Biliyer Pankreatit Hastalarının Prognozunda Sarkopeninin Etkisi

Öz

Amaç: Akut biliyer pankreatit hastalarında progonozun hesaplanmasında kullanılan mevcut skorlama sistemlerinin karşılaştırılması ve beslenme ile sarkopeninin prognozdaki öneminin ortaya koymak. Gereç ve Yöntem: 70 akut biliyer pankreatit hastasının Ranson, ‘Harmless Acute Pancreatitis Score’ (Zararsız Akut Pankreatit Skoru) (HAPS), ‘Bedside Index of Severity in Acute Pancreatitis’ (Akut Pankreatitte Yatak Başı Şiddet İndeksi) (BISAP), Glasgow-Imrie skorları ve Bilgisayarlı tomografi (BT) şiddet indeksi değerleri hesaplanarak kaydedildi. Biyoelektrik impedans analizleri yapıldı. Tomografi görüntüleri üzerinden ölçülen psoas kasının kesitsel alanı kullanılarak sarkopeni ölçümleri yapıldı. Bulgular: Pankreartit skorlamalarından BISAP (p=0,024) ve BT şiddet indeksi (p=0,050) uzun hastane yatışı ile ilişkilendirildi. Ranson, HAPS, Glasgow-Imrie skorlamaları hastaların yatış süresi ve komplikasyon gelişimine etkisiz bulundu. Vücut yağ yüzdesi yüksek olan hastalarda komplikasyonlar daha yüksek olarak görüldü (p=0,039), BT şiddet indeksi yüksek olan hastalarda komplikasyon oranlarının arttıı görüldü (p=0,000). Yaş ortalamasına göre sarkopeni prevelansı beklenenden yüksek bulundu (%47). İleri yaş (p=0,027), komorbid hastalıklar (p=0,032) ve düşük kilonun (p=0,012) sarkopeni için risk faktörü olduğu istatistiksel olarak kanıtlandı. Sarkopeni ve Obezite ile pankreatit prognozu arasında ilişki bulunamadı. Tartışma: Pankreatit prognozunu öngörmek için BISAP ve BT şiddet indeksinin kullanılması tarafımızca önerilir. Sarkopeni ve Obezite ile pankreatit prognozu arasındaki ilişkinin daha net ortaya koyulması için konuyla ilgili daha kapsamlı çalışmalar yapılması gerekmektedir.

Anahtar Kelimeler

• Pankreatit
• Sarkopeni
• Obezite
• Ranson kriterleri
• BISAP
• BT şiddet indeksi

The Effect of Sarcopenia on the Prognosis of Biliary Pancreatitis Patients

Öz

Background: To compare the current scoring systems used for predicting acute biliary pancreatitis prognosis and to determine the importance of sarcopenia in prognosis. Materials and Methods: 70 acute biliary pancreatitis patients Ranson’s, Harmless Acute Pancreatitis Score (HAPS), Bedside Index of Acute Pancreatitis Severity (BISAP) Glasgow-Imrie scores and computed tomography (CT) severity index results were recorded. Patients bioelectrical impedance were analyzed and psoas muscle cross-sectional areas were measured on CT images to determine presence of sarcopenia. Results: Increased BISAP (p = 0.024) and CT severity index (p=0.050) scores were associated with longer hospitalization. Ranson’s, HAPS and Glasgow-Imrie scores were ineffective to predict hospitalization length and complications. High body fat percentage (p=0,039) and CT severity index (p=0.000) were associated with increased complications. The prevalence of sarcopenia according to age was higher than expected in patient group (47%). There was no relationship between sarcopenia and the prognosis of pancreatitis. Conclusion: BISAP and CT severity index are reliable scoring systems to determine prognosis of acute biliary pancreatitis. Understanding the effect of sarcopenia in acute pancreatitis warrants further investigation.

Anahtar Kelimeler

• Pancreatitis
• Sarcopenia
• Obesity
• BISAP
• CT sevirity index
• Ranson's criteria

Kaynakça

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