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İnsülin direncinin akut pankreatit şiddetine etkisi

Yıl 2022, Cilt: 21 Sayı: 3, 149 - 156, 29.12.2022
https://doi.org/10.17941/agd.1134955

Öz

Giriş ve Amaç: Akut pankreatit, pankreasın çeşitli nedenlere bağlı inflamasyonudur. Tüm dünyada önemli bir morbidite ve mortalite nedenidir. Metabolik sendromun önemli bir komponenti olan insülin direncinin inflamatuvar bir durum olması nedeniyle akut pankreatit hastalarında hastalık şiddetini etkileyebileceği düşünülmektedir. Çalışmamızda insülin direncinin akut pankreatit şiddeti ile ilişkisini araştırmayı ve diğer prognostik faktörlerle karşılaştırmayı amaçladık. Gereç ve Yöntem: Çalışmamızda klinikte akut pankreatit tanısı ile yatarak tedavi almış 84 hasta değerlendirmeye alınmıştır. Çalışmamız prospektif olarak dizayn edilmiştir. Akut pankreatit şiddetini belirlemek için hastaların laboratuvar ve görüntüleme bulguları kullanılarak Atlanta Sınıflandırması, 'Bedside Index of Severity in Acute Pancreatitis' skoru, Imrie skoru, Ranson skoru, Balthazar skoru belirlenmiştir. Hastalarda insülin direnci değerlendirilmesi için “İnsülin Direncinin Homeostatik Modeli Değerlendirmesi” skoru kullanılmıştır. Buna göre insülin direnci olan ve olmayan gruplar arasında hastalık şiddeti açısından fark olup olmadığı araştırılmıştır. Bulgular: Hastaların %45.2’si insülin direnci olan grupta yer aldı. Atlanta sınıflandırmasına göre 6 hasta (%7.1) şiddetli akut pankreatit olarak sınıflandırıldı. 4 hasta prerenal akut böbrek hasarı gelişmesi ve 2 hasta sepsis ve yoğun bakım gereksinimi olması nedeniyle şiddetli akut pankreatit olarak değerlendirildi. Hastalık şiddeti açısından yapılan Receiver Operating Characteristic analizinde Balthazar ve “Yatak başı akut pankreatit şiddet indeksi” skorunun hastaların prognozunu belirlemede güçlü oldukları görüldü (sırasıyla eğri altındaki alan; 0.955 ve 0.979). İnsülin direnci olan grubun “Yatak başı akut pankreatit şiddet indeksi” ve Balthazar skorları, insülin direnci olmayan grup ile karşılaştırıldığında istatistiksel olarak anlamlı farklılık saptandı (sırasıyla p = 0.019 ve p = 0.013). Sonuç: Çalışmamızda insülin direnci olan akut pankreatit hastalarında “Yatak başı akut pankreatit şiddet indeksi” ve Balthazar skorlarının yüksek saptanması, insülin direnci varlığının akut pankreatitin şiddetli seyretmesi yönünde prognostik bir faktör olarak kullanılabileceğini düşündürmektedir.

