Pankreatitin Ciddiyetini Değerlendirmede C-Reaktif Protein ve Prokalsitoninin Değerliliği

Yıl 2023, , 160 - 164, 29.12.2023

Sinan Karacabey , Erkman Sanrı

https://doi.org/10.54996/anatolianjem.1370332

Öz

Amaç: Şiddetli AP'nin erken tespiti için pek çok skorlama sistemi geliştirilmiştir, ancak birçok parametreyi içerdikleri için AP'nin ciddiyetini tahmin etmede uygun değildirler. Son zamanlarda, C-reaktif proteinin rolü, inflamatuar ve enfektif durumların ciddiyetinin değerlendirilmesinde incelenmiştir. Biyokimyasal belirteç olan serum prokalsitonin , AP'nin ciddiyetini tahmin etmek için nispeten doğru ve uygun bir yöntemdir ve kolayca ölçülür. Çalışmamızda kullanılmakta olan ciddiyet skorlarından BISAP, BCTSI skorlarının ve PCT ve CRP değerlerinin akut pankreatitin ciddiyetini öngördürmedeki değerliliğini RAS ile karşılaştırılması amaçlanmıştır.

Gereç ve Yöntemler: Çalışmaya 18 yaş üstü AP şüphesi olan ve aydınlatılmış onam veren tüm hastalar dahil edilmiştir. Hastalar kabul edilen standart AP yönetimi kullanılarak tedavi edildi. Başvuru sırasında PCT ve CRP için kan örnekleri toplandı ve diğer skorlama sistemleri için biyokimyasal testler başvuru sırasında (0. gün) yapıldı. Ranson, BISAP, SIRS puanları kaydedildi. BCTSI skoru için; Kontrastlı BT, başvuru esnasında yapıldı ve semptomların kötüleşmesi durumunda tekrarlandı ve sonuçları kayıt altına alındı.

Bulgular: Hastaların 100'ü Erkek, 75'i kadındı. Ortalama hasta yaşı 53 yıldı. Atlanta kriterlerine göre 136 hasta hafif, 19 hasta orta, 20 hasta ise ağır AP olarak sınıflandırıldı. Yaşa göre anlamlı fark varken(p<0,01); cinsiyete (p=0,052) göre anlamlı farklılık yoktu. Çalışmaya alınan hastalardan dokuzu ex oldu. Bir hastada hafif AP mevcutken sekiz hastada da şiddetli AP vardı. Altı parametrenin tümü, şiddetli AP'yi tahmin etmek için eğri altında kalan alan (AUC) kullanılarak analiz edildi. Analize göre BISAP sonuçları mükemmeldi (AUC = 0,884; p <0,001) ve serum PCT'nin sonucu da BISAP skoruna benzer şekilde iyiydi (AUC = 0,880; p <0,001). Analize göre Ranson, BCTSI, SIRS ve CRP genel olarak iyi sonuçlar verdi (sırasıyla AUC= 0,704, AUC = 0,783, AUC=0,766 ve AUC =0,649).

Sonuç: Sonuç olarak, serum PCT'si AP'nin ciddiyetini öngörmede faydalıdır ve BISAP skoruna benzer bir doğruluğa sahiptir. BISAP nispeten basittir ve Ranson skoruda dahil diğer çok faktörlü skorlama sistemlerinden daha fazla doğruluğa sahiptir, bu da onu AP'nin klinik şiddetini tahmin etmede umut verici bir yöntem haline getirmektedir.

Anahtar Kelimeler

CRP, prokalsitonin, akut pankreatit, ciddiyet

Value of C-Reactive Protein and Procalcitonin in Assessing the Severity of Acute Pancreatitis

Öz

Aim: Many scoring systems have been developed for the early detection of severe AP, but they are not suitable for predicting the severity of AP because they include many parameters. Recently, the role of C-reactive protein has been examined in assessing the severity of inflammatory and infective conditions. The biochemical marker serum procalcitonin is a relatively accurate and convenient method to estimate the severity of AP and is easily measured. It was aimed to compare the value of BISAP, BCTSI scores, PCT and CRP values, which are among the severity scores used in our study, with RAS in predicting the severity of acute pancreatitis.

Material and Methods: All patients over the age of 18 with suspected AP and who gave informed consent were included in the study. Patients were treated using accepted standard AP management. Blood samples for PCT and CRP were collected at admission, and biochemical tests for other scoring systems were performed at admission (day 0). Ranson, BISAP, SIRS scores were recorded. For BCTSI score; Contrast-enhanced CT was performed at admission and repeated if symptoms worsened, and the results were recorded.

Results: 100 of the patients were male and 75 were female. The average patient age was 53 years. According to the Atlanta criteria, 136 patients were classified as mild, 19 patients as moderate, and 20 patients as severe AP. While there is a significant difference according to age (p <0.01); There was no significant difference according to gender (p = 0.052). Nine of the patients included in the study died. While one patient had mild AP, eight patients had severe AP. All six parameters were analyzed using the area under the curve (AUC) to predict severe AP. According to the analysis, the results of BISAP were excellent (AUC = 0.884; p < 0.001), and the result of serum PCT was also good (AUC = 0.880; p < 0.001), similar to the BISAP score. According to the analysis, Ranson, BCTSI, SIRS and CRP showed generally good results (AUC = 0.704, AUC = 0.783, AUC = 0.766 and AUC = 0.649, respectively).

Conclusion: In conclusion, serum PCT is useful in predicting the severity of AP and has an accuracy similar to the BISAP score. BISAP is relatively simple and has greater accuracy than other multifactorial scoring systems, including the Ranson score, making it a promising method for predicting the clinical severity of AP.

Anahtar Kelimeler

CRP, procalcitonin, acute pancreatitis, severity

Destekleyen Kurum

None

Teşekkür

None

Kaynakça

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