Akut Pankreatitte Klinik ve Radyolojik Skorlamaların Hastalığın Şiddetini Belirlemede Etkinliğinin Karşılaştırılması

Year 2022, , 20 - 25, 09.03.2022

İbrahim Aktaş Çiğdem Özpolat , Hasan Demir , Ebru Ünal Akoğlu , Haldun Akoğlu , Arzu Denizbaşı

https://doi.org/10.54996/anatolianjem.1036478

Abstract

Amaç: Akut pankreatit (AP) acil servis hasta başvurularının önemli nedenlerinden biridir. Çok çeşitli klinik belirtiler nedeniyle yoğun bakım veya cerrahi müdahale ihtiyacının belirlenmesi açısından hastalığın derecesini objektif olarak değerlendirmek zordur. Şu an, hastalığın şiddetini belirleyen mükemmel bir puanlama sistemi yoktur. Bu çalışmada hastalık şiddetini tahmin etmek için klinik olarak kullanılan AP skorlama sistemleri olan Ranson, BISAP ve Balthazar (CTSI), SIRS skorlamalarını karşılaştırmayı amaçladık.

Gereç ve Yöntemler: Bu çalışmada Atlanta kriterlerine göre tanı konulan AP hastaları retrospektif olarak incelendi. Hastaların klinik, laboratuvar sonuçları ve radyolojik görüntüleri kullanılarak "ilk 24 saat Ranson", "BISAP" ve SIRS skorları analiz edildi. Balthazar skorları geriye dönük olarak BT raporlarından hesaplandı.

Bulgular: Mortal seyreden hastaların yaş, solunum hızı ve BUN değerleri, hayatta kalanlara göre anlamlı olarak yüksek bulunurken, mortalitesi olan hastaların diyastolik kan basıncı, sistolik kan basıncı, SO2 ve amilaz değerleri anlamlı olarak düşük bulundu. Prognostik skorlama sistemlerinin 6 aylık mortalite tahmini incelendiğinde BİSAP skorunun mortalitenin %94'ünü yakalayabildiği (%95 GA: 0.88-0.97), SIRS skorunun mortaliteyi %74,7 (%95 CI: 0,66-0,82) öngörebildiği bulundu.

Sonuç: Hastalarda AP şiddeti tahmini ile ilgili olarak BİSAP ve SIRS skorları aylık ve genel mortalite açısından daha duyarlı ve spesifikti.

Keywords

Akut pankreatit, BISAP, Baltazar, Ranson

Supporting Institution

yok

Comparison of Predicting the Severity of Disease by Clinical and Radiological Scoring Systems in Acute Pancreatitis

Abstract

Aim: Acute pancreatitis (AP) is a frequent reason for patient presentation in emergency department. It is hard to assess objectively the grade of the disease due to a wide range of clinical signs in terms of determination the need for intensive care or surgical intervention. At this stage there is not a unique, unified scoring system that determines the severity of the disease. In this study we aimed to compare clinically used AP scoring systems; Ranson, BISAP and Balthazar (CTSI), SIRS to predict disease severity.

Material and Methods: In this study, AP patients that were diagnosed by Atlanta criteria were analyzed retrospectively. The clinical, laboratory and radiological images and results of the patients were analyzed by using the "first 24 hours Ranson", "BISAP" and SIRS scores. The Balthazar scores were calculated from the CT reports retrospectively.

Results: Age, respiratory rate and BUN values of the patients with mortality were significantly higher than the patients who survived, whereas diastolic blood pressure, systolic blood pressure, SO2 and amylase values of the patients with mortality were found to be significantly lower than the patients who survived. When the 6 month mortality prediction of prognostic scoring systems was examined, it was found that the BISAP score could catch 94% of mortality (95% CI: 0.88-0.97), and the SIRS score could predict mortality by 74.7% (95% CI: 0,66-0,82).

Conclusion: Regarding the APs severity prediction, BISAP and SIRS scores were more sensitive and specific in terms of monthly and overall mortality in patients.

