Pankreatitin Ciddiyetini Değerlendirmede C-Reaktif Protein ve Prokalsitoninin Değerliliği

Yıl 2023, Cilt: 6 Sayı: 4, 160 - 164, 29.12.2023

Sinan Karacabey , Erkman Sanrı

https://doi.org/10.54996/anatolianjem.1370332

Öz

Amaç: Şiddetli AP'nin erken tespiti için pek çok skorlama sistemi geliştirilmiştir, ancak birçok parametreyi içerdikleri için AP'nin ciddiyetini tahmin etmede uygun değildirler. Son zamanlarda, C-reaktif proteinin rolü, inflamatuar ve enfektif durumların ciddiyetinin değerlendirilmesinde incelenmiştir. Biyokimyasal belirteç olan serum prokalsitonin , AP'nin ciddiyetini tahmin etmek için nispeten doğru ve uygun bir yöntemdir ve kolayca ölçülür. Çalışmamızda kullanılmakta olan ciddiyet skorlarından BISAP, BCTSI skorlarının ve PCT ve CRP değerlerinin akut pankreatitin ciddiyetini öngördürmedeki değerliliğini RAS ile karşılaştırılması amaçlanmıştır.

Gereç ve Yöntemler: Çalışmaya 18 yaş üstü AP şüphesi olan ve aydınlatılmış onam veren tüm hastalar dahil edilmiştir. Hastalar kabul edilen standart AP yönetimi kullanılarak tedavi edildi. Başvuru sırasında PCT ve CRP için kan örnekleri toplandı ve diğer skorlama sistemleri için biyokimyasal testler başvuru sırasında (0. gün) yapıldı. Ranson, BISAP, SIRS puanları kaydedildi. BCTSI skoru için; Kontrastlı BT, başvuru esnasında yapıldı ve semptomların kötüleşmesi durumunda tekrarlandı ve sonuçları kayıt altına alındı.

Bulgular: Hastaların 100'ü Erkek, 75'i kadındı. Ortalama hasta yaşı 53 yıldı. Atlanta kriterlerine göre 136 hasta hafif, 19 hasta orta, 20 hasta ise ağır AP olarak sınıflandırıldı. Yaşa göre anlamlı fark varken(p<0,01); cinsiyete (p=0,052) göre anlamlı farklılık yoktu. Çalışmaya alınan hastalardan dokuzu ex oldu. Bir hastada hafif AP mevcutken sekiz hastada da şiddetli AP vardı. Altı parametrenin tümü, şiddetli AP'yi tahmin etmek için eğri altında kalan alan (AUC) kullanılarak analiz edildi. Analize göre BISAP sonuçları mükemmeldi (AUC = 0,884; p <0,001) ve serum PCT'nin sonucu da BISAP skoruna benzer şekilde iyiydi (AUC = 0,880; p <0,001). Analize göre Ranson, BCTSI, SIRS ve CRP genel olarak iyi sonuçlar verdi (sırasıyla AUC= 0,704, AUC = 0,783, AUC=0,766 ve AUC =0,649).

Sonuç: Sonuç olarak, serum PCT'si AP'nin ciddiyetini öngörmede faydalıdır ve BISAP skoruna benzer bir doğruluğa sahiptir. BISAP nispeten basittir ve Ranson skoruda dahil diğer çok faktörlü skorlama sistemlerinden daha fazla doğruluğa sahiptir, bu da onu AP'nin klinik şiddetini tahmin etmede umut verici bir yöntem haline getirmektedir.

Anahtar Kelimeler

CRP, prokalsitonin, akut pankreatit, ciddiyet

Value of C-Reactive Protein and Procalcitonin in Assessing the Severity of Acute Pancreatitis

Öz

Aim: Many scoring systems have been developed for the early detection of severe AP, but they are not suitable for predicting the severity of AP because they include many parameters. Recently, the role of C-reactive protein has been examined in assessing the severity of inflammatory and infective conditions. The biochemical marker serum procalcitonin is a relatively accurate and convenient method to estimate the severity of AP and is easily measured. It was aimed to compare the value of BISAP, BCTSI scores, PCT and CRP values, which are among the severity scores used in our study, with RAS in predicting the severity of acute pancreatitis.

