The changes of parameters of the systemic inflammatory answer syndrome on early stages of complicated acute pancreatitis
Objective. To determine a prognostic validity of parameters of the systemic inflammatory answer syndrome for early diagnosis of an acute pancreatitis severity and prognostication of the pathological processes exacerbation.
Materials and methods. The treatment results in 71 patients, suffering an acute pancreatitis, were analyzed. An acute pancreatitis in a light form was diagnosed in 39 patients (Group I), and in a severe one-in 32 patients (GroupII). In the patients while hospitalization and in consequent two days an absolute quantity of leucocytes, relative quantity of immature granulocytes and value of neutrophil-lymphocytic ratio, concentration of C-reactive protein were investigated. ROC-curve was applied while doing calculation of the «cut-off» point for neutrophil-lymphocytic ratio and studied a three-week survival, using Kaplan-Meyer method.
Results. In the Group II patients the leucocytes quantity was trustworthily more - (15.4 ± 2.3) × 109/l, than in patients of Group I - (12.7 ± 1.2) × 109/l. Relative quantity of neutrophils and immature granulocytes was high in Group II, but absolute quantity of lymphocytes in these patients was lower, than in the patients of Group I. In accordance to the neutrophil-lymphocytic ratio in the admittance day the Group II differed from Group I statistically significant - 12.6 ± 1.4 and 9.78 ± 1.3 accordingly. In Group I during consequent two days this marker have lowered, аnd in Group II demonstrated further raising (p < 0.05). Optimal point of «cut-off» for neutrophil-lymphocytic ratio was determined as 10.5. The three-week survival of patients with the neutrophil-lymphocytic ratio value 10.5 has constituted 95,9%. In the values of neutrophil-lymphocytic ratio more than 10.5 a survival have lowered down to 79.2%,and mortality have been raised up to 21/8%. Relative quantity of immature granulocytes in Group I have constituted (0.39 ± 0.21)%, and in Group II - (1.7 ± 0.51)%. Doing analysis of square under the ROC-curve the threshold meaning for immature granulocytes was determined as 0.81%. In the admittance day the Groups did not differ for index of C-reactive protein. But, on the second day the C-reactive protein concentration have been enhanced by 55.3% in Group II and was significantly higher, than in Group I. Multifactorial analysis have shown, that diabetes mellitus constitutes independent predictor of risk for the septic complications occurrence. Negative impact of hepatic adipose dystrophy on occurrence and progress of polyorgan insufficiency in patients with pancreonecrosis were revealed as well.
Conclusion.There was proved, that studying of values of neutrophil-lymphocytic ratio permits to prognosticate the survival indices in patients, suffering an acute pancreatitis of early stage. The level of C-reactive protein on the second day after admittance takes effect of prognostic significance and must be applied as a marker for the further clinical signs prognostication. In controversial cases theneutrophil-lymphocyticratioand relative quantity of immature granulocytes helps to determine the prognosis. Using simple analysis of peripheral blood it is possible to prognosticate theclinical signs of an acute pancreatitis on early stages of the disease. Theparameters of the systemic inflammatory answer syndrome owe important significance in determination of the pathological changes severity.
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