosit/trombosit, hematokrit/kreatinin ve C-reaktif protein/albümin oranlarının prediktif rolleri incelenmiş ve Akut Pankreatitte Yatak Başı Şiddet İndeksi, Zararsız Akut Pankreatit Skoru ve Pankreatit Aktivite Skorlama Sistemleriyle korelasyonları değerlendirilmiştir. Şiddet skorları, hastaneye yatış anında ve ilk 24 saat içinde hesaplanmıştır. Bulgular: Çalışmaya dahil edilen 325 hastanın yaş ortalaması 55.6 ± 17.8 olup, %53.8’i kadın, %46.2’si erkektir. Hastaların ortalama beden kitle indeksi 27.96 ± 3.94 idi. Ortalama yatış süresi 5.5 ± 3.1 gün, ortalama atak sayısı ise 2 ± 1 idi. Plazmaferez uygulanan hasta oranı %6.2, yoğun bakım ihtiyacı olan hasta oranı %6.5 ve mortalite oranı %1.5 olarak kaydedilmiştir. Değerlendirilen biyobelirteçlerden Akut Pankreatitte Yatak Başı Şiddet İndeksi, Zararsız Akut Pankreatit Skoru ve Pankreatit Aktivite Skorlama Sistemi şiddet skorları ile kreatinin, kreatinin/albümin ve lökosit/trombosit oranları arasında anlamlı, güçlü ve pozitif korelasyon saptanmıştır (p < 0.001). Özellikle kreatinin/albümin oranının ({r}= 0.58; p 0.001) tüm skorlama sistemleriyle en güçlü ilişkiyi gösterdiği belirlenmiştir. Diğer oranlar ve tek belirteçler arasındaki korelasyonlar daha zayıf ({r} < 0.30) düzeyde kalmıştır. Sonuç: Başvuru anındaki serum kreatinin, kreatinin/albümin ve lökosit/trombosit oranlarının, akut pankreatit şiddeti ve hastanede yatış süresi ile anlamlı düzeyde pozitif korelasyon gösterdiği belirlenmiştir. Bu oranlar, hastaneye kabul sırasında akut pankreatit şiddetinin öngörülmesinde hızlı değerlendirilebilir ve kolay uygulanabilir yüksek duyarlılığa sahip potansiyel biyobelirteçler olabilir. Bu parametrelerin klinik karar verme süreçlerine dahil edilmesi önerilebilir.