Kaynakça

  • 1. Peery AF, Dellon ES, Lund J, et al. Burden of gastrointestinal disease in the United States : 2012 Update. Gastroenterology 2012;143:1179-87.e3.
  • 2. Toouli J, Brooke-Smith M, Bassi C, et al; Working Party of the Program Commitee of the Bangkok World Congress of Gastroenterology 2002. Guidelines for the management of acute pancreatitis. J Gastroenterol Hepatol 2002;17(Suppl):S15-39.
  • 3. Gloor B, Mu CA, Worni M, et al. Late mortality in patients with severe acute pancreatitis. Br J Surg 2001;88:975-9.
  • 4. Singh VK, Bollen TL, Wu BU, et al. An assessment of the severity of interstitial pancreatitis. Clin Gastroenterol Hepatol 2011;9:1098-103.
  • 5. Kahaleh M, Freeman M. Prevention and management of post-endoscopic retrograde cholangiopancreatography complications. Clin Endosc 2012;45:305-12.
  • 6. Huh JH, Jeon H, Park M, et al. Diabetes mellitus is associated with mortality in acute pancreatitis. J Clin Gastroenterol 2018;52:178-83.
  • 7. Krishna SG, Hinton A, Oza V, et al. Morbid obesity is associated with adverse clinical outcomes in acute pancreatitis: A propensity-matched study. Am J Gastroenterol 2015;110:1608-19.
  • 8. Huh JH, Kim JW, Lee KJ. Vitamin D deficiency predicts severe acute pancreatitis. United Eur Gastroenterol J 2019;7:90-5.
  • 9. Haas JT, Biddinger SB. Dissecting the role of insulin resistance in the metabolic syndrome. Curr Opin Lipidol 2009;20:206-10.
  • 10. Bollen TL. Acute pancreatitis: international classification and nomenclature. Clin Radiol 2016;71:121-33.
  • 11. Lankisch PG, Apte M, Banks PA. Acute pancreatitis. Lancet 2015;386:85-96.
  • 12. Altunoglu EG. Insulin resistance. Istanbul Med J 2012;13:137-40.
  • 13. Mikó A, Farkas N, Garami A, et al. Preexisting diabetes elevates risk of local and systemic complications in acute pancreatitis: Systematic review and meta-analysis. Pancreas 2018;47:917-23.
  • 14. Lee YH, Pratley RE. The evolving role of inflammation in obesity and the metabolic syndrome. Curr Diab Rep 2005;5:70-5.
  • 15. Yalniz M, Toksoy R, Demirel U, et al. Insulin resistance and adipocytokine levels in patients with acute pancreatitis. The Turkish Journal of Academic Gastroenterology 2012;11:103-9.
  • 16. Cho SK, Huh JH, Yoo JS, et al. HOMA-estimated insulin resistance as an independent prognostic factor in patients with acute pancreatitis. Sci Rep 2019;9:14894.
  • 17. Koksal AR, Boga S, Alkim H, et al. Insulin resistance as a novel risk factor for post-ERCP pancreatitis: A Pilot Study. Dig Dis Sci 2016;61:2397-405.
  • 18. Tenner S, Sica G, Hughes M, et al. Relationship of necrosis to organ failure in severe acute pancreatitis. Gastroenterology 1997;113:899-903.
  • 19. Papachristou GI, Muddana V, Yadav D, et al. Comparison of BISAP, Ranson's, APACHE-II, and CTSI scores in predicting organ failure, complications, and mortality in acute pancreatitis. Am J Gastroenterol 2010;105:435-41; quiz 442.

Effect of insulin resistance on the severity of acute pancreatitis

Yıl 2022, Cilt: 21 Sayı: 3, 149 - 156, 29.12.2022
https://doi.org/10.17941/agd.1134955

Öz

Background and Aims: Acute pancreatitis is inflammation of the pancreas due to various causes. Insulin resistance is an important component of the metabolic syndrome and causes a chronic inflammatory condition, so it may affect disease severity in acute pancreatitis patients. In our study, we aimed to investigate the relationship of insulin resistance with acute pancreatitis severity and to compare it with other prognostic factors. Materials and Methods: In our study, 84 patients hospitalized in the clinic with a diagnosis of acute pancreatitis were evaluated. Our study was designed prospectively. To determine the severity of acute pancreatitis, the Atlanta Classification, Bedside Index of Severity in Acute Pancreatitis score, Imrie score, Ranson score, and Balthazar score were determined using the laboratory and imaging findings of the patients. The 'Homeostasis Model Assessment of Insulin Resistance' score was used to evaluate insulin resistance in patients. Accordingly, it was investigated whether there was a difference between the groups with and without insulin resistance in terms of disease severity. Results: 45.2% of the patients were in the group with insulin resistance. According to the Atlanta classification, 6 patients (7.1%) were evaluated as severe acute pancreatitis. 4 patients were evaluated as severe acute pancreatitis because of the development of prerenal acute kidney injury and 2 patients due to sepsis and need for intensive care. In the Receiver Operating Characteristic analysis performed in terms of disease severity, Balthazar and the 'Bedside Index of Severity in Acute Pancreatitis' score were found to be strong in determining the prognosis of the patients (Area Under the Curve; 0.955 and 0.979, respectively). When the 'Bedside Index of Severity in Acute Pancreatitis' and Balthazar scores of the group with insulin resistance were compared with the group without insulin resistance, a statistically significant difference was found (p = 0.019 and p = 0.013, respectively). Conclusion: The high 'Bedside Index of Severity in Acute Pancreatitis' and Balthazar scores in our study in acute pancreatitis patients with insulin resistance suggest that the presence of insulin resistance can be used as a prognostic factor for severe acute pancreatitis.

