Predictive factors for acute pancreatic and peripancreatic fluid development in patients with acute pancreatitis
Öz
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.
Anahtar Kelimeler
Acute fluid collections acute necrotic collection acute pancreatitis acute peripancreatic fluid collections
Kaynakça
- Cui ML, Kim KH, Kim HG, et al. Incidence, risk factors and clinical course of pancreatic fluid collections in acute pancreatitis. Dig Dis Sci. 2014;59(5):1055-1062.
- Guzmán-Calderón E, Diaz-Arocutipa C, Monge E. Lactate ringer’s versus normal saline in the management of acute pancreatitis: a systematic review and meta-analysis of randomized controlled trials. Dig Dis Sci. 2022;67(8):4131-4139.
- Heckler M, Hackert T, Hu K, Halloran CM, Büchler MW, Neoptolemos JP. Severe acute pancreatitis: surgical indications and treatment. Langenbecks Arch Surg. 2021;406(3):521-535.
- Matta B, Gougol A, Gao X, et al. Worldwide variations in demographics, management, and outcomes of acute pancreatitis. Clin Gastroenterol Hepatol. 2020;18(7):1567-1575.
- Diculescu M, Ciocîrlan M, Ciocîrlan M, Stănescu D, Ciprut T, Marinescu T. Predictive factors for pseudocysts and peripancreatic collections in acute pancreatitis. Rom J Gastroenterol. 2005;14(2):129-134.
- Poornachandra KS, Bhasin DK, Nagi B, et al. Clinical, biochemical, and radiologic parameters at admission predicting formation of a pseudocyst in acute pancreatitis. J Clin Gastroenterol. 2011;45(2):159-163.
- Banks PA, Bollen TL, Dervenis C, et al. Acute Pancreatitis Classification Working Group. classification of acute pancreatitis-2012: revision of the Atlanta classification and definitions by international consensus. Gut. 2013;62(1):102-111.
- Eguchi T, Tsuji Y, Okada A, et al. Reducing the risk of developing walled-off necrosis in patients with acute necrotic collection using recombinant human soluble thrombomodulin. J Hepatobiliary Pancreat Sci. 2021;28(9):788-797.
- Iannuzzi JP, King JA, Leong JH, et al. Global incidence of acute pancreatitis is increasing over time: a systematic review and meta-analysis. Gastroenterol. 2022;162(1):122-134.
- Tan JH, Zhou L, Cao RC, Zhang GW. Identification of risk factors for pancreatic pseudocysts formation, intervention and recurrence: a 15-year retrospective analysis in a tertiary hospital in China. BMC Gastroenterology. 2018;18(1):143.
- Manrai M, Kochhar R, Gupta V, et al. Outcome of acute pancreatic and peripancreatic collections occurring in patients with acute pancreatitis. Ann Surg. 2018;267(2):357-363.
- Stamatakos M, Stefanaki C, Kontzoglou K, Stergiopoulos S, Giannopoulos G, Safioleas M. Walled-off pancreatic necrosis. World J Gastroenterol. 2010;16(14):1707-1712.
- Ramia JM, de la Plaza R, Quiñones-Sampedro JE, Ramiro C, Veguillas P, García-Parreño J. Walled-off pancreatic necrosis. Neth J Med. 2012;70(4):168-171
- Akgül Ö, Ersöz Ş, Şenol K, Gündoğdu SB, Çetinkaya E, Tez M. Calcium level may be a predictive factor for pseudocyst formation after acute pancreatitis. Acta Gastroenterol Belg. 2015;78(2):219-222.
- Lin CT, McKenzie M, Pell J, Caplan L. Hypertriglyceridemia and acute pancreatitis. JAMA Inter Med. 2013;173(2):160-162.
- Carr RA, Rejowski BJ, Cote GA, Pitt HA, Zyromski NJ. Systematic review of hypertriglyceridemia-induced acute pancreatitis: a more virulent etiology? Pancreatol. 2016;16(4):469-476.
