Is there a correlation between the initial calcium level and Balthazar classification in patients with acute pancreatitis?

BACKGROUND: While a life-threatening course is observed in 2–3% of patients with acute pancreatitis (AP), mortality can be up to 50% in severe AP. In our study, we research relationship between calcium level and Modified Balthazar (MB) score.
METHODS: 354 patients who were followed up with a diagnosis of AP between 2013 and 2019 were included in our study. Serum calcium level was measured within the first 24 h. Abdominal computed tomography (CT) was performed in all patients in the first 12 h and between 3 and 7 days. The severity of AP was determined according to the MB classification. The correlation between calcium level and MB classification was examined.
RESULTS: 206 (58.2%) of the patients were women. Mean age was 54.8±17.9 years (range: 18–100). It was observed that the rate of severe AP was significantly higher in the low calcium group compared to the MB classification in which tomographies taken at ad-mission and 72 h after were evaluated (p<0.05). Furthermore, progression was higher in low calcium group (p<0.05). The cutoff value was 9.35 mg/dl for the ROC analysis performed to distinguish mild pancreatitis from moderate-severe pancreatitis according to the MB classification performed by CT obtained after 72 h based on the Ca values. For the cutoff value of 9.35 mg/dl (AUC: 0.581, p=0.018, 95% Cl: 0.514–0.649), the sensitivity was 57.4% and the specificity was 53.1%.
CONCLUSION: Since there is a correlation between the initial calcium level and the severity of the disease according to the CT-scan obtained later, the calcium level gives us an idea of the course of the disease.

Akut pankreatit hastalarýnda baþlangýçta bakýlan kalsiyum seviyesi ile Balthazar sýnýflamasý arasýnda korelasyon var mý?

AMAÇ: Akut pankreatit (AP) hastalarnýn %2–3’ünde hayatý tehdit eden bir seyir görülürken, aðýr seyirli AP’de mortalite %50’ye kadar çýkabilmektedir. Çalýþmamýzda kalsiyum düzeyi ile Modifiye Balthazar (MB) skoru arasýndaki iliþkiyi saptamaya çalýþtýk.
GEREÇ VE YÖNTEM: Çalýþmamýza 2013–2019 tarihleri arasýnda AP tanýsý ile takip edilen 354 hasta alýndý. Ýlk 24 saat içinde serum kalsiyum seviyesi ölçüldü. Çalýþmaya alýnan tüm hastalara ilk 12 saatte ve 3–7 günler arasýnda abdominal bilgisayarlý tomografi (BT) çekildi. MB sýnýflamasýna göre AP’nin þiddeti belirlendi. Kalsiyum seviyesi ile MB sýnýflamasý arasýndaki korelasyon incelendi.
BULGULAR: Çalýþmaya alýnan hastalarýn 206’sý (%58.2) kadýndý. Ortalama yaþlarý 54.8±17.9 yýl (yaþ aralýðý: 18–100) idi. Baþvuru sýrasýnda ve 72 saat sonrasýnda çekilen tomografilerin deðerlendirilerek yapýldýðý MB sýnýflamasýna göre düþük kalsiyum grubunda aðýr AP oranýnýn anlamlý olarak daha yüksek olduðu izlendi (p<0.05). Ayrýca düþük kalsiyum gurubunda progresyon daha yüksek oranda gözlendi (p<0.05). Hastalarýn baþvuru anýndaki total Ca deðerleri baz alýnarak 72. saat sonrasý çekilen BT ile yapýlan MB sýnýflamasýna göre hafif pankreatitleri orta-aðýr pankreatitlerden ayýrmak için yapýlan ROC analizi için kestirim deðeri 9.35 mg/dl bulundu. 9.35 mg/dl kestirim deðeri için (AUC: 0.581, p=0.018, %95 Cl: 0.514–0.649) hassasiyet %57.4, özgüllük %53.1 olarak hesaplandý.
TARTIÞMA: Baþlangýçta bakýlan kalsiyum seviyesi ile daha sonra çekilen BT’ye göre hastalýðýn ciddiyeti arasýnda korelasyon olmasý nedeniyle, kalsiyum seviyesi hastalýðýn seyrinin nasýl olacaðý konusunda bize fikir vermektedir.