Ulus Travma Acil Cerrahi Derg. 2023; 29(3): 350-357 | DOI: 10.14744/tjtes.2022.33332

Utility of Ranson score, computed tomography severity index, and CRP criteria in risk stratification on the day of hospital admission in patients with acute pancreatitis: A cross-sectional analysis

Huseyin Duru
Department of Internal Medicine, Rize State Hospital, Rize-Türkiye

BACKGROUND: The early identification of severe acute pancreatitis (AP) remains a great challenge in clinical practice and novel predictors are needed to complement available scoring systems. This study aimed to investigate utility of Ranson score, and computed tomography severity index (CTSI) and C-reactive protein (CRP) criteria in determination of risk prognostic status in AP.
METHODS: A total of 104 patients with AP (median age: 71.5 (range, 21–102) years, (59.6% were males) were included in this cross-sectional study. Patients were divided into two groups according to risk prognostic status including good prognosis (n=67) and poor prognosis (n=37) groups, based on presence of at least one of the poor prognostic criteria including Ranson score ≥3, presence of pseudocyst and necrotizing fluid collection on ultrasonography or computed tomography imaging and CRP levels >15 mg/L. Data on patient demographics, etiology of AP, smoking, blood biochemistry and hemogram findings and inflammatory markers including CRP (mg/L), mean platelet volume (fL), neutrophil-lymphocyte ratio, and platelet-lymphocyte ratio were recorded.
RESULTS: Overall, 37 (35.6) patients with at least one these criteria comprised the poor prognosis group. Most of patients were considered to be in the poor prognosis group based on CTSI only (35.1%), CTSI + CRP (18.9%), and CTSI + Ranson (16.2%). Overall, 6 (5.8%) patients died, and all of them were in the poor prognosis group (p=0.002). Patients with poor versus good prognosis had significantly higher median (min-max) values for creatinine (1 [0.57–10.0] vs. 0.76 [0.5–8.4] mg/dL, p=0.004) and urea (48.0 [9.0–247.0] vs. 27.0 [10.0–111.0] mg/dL, p<0.001), and lower albumin values (3.5 [2.4–4.3] vs. 3.6 [2.7–4.6] g/L, p=0.021). Kappa values indicated presence of a moderate agreement between CTSI and CRP (kappa: 0.408), a fair agreement between CTSI and Ranson (kappa: 0.312), and a none to slight agreement between Ranson and CRP (kappa: 0.175). CTSI was able to discriminate all 6 patients (100.0%) with mortality, whereas Ranson and CRP each discriminated only 2 (33.3%) of 6 patients with mortality.
CONCLUSION: Our findings suggest a stronger individual prognostic value of CTSI alone, rather than CRP or Ranson score alone, in risk stratification of AP patients for severity of disease and related mortality risk on the day of admission, whereas emphasize the likelihood of using CRP or Ranson score complementary to CTSI to enable further identification of poor prognostic status.

Keywords: Acute pancreatitis, computed tomography severity index; C-reactive protein; inflammatory markers; peripheral blood; prog-nosis; ranson score; risk stratification.

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Akut pankreatit hastalarýnda Ranson, bilgisayarlý tomografi þiddet indeksi ve CRP kriterlerinin yatýþ günü risk derecelendirmesinde kullanýmý: Kesitsel bir çalýþma

Huseyin Duru
Rize Devlet Hastanesi, Ýç Hastalýklarý Kliniði, Rize

AMAÇ: Þiddetli pankreatit, erken tanýsý klinik pratikte zorluk teþkil etmeye devam eden bir hastalýk olup, mevcut skorlama sistemlerini tamamlayýcý yeni öngördürücülere ihtiyaç vardýr. Bu çalýþmada, Ranson skoru, bilgisayarlý tomografi þiddet indeksi (BTÞÝ) ve C-reaktif protein (CRP) kriterlerinin akut pankreatitte (AP) risk prognostik durum belirlenmesinde kullanýmýnýn incelenmesi amaçlandý.
GEREÇ VE YÖNTEM: Bu kesitsel çalýþmaya AP tanýlý 104 hasta (ortanca yaþ: 71.5 (21–102) yýl, %59.6’sý erkek) dahil edildi. Hastalar Ranson skoru ≥3, ultrason veya CT görüntülemede psödokist ve nekrotize sývý birikimi ve CRP düzeyleri >15 mg/L kriterlerinden en az birini karþýlayanlar teme-linde, risk prognostik durumlarýna göre, iyi prognoz (n=67) ve kötü prognoz (n=37) olmak üzere iki gruba ayrýldý. Hastalarýn demografik özellikleri, sigara içme durumu, AP etiyolojisi, kan biyokimya ve hemogram bulgularý ve CRP (mg/L), MPV (fL), nötrofil-lenfosit oraný (NLR), platelet-lenfosit oraný (PLR) olmak üzere enflamatuvar belirteçleri kaydedildi.
BULGULAR: Toplamda, 37 (%35.6) hasta kötü prognoz lehine en az bir kriter mevcuttu. Kötü prognoz grubundaki hastalar, çoðunlukla sadece BTÞÝ (%35.1), BTÞÝ+CRP (%18.9), BTÞÝ+Ranson (%16.2) kriterleri bazýnda saptandý. Tümü kötü prognoz grubunda sýnýflanmýþ 6 (%5.8) hastada ölüm gerçekleþti (p=0.002). Kötü prognoz gurunda iyi prognoz grubuna göre ortanca (min-mak) kreatinine (1 (0.57–10.0) vs. 0.76 (0.5–8.4) mg/dL, p=0.004) ve üre (48.0 (9.0–247.0) vs. 27.0 (10.0–111.0) mg/dL, p<0.001) deðerleri anlamlý olarak daha yüksel, albümin deðerleri (3.5 (2.4–4.3) vs. 3.6 (2.7–4.6) g/L, p=0.021) ise daha düþüktü. Kappa deðerlerine göre, BTÞÝ ile CRP arasýnda orta dereceli (kappa: 0.408), BTÞÝ ile Ranson arasýnda ise ekseriyetle (kappa: 0.312) uyuþma olduðu saptandý. BTÞÝ, ölümle sonuçlanan altý olgunun tümünü, Ranson ve CRP ise sadece ikiþer olguyu öngörebildi.
TARTIÞMA: Bulgularýmýz, AP hastalarýnda risk derecelendirmesinde, BTÞÝ’nin tek baþýna kullanýmýnýn, CRP ve Ranson skorunun tek baþlarýna kulla-nýmýna göre, hastalýk þiddeti ve mortalite riski açýsýndan daha güçlü bir prognostik deðeri olduðunu düþündürmekte ve CRP veya Ranson skorunun BTÞÝ’ye komplementer olarak kullanýmýnýn AP hastalarýnda kötü prognostik durumun daha iyi belirlenmesinde katkýsý olacaðýna iþaret etmektedir.

Anahtar Kelimeler: Akut pankreatit, bilgisayarlý tomografi þiddet indeksi; CRP; enflamatuvar belirteçler; periferik kan; prognoz; Ranson skoru; risk derece-lendirme.

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