Akut pankreatitde organ yetersizliðinin önemi ve prognostik belirteç sistemleri ile karþýlaþtýrýlmasý

AMAÇ: Akut pankreatit (AP) pankreas bezinde inaktif halde bulunan sindirim enzimlerinin çeþitli nedenlerle aktif hale geçmesi sonucunda, pankreas bezinde, çevre dokularda ve enflamasyonun yayýlmasýyla sistemik bir etki gösterebilen klinik durumdur. Hastalýðýn prognozunda en sýk Ranson ve Atlanta gibi sýnýflama sistemleri kullanýlmaktadýr. Ancak akut pankreatite baðlý geliþen organ yetersizlikleri, laboratuvar verileri ve hastalarýn antropometrik özelliklerinin de hastalýðýn þiddeti ve prognozuyla iliþkili olduðu ortaya konmuþtur. Çalýþmamýzda AP seyrinde ortaya çýkan organ yetersizlikleri, biyokimyasal parametreler ve hastalara ait antropometrik verilerin, Ranson ve Atlanta sýnýflama (AS) sistemleri ile arasýndaki iliþkiyi ortaya koymayý amaçladýk.
GEREÇ VE YÖNTEM: AP’li 19 ile 89 yaþlarý arasýnda 153 hastanýn Ranson ve Modifiye Atlanta Sýnýflamasý (MAS) skoru hesaplanarak laboratuvar verileri, bel çevresi, vücut kitle indeksi (VKÝ) gibi antropometrik verileri, organ yetersizliði tablosu araþtýrýldý. Geliþen organ yetersizlikleri (akciðer, karaciðer, böbrek, kalp ve multiorgan yetersizliði) Ranson deðeri ve MAS skoru yüksekliðiyle iliþkili (p<0.05) olarak bulundu. Çalýþmaya alýnan hastalardan 13’ünde (%8.4) multiorgan yetersizliði, 17’sinde (%11.1) Sistemik enflamatuvar response sendromu (SIRS) geliþmiþtir. On hasta (%6.5) hayatýný kaybetti. Organ yetersizlikleri, multiorgan yetersizliði (MOY) ve SIRS geliþen hastalarla hayatýný kaybeden hastalar arasýnda yapýlan istatistiksel analizde p deðeri (p<0.05) olarak anlamlý iliþki saptandý. Bel çevresi ve vücut kitle indeksi Ranson deðeriyle iliþkili saptanmazken, Modifiye Atlanta Sýnýflamasýyla bel çevresi arasýnda anlamlý iliþki saptandý (p<0.01). Laboratuvar verilerinden üre ve ALT yüksekliði, Ranson ve Modifiye Atlanta Sýnýflamasýyla iliþkili saptanýrken (p<0.001), 0 ve 48. saatte bakýlan C-reaktif protein (CRP) deðerindeki yüksekliklerden sadece 48. saatteki CRP deðeri Ranson deðeriyle iliþkili olarak bulundu (p<0.05).
BULGULAR: Organ yetersizliði, MOY, SIRS, her iki þiddet skoruyla korele olmasýnýn yanýnda mortalite ile de anlamlý olarak koreleydi. Ek olarak kolesterol, trigliserit ve yatýþ anýndaki CRP düzeyiyle mortalite arasýnda anlamlý korelasyon elde edilirken; kalsiyum, lipaz ve hematokrit gibi laboratuvar verileriyle anlamlý iliþki saptanmadý.
TARTIÞMA: Sonuç olarak, akut pankreatitin þiddet ve prognozunu belirlemede ve þiddetli seyreden pankreatitlerde ortaya çýkabilecek olan organ yetersizlikleri açýsýndan dikkatli olunmasýnda; klasik þiddet skorlama sistemlerinin yanýnda hastalara ait vücut kitle indeksi, bel çevresi ve kolesterol, trigliserit, ALT, CRP gibi laboratuvar verileri önemli prognostik bilgiler vermektedir.

Comparison between prognostic indicators in organ insufficiency with acute pancreatitis

BACKGROUND: Organ failures that develop due to acute pancreatitis (AP), some laboratory values and the anthropometric characteristics of the patients have been shown to play a role in the prognosis AP and have been increasingly used to investigate the prognosis of the disease although classification systems, such as Ranson’s criteria, are still used habitually. In this stud, we aimed to investigate the relationship of the organ failures observed during the course of AP, the biochemical parameters and the anthropometric characteristics of the patients and compare using Ranson’s and Atlanta Classifica-tion (AC) systems.
METHODS: Laboratory values, anthropometric data, including the waist circumference and body mass index, Systemic inflammatory response syndrome (SIRS) and organ failures developed during the course of the disease, were investigated prospectively in 153 AP patients and the Ranson and Modified Atlanta Classifications (MAC) were made.
RESULTS: A relationship was observed between the organ failures that were established in the course of the disease (lung, liver, kidney, heart and MOF (multiple organ failure)) and higher Ranson’s and MAC scores (p<0.05). Among the patients included in this study, 13 (8.4%) had multiple organ failure and 17 (11.1%) had SIRS. Exitus occurred in 10 patients (6.5%). A statistically significant relationship was found with organ failure, multiple organ failure and SIRS; and ensuing exitus (p<0.05). While no relationship was observed between the waist circumference, body mass index, Ranson’s score, there was a significant relationship between the MAC and the waist circumference (p<0.01). Among the laboratory values, high urea and ALT values showed a relationship with the Ranson and MAC (p<0.001), while between the CRP values tested at the 0 time point and the 48th hour, only the CRP value at the 48th hour had a relationship with Ranson’s score (p<0.05). Organ failure, MOF, and SIRS showed a correlation with both the severity scores and the mortality rate. In addition, a significant corre-lation was observed between the cholesterol, triglycerides and the CRP level at the time of hospitalisa-tion and mortality. On the contrary, no significant relationship was observed with the other laboratory results, including calcium, lipase and hematocrit.
CONCLUSION: In conclusion, to determine the severity and prognosis of acute pancreatitis, and ex-pect the organ failures that may occur in severe pancreatitis, the body mass index, waist circumference and laboratory values, including cholesterol, triglycerides, ALT, and CRP may supply important prog-nostic data besides the conventional disease severity scoring methods.