EARLY CLINICAL MARKERS OF SEVERITY OF ACUTE NECROTIC PANCREATITIS

Summary. Acute necrotic pancreatitis carries enough difficulty in diagnosis and treatment. Destructive forms with retroperitoneal tissue damage cause lethality up to 70 %. The aim was to establish early clinical markers of disease severity. Material and methods. The results of surgical treatment of 120 patients with acute pancreatitis were analyzed. Patients were divided into groups: first group – 40 patients without parapancreatitis; second group — 80 patients with parapancreatitis. Peripheral blood reaction, main biochemical indicators, blood electrolytes, general condition by integral