Anahtar Kelimeler

Akut pankreatit biyokimyasal belirteçler şiddet indeksleri

Kaynakça

  • 1. Banks PA, Bollen TL, Dervenis C, et al; Acute Pancreatitis Classification Working Group. Classification of acute pancreatitis--2012: revision of the Atlanta classification and definitions by international consensus. Gut. 2013;62(1):102-11. doi: 10.1136/gutjnl-2012-302779.
  • 2. Beij A, Verdonk RC, van Santvoort HC, de-Madaria E, Voermans RP. Acute Pancreatitis: An Update of Evidence-Based Management and Recent Trends in Treatment Strategies. United European Gastroenterol J. 2025;13(1):97-106. doi: 10.1002/ueg2.12743.
  • 3. Boxhoorn L, Voermans RP, Bouwense SA, et al. Acute pancreatitis. Lancet. 2020;396(10252):726-34. doi: 10.1016/S0140-6736(20)31310-6.
  • 4. Mederos MA, Reber HA, Girgis MD. Acute Pancreatitis: A Review. JAMA. 2021;325(4):382-90. doi: 10.1001/jama.2020.20317.
  • 5. Ranson JH, Rifkind KM, Roses DF, et al. Prognostic signs and the role of operative management in acute pancreatitis. Surg Gynecol Obstet. 1974;139(1):69-81.
  • 6. Knaus WA, Draper EA, Wagner DP, Zimmerman JE. APACHE II: a severity of disease classification system. Crit Care Med. 1985;13(10):818-29.
  • 7. Lee DW, Cho CM. Predicting Severity of Acute Pancreatitis. Medicina (Kaunas). 2022;58(6):787. doi: 10.3390/medicina58060787.
  • 8. van den Berg FF, de Bruijn AC, van Santvoort HC, Issa Y, Boermeester MA. Early laboratory biomarkers for severity in acute pancreatitis; A systematic review and meta-analysis. Pancreatology. 2020;20(7):1302-11. doi: 10.1016/j.pan.2020.09.007.
  • 9. Zhao Z, Yu Y, Xie R, et al. Prognostic value of the creatinine-albumin ratio in acute pancreatitis debridement. BMC Surg. 2020;20(1):322. doi: 10.1186/s12893-020-00991-6.
  • 10. Wang J, Li H, Luo H, et al. Association between serum creatinine to albumin ratio and short- and long-term all-cause mortality in patients with acute pancreatitis admitted to the intensive care unit: a retrospective analysis based on the MIMIC-IV database. Front Immunol. 2024;15:1373371. doi: 10.3389/fimmu.2024.1373371.
  • 11. Vo HH, Truong-Thi NN, Ho-Thi HB, et al. The value of neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio, red cell distribution width, and their combination in predicting acute pancreatitis severity. Eur Rev Med Pharmacol Sci. 2023;27(23):11464-71. doi: 10.26355/eurrev_202312_34585.
  • 12. Wu BU, Johannes RS, Sun X, et al. The early prediction of mortality in acute pancreatitis: a large population-based study. Gut. 2008;57(12):1698-703. doi: 10.1136/gut.2008.152702.
  • 13. Sayraç AV, Cete Y, Yiğit Ö, Aydın AG, Sayrac N. Utility of HAPS for predicting prognosis in acute pancreatitis. Ulus Travma Acil Cerrahi Derg. 2018;24:327-32. doi: 10.5505/tjtes.2017.50794.
  • 14. Avadhani KG, Shirshetty AK. An epidemiological study of acute pancreatitis in rural population. J Med Sci Health. 2016;2:25-9. doi: 10.46347/jmsh.2016.v02i03.005
  • 15. Wu BU, Batech M, Quezada M, et al. Dynamic Measurement of Disease Activity in Acute Pancreatitis: The Pancreatitis Activity Scoring System. Am J Gastroenterol. 2017;112(7):1144-52. doi: 10.1038/ajg.2017.114.
  • 16. Aktaş AA, Taşar P, Siğirli D, Kılıçturgsy SA. Comparison of the effectiveness of different scoring systems and biochemical markers in determining the severity and complications of acute pancreatitis. Turk J Med Sci. 2025;55(2):451-60. doi: 10.55730/1300-0144.5989.
  • 17. van Schrojenstein Lantman M, van de Logt AE, Thelen M, Wetzels JF, van Berkel M. Serum albumin measurement in nephrology: Room for improvement. Nephrol Dial Transplant. 2022;37:1792-9. doi: 10.1093/ndt/gfaa375.
  • 18. Biyik Z, Biyik M, Yavuz YC, et al. The Role of the BUN/Albumin Ratio in Predicting Poor Clinical Outcomes in Patients with Acute Pancreatitis. Niger J Clin Pract. 2025;28(3):360-6. doi: 10.4103/njcp.njcp_528_24.
  • 19. Muddana V, Whitcomb DC, Khalid A, et al. Elevated serum creatinine as a marker of pancreatic necrosis in acute pancreatitis. Am J Gastroenterol. 2009;104:164-70. doi: 10.1038/ajg.2008.66.
  • 20. de-Madaria E, Buxbaum JL, Maisonneuve P, et al; ERICA Consortium. Aggressive or Moderate Fluid Resuscitation in Acute Pancreatitis. N Engl J Med. 2022;387(11):989-1000. doi: 10.1056/NEJMoa2202884.
  • 21. Zijlstra GJ. Aggressive or Moderate Fluids in Acute Pancreatitis. N Engl J Med. 2022;387(23):2198-9. doi: 10.1056/NEJMc2213440.
  • 22. Dumnicka P, Maduzia D, Ceranowicz P, et al. The Interplay between Inflammation, Coagulation and Endothelial Injury in the Early Phase of Acute Pancreatitis: Clinical Implications. Int J Mol Sci. 2017;18(2):354. doi: 10.3390/ijms18020354.
  • 23. Osada J, Wereszczynska-Siemiatkowska U, Dabrowski A, Dabrowska MI. Platelet activation in acute pancreatitis. Pancreas. 2012;41(8):1319-24. doi: 10.1097/MPA.0b013e31824bd89f.
  • 24. Lin XY, Lai YX, Lin Y, Lin ZH. Low-grade inflammation for predicting severe acute pancreatitis in patients with hypertriglyceridemic acute pancreatitis. J Dig Dis. 2023;24(10):562-9. doi: 10.1111/1751-2980.13231.
  • 25. Salehi AM, Rezaei R, Sadeghi A, et al. Diagnostic value of neutrophil/lymphocyte ratio, platelet/lymphocyte ratio and systemic immune-inflammation index for predicting the severity of acute pancreatitis. BMC Gastroenterol. 2025;25(1):751. doi: 10.1186/s12876-025-04370-4.