Material and Methods: All patients over the age of 18 with suspected AP and who gave informed consent were included in the study. Patients were treated using accepted standard AP management. Blood samples for PCT and CRP were collected at admission, and biochemical tests for other scoring systems were performed at admission (day 0). Ranson, BISAP, SIRS scores were recorded. For BCTSI score; Contrast-enhanced CT was performed at admission and repeated if symptoms worsened, and the results were recorded.

Results: 100 of the patients were male and 75 were female. The average patient age was 53 years. According to the Atlanta criteria, 136 patients were classified as mild, 19 patients as moderate, and 20 patients as severe AP. While there is a significant difference according to age (p <0.01); There was no significant difference according to gender (p = 0.052). Nine of the patients included in the study died. While one patient had mild AP, eight patients had severe AP. All six parameters were analyzed using the area under the curve (AUC) to predict severe AP. According to the analysis, the results of BISAP were excellent (AUC = 0.884; p < 0.001), and the result of serum PCT was also good (AUC = 0.880; p < 0.001), similar to the BISAP score. According to the analysis, Ranson, BCTSI, SIRS and CRP showed generally good results (AUC = 0.704, AUC = 0.783, AUC = 0.766 and AUC = 0.649, respectively).

Conclusion: In conclusion, serum PCT is useful in predicting the severity of AP and has an accuracy similar to the BISAP score. BISAP is relatively simple and has greater accuracy than other multifactorial scoring systems, including the Ranson score, making it a promising method for predicting the clinical severity of AP.

