Scripta Medica (Jan 2017)
Impact of biochemical parameters in the assessment of local complications and outcome of acute
Abstract
Introduction: The mortality in severe acute pancreatitis is caused by sepsis and multiple organ failure. The disease is progressing from decade to decade, as shown by numerous international epidemiological reports. The mortality is higher after complications in addition to local and systemic defects, affecting the following organs: cardiovascular system, respiratory system, kidneys, central nervous system and metabolism in general. Aim of the Study: To determine whether a low-cost and commonly used laboratory parameters (hematocrit and CRP), determined upon the admission of patients with acute pancreatitis in the intensive care unit can be predictors of necrosis of pancreatic tissue in a CT scan of the abdomen, and whether the trend of their values is the predictor of disease outcome. Patients and Methods: This study was performed in patients (n = 61) who were treated for acute pancreatitis in the Intensive Care Unit at the University Clinical Center in Banja Luka, RS, General Hospital in Gradiska and Trebinje Hospital, from October, 2008 to October, 2013. Results: The distribution of age exhibited an effect equal to the percentage of patients in the decade of 51.y.-60.y./ 61.y.-70.y., (20%), that is, equal to the number of patients and in the decade of 31.y.-40.y. and over 71.y. The minimum number of patients who got sick was in the decade 21.y.-30.y. 10% of patients got sick in the decade 41.y.-50.y. The percentage of etiology determined cases was 64% and 36% was undetermined. Regarding the representation of the etiological factors, the most represented was biliary etiology (39%), then 36% of the cases were idiopathic, alcoholism as etiological factor was represented in 23% of cases, and the etiology of post-operative acute pancreatitis in 2%. CRP values on the admission to the ICU, higher than 150, and in accordance with the results of chi-square test, was shown to have been the predictor of the pancreatic tissue necrosis ch2 (1) = 13.97 p = .00.Hct value upon the admission to the ICU, higher or equal to .45, and in accordance with the results of chi square test, was shown to have been the early predictor of necrosis: ch2 (1) = 4.21 p = .04. According to the results of the logistic regression model, decrease in CRP and HCT values of 20% for at least 48 hours after the admission to the ICU, was not the predictor of disease outcome: B (SE) = 20:24 (23205.42); p = .99; R2 (Negelkerke) = .044. Conclusion: Low-cost laboratory tests in terms of hematocrit and CRP are simple, often used and available. According to the results of our study, we recommend them as a screening test when you are in doubt whether or not to send patients with acute pancreatitis on CT diagnostics although the trends of their values in the first 48 hours of treatment in an intensive care unit cannot be the predictor of outcome of disease.