- Frick TW. The role of calcium in acute pancreatitis. Surg. 2012;152(3):157-163
- Valverde-López F, Matas-Cobos AM, Alegría-Motte C, Jiménez-Rosales R, Úbeda-Muñoz M, Redondo-Cerezo E. BISAP, RANSON, lactate and others biomarkers in prediction of severe acute pancreatitis in a European cohort. J Gastroenterol Hepatol. 2017;32(9):1649-1656.
- Lallès JP. Recent advances in intestinal alkaline phosphatase, inflammation, and nutrition. Nutr Rev. 2019;77(10):710-724.
- Fawley J, Gourlay DM. Intestinal alkaline phosphatase: a summary of its role in clinical disease. J Surgic Res. 2016;202(1):225-234.
- Yarkaç A, Kose A, Bozkurt Babuş S, Ates F, Orekici Temel G, Ölmez A. Akut pankreatitte hematolojik parametrelerin değeri. Ulus Travma Acil Cerrahi Derg. 2019;25(5):453-460.
- Kong W, He Y, Bao H, Zhang W, Wang X. Diagnostic value of neutrophil-lymphocyte ratio for predicting the severity of acute pancreatitis: a meta-analysis. Disease Markers. 2020;2020:9731854.
- Kaplan M, Ates I, Oztas E, et al. A new marker to determine prognosis of acute pancreatitis: PLR and NLR combination. J Med Biochemis. 2018;37(1):21-30.
- Dancu GM, Popescu A, Sirli R, et al. The BISAP score, NLR, CRP, or BUN: which marker best predicts the outcome of acute pancreatitis? Medicine. 2021;100(51):E28121.
- Cho SK, Jung S, Lee KJ, Kim JW. Neutrophil to lymphocyte ratio and platelet to lymphocyte ratio can predict the severity of gallstone pancreatitis. BMC Gastroenterol. 2018;18(1):18
- Werner J, Hartwig W, Uhl W, Müller C, Büchler MW. Useful markers for predicting severity and monitoring progression of acute pancreatitis. pancreatology. Elsevier B V. 2003;3(2):115-127.
- Kandasamy S. Is it all clear if procalcitonin clears in acute pancreatitis? Indian J Critic Care Med. 2020;24(3):149-150.
- Clyne B, Olshaker JS. The C-reactive protein. J Emerg Med. 1999;17(6):1019-1025.
- Stirling AD, Moran NR, Kelly ME, Ridgway PF, Conlon KC. The predictive value of C-reactive protein (CRP) in acute pancreatitis – is interval change in CRP an additional indicator of severity? HPB. 2017;19(10):874-880.
- Vinish DB, Abishek V, Sujatha K, Arulprakash S, Solomon R, Ganesh P. Role of bedside pancreatic scores and C-reactive protein in predicting pancreatic fluid collections and necrosis. Indian J Gastroenterol. 2017;36(1):43-49.
- Bozkurt E, Muhafiz E, Sengul D, Uçak T, Atum M. Can the CRP/albumin ratio be used as a new indicator of activation in patients with uveitis? Ocular Immun Inflammat. 2021;29(5):1017-1022.
- Gibson DJ, Hartery K, Doherty J, et al. CRP/Albumin ratio: an early predictor of steroid responsiveness in acute severe ulcerative colitis. J Clin Gastroenterol. 2018;52(6):48-52.
- Kaplan M, Ates I, Akpinar MY, et al. Predictive value of C-reactive protein/albumin ratio in acute pancreatitis. Hepatobil Pancr Diseas Int. 2017;16(4):424-430.
- Yılmaz EM, Kandemir A. Significance of red blood cell distribution width and c-reactive protein/albumin levels in predicting prognosis of acute pancreatitis. Ulus Trav Acil Cerrahi Derg. 2018;24(6):528-531.
Öz
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.
Anahtar Kelimeler
Akut sıvı koleksiyonları akut nekrotik koleksiyon akut pankreatit akut peripankreatik sıvı koleksiyonları
Kaynakça
- Cui ML, Kim KH, Kim HG, et al. Incidence, risk factors and clinical course of pancreatic fluid collections in acute pancreatitis. Dig Dis Sci. 2014;59(5):1055-1062.