Yıl 2026, Cilt: 25 Sayı: 1 , 37 - 44 , 21.04.2026

Mehmet Kasım Aydın Zekiye Nur Harput , Oktay Bayraktar , Elif Ertaş , Orhan Sezgin , Engin Altintas

https://doi.org/10.17941/agd.1916118
https://izlik.org/JA59HS44RN

Öz

Background and Aims: Accurate prediction of acute pancreatitis severity is critical for reducing mortality. The aim of this study was to investigate the predictive value of novel composite ratios-including creatinine, creatinine/albumin, C-reactive protein/platelet, and leukocyte/platelet-in assessing disease severity and prognosis in patients with acute pancreatitis, and to evaluate their correlation with established severity scoring systems: the Bedside Index for Severity in Acute Pancreatitis, the Harmless Acute Pancreatitis Score, and the Pancreatitis Activity Scoring System. Materials and Methods: This retrospective study included clinical data from 325 patients hospitalized with acute pancreatitis between January 2018 and November 2023. The predictive roles of creatinine, creatinine/albumin, albumin/non-albumin protein, hematocrit/albumin, C-reactive protein/platelet, eosinophil/platelet, leukocyte/platelet, hematocrit/creatinine, and C-reactive protein/albumin ratios were analyzed. Their correlations with the Bedside Index for Severity in Acute Pancreatitis, the Harmless Acute Pancreatitis Score, and the Pancreatitis Activity Scoring System were evaluated. Severity scores were calculated at hospital admission and within the first 24 hours. Results: The mean age of the 325 patients was 55.6 ± 17.8 years; 53.8% were female and 46.2% were male. The mean body mass index was 27.96 ± 3.94 kg/m². The average length of hospital stay was 5.5 ± 3.1 days, and the mean number of attacks was 2 ± 1. Plasmapheresis was performed in 6.2% of patients, 6.5% required intensive care unit admission, and the mortality rate was 1.5%. Among the evaluated biomarkers, significant, strong, and positive correlations were found between the Bedside Index for Severity in Acute Pancreatitis, the Harmless Acute Pancreatitis Score, and the Pancreatitis Activity Scoring System severity scores and creatinine, creatinine/albumin, and leukocyte/platelet ratios (p < 0.001). Notably, the creatinine/albumin ratio demonstrated the strongest association with all scoring systems (r = 0.58; p < 0.001). Correlations involving other ratios and single biomarkers were weaker (r < 0.30). Conclusion: Serum creatinine, creatinine/albumin, and leukocyte/platelet ratios at admission were significantly and positively correlated with acute pancreatitis severity and length of hospital stay. These ratios may serve as rapid, easily applicable, and highly sensitive potential biomarkers for early prediction of acute pancreatitis severity at hospital admission. Incorporation of these parameters into clinical decision-making processes may be recommended.

