Acil Serviste Akut Pankreatitli Hastalarda Mortaliteyi Öngörmede Beslenme Temelli Skorlama Sistemlerinin Karşılaştırılması

Year 2025, Volume: 8 Issue: 3, 120 - 127, 30.09.2025

Suleyman Alpar , Neslihan Ergün Süzer , Sarper Yılmaz

https://doi.org/10.54996/anatolianjem.1742080

Abstract

Amaç: Acil servis (AS)'te akut pankreatit (AP) hastalarının yönetiminde yalnızca erken tanının konulması değil, aynı zamanda risk sınıflandırmasının da klinik karar verme sürecine dâhil edilmesi önerilmektedir. AP’nin immünonutrisyonel bir hastalık olduğu göz önüne alındığında, bu çalışmada, AS başvurusunda elde edilen laboratuvar parametreleri kullanılarak hesaplanan iki immünonutrisyon temelli skorlama sistemi—Prognostik Nutrisyonel İndeks (PNI) ve Kontrol Edilen Nutrisyonel Durum (CONUT)—arasında karşılaştırma yapılması ve bu skorların hastaneye yatırılan AP hastalarında 30 günlük mortaliteyi öngörmedeki performanslarının değerlendirilmesi amaçlanmıştır.
Gereç ve Yöntemler: Bu retrospektif gözlemsel çalışmada, iki yıllık bir süre boyunca AS aracılığıyla AP tanısıyla hastaneye yatırılan erişkin hastaların verileri analiz edilmiştir. PNI ve CONUT skorları, hastaların ilk başvuru anında elde edilen laboratuvar parametreleri kullanılarak hesaplanmış ve bu skorların 30 günlük mortaliteyi öngörmedeki performansları karşılaştırılmıştır.
Bulgular: Çalışmaya toplam 330 AP hastası dâhil edilmiştir. Otuz günlük takip sonunda 42 hasta (%12,7) hayatını kaybetmiştir. Ölen hastalar, sağ kalanlara kıyasla anlamlı derecede daha yaşlıydı (69,1 ± 11,4 vs. 52,2 ± 14,0 yıl, p < 0,001). Albümin ve total kolesterol düzeyleri ölenlerde anlamlı şekilde daha düşük, C-reaktif protein (CRP) ve CRP/albümin oranı ise anlamlı şekilde daha yüksekti (tümü p < 0,001). PNI skoru ölen hastalarda anlamlı olarak daha düşük bulunurken (36,1 ± 3,02 vs. 43,0 ± 3,50, p < 0,001), CONUT skoru daha yüksekti (5,50 ± 1,71 vs. 2,50 ± 1,35, p < 0,001). Lojistik regresyon analizinde her iki skor da 30 günlük mortalitenin bağımsız öngördürücüleri olarak belirlendi (PNI: OR = 0,64, %95 GA: 0,55–0,72; CONUT: OR = 2,95, %95 GA: 2,20–4,05; p < 0,001). ROC analizinde PNI için eğri altı alan (AUC) 0,82 (%95 GA: 0,76–0,88), CONUT için ise 0,85 (%95 GA: 0,80–0,90) olarak bulundu. İki skor arasında ayırt edici performans açısından istatistiksel olarak anlamlı bir fark saptanmadı (p = 0,116).
Sonuç: Bu çalışma, AS üzerinden başvuran akut pankreatitli hastalarda 30 günlük mortaliteyi öngörmede PNI ve CONUT skorlarının performansını karşılaştırmıştır. Her iki skorlama sistemi de anlamlı prognostik bilgi sağlamıştır. CONUT skoru yüksek riskli hastaları belirlemede daha hassas iken, PNI skoru düşük mortalite riskine sahip hastaları ayırt etmede daha etkili bulunmuştur.

Keywords

Akut pankreatit , Prognostik Nutrisyonel İndeks , mortalite , skorlama sistemleri , acil servis , nutrisyonel değerlendirme

Comparison of Nutrition-Based Scoring Systems for Predicting Mortality in Patients with Acute Pancreatitis in the Emergency Department

Abstract

Aim: In the emergency department (ED) management of patients with acute pancreatitis (AP), it is recommended not only to establish an early diagnosis but also to assess and apply risk stratification in clinical decision-making. Considering that AP is an immunonutritional disease, this study aimed to compare the performance of two immunonutrition-based scoring systems—the Prognostic Nutritional Index (PNI) and the Controlling Nutritional Status (CONUT)—calculated using laboratory parameters obtained at ED admission, in predicting 30-day mortality among hospitalized AP patients.
Material and Methods: This retrospective observational study analyzed the data of adult patients who were admitted to the hospital with a diagnosis of AP through the ED over a two-year period. PNI and CONUT scores were calculated using laboratory parameters obtained at initial presentation, and their predictive performance for 30-day mortality was compared.
Results: A total of 330 patients with AP were included in the study. By the end of the 30-day follow-up, 42 patients (12.7%) had died. Deceased patients were significantly older compared to survivors (69.1 ± 11.4 vs. 52.2 ± 14.0 years, p < 0.001). Albumin and total cholesterol levels were significantly lower, while C-reactive protein (CRP) and the CRP/albumin ratio were significantly higher in non-survivors (all p < 0.001). The PNI score was significantly lower in the deceased group (36.1 ± 3.02 vs. 43.0 ± 3.50, p < 0.001), while the CONUT score was significantly higher (5.50 ± 1.71 vs. 2.50 ± 1.35, p < 0.001). Logistic regression analysis identified both scores as independent predictors of 30-day mortality (PNI: OR = 0.64, 95% CI: 0.55–0.72; CONUT: OR = 2.95, 95% CI: 2.20–4.05; p < 0.001). Receiver operating characteristic (ROC) analysis showed an area under the curve (AUC) of 0.82 (95% CI: 0.76–0.88) for PNI and 0.85 (95% CI: 0.80–0.90) for CONUT. No statistically significant difference in discriminative performance was found between the two scores (p = 0.116).
Conclusion: This study compared the performance of the PNI and CONUT scores in predicting 30-day mortality among patients with acute pancreatitis admitted through the ED. Both scoring systems provided meaningful prognostic information. While the CONUT score was more sensitive in identifying high-risk patients, the PNI score was more effective in distinguishing those with lower mortality risk.

Keywords

Acute pancreatitis , Prognostic Nutritional Index , mortality , scoring systems , emergency department , nutritional assesment

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