- Guzmán-Calderón E, Diaz-Arocutipa C, Monge E. Lactate ringer’s versus normal saline in the management of acute pancreatitis: a systematic review and meta-analysis of randomized controlled trials. Dig Dis Sci. 2022;67(8):4131-4139.
- Heckler M, Hackert T, Hu K, Halloran CM, Büchler MW, Neoptolemos JP. Severe acute pancreatitis: surgical indications and treatment. Langenbecks Arch Surg. 2021;406(3):521-535.
- Matta B, Gougol A, Gao X, et al. Worldwide variations in demographics, management, and outcomes of acute pancreatitis. Clin Gastroenterol Hepatol. 2020;18(7):1567-1575.
- Diculescu M, Ciocîrlan M, Ciocîrlan M, Stănescu D, Ciprut T, Marinescu T. Predictive factors for pseudocysts and peripancreatic collections in acute pancreatitis. Rom J Gastroenterol. 2005;14(2):129-134.
- Poornachandra KS, Bhasin DK, Nagi B, et al. Clinical, biochemical, and radiologic parameters at admission predicting formation of a pseudocyst in acute pancreatitis. J Clin Gastroenterol. 2011;45(2):159-163.
- Banks PA, Bollen TL, Dervenis C, et al. Acute Pancreatitis Classification Working Group. classification of acute pancreatitis-2012: revision of the Atlanta classification and definitions by international consensus. Gut. 2013;62(1):102-111.
- Eguchi T, Tsuji Y, Okada A, et al. Reducing the risk of developing walled-off necrosis in patients with acute necrotic collection using recombinant human soluble thrombomodulin. J Hepatobiliary Pancreat Sci. 2021;28(9):788-797.
- Iannuzzi JP, King JA, Leong JH, et al. Global incidence of acute pancreatitis is increasing over time: a systematic review and meta-analysis. Gastroenterol. 2022;162(1):122-134.
- Tan JH, Zhou L, Cao RC, Zhang GW. Identification of risk factors for pancreatic pseudocysts formation, intervention and recurrence: a 15-year retrospective analysis in a tertiary hospital in China. BMC Gastroenterology. 2018;18(1):143.
- Manrai M, Kochhar R, Gupta V, et al. Outcome of acute pancreatic and peripancreatic collections occurring in patients with acute pancreatitis. Ann Surg. 2018;267(2):357-363.
- Stamatakos M, Stefanaki C, Kontzoglou K, Stergiopoulos S, Giannopoulos G, Safioleas M. Walled-off pancreatic necrosis. World J Gastroenterol. 2010;16(14):1707-1712.
- Ramia JM, de la Plaza R, Quiñones-Sampedro JE, Ramiro C, Veguillas P, García-Parreño J. Walled-off pancreatic necrosis. Neth J Med. 2012;70(4):168-171
- Akgül Ö, Ersöz Ş, Şenol K, Gündoğdu SB, Çetinkaya E, Tez M. Calcium level may be a predictive factor for pseudocyst formation after acute pancreatitis. Acta Gastroenterol Belg. 2015;78(2):219-222.
- Lin CT, McKenzie M, Pell J, Caplan L. Hypertriglyceridemia and acute pancreatitis. JAMA Inter Med. 2013;173(2):160-162.
- Carr RA, Rejowski BJ, Cote GA, Pitt HA, Zyromski NJ. Systematic review of hypertriglyceridemia-induced acute pancreatitis: a more virulent etiology? Pancreatol. 2016;16(4):469-476.
- Frick TW. The role of calcium in acute pancreatitis. Surg. 2012;152(3):157-163
- Valverde-López F, Matas-Cobos AM, Alegría-Motte C, Jiménez-Rosales R, Úbeda-Muñoz M, Redondo-Cerezo E. BISAP, RANSON, lactate and others biomarkers in prediction of severe acute pancreatitis in a European cohort. J Gastroenterol Hepatol. 2017;32(9):1649-1656.