Anahtar Kelimeler

Acute pancreatitis biochemical markers severity indices

Kaynakça

  • 1. Banks PA, Bollen TL, Dervenis C, et al; Acute Pancreatitis Classification Working Group. Classification of acute pancreatitis--2012: revision of the Atlanta classification and definitions by international consensus. Gut. 2013;62(1):102-11. doi: 10.1136/gutjnl-2012-302779.
  • 2. Beij A, Verdonk RC, van Santvoort HC, de-Madaria E, Voermans RP. Acute Pancreatitis: An Update of Evidence-Based Management and Recent Trends in Treatment Strategies. United European Gastroenterol J. 2025;13(1):97-106. doi: 10.1002/ueg2.12743.
  • 3. Boxhoorn L, Voermans RP, Bouwense SA, et al. Acute pancreatitis. Lancet. 2020;396(10252):726-34. doi: 10.1016/S0140-6736(20)31310-6.
  • 4. Mederos MA, Reber HA, Girgis MD. Acute Pancreatitis: A Review. JAMA. 2021;325(4):382-90. doi: 10.1001/jama.2020.20317.
  • 5. Ranson JH, Rifkind KM, Roses DF, et al. Prognostic signs and the role of operative management in acute pancreatitis. Surg Gynecol Obstet. 1974;139(1):69-81.
  • 6. Knaus WA, Draper EA, Wagner DP, Zimmerman JE. APACHE II: a severity of disease classification system. Crit Care Med. 1985;13(10):818-29.
  • 7. Lee DW, Cho CM. Predicting Severity of Acute Pancreatitis. Medicina (Kaunas). 2022;58(6):787. doi: 10.3390/medicina58060787.
  • 8. van den Berg FF, de Bruijn AC, van Santvoort HC, Issa Y, Boermeester MA. Early laboratory biomarkers for severity in acute pancreatitis; A systematic review and meta-analysis. Pancreatology. 2020;20(7):1302-11. doi: 10.1016/j.pan.2020.09.007.
  • 9. Zhao Z, Yu Y, Xie R, et al. Prognostic value of the creatinine-albumin ratio in acute pancreatitis debridement. BMC Surg. 2020;20(1):322. doi: 10.1186/s12893-020-00991-6.
  • 10. Wang J, Li H, Luo H, et al. Association between serum creatinine to albumin ratio and short- and long-term all-cause mortality in patients with acute pancreatitis admitted to the intensive care unit: a retrospective analysis based on the MIMIC-IV database. Front Immunol. 2024;15:1373371. doi: 10.3389/fimmu.2024.1373371.
  • 11. Vo HH, Truong-Thi NN, Ho-Thi HB, et al. The value of neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio, red cell distribution width, and their combination in predicting acute pancreatitis severity. Eur Rev Med Pharmacol Sci. 2023;27(23):11464-71. doi: 10.26355/eurrev_202312_34585.
  • 12. Wu BU, Johannes RS, Sun X, et al. The early prediction of mortality in acute pancreatitis: a large population-based study. Gut. 2008;57(12):1698-703. doi: 10.1136/gut.2008.152702.
  • 13. Sayraç AV, Cete Y, Yiğit Ö, Aydın AG, Sayrac N. Utility of HAPS for predicting prognosis in acute pancreatitis. Ulus Travma Acil Cerrahi Derg. 2018;24:327-32. doi: 10.5505/tjtes.2017.50794.
  • 14. Avadhani KG, Shirshetty AK. An epidemiological study of acute pancreatitis in rural population. J Med Sci Health. 2016;2:25-9. doi: 10.46347/jmsh.2016.v02i03.005
  • 15. Wu BU, Batech M, Quezada M, et al. Dynamic Measurement of Disease Activity in Acute Pancreatitis: The Pancreatitis Activity Scoring System. Am J Gastroenterol. 2017;112(7):1144-52. doi: 10.1038/ajg.2017.114.
