Role of Intra-Abdominal Pressure as a Prognostic Marker and Its Correlation with APACHE II and SOFA Scores in Patients of Acute Pancreatitis

Abstract In acute pancreatitis some prognostic scores have been suggested, based on clinical, laboratory and radiological criteria. The most popular are: Ranson score, APACHE II score and CT severity index (CTSI). The trend is to find a prognostic marker that is easy to use, cheap, and reproductible. Recently, the increase of the intra-abdominal pressure (IAP) has drawn attention. Material and Methods: From January 2012 to April 2014, a group of 64 patients, admitted to the Clinical Department of Anaesthesia and Intensive Care and the Surgical Departments of the SCJU Sibiu, with the diagnosis of acute pancreatitis, were included in this observational prospective study. The cut-off values, the specificity and sensitivity of the prognostic scores were calculated using the receiver operating characteristics (ROC) analysis curves. Results: At a cut-off value of 12 mm Hg IAP max has a sensitivity of 0,75, similar to Ranson score at 48 h (0.72 at a cut-off value 3) and CTSI (0,73 at a cut-off value 4). Better results are just for APACHE II score at 24 h (0,88 at a cut-off value 8). IAP max has a specificity of 0,88, simillary to CTSI (0,83) and APACHE II score (0,82). Conclusions: In our study maximum IAP could be correlated with prognostic markers for severe evolution in acute pancreatitis.

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Role of serum myeloperoxidase in patients of acute pancreatitis: a sole prognostic marker

Journal of the American College of Surgeons ◽

10.1016/j.jamcollsurg.2014.07.675 ◽

2014 ◽

Vol 219 (4) ◽

pp. e108-e109

Author(s):

Surender Kumar ◽

Devendra Singh ◽

Anit Parihaar ◽

Wahid Ali ◽

Gursagar Singh Sahota

Keyword(s):

Acute Pancreatitis ◽

Prognostic Marker

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Role of modified CT severity index as a prognostic marker of acute pancreatitis

International Journal of Radiology and Diagnostic Imaging ◽

10.33545/26644436.2020.v3.i1b.67 ◽

2020 ◽

Vol 3 (1) ◽

pp. 135-140

Author(s):

Dr. Prashanth Kumar KS ◽

Dr. Suraj Kabra

Keyword(s):

Acute Pancreatitis ◽

Prognostic Marker ◽

Severity Index

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D-dimer levels in predicting the severity of acute pancreatitis

International Surgery Journal ◽

10.18203/2349-2902.isj20175398 ◽

2017 ◽

Vol 4 (12) ◽

pp. 3993

Author(s):

Anil Kumar ◽

Ranjith Kothagattu

Keyword(s):

Acute Pancreatitis ◽

Prognostic Marker ◽

Clinical Parameter ◽

Multiple Organ ◽

Apache Ii ◽

Apache Ii Score ◽

Reactive Protein ◽

Failure Assessment ◽

The Mean ◽

D Dimer

Background:Coagulative disorder is known to occur in the early phase of acute pancreatitis. (AP) and D-dimer is a commonly used clinical parameter of haemostasis. The aim of this study was to assess the value of the plasma D-dimer level as a marker of severity in the 1.3.5 days after admission in patients with Acute pancreatitis.Methods: From September 2015 to September 2017, 60 patients admitted for AP were included in this observational study. The D-dimer level was measured during days 1,3,5 after admission and the acute physiology and chronic health evaluation (APACHE) II score, sequential organ failure assessment (SOFA) score, and other clinical parameters were recorded at the same time. The maximum and the mean D-dimer values were used for analysis and compared with other prognostic factors of AP.Results:Both the maximum and mean levels of D-dimer were signiﬁcantly different between patients with and without clinical variables such as multiple-organ dysfunction syndrome (MODS), need for surgical intervention, and the mortality. Additionally, the D-dimer level correlated well with two usual markers of AP severity-the APACHE II score and the C-reactive protein level. Conclusion D-dimer measurement is a useful, easy, and inexpensive early prognostic marker of the evolution and complications of AP.Conclusions:D-dimer measurement is a useful, easy, and inexpensive early prognostic marker of the evolution and complications of SAP.

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Role of Clinical, Biochemical, and Imaging Parameters in predicting the Severity of Acute Pancreatitis

Euroasian Journal of Hepato-Gastroenterology ◽

10.5005/jp-journals-10018-1202 ◽

2017 ◽

Vol 7 (1) ◽

pp. 1-5 ◽

Cited By ~ 4

Author(s):

Dina Zerem ◽

Omar Zerema ◽

Enver Zerem

Keyword(s):