- Lallès JP. Recent advances in intestinal alkaline phosphatase, inflammation, and nutrition. Nutr Rev. 2019;77(10):710-724.
- Fawley J, Gourlay DM. Intestinal alkaline phosphatase: a summary of its role in clinical disease. J Surgic Res. 2016;202(1):225-234.
- Yarkaç A, Kose A, Bozkurt Babuş S, Ates F, Orekici Temel G, Ölmez A. Akut pankreatitte hematolojik parametrelerin değeri. Ulus Travma Acil Cerrahi Derg. 2019;25(5):453-460.
- Kong W, He Y, Bao H, Zhang W, Wang X. Diagnostic value of neutrophil-lymphocyte ratio for predicting the severity of acute pancreatitis: a meta-analysis. Disease Markers. 2020;2020:9731854.
- Kaplan M, Ates I, Oztas E, et al. A new marker to determine prognosis of acute pancreatitis: PLR and NLR combination. J Med Biochemis. 2018;37(1):21-30.
- Dancu GM, Popescu A, Sirli R, et al. The BISAP score, NLR, CRP, or BUN: which marker best predicts the outcome of acute pancreatitis? Medicine. 2021;100(51):E28121.
- Cho SK, Jung S, Lee KJ, Kim JW. Neutrophil to lymphocyte ratio and platelet to lymphocyte ratio can predict the severity of gallstone pancreatitis. BMC Gastroenterol. 2018;18(1):18
- Werner J, Hartwig W, Uhl W, Müller C, Büchler MW. Useful markers for predicting severity and monitoring progression of acute pancreatitis. pancreatology. Elsevier B V. 2003;3(2):115-127.
- Kandasamy S. Is it all clear if procalcitonin clears in acute pancreatitis? Indian J Critic Care Med. 2020;24(3):149-150.
- Clyne B, Olshaker JS. The C-reactive protein. J Emerg Med. 1999;17(6):1019-1025.
- Stirling AD, Moran NR, Kelly ME, Ridgway PF, Conlon KC. The predictive value of C-reactive protein (CRP) in acute pancreatitis – is interval change in CRP an additional indicator of severity? HPB. 2017;19(10):874-880.
- Vinish DB, Abishek V, Sujatha K, Arulprakash S, Solomon R, Ganesh P. Role of bedside pancreatic scores and C-reactive protein in predicting pancreatic fluid collections and necrosis. Indian J Gastroenterol. 2017;36(1):43-49.
- Bozkurt E, Muhafiz E, Sengul D, Uçak T, Atum M. Can the CRP/albumin ratio be used as a new indicator of activation in patients with uveitis? Ocular Immun Inflammat. 2021;29(5):1017-1022.
- Gibson DJ, Hartery K, Doherty J, et al. CRP/Albumin ratio: an early predictor of steroid responsiveness in acute severe ulcerative colitis. J Clin Gastroenterol. 2018;52(6):48-52.
- Kaplan M, Ates I, Akpinar MY, et al. Predictive value of C-reactive protein/albumin ratio in acute pancreatitis. Hepatobil Pancr Diseas Int. 2017;16(4):424-430.
- Yılmaz EM, Kandemir A. Significance of red blood cell distribution width and c-reactive protein/albumin levels in predicting prognosis of acute pancreatitis. Ulus Trav Acil Cerrahi Derg. 2018;24(6):528-531.
Ayrıntılar
| Birincil Dil | İngilizce |
|---|---|
| Konular | Gastroenteroloji ve Hepatoloji |
| Bölüm | Research Articles [en] Araştırma Makaleleri [tr] |
| Yazarlar | |
| Yayımlanma Tarihi | 31 Aralık 2023 |
| Gönderilme Tarihi | 18 Kasım 2023 |
| Kabul Tarihi | 6 Aralık 2023 |
| Yayımlandığı Sayı | Yıl 2023 Cilt: 4 Sayı: 6 |
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