Akut pankreatitli hastalarda akut pankreatik ve peripankreatik sıvı gelişiminde prediktif faktörler

Abstract

Amaç: Akut pankreatit sonrası oluşan akut sıvı koleksiyonları, enfekte psödokist ve Wall off Nekroz gelişimi gibi ciddi komplikasyon riski taşır. Bu nedenle akut pankreatitin tedavisi ve yönetimi için akut sıvı koleksiyonlarının gelişimini öngörmek önem taşımaktadır. Bu çalışmada akut pankreatitli hastalarda akut sıvı koleksiyonlarının gelişimini öngören faktörlerin araştırılması amaçlanmıştır. Yöntemler: Akut pankreatit tanısı alan toplam 438 hasta tarandı. Revize Edilmiş Atlanta Sınıflandırmasına göre akut pankreatit sonrası sıvı gelişimi belirlenerek sıvı gelişimi ile hastaların başvuru anındaki hematolojik/biyokimyasal parametreleri arasındaki ilişki araştırılmıştır. Sıvı gelişimi için laboratuvar ölçümlerinin en iyi kesim noktası ROC analizi ile belirlenirken sıvı gelişimi olan ve olmayan hastaların ayrımında en belirleyici olabilecek faktörler çok değişkenli ileri adımlı lojistik regresyon analizi ile belirlendi. Bulgular: Akut pankreatit sonrası akut sıvı koleksiyonları gelişiminin genç yaşta ve erkek cinsiyette daha fazla olduğu saptanmıştır. Ayrıca CRP/Albümin oranı 1,09'un üzerinde olan hastalarda akut pankreatit sonrası akut sıvı toplanması gelişme riskinin 6,2 kat; ALP değeri 199,5 U/L'nin altında olan hastalarda 2,5 kat; WBC değeri 11,6 x 10/L'den yüksek olan hastalarda 1,9 kat, PLR değeri 197,1'in üzerinde olan hastalarda ise 1,5 kat daha yüksek olduğu gözlenmiştir. Bununla birlikte serum kalsiyum düzeyi 8,6 mg/dl'nin altında olan hastalarda akut pankreatit sonrası akut nekrotik koleksiyon gelişme riski 3 kat daha fazla olduğu saptanmıştır. Sonuç: Yüksek CRP/albümin oranı, yüksek NLR ve düşük serum ALP düzeyi varlığının akut pankreatik ve peripankreatik sıvı gelişimini öngörmede bir gösterge olarak kullanılabileceği belirlenmiştir.

Keywords

• Akut sıvı koleksiyonları
• akut nekrotik koleksiyon
• akut pankreatit
• akut peripankreatik sıvı koleksiyonları

Predictive factors for acute pancreatic and peripancreatic fluid development in patients with acute pancreatitis

Abstract

Aims: Acute fluid collections after acute pancreatitis carries risk of serious complications as infected pseudocyst and Wall off Necrose development. Hence, it is important to predict the development of acute fluid collections for treatment and management of acute pancreatitis. In this study, it is aimed to investigate predictive factors for development of acute fluid collections in patients with acute pancreatitis. Methods: Total of 438 patients diagnosed with acute pancreatitis were screened. According to the Revised Atlanta Classification fluid development after acute pancreatitis was determined and the relationship between fluid development and the hematological/biochemical parameters of the patients at the time of admission was investigated. The best cut-off point of laboratory measurements for fluid development was determined by ROC analysis and the factors that may be most decisive in distinguishing between the patients with and without fluid development were determined by multivariate forward stepwise logistic regression analysis. Results: It is found that developing acute fluid collections after acute pancreatitis was higher in patients with younger age and male gender. Also the risk of developing acute fluid collections after acute pancreatitis was found to be 6.2 times higher in patients with CRP/Albumin ratio greater than 1.09; 2.5 times higher in patients with ALP below 199.5 U/L; 1.9 times higher in patients with WBC greater than 11,6 ×10⁹/L and 1.5 times higher in patients with PLR above 197.1. Also the risk of developing acute necrotic collections after acute pancreatitis was 3 times higher in patients with serum calcium level below 8,6 mg/dl. Conclusion: It has been determined that, presence of high CRP/albumin ratio, high NLR and low serum ALP level can be used as an indicator in predicting acute pancreatic and peripancreatic fluid development.

Keywords

• Acute fluid collections
• acute necrotic collection
• acute pancreatitis
• acute peripancreatic fluid collections

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