  • 16. Aktaş AA, Taşar P, Siğirli D, Kılıçturgsy SA. Comparison of the effectiveness of different scoring systems and biochemical markers in determining the severity and complications of acute pancreatitis. Turk J Med Sci. 2025;55(2):451-60. doi: 10.55730/1300-0144.5989.
  • 17. van Schrojenstein Lantman M, van de Logt AE, Thelen M, Wetzels JF, van Berkel M. Serum albumin measurement in nephrology: Room for improvement. Nephrol Dial Transplant. 2022;37:1792-9. doi: 10.1093/ndt/gfaa375.
  • 18. Biyik Z, Biyik M, Yavuz YC, et al. The Role of the BUN/Albumin Ratio in Predicting Poor Clinical Outcomes in Patients with Acute Pancreatitis. Niger J Clin Pract. 2025;28(3):360-6. doi: 10.4103/njcp.njcp_528_24.
  • 19. Muddana V, Whitcomb DC, Khalid A, et al. Elevated serum creatinine as a marker of pancreatic necrosis in acute pancreatitis. Am J Gastroenterol. 2009;104:164-70. doi: 10.1038/ajg.2008.66.
  • 20. de-Madaria E, Buxbaum JL, Maisonneuve P, et al; ERICA Consortium. Aggressive or Moderate Fluid Resuscitation in Acute Pancreatitis. N Engl J Med. 2022;387(11):989-1000. doi: 10.1056/NEJMoa2202884.
  • 21. Zijlstra GJ. Aggressive or Moderate Fluids in Acute Pancreatitis. N Engl J Med. 2022;387(23):2198-9. doi: 10.1056/NEJMc2213440.
  • 22. Dumnicka P, Maduzia D, Ceranowicz P, et al. The Interplay between Inflammation, Coagulation and Endothelial Injury in the Early Phase of Acute Pancreatitis: Clinical Implications. Int J Mol Sci. 2017;18(2):354. doi: 10.3390/ijms18020354.
  • 23. Osada J, Wereszczynska-Siemiatkowska U, Dabrowski A, Dabrowska MI. Platelet activation in acute pancreatitis. Pancreas. 2012;41(8):1319-24. doi: 10.1097/MPA.0b013e31824bd89f.
  • 24. Lin XY, Lai YX, Lin Y, Lin ZH. Low-grade inflammation for predicting severe acute pancreatitis in patients with hypertriglyceridemic acute pancreatitis. J Dig Dis. 2023;24(10):562-9. doi: 10.1111/1751-2980.13231.
  • 25. Salehi AM, Rezaei R, Sadeghi A, et al. Diagnostic value of neutrophil/lymphocyte ratio, platelet/lymphocyte ratio and systemic immune-inflammation index for predicting the severity of acute pancreatitis. BMC Gastroenterol. 2025;25(1):751. doi: 10.1186/s12876-025-04370-4.
Toplam 25 adet kaynakça vardır.

Ayrıntılar

Birincil Dil Türkçe
Konular Gastroenteroloji ve Hepatoloji
Bölüm Araştırma Makalesi
Yazarlar

Mehmet Kasım Aydın Bu kişi benim

Zekiye Nur Harput 0000-0002-7969-7968

Oktay Bayraktar 0009-0005-0838-4162

Elif Ertaş 0000-0003-1827-4862

Orhan Sezgin 0000-0002-6704-4716

Engin Altintas 0000-0003-0796-1456

Gönderilme Tarihi 13 Mayıs 2025
Kabul Tarihi 18 Aralık 2025
Yayımlanma Tarihi 21 Nisan 2026
DOI https://doi.org/10.17941/agd.1916118
IZ https://izlik.org/JA59HS44RN
Yayımlandığı Sayı Yıl 2026 Cilt: 25 Sayı: 1

Kaynak Göster

APA Aydın, M. K., Harput, Z. N., Bayraktar, O., Ertaş, E., Sezgin, O., & Altintas, E. (2026). Akut pankreatitte şiddeti belirlemede biyokimyasal belirteçlerin yeri. Akademik Gastroenteroloji Dergisi, 25(1), 37-44. https://doi.org/10.17941/agd.1916118