Abstract
Amaç: 1974'te tanıtılan Ranson kriterleri, klinik bir karara varmak için 48 saat içinde toplanan 5 kabul parametresi ve 6 (veya 5) geç bileşenin kullanıldığı akut pankreatit için ilk klinik tahmin kuralıydı. Bu 48 saatlik takip gerekliliği, Acil Servis ortamında kullanım için uygun değildi. Bu çalışma, acil servis ortamında ödematöz pankreatitin nekrotizan pankreatitten ayırt edilmesinde 5 kabul Ranson parametresinin kullanılıp kullanılamayacağını değerlendirmek için yapılmıştır.
Gereç ve Yöntem: Bu retrospektif kohort çalışması için hasta verileri, üçüncü basamak bir bakım merkezinde Ocak 2018 ile Aralık 2022 arasında akut pankreatit nedeniyle tedavi edilen 205 hastadan toplandı. Hasta dosyaları, klinik veri toplamak için arşivlerden çıkarıldı. Laboratuvar kabul verileri ve radyoloji raporları otomatik laboratuvar raporlama sisteminden alınmıştır.
Bulgular: 205 akut pankreatit hastasının çoğu kadındı ve altıncı dekattaydı. Etiyoloji çoğunlukla biliyer pankreatit (%76) idi. Hastaöyküsü, %80'inin ilk atak olduğunu ortaya koydu. Radyolojik görüntüleme çalışması incelemesi, hastaların çoğunda (%87) ödematöz pankreatit olduğunu ortaya çıkardı. Başvurudaki daha yüksek Ranson skoru (aRS), istatistiksel anlamlılığa ulaşmadan (p=0.055) nekroz varlığı için daha yüksek bir olasılığı (aRS 0 için %2.6 ila aRS 4-5 için %28.6) zayıf şekilde öngördü. Skorun bileşenleri analiz edildiğinde, yaş, LDH düzeyleri ve glukozun ayırt edici bir değeri yoktu, WBC parametresinin pozitifliği nekrotizan pankreatit olasılığını önemli ölçüde artırırken, pozitif AST düzeyi nekrotizan pankreatit riskini önemli ölçüde azalttı.
Sonuç: Sonuç olarak, aRS'nin pankreas nekrozunu tahmin etmede çok az faydası vardı.
References
- 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. [CrossRef] google scholar
- Petrov MS, Yadav D. Global epidemiology and holistic prevention of pancreatitis. Nat Rev Gastroenterol Hepatol 2019;16(3):175-84. [CrossRef] google scholar
- van Santvoort HC, Bakker OJ, Bollen TL, Besselink MG, Ahmed Ali U, Schrijver A, et al. Dutch Pancreatitis Study Group. A conservative and minimally invasive approach to necrotizing pancreatitis improves outcome. Gastroenterology 2011;141(4):1254-63. [CrossRef] google scholar
- Ranson JH, Rifkind KM, Roses DF, Fink SD, Eng K, Spencer FC. Prognostic signs and the role of operative management in acute pancreatitis. Surg Gynecol Obstet 1974;139(1):69- 81. google scholar
- Knaus WA, Draper EA, Wagner DP, Zimmerman JE. APACHE II: a severity of disease classification system. Crit Care Med 1985;13(10):818-29. [CrossRef] google scholar
- 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. [CrossRef] google scholar
- Harshit Kumar A, Singh Griwan MA. comparison of APACHE II, BISAP, Ranson’s score and modified CTSI in predicting the severity of acute pancreatitis based on the 2012 revised Atlanta Classification. Gastroenterology report 2018;6(2):127-31. [CrossRef] google scholar
- Windsor JA. A better way to predict the outcome in acute pancreatitis? Am J Gastroenterol 2010;105(7):1671-3. [CrossRef] google scholar
- Delphi Classics. Complete Works of Hippocrates. Delphi Publishing Ltd. Hastings 2015. google scholar
- Kuo DC, Rider AC, Estrada P, Kim D, Pillow MT. Acute Pancreatitis: What’s the Score? J Emerg Med 2015;48(6):762- 70. [CrossRef] google scholar
- Basit H, Ruan GJ, Mukherjee S. Ranson Criteria. [Updated 2022 Sep 26]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from: https:// www.ncbi.nlm.nih.gov/books/NBK482345/. google scholar
- Atul Gawande. The Checklist Manifesto: How to get things right. Metropolitan Books 2009. google scholar
- De Bernardinis M, Violi V, Roncoroni L, Boselli AS, Giunta A, Peracchia A. Discriminant power and information content of Ranson’s prognostic signs in acute pancreatitis: a meta-analytic study. Crit Care Med 1999;27(10):2272-83. [CrossRef] google scholar
- Zhou H, Mei X, He X, Lan T, Guo S. Severity stratification and prognostic prediction of patients with acute pancreatitis at early phase: A retrospective study. Medicine 2019;98(16):e15275. [CrossRef] google scholar
- Lautz TB, Chin AC, Radhakrishnan J. Acute pancreatitis in children: spectrum of disease and predictors of severity. J Pediatr Surg 2011;46(6):1144-9. [CrossRef] google scholar
- Abu-Eshy SA, Abolfotouh MA, Nawar E, Abu Sabib AR. Ranson’s criteria for acute pancreatitis in high altitude: do they need to be modified? Saudi J Gastroenterol 2008;14(1):20-3. [CrossRef] google scholar
- Acehan F, Tez M, Kalkan C, Akdogan M, Altiparmak E, google scholar
ASSESSMENT OF THE RANSON SCORE IN ACUTE PANCREATITIS: ITS VALUE IN AN EMERGENCY SETTING UPON ADMISSION
Abstract
Objective: Ranson criteria, introduced in 1974, was the first clinical prediction rule for acute pancreatitis in which five admission parameters and six (or five) late components collected within 48 hours were used to reach a clinical decision. This 48- hour follow-up requirement was not convenient for use in the Emergency Department setting. This study was undertaken to assess whether five admission Ranson parameters may have use in differentiating edematous pancreatitis from necrotizing pancreatitis in the emergency department setting.
