Ulus Travma Acil Cerrahi Derg. 2022; 28(11): 1609-1615 | DOI: 10.14744/tjtes.2021.96782

Investigating the correlation between severe acute pancreatitis and pancreatic necrosis with some serum parameters

Server Sezgin Uludað¹, Nazim Güreþ², Sabri Þirolu³, Ahmet Aþkar¹, Ahmet Necati Þanlý¹, Abdullah Kaðan Zengin¹, Mehmet Faik Özçelik^1
1Department of General Surgery, Ýstanbul University-Cerrahpaþa, Cerrahpaþa Faculty of Medicine, Ýstanbul-Türkiye
²Department of General Surgery, Balýkesir Atatürk City Hospital, Balikesir-Türkiye
³Department of Radiology, Ýstanbul University-Cerrahpaþa Cerrahpaþa, Faculty of Medicine, Ýstanbul-Türkiye

BACKGROUND: Acute pancreatitis (AP) is a disease related to significant morbidity and even mortality. Various factors are involved in the etiology, especially gallstones and excessive alcohol consumption. Although, the course of the disease in most of the cases is generally mild, in some cases, the disease can be severe and lead to pancreatic or peripancreatic necrosis. Radiologically, “Balthazar computed tomography severity index” (CTSI) is used to assess the severity and presence of necrosis in pancreatitis. In this study, we classified the severity of AP in patients with Balthazar CTSI and investigated whether there is a correlation between some serum parameters and AP severity and which serum parameters can be used as a safe marker to predict the AP severity and the development of pancreatic necrosis (PN).
METHODS: A total of 341 patients diagnosed with AP and hospitalized in our general surgery clinic between the years 2012 and 2018 were included in this study. Hematological and biochemical parameters of the patients were recorded. Abdominal CT’s of the patients were evaluated according to the Balthazar CTSI. The correlation between these parameters and AP severity evaluated by Balthazar CTSI was investigated.
RESULTS: PN was detected in 19.4% of 341 patients who participated in the study. Patients whose PN detected in their abdominal CT’s by Balthazar CTSI; neutrophil counts, neutrophil/lymphocyte ratio (NLR), thrombocyte/lymphocyte ratio, plateletlymphocyte ratio, and neutrophil/monocyte ratio (NMR) were significantly higher and the serum albumin was significantly lower than patients with PN.
CONCLUSION: Neutrophil count, serum albumin levels, NLR, LR, and NMR can be used as predictive markers to determine AP severity.

Keywords: Acute pancreatitis, Balthazar score, pancreatic necrosis, serum parameters.

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Bazý serum parametreleri ile þiddetli akut pankreatit ve pankreas nekrozu arasýndaki iliþkinin araþtýrýlmasý

Server Sezgin Uludað¹, Nazim Güreþ², Sabri Þirolu³, Ahmet Aþkar¹, Ahmet Necati Þanlý¹, Abdullah Kaðan Zengin¹, Mehmet Faik Özçelik^1
1Ýstanbul Üniversitesi-Cerrahpaþa, Cerrahpaþa Týp Fakültesi, Genel Cerrahi Anabilim Dalý, Ýstanbul
²Balýkesir Atatürk Þehir Hastanesi, Genel Cerrahi Bölümü, Balýkesir
³Ýstanbul Üniversitesi-Cerrahpaþa, Cerrahpaþa Týp Fakültesi, Radyoloji Anabilim Dalý, Ýstanbul

AMAÇ: Akut pankreatit (AP), önemli morbidite ve hatta mortalite ile iliþkili bir hastalýktýr. Etiyolojide özellikle safra taþlarý ve aþýrý alkol tüketimi olmak üzere çeþitli faktörler rol oynamaktadýr. Çoðu olguda hastalýðýn seyri genellikle hafif olmakla birlikte, bazý durumlarda hastalýk þiddetli olabilir ve pankreas veya peripankreatik nekroza yol açabilir. Radyolojik olarak “Balthazar CT þiddet indeksi” (CTSI), pankreatitte nekrozun þiddetini ve varlýðýný deðerlendirmek için kullanýlýr. Bu çalýþmada, Balthazar CTSI ile AP’nin þiddetini sýnýflandýrarak bazý serum parametreleri ile AP þiddeti arasýnda korelasyon olup olmadýðýný, hangi serum parametrelerinin AP þiddetini ve pankreas nekrozunun (PN) geliþimini tahmin etmek için güvenli bir belirteç olarak kullanýlabileceði araþtýrdýk.
GEREÇ VE YÖNTEM: 2012–2018 yýllarý arasýnda genel cerrahi kliniðimizde yatan ve AP tanýsý alan 341 hasta çalýþmaya dahil edildi. Hastalarýn hematolojik ve biyokimyasal parametreleri kaydedildi. Hastalarýn abdominal BT’leri Balthazar CTSI’ye göre deðerlendirildi. Bu parametreler ile Balthazar CTSI tarafýndan deðerlendirilen AP þiddeti arasýndaki iliþki araþtýrýldý.
BULGULAR: Çalýþmaya katýlan 341 hastanýn %19.4’ünde pankreas nekrozu saptandý. Balthazar CTSI tarafýndan abdominal BT’lerinde pankreas nekrozu saptanan hastalar; nötrofil sayýlarý, nötrofil/lenfosit oraný (NLR), trombosit/lenfosit oraný (PLR), nötrofil/monosit oraný (NMR) önemli ölçüde daha yüksekti ve serum albümini, pankreas nekrozu olan hastalara göre önemli ölçüde daha düþüktü.
TARTIÞMA: Nötrofil sayýsý, serum albümin seviyeleri, NLR, LR ve NMR, AP þiddetini belirlemek için prediktif belirteçler olarak kullanýlabilir.

Anahtar Kelimeler: Akut pankreatit, Balthazar skoru, pankreas nekrozu, serum parametreleri.

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