Keywords

Acute pancreatitis, BISAP, Balthazar, Ranson

References

• Garg PK, Singh VP. Organ Failure Due to Systemic Injury in Acute Pancreatitis. Gastroenterology. 2019 May;156(7):2008-2023.
• Toouli J, Brooke‐Smith M, Bassi C, Carr‐Locke D, Telford J, Freeny P, et al. Guidelines for the management of acute pancreatitis. Journal of gastroenterology and hepatology. 2002;17(s1):S15-S39.
• Ranson JH, Pasternack BS. Statistical methods for quantifying the severity of clinical acute pancreatitis. Journal of Surgical Research. 1977;22(2):79-91.
• Polderman KH, Thijs LG, Girbes AR. Interobserver variability in the use of APACHE II scores. The Lancet. 1999;353(9150):380.
• Banks PA, Bollen TL, Dervenis C, Gooszen HG, Johnson CD, Sarr MG, et al. Classification of acute pancreatitis—2012: revision of the Atlanta classification and definitions by international consensus. Gut. 2013;62(1):102-11.
• Wu BU, Johannes RS, Sun X, Tabak Y, Conwell DL, Banks PA. The early prediction of mortality in acute pancreatitis: a large population-based study. Gut. 2008;57(12):1698-703.
• Balthazar EJ. Acute Pancreatitis: Assessment of Severity with Clinical and CT Evaluation 1. Radiology. 2002;223(3):603-13.
• Waller A, Long B, Koyfman A, Gottlieb M. Acute Pancreatitis: Updates for Emergency Clinicians. J Emerg Med. 2018 Dec;55(6):769-779.
• Polishchuk I, Halperin D, Algedafy A, Delgado JS, Zamir M, Zamir D. Epidemiology of Acute Pancreatitis in Southern Israel: A Retrospective Study. Isr Med Assoc J. 2020 May;22(5):310-314.
• Koutroumpakis E, Wu BU, Bakker OJ, Dudekula A, Singh VK, Besselink MG, et al. Admission Hematocrit and Rise in Blood Urea Nitrogen at 24 h Outperform other Laboratory Markers in Predicting Persistent Organ Failure and Pancreatic Necrosis in Acute Pancreatitis: A Post Hoc Analysis of Three Large Prospective Databases. Am J Gastroenterol. 2015;110(12):1707-16.
• Yang CJ, Chen J, Phillips AR, Windsor JA, Petrov MS. Predictors of severe and critical acute pancreatitis: a systematic review. Digestive and liver disease : official journal of the Italian Society of Gastroenterology and the Italian Association for the Study of the Liver. 2014;46(5):446-51.
• Heller SJ, Noordhoek E, Tenner SM, Ramagopal V, Abramowitz M, Hughes M, et al. Pleural effusion as a predictor of severity in acute pancreatitis. Pancreas. 1997;15(3):222-5
• Gumaste V, Singh V, Dave P. Significance of pleural effusion in patients with acute pancreatitis. Am J Gastroenterol. 1992;87(7):871-4.
• Balthazar EJ, Robinson DL, Megibow AJ, Ranson J. Acute pancreatitis: value of CT in establishing prognosis. Radiology. 1990;174(2):331-6.
• Papachristou GI, Muddana V, Yadav D, O’Connell M, Sanders MK, Slivka A, et al. Comparison of BISAP, Ranson's, APACHE-II, and CTSI scores in predicting organ failure, complications, and mortality in acute pancreatitis. The American journal of gastroenterology. 2010;105(2):435-41
• Liu D, Song B, Huang ZX, Yuan F, Li WM. [The value of chest CT features evaluating the severity and prognosis for acute pancreatitis]. Sichuan da xue xue bao Yi xue ban = Journal of Sichuan University Medical science edition. 2013;44(2):319-22.
• Lankisch P, Struckmann K, Assmus C, Lehnick D, Maisonneuve P, Lowenfels A. Do we need a computed tomography examination in all patients with acute pancreatitis within 72 h after admission to hospital for the detection of pancreatic necrosis? Scandinavian journal of gastroenterology. 2001;36(4):432-6.
• Simchuk EJ, Traverso LW, Nukui Y, Kozarek RA. Computed tomography severity index is a predictor of outcomes for severe pancreatitis. The American journal of surgery. 2000;179(5):352-5.
• Leung T-K, Lee C-M, Lin S-Y, Chen H-C, Wang H-J, Shen L-K, et al. Balthazar computed tomography severity index is superior to Ranson criteria and APACHE II scoring system in predicting acute pancreatitis outcome. World journal of gastroenterology. 2005;11(38):6049-52.
• Zhang J, Shahbaz M, Fang R, Liang B, Gao C, Gao H, et al. Comparison of the BISAP scores for predicting the severity of acute pancreatitis in Chinese patients according to the latest Atlanta classification. Journal of hepato-biliary-pancreatic sciences. 2014;21(9):689-94.