The Effect of Sarcopenia on the Prognosis of Biliary Pancreatitis Patients

Yıl 2024, Cilt: 5 Sayı: 1, 1 - 10, 31.05.2024

Leyla Zeynep Tigrel , Gamze Çıtlak , Sercan Yüksel , Tuba Selçuk Can

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

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

Kaynakça

• 1. Peery, A.F., et al., Burden of gastrointestinal disease in the United States: 2012 update. Gastroenterology, 2012. 143(5): p. 1179-1187.e3.
• 2. Gloor, B., et al., Late mortality in patients with severe acute pancreatitis. Br J Surg, 2001. 88(7): p. 975-9.
• 3. Banks, P.A. and M.L. Freeman, Practice guidelines in acute pancreatitis. Am J Gastroenterol, 2006. 101(10): p. 2379-400.
• 4. Forsmark, C.E. and J. Baillie, AGA Institute technical review on acute pancreatitis. Gastroenterology, 2007. 132(5): p. 2022-44.
• 5. Beger, H.G. and B.M. Rau, Severe acute pancreatitis: Clinical course and management. World J Gastroenterol, 2007. 13(38): p. 5043-51.
• 6. Morley, J.E., Sarcopenia: diagnosis and treatment. J Nutr Health Aging, 2008. 12(7): p. 452-6.
• 7. Koch, C., et al., Sarcopenia as a prognostic factor for survival in patients with locally advanced gastroesophageal adenocarcinoma. PLoS One, 2019. 14(10): p. e0223613.
• 8. Hopkins, J.J., et al., The Impact of Muscle and Adipose Tissue on Long-term Survival in Patients With Stage I to III Colorectal Cancer. Dis Colon Rectum, 2019. 62(5): p. 549-560.
• 9. Aliberti, M.J.R., et al., Prognostic value of a rapid sarcopenia measure in acutely ill older adults. Clin Nutr, 2019.
• 10. Derstine, B.A., et al., Skeletal muscle cutoff values for sarcopenia diagnosis using T10 to L5 measurements in a healthy US population. Sci Rep, 2018. 8(1): p. 11369.
• 11. Taylor, S.L., et al., A comparison of the Ranson, Glasgow, and APACHE II scoring systems to a multiple organ system score in predicting patient outcome in pancreatitis. Am J Surg, 2005. 189(2): p. 219-22.
• 12. Chavarria Herbozo, C.M., et al., (Hemoconcentration, Apache II and Ranson as early predictors of severity in patients with acute pancreatitis in a hospital in Lima - Peru). Rev Gastroenterol Peru, 2011. 31(1): p. 26-31.
• 13. Lankisch, P.G., et al., The harmless acute pancreatitis score: a clinical algorithm for rapid initial stratification of nonsevere disease. Clin Gastroenterol Hepatol, 2009. 7(6): p. 702-5; quiz 607.
• 14. Hagjer, S. and N. Kumar, Evaluation of the BISAP scoring system in prognostication of acute pancreatitis - A prospective observational study. Int J Surg, 2018. 54(Pt A): p. 76-81.
• 15. Simoes, M., et al., Predicting Acute Pancreatitis Severity: Comparison of Prognostic Scores. Gastroenterology Res, 2011. 4(5): p. 216-222.
• 16. Barreto, S.G. and J. Rodrigues, Comparison of APACHE II and Imrie Scoring Systems in predicting the severity of Acute Pancreatitis. World J Emerg Surg, 2007. 2: p. 33.
• 17. Raghuwanshi, S., et al., CT Evaluation of Acute Pancreatitis and its Prognostic Correlation with CT Severity Index. J Clin Diagn Res, 2016. 10(6): p. Tc06-11.
• 18. Taydas, O., et al., Accuracy of early CT findings for predicting disease course in patients with acute pancreatitis. Jpn J Radiol, 2018. 36(2): p. 151-158.
• 19. Sahu, B., et al., Severity assessment of acute pancreatitis using CT severity index and modified CT severity index: Correlation with clinical outcomes and severity grading as per the Revised Atlanta Classification. Indian J Radiol Imaging, 2017. 27(2): p. 152-160.
• 20. Lee, Y.H., et al., Bioelectrical impedance analysis values as markers to predict severity in critically ill patients. J Crit Care, 2017. 40: p. 103-107.
• 21. Madico, C., et al., Intra peritoneal abdominal fat area measured from computed tomography is an independent factor of severe acute pancreatitis. Diagn Interv Imaging, 2019. 100(7-8): p. 421-426.
• 22. Ninomiya, G., et al., Clinical impact of sarcopenia on prognosis in pancreatic ductal adenocarcinoma: A retrospective cohort study. Int J Surg, 2017. 39: p. 45-51.
• 23. Olesen, S.S., et al., Sarcopenia associates with increased hospitalization rates and reduced survival in patients with chronic pancreatitis. Pancreatology, 2019. 19(2): p. 245-251.
• 24. Shintakuya, R., et al., Sarcopenia is closely associated with pancreatic exocrine insufficiency in patients with pancreatic disease. Pancreatology, 2017. 17(1): p. 70-75.
• 25. Yoshida, D., et al., Using two different algorithms to determine the prevalence of sarcopenia. Geriatr Gerontol Int, 2014. 14 Suppl 1: p. 46-51.
• 26. Smeets, X., et al., The association between obesity and outcomes in acute pancreatitis: an individual patient data meta-analysis. Eur J Gastroenterol Hepatol, 2019. 31(3): p. 316-322.
• 27. Martinez, J., et al., Is obesity a risk factor in acute pancreatitis? A meta-analysis. Pancreatology, 2004. 4(1): p. 42-8.
• 28. Chen, S.M., G.S. Xiong, and S.M. Wu, Is obesity an indicator of complications and mortality in acute pancreatitis? An updated meta-analysis. J Dig Dis, 2012. 13(5): p. 244-51.