Anahtar Kelimeler

CRP, procalcitonin, acute pancreatitis, severity

Destekleyen Kurum

None

Teşekkür

None

Kaynakça

• Workıng Group IAP/APA Acute Pancreatıtıs Guıdelınes. IAP/APA evidence-based guidelines for the management of acute pancreatitis. Pancreatology, 2013; 13 : e1-15.
• Roberts SE, Morrıson-Rees S, John A, Wıllıams JG, Brown TH, Samuel DG. The incidence and aetiology of acute pancreatitis across Europe. Pancreatology, 2017; 17 : 155-165.
• Fagenholz PJ, Castillo CF, Harris NS, PelletierAJ, Camargo CA, JR. Increasing United States hospital admissions for acute pancreatitis, 1988-2003. Ann Epidemiol., 2007; 17 : 491-497.
• Krıshna SG, Kamboj AK, Hart PA, Hinton A, Conwell DL. The Changing Epidemiology of Acute Pancreatitis Hospitalizations: A Decade of Trends and the Impact of Chronic Pancreatitis. Pancreas, 2017; 46 : 482-488.
• Sıngla A, Sımons J, Li Y, Csıkesz NG, NG SC, Tseng JF, et al. Admission volume determines outcome for patients with acute pancreatitis. Gastroenterology, 2009; 137 : 1995-2001.
• Popa CC, Badiu DC, Rusu OC, Grıgorean VT, Neagu SI, Strugaru CR. Mortality prognostic factors in acute pancreatitis. J Med Life, 2016; 9 : 413-418.
• Banks PA, Bollen TL, Dervenıs C, Gooszen HG, Johnson CD, Sarr MG, et al. Classification of acute pancreatitis–2012: revision of the Atlanta classification and definitions by international consensus. Gut, 2013; 62 : 102-111.
• Ranson JH, Pasternack BS. Statistical methods for quantifying the severity of clinical acute pancreatitis. J Surg Res 1977;22:79-91.
• Yeung YP, Lam BY, Yip AW. APACHE system is better than Ranson system in the prediction of severity of acute pancreatitis. Hepatobiliary Pancreat Dis Int 2006;5:294-299.
• Wilson C, Heath DI, Imrie CW. Prediction of outcome in acute pancreatitis: a comparative study of APACHE II, clinical assessment and multiple factor scoring systems. Br J Surg 1990;77:1260-1264.
• Knaus WA, Draper EA, Wagner DP, Zimmerman JE. APACHE II: a severity of disease classification system. Crit Care Med 1985;13:818-829.
• Balthazar EJ, Robinson DL, Megibow AJ, Ranson JH. Acute pancreatitis: value of CT in establishing prognosis. Radiology 1990;174:331-336.
• Sproston NR, Ashworth JJ: Role of C-reactive protein at sites of inflammation and infection. Front Immunol. 2018, 9:754. 10.3389/fimmu.2018.00754 6.
• Wilson C, Heads A, Shenkin A, Imrie CW: C-reactive protein, antiproteases and complement factors as objective markers of severity in acute pancreatitis. Br J Surg. 1989, 76:177-81. 10.1002/bjs.1800760224 7.
• Hong W, Lin S, Zippi M, et al.: Serum albumin is independently associated with persistent organ failure in acute pancreatitis. Can J Gastroenterol Hepatol. 2017, 2017:5297143. 10.1155/2017/5297143
• Gurda-Duda A, Kusnierz-Cabala B, Nowak W, Naskalski JW, Kulig J. Assessment of the prognostic value of certain acute-phase proteins and procalcitonin in the prognosis of acute pancreatitis. Pancreas 2008;37:449- 453.
• Modrau IS, Floyd AK, Thorlacius-Ussing O. The clinical value of procalcitonin in early assessment of acute pancreatitis. Am J Gastroenterol 2005;100:1593-1597.
• Kylanpaa-Back ML, Takala A, Kemppainen E, Puolak- kainen P, Haapiainen R, Repo H. Procalcitonin strip test in the early detection of severe acute pancreatitis. Br J Surg 2001;88:222-227.
• Wu BU, Johannes RS, Sun X, Tabak Y, Conwell DL, Banks PA. The early prediction of mortality in acute pancreatitis: a large population-based study. Gut 2008;57:1698-1703.
• Bradley EL 3rd. A clinically based classification system for acute pancreatitis: summary of the International Symposium on Acute Pancreatitis, Atlanta, Ga, September 11 through 13, 1992. Arch Surg 1993;128:586-590.
• Buter A, Imrie CW, Carter CR, Evans S, McKay CJ. Dynamic nature of early organ dysfunction determines outcome in acute pancreatitis. Br J Surg 2002;89:298- 302.
• Villatoro E, Mulla M, Larvin M. Antibiotic therapy for prophylaxis against infection of pancreatic necrosis in acute pancreatitis. Cochrane Database Syst Rev 2010;(5):CD002941.
• Servin-Torres E, Velazquez-Garcia JA, Delgadillo-Teyer G, Galindo-Mendoza L, Bevia-Perez F, Rivera-Bennet F. Severe acute pancreatitis: surgical management in a third-level hospital. Cir Cir 2009;77:407-410.
• Dervenis C, Bassi C. Evidence-based assessment of severity and management of acute pancreatitis. Br J Surg 2000;87:257-258.
• Lempinen M, Puolakkainen P, Kemppainen E. Clinical value of severity markers in acute pancreatitis. Scand J Surg 2005;94:118-123.
• Wyncoll DL. The management of severe acute necrotising pancreatitis: an evidence-based review of the literature. Intensive Care Med 1999;25:146-156.
• Neoptolemos JP, Kemppainen EA, Mayer JM, et al. Early prediction of severity in acute pancreatitis by urinary trypsinogen activation peptide: a multicentre study. Lancet 2000;355:1955-1960.
• Muller CA, Uhl W, Printzen G, et al. Role of procalcitonin and granulocyte colony stimulating factor in the early prediction of infected necrosis in severe acute pancreatitis. Gut 2000;46:233-238.
• Papachristou GI, Muddana V, Yadav D, et al. Compari- son 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.
• Puolakkainen P, Valtonen V, Paananen A, Schroder T. C-reactive protein (CRP) and serum phospholipase A2 in the assessment of the severity of acute pancreatitis. Gut 1987;28:764-771.