Acute Pancreatitis ◽

Leukocyte Count ◽

Apache Ii ◽

Close Monitoring ◽

Early Assessment ◽

Diagnostic Parameters ◽

Factors Associated ◽

Imaging Parameters ◽

Glasgow Score

ABSTRACT Aim The assessment of the severity of acute pancreatitis (AP) is important for proper management of the disease and for its prognosis. The aim was to correlate clinical, biochemical, and imaging diagnostic parameters and evaluate their prognostic values in the early assessment of severity of AP. Materials and methods We prospectively studied 128 consecutive patients with AP. The predictors were clinical, biochemical, and imaging diagnostic parameters. The outcome measure was the occurrence of complications. Abdominal sonogram, contrast-enhanced computer tomography, and pancreatitis-specific clinical and laboratory findings were done. Results According to the Atlanta classification, 84 patients (65.6%) had mild and 44 (34.4%) had severe AP. The severity markers were significantly different between the mild and the severe groups (p < 0.001). Leukocyte count, serum albumin level, C-reactive protein (CRP), Ranson, acute physiology and chronic health evaluation II (APACHE II), and Glasgow score were the factors associated with radiological severity grade. Leukocyte count, CRP, Ranson score, APACHE II, and Glasgow score were the factors associated with the number and appearance of acute fluid collections (AFCs). A significant association was found between the number of AFCs and the occurrence of complications [odds ratio 4.4; 95% confidence interval 2.5–7.6]. Hospital stay was significantly longer in the group with severe disease as compared with the group with mild disease (p < 0.001). Conclusion Clinical, biochemical, and imaging diagnostic parameters are related to the clinical course of AP and they can predict its severity. This allows us to determine the severity of the disease and to target the patients with high scores for close monitoring and more aggressive intervention. How to cite this article Zerem D, Zerem O, Zerem E. Role of Clinical, Biochemical, and Imaging Parameters in predicting the Severity of Acute Pancreatitis. Euroasian J Hepato-Gastroenterol 2017;7(1):1-5.

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The Choice of Treatment Tactics in Patients with Severe Acute Pancreatitis Taking Into Account the Factor of Intra-Abdominal Hypertension

Russian Sklifosovsky Journal Emergency Medical Care ◽

10.23934/2223-9022-2020-9-3-400-409 ◽

2020 ◽

Vol 9 (3) ◽

pp. 400-409

Author(s):

B. M. Belik ◽

G. M. Chirkinyan ◽

R. S. Tenchurin ◽

Z. A. Abduragimov ◽

D. V. Mareyev ◽

...

Keyword(s):

Acute Pancreatitis ◽

Severe Acute Pancreatitis ◽

Treatment Strategy ◽

Apache Ii ◽

Abdominal Pressure ◽

Group I ◽

Abdominal Hypertension ◽

Choice Of Treatment ◽

Therapeutic Measures ◽

Severity Of The Disease

Relevance. Increased intra-abdominal pressure (IAP) in patients with severe acute pancreatitis (AP) is one of the triggers for the development of a functional organ failure, which leads to death. In this case, the favorable outcome of treatment of patients with severe AP is largely determined by early diagnosis and timely elimination of intra-abdominal hypertension (IAH). At the same time, there is no unified and agreed opinion on the principles and specific methods of eliminating the IAH syndrome in patients with severe AP today, which greatly complicates the choice of treatment strategy and tactics.Aim of study. To assess the role and clinical significance of IAP monitoring in patients with severe AP with various manifestations of organ dysfunction and, offer a set of therapeutic measures aimed at resolving intra-abdominal hypertension.Material and methods. The current study included 199 patients with severe AP, divided into two groups depending on the chosen treatment strategy. Group I included 107 patients where the diagnosis and treatment of the disease corresponded to generally accepted standards. Group II included 92 patients, where, in order to objectify the severity and prognosis of the course of AP, along with standard studies, IAP and APACHE II scale indicators were additionally monitored during treatment, and the severity of organ dysfunctions was assessed. In these patients the choice of medical tactics, including the use of conservative and surgical interventions, was made on a differentiated basis, based on the severity of the disease and the dynamics of the IAH.Results. The role and significance of IAP monitoring and APACHE II scale indicators in the treatment of patients with severe AP were determined. The use of a differentiated approach to the choice of treatment strategies for patients with AP considering the severity of the disease and severity of IAH syndrome results in reduced hospital mortality by 10.3% and reduced postoperative mortality by 11.4%.Conclusion. Monitoring of intra-abdominal pressure and APACHE II scale indices in conjunction with standard clinical and laboratory parameters allows patients to be clearly stratified according to the severity of acute pancreatitis, which helps optimize the choice of treatment tactics, including methods and timing of surgery, as well as the use of a set of effective therapeutic measures aimed at eliminating intra-abdominal hypertension.

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Role of Static and Dynamic Intra-abdominal Pressure Monitoring in Acute Pancreatitis

Pancreas ◽

10.1097/mpa.0000000000001544 ◽

2020 ◽

Vol 49 (5) ◽

pp. 663-667

Author(s):

Mahesh Kumar Goenka ◽

Usha Goenka ◽

Shivaraj Afzalpurkar ◽

Subhash Chandra Tiwari ◽

Rachit Agarwal ◽

...

Keyword(s):

Acute Pancreatitis ◽

Abdominal Pressure ◽

Pressure Monitoring

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ROLE OF INTRA-ABDOMINAL PRESSURE IN PREDICTING OUTCOME IN ACUTE SEVERE PANCREATITIS

10.36106/paripex/5000665 ◽

2020 ◽

pp. 18-19

Author(s):

B. Narendra Babu ◽

N. Siva Durgesh ◽

P. Satya Sundeep

Keyword(s):

Acute Pancreatitis ◽

Severe Acute Pancreatitis ◽

Pancreatic Necrosis ◽

Abdominal Pressure ◽

Acute Severe Pancreatitis ◽

Severe Pancreatitis ◽

Background Mortality ◽

Predicting Outcome ◽

The Relationship

Background mortality in patients with severe acute pancreatitis (SAP) remains high. Some of these patients develop increased intra-abdominal pressure (IAP) which may contribute to organ dysfunction. The aims of this study was to evaluate intra-abdominal pressure as a marker of severity in severe acute pancreatitis and to evaluate the relationship between intra-abdominal pressure and development of complications like SIRS, organ failure, pancreatic necrosis in patients with severe acute pancreatitis.

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