The role of biomarkers in the early diagnosis of acute kidney injury associated with acute pancreatitis: Evidence from 582 cases

BACKGROUND: One of the systemic complications of acute pancreatitis (AP) is acute kidney injury (AKI). AKI development in patients with AP increases mortality, morbidity, and the cost of treatment. Therefore, early diagnosis and prevention of AKI is important. The purpose of our study was to present biomarkers and case management of AKI developing in patients with AP.
METHODS: The participants of this retrospective study consisted of 582 patients who were followed up with the diagnosis of AP. Atlanta classification was used for the diagnosis and the identification of severity of AP. The laboratory values of patients at the time of first application to the emergency room were recorded. Blood tests were checked 48 h/l. Their blood tests were monitored daily until the day of discharge.
RESULTS: Of the 582 patients who were admitted with the AP diagnosis, 344 were female. AKI was detected in 147 patients (25.2%) of the patients admitted with AP diagnosis. The mean age of patients developing AKI was higher than those who did not develop AKI. The albumin and calcium levels in patients developing AKI were significantly lower than the group without AKI. The C-reactive protein (CRP)/albumin and neutrophil/lymphocyte ratios were statistically significantly higher in the group with AKI than the group without AKI. The increase values in AST and ALT levels between the group with AKI and the group without AKI were not statistically significant. The mean leukocyte, CRP, procalcitonin levels, and immature granulocyte percentage (IG%) ratio were higher in patients with AKI in comparison to the patient group without AKI. The decrease in the lymphocyte, hematocrit, and platelet levels was higher in the patient group with AKI compared to the patient group without AKI. Urea and creatinine levels of the group with AKI at the time of admission were higher than the group without AKI. The clinical picture in 13 of the patients we followed up with AP diagnosis was mortal.
CONCLUSION: The values of hematocrit, platelet, leukocyte, lymphocyte, albumin, CRP, CRP/albumin ratio, neutrophil/lymphocyte ration, IG%, procalcitonin, urea, and creatinine that were examined at the time of hospital admission can be useful biomarkers in predicting the development of AKI in patients with AP. In addition, accompanying diseases and age are among the factors affecting AKI development.

Akut pankreatit ile iliþkili akut böbrek hasarýnýn erken tanýsýnda biyobelirteçlerin rolü: 582 olgudandan kanýtlar

AMAÇ: Akut pankreatitin (AP) sistemik komplikasyonlarýndan biri akut böbrek hasarýdýr (ABH). Akut pankreatitli hastalarda ABH geliþimi mortalite, morbidite ve tedavi maliyetini artýrmaktadýr. Bu nedenle ABH’nIn erken teþhisi ve önlenmesi önemlidir. Çalýþmamýzýn amacý, AP’li hastalarda geliþen ABH’nin biyobelirteçlerini ve olgu yönetimini sunmaktýr.
GEREÇ VE YÖNTEM: Bu geriye dönük çalýþmanýn katýlýmcýlarýný akut pankreatit tanýsý ile takip edilen 582 hasta oluþturdu. Akut pankreatitin tanýsýnda ve þiddetinin belirlenmesinde Atlanta sýnýflamasý kullanýldý. Hastalarýn acil servise ilk baþvuru anýndaki laboratuvar deðerleri kaydedildi. Kýrk sekiz saat sonra kan testleri yapýldý. Kan testleri taburcu olduklarý güne kadar günlük olarak izlendi.
BULGULAR: Akut pankreatit tanýsý ile baþvuran 582 hastanýn 344’ü kadýndý. AP tanýsý ile baþvuran hastalarýn 147’sinde (%25.2) ABH saptandý. ABH geliþen hastalarýn ortalama yaþý, ABH geliþmeyenlere göre daha yüksekti. ABH geliþen hastalarda albümin ve kalsiyum düzeyleri ABH olmayan gruba göre anlamlý derecede düþüktü. ABH olan grupta, ABH olmayan gruba göre CRP/albümin ve nötrofil/lenfosit oranlarý istatistiksel olarak anlamlý derecede yüksekti. ABH olan grup ile ABH olmayan grup arasýnda AST ve ALT düzeylerindeki artýþ deðerleri istatistiksel olarak anlamlý deðildi. ABH olan hastalarda, AKI’si olmayan hasta grubuna göre ortalama lökosit, CRP, prokalsitonin düzeyleri ve % IG oraný daha yüksekti. ABH olan hasta grubunda, AKI olmayan hasta grubuna göre lenfosit, hematokrit ve trombosit düzeylerindeki azalma daha yüksekti. ABH olan grubun baþvuru sýrasýndaki üre ve kreatinin düzeyleri, ABH olmayan gruba göre daha yüksekti. AP tanýsý ile takip ettiðimiz hastalarýn 13’ünde klinik tablo ölümle sonlandý. TARTIÞMA: Akut pankreatitli hastalarda hastaneye yatýþ anýnda bakýlan hematokrit, trombosit, lökosit, lenfosit, albümin, CRP, CRP/albümin oraný, nötrofil/lenfosit oraný, IG%, prokalsitonin, üre, kreatinin deðerleri ABH geliþimini öngörmede faydalý biyobelirteçler olabilir. Ayrýca eþlik eden hastalýklar ve yaþ da ABH geliþimini etkileyen faktörler arasýndadýr.