Kaynakça

  • 1. Peery AF, Dellon ES, Lund J, et al. Burden of gastrointestinal disease in the United States : 2012 Update. Gastroenterology 2012;143:1179-87.e3.
  • 2. Toouli J, Brooke-Smith M, Bassi C, et al; Working Party of the Program Commitee of the Bangkok World Congress of Gastroenterology 2002. Guidelines for the management of acute pancreatitis. J Gastroenterol Hepatol 2002;17(Suppl):S15-39.
  • 3. Gloor B, Mu CA, Worni M, et al. Late mortality in patients with severe acute pancreatitis. Br J Surg 2001;88:975-9.
  • 4. Singh VK, Bollen TL, Wu BU, et al. An assessment of the severity of interstitial pancreatitis. Clin Gastroenterol Hepatol 2011;9:1098-103.
  • 5. Kahaleh M, Freeman M. Prevention and management of post-endoscopic retrograde cholangiopancreatography complications. Clin Endosc 2012;45:305-12.
  • 6. Huh JH, Jeon H, Park M, et al. Diabetes mellitus is associated with mortality in acute pancreatitis. J Clin Gastroenterol 2018;52:178-83.
  • 7. Krishna SG, Hinton A, Oza V, et al. Morbid obesity is associated with adverse clinical outcomes in acute pancreatitis: A propensity-matched study. Am J Gastroenterol 2015;110:1608-19.
  • 8. Huh JH, Kim JW, Lee KJ. Vitamin D deficiency predicts severe acute pancreatitis. United Eur Gastroenterol J 2019;7:90-5.
  • 9. Haas JT, Biddinger SB. Dissecting the role of insulin resistance in the metabolic syndrome. Curr Opin Lipidol 2009;20:206-10.
  • 10. Bollen TL. Acute pancreatitis: international classification and nomenclature. Clin Radiol 2016;71:121-33.
  • 11. Lankisch PG, Apte M, Banks PA. Acute pancreatitis. Lancet 2015;386:85-96.
  • 12. Altunoglu EG. Insulin resistance. Istanbul Med J 2012;13:137-40.
  • 13. Mikó A, Farkas N, Garami A, et al. Preexisting diabetes elevates risk of local and systemic complications in acute pancreatitis: Systematic review and meta-analysis. Pancreas 2018;47:917-23.
  • 14. Lee YH, Pratley RE. The evolving role of inflammation in obesity and the metabolic syndrome. Curr Diab Rep 2005;5:70-5.
  • 15. Yalniz M, Toksoy R, Demirel U, et al. Insulin resistance and adipocytokine levels in patients with acute pancreatitis. The Turkish Journal of Academic Gastroenterology 2012;11:103-9.
  • 16. Cho SK, Huh JH, Yoo JS, et al. HOMA-estimated insulin resistance as an independent prognostic factor in patients with acute pancreatitis. Sci Rep 2019;9:14894.
  • 17. Koksal AR, Boga S, Alkim H, et al. Insulin resistance as a novel risk factor for post-ERCP pancreatitis: A Pilot Study. Dig Dis Sci 2016;61:2397-405.
  • 18. Tenner S, Sica G, Hughes M, et al. Relationship of necrosis to organ failure in severe acute pancreatitis. Gastroenterology 1997;113:899-903.
  • 19. Papachristou GI, Muddana V, Yadav D, et al. Comparison of BISAP, Ranson's, APACHE-II, and CTSI scores in predicting organ failure, complications, and mortality in acute pancreatitis. Am J Gastroenterol 2010;105:435-41; quiz 442.
Toplam 19 adet kaynakça vardır.

Ayrıntılar

Birincil Dil Türkçe
Konular Sağlık Kurumları Yönetimi
Bölüm Makaleler
Yazarlar

Enes Keskin Bu kişi benim 0000-0003-0040-7057

Engin Altınkaya Bu kişi benim 0000-0001-6636-7073

Yayımlanma Tarihi 29 Aralık 2022
Yayımlandığı Sayı Yıl 2022 Cilt: 21 Sayı: 3

Kaynak Göster

APA Keskin, E., & Altınkaya, E. (2022). İnsülin direncinin akut pankreatit şiddetine etkisi. Akademik Gastroenteroloji Dergisi, 21(3), 149-156. https://doi.org/10.17941/agd.1134955

test-5