González-Garza F, García-Zermeño K, Álvarez-López F

Language: Spanish
References: 13
Page: 66-72
PDF size: 643.14 Kb.

ABSTRACT

Introduction Acute pancreatitis (AP) is a diseases characterized by a pancreas inflammatory process present on a mild course in a 80%, and severe course on 20% of the cases, the latter group being of utmost importance to predict the severity. The AP is a clinical entity that during the past years has showed an increasing prevalence. Worldwide, its handling on most of the patients is medical, saving its surgical handling for the severe cases or with complications, because of this, it is very important to have a scoring scale to evaluate the patients during the first 24 hours of hospitalization allowing a more accurate prediction of the possibility of complication development.
Material and methods A descriptive, open, prospective, cohort study was performed in the gastroenterology department of Fray Antonio Alcalde Hospital starting January 1st 2012. This study included patients 18 years old and over, of both sexes, admitted with diagnosis of acute pancreatitis assessed by the presence of typical abdominal pain, elevation of lipase and/or amylase ≤3 times their normal upper limit as well as characteristic findings in abdominal contrast axial tomography scan taken in the first 72 hours upon hospital admittance. RANSON, APACHE II and BISAP scales were assessed as well as their usefulness as predictors of severity, organic failure, complications and mortality.
Results A total of 69 patients were included in the study prospectively. Clinical and laboratorial data of all the patients was gathered in the first 24 hours upon hospital admission and RANSON, APACHE II, BISAP scales calculated. Etiology od acute pancreatitis was as follows: Biliary in 49 cases (70%) of which 35 (50%) were mild and 14 (20%) severe .being most of the cases men 41 (59.2%). Alcoholic 9 cases (12.9%) of which 7 cases (10%) were mild and 2 (2.9%) severe, being predominantly female patients (88.9%). There was one case of AP following endoscopic retrograde cholangiopancreatography, which was mild; 4 cases secondary to hypertriglyceridemia predominantly female in 3 of the cases (75%); 1 case due to hypercalcemia; 1 due to neoplasia and 4cases (5.7%) idiopathic. Twenty one of the patients had CAT scans done in the first 72 hours upon hospital admission. Overall mortality in this study was 2.9%
Discussion Accurateness of these three multifactorial prognostic scales was compared in a prospective study which included patients diagnosed with acute pancreatitis. It was confirmed that BISAP, RANSON, APACHE II scales are a reliable tool to stratify patients with AP within their first 24 hours of their admission to hospital, and up to 48 hours in the case of RANSON scale. However, there is the evident disadvantage that these scales are not designed to predict potentially foreseeable complications in acute pancreatitis.

REFERENCES

1. 1.Gardner TB, Olenec Ch A, Chertoff JD, et al. Hemoconcentration and Pancreatic Necrosis Further Defining the Relationship. Pancreas 2006;33:169-173.

2. AGA Institute Technical Review on Acute Pancreatitis. Gastroenterology;2007;132: 2022–2044.

3. Singh VK, Chien B, Bollen Th L, et al. A Prospective Evaluation of the Bedside Index for Severity in Acute Pancreatitis Score in Assessing Mortality and Intermediate Markers of Severity in Acute Pancreatitis. Am J Gastroenterol 2009;104:966–971.

4. Pitchumoni C, Nayan P, Shah P. Factors Influencing Mortality in Acute Pancreatitis Can We Alter Them? J Clin Gastroenterol 2005;39:798–814.

5. Georgius I, Muddana V, Yardav D, et al. Comparison of BISAP, Ranson's, APACHE-II and CTSI Scores in Predicting Organ Failure, Complications, and Mortality in Acute Pancreatitis, Am J Gastroenterol 2010;105:435-441.

6. Heyer J, Amaral J. Pancreatitis aguda; Med Int Mex 2009;25:285-294.

7. Banks P, Freeman M, et al. Practice Guidelines in Acute Pancreatitis, Am J Gastroenterol 2006; 101:2379–2400

8. Banks P, Bollen T, Dervenis C. Classification of acute pancreatitis 2012: revision of the Atlanta classification and definitions by international consensus. Gut 2013;62:102-111.

9. Mounzer R, Christopher J, Bechien U, et al. Comparison of Existing Clinical Scoring Systems to Predict Persistent Organ Failure in Patients With Acute Pancreatitis, Am J Gastroenterol 2012;142:1476–1482.

10. AGA Institute Medical Position Statement on Acute Pancreatitis. Gastroenterology 2007;132: 2019–2021.

11. Baron TH and Morgan DE. Treatment of Necrotizing Pancreatitis; Clin Gastroenterol Hepatol 2012;10:1412-1417

12. Anand N, Park J, Bechien U, et al. Modern Management of Acute Pancreatitis, Gastroenterol Clin N Am 2012;41:1-8.

13. Whitcomb D. Acute pancreatitis. N Engl J Med; 2006; 354:2142-2150.