The changes of parameters of the systemic inflammatory answer syndrome on early stages of complicated acute pancreatitis

Keywords: acute pancreatitis, complication, predictor, treatment, prognosis

Abstract

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.

Author Biographies

R. M. Agayev, Scientific Centre of Surgery Named After Acad. M. A. Topchibashev, Baku, Republic of Azerbaijan

Agayev Rauf Magsud, MD, DSci(Med), professor,
Director of Scientific Center of Surgery named after M.A. Topchubashov, Baku, Republic of Azerbaijan
196 Sharifzade str., Baku, AZ1122, Azerbaijan Republic of Azerbaijan
099 432 18 30
+99450 325 33 08
rainika@mail.ru
https://orcid.org/0000-0003-0954-1439

A. A. Mamadov, Scientific Centre of Surgery Named After Acad. M. A. Topchibashev, Baku, Republic of Azerbaijan

Mammadov Aliniyaz Ali, MD, DSci(Med), professor,
Head of the Department of Hepatobiliary Surgery
Scientific Center of Surgery named after M.A. Topchubashov, Baku, Republic of Azerbaijan
196 Sharifzade str., Baku, AZ1122, Azerbaijan Republic of Azerbaijan
099 432 18 30
mammadovaliniyaz@gmail.com
+99450220 55 35
https://orcid.org/0000-0001-6352-1290

F. S. Idrisov, Scientific Centre of Surgery Named After Acad. M. A. Topchibashev, Baku, Republic of Azerbaijan

Idrisov Faracullah Sadullah, MD, PhD(Med)
Department of Hepatobiliary Surgery
Scientific Center of Surgery named after M.A. Topchubashov, Baku, Republic of Azerbaijan
196 Sharifzade str., Baku, AZ1122, Azerbaijan Republic of Azerbaijan
099 432 18 30
idrisovfarac@gmail.com
+99450513 64 08
https://orcid.org/0000-0002-8848-9212

E. A. Iskandarov, Scientific Centre of Surgery Named After Acad. M. A. Topchibashev, Baku, Republic of Azerbaijan

Iskandarov Emil Almammad, MD, DSci(Med),
Leading scientists surgeon of Scientific Center of Surgery named after M.A. Topchubashov, Baku, Republic of Azerbaijan
196 Sharifzade str., Baku, AZ1122, Azerbaijan Republic of Azerbaijan
099 432 18 30
eiskenderov@mail.ru
+99450335 40 84
https://orcid.org/0000-0002-4015-3605

E. A. Aliyeva, Scientific Centre of Surgery Named After Acad. M. A. Topchibashev, Baku, Republic of Azerbaijan

Aliyeva Elmira Agasaf, MD, DSci(Med),
Department of Hepatobiliary Surgery
Scientific Center of Surgery named after M.A. Topchubashov, Baku, Republic of Azerbaijan
196 Sharifzade str., Baku, AZ1122, Azerbaijan Republic of Azerbaijan
099 432 18 30
agaali.aliev@gmail.com
+99450345 93 95
https://orcid.org/0000-0002-7626-9490

References

Xiao AY, Tan ML, Wu LM, Asrani VM, Windsor JA, Yadav D, et al. Global incidence and mortality of pancreatic diseases: a systematic review, meta-analysis, and meta-regression of population-based cohort studies. Lancet Gastroenterol Hepatol. 2016 Sep;1(1):45-55. doi: 10.1016/S2468-1253(16)30004-8. Epub 2016 Jun 28. PMID: 28404111.

Machicado JD, Yadav D. Epidemiology of Recurrent Acute and Chronic Pancreatitis: Similarities and Differences. Dig Dis Sci. 2017 Jul;62(7):1683-91. doi: 10.1007/s10620-017-4510-5. Epub 2017 Mar 9. PMID: 28281168; PMCID: PMC5478431.

Whitcomb DC, Yadav D, Adam S, Hawes RH, Brand RE, Anderson MA, et al. Multicenter approach to recurrent acute and chronic pancreatitis in the United States: the North American Pancreatitis Study 2 (NAPS2). Pancreatology. 2008;8(4-5):520-31. doi: 10.1159/000152001. Epub 2008 Sep 3. PMID: 18765957; PMCID: PMC2790781.

Peery AF, Dellon ES, Lund J, Crockett SD, McGowan CE, Bulsiewicz WJ, et al. Burden of gastrointestinal disease in the United States: 2012 update. Gastroenterology. 2012 Nov;143(5):1179-87.e3. doi: 10.1053/j.gastro.2012.08.002. Epub 2012 Aug 8. PMID: 22885331; PMCID: PMC3480553.

Krishna 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 Apr;46(4):482-88. doi: 10.1097/MPA.0000000000000783. PMID: 28196021; PMCID: PMC5435121.

Greenberg JA, Hsu J, Bawazeer M, Marshall J, Friedrich JO, Nathens A, et al. Clinical practice guideline: management of acute pancreatitis. Can J Surg. 2016 Apr;59(2):128-40. doi: 10.1503/cjs.015015. PMID: 27007094; PMCID: PMC4814287.

Janisch NH, Gardner TB. Advances in Management of Acute Pancreatitis. Gastroenterol Clin North Am. 2016 Mar;45(1):1-8. doi: 10.1016/j.gtc.2015.10.004. Epub 2015 Dec 19. PMID: 26895677; PMCID: PMC4761403.

Neoptolemos JP, Raraty M, Finch M, Sutton R. Acute pancreatitis: the substantial human and financial costs. Gut. 1998 Jun;42(6):886-91. doi: 10.1136/gut.42.6.886. PMID: 9691932; PMCID: PMC1727149.

Published
2021-11-28
How to Cite
Agayev, R. M., Mamadov, A. A., Idrisov, F. S., Iskandarov, E. A., & Aliyeva, E. A. (2021). The changes of parameters of the systemic inflammatory answer syndrome on early stages of complicated acute pancreatitis. Klinicheskaia Khirurgiia, 88(9-10), 11-15. https://doi.org/10.26779/2522-1396.2021.9-10.11
Section
General Problems of Surgery