Material and Method: Patient data for this retrospective cohortstudy was gathered from 205 patients treated for acute pancreatitis from January 2018 to December 2022 in a tertiary care center. The patient files were extracted from the archives for clinical data gathering. Laboratory admission data and radiology reports were extracted from the automated laboratory reporting system.
Result: The 205 acute pancreatitis patients were mostly female and in their sixth decade. The etiology was mostly biliary pancreatitis (76%). Patient history revealed that 80% was the first attack. The radiologic imaging study review revealed the majority of the patients had edematous pancreatitis (87%). Higher scores in admission Ranson score (aRS) weakly predicted increasingly higher probability (2.6% for aRS 0 to 28.6% for aRS 4-5) for the presence of necrosis without reaching statistical significance (p=0.055) When components of the score were analyzed, age, LDH levels, and glucose had no discriminating value, WBC parameter posi tivity significantly increased the odds of necrotizing pancreatitis, whereas positive AST level significantly decreased the risk of necrotizing pancreatitis.
Conclusion: In conclusion, aRS had little utility in predicting pancreatic necrosis
References
- 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. [CrossRef] google scholar
- Petrov MS, Yadav D. Global epidemiology and holistic prevention of pancreatitis. Nat Rev Gastroenterol Hepatol 2019;16(3):175-84. [CrossRef] google scholar
- van Santvoort HC, Bakker OJ, Bollen TL, Besselink MG, Ahmed Ali U, Schrijver A, et al. Dutch Pancreatitis Study Group. A conservative and minimally invasive approach to necrotizing pancreatitis improves outcome. Gastroenterology 2011;141(4):1254-63. [CrossRef] google scholar
- Ranson JH, Rifkind KM, Roses DF, Fink SD, Eng K, Spencer FC. Prognostic signs and the role of operative management in acute pancreatitis. Surg Gynecol Obstet 1974;139(1):69- 81. google scholar
- Knaus WA, Draper EA, Wagner DP, Zimmerman JE. APACHE II: a severity of disease classification system. Crit Care Med 1985;13(10):818-29. [CrossRef] google scholar
- 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. [CrossRef] google scholar
- Harshit Kumar A, Singh Griwan MA. comparison of APACHE II, BISAP, Ranson’s score and modified CTSI in predicting the severity of acute pancreatitis based on the 2012 revised Atlanta Classification. Gastroenterology report 2018;6(2):127-31. [CrossRef] google scholar
- Windsor JA. A better way to predict the outcome in acute pancreatitis? Am J Gastroenterol 2010;105(7):1671-3. [CrossRef] google scholar
- Delphi Classics. Complete Works of Hippocrates. Delphi Publishing Ltd. Hastings 2015. google scholar
- Kuo DC, Rider AC, Estrada P, Kim D, Pillow MT. Acute Pancreatitis: What’s the Score? J Emerg Med 2015;48(6):762- 70. [CrossRef] google scholar
- Basit H, Ruan GJ, Mukherjee S. Ranson Criteria. [Updated 2022 Sep 26]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from: https:// www.ncbi.nlm.nih.gov/books/NBK482345/. google scholar
- Atul Gawande. The Checklist Manifesto: How to get things right. Metropolitan Books 2009. google scholar
- De Bernardinis M, Violi V, Roncoroni L, Boselli AS, Giunta A, Peracchia A. Discriminant power and information content of Ranson’s prognostic signs in acute pancreatitis: a meta-analytic study. Crit Care Med 1999;27(10):2272-83. [CrossRef] google scholar
- Zhou H, Mei X, He X, Lan T, Guo S. Severity stratification and prognostic prediction of patients with acute pancreatitis at early phase: A retrospective study. Medicine 2019;98(16):e15275. [CrossRef] google scholar
- Lautz TB, Chin AC, Radhakrishnan J. Acute pancreatitis in children: spectrum of disease and predictors of severity. J Pediatr Surg 2011;46(6):1144-9. [CrossRef] google scholar
- Abu-Eshy SA, Abolfotouh MA, Nawar E, Abu Sabib AR. Ranson’s criteria for acute pancreatitis in high altitude: do they need to be modified? Saudi J Gastroenterol 2008;14(1):20-3. [CrossRef] google scholar
- Acehan F, Tez M, Kalkan C, Akdogan M, Altiparmak E, google scholar
Details
| Primary Language | English |
|---|---|
| Subjects | Health Services and Systems (Other) |
| Journal Section | RESEARCH |
| Authors | |
| Publication Date | October 26, 2023 |
| Submission Date | March 29, 2023 |
| Published in Issue | Year 2023 Volume: 86 Issue: 3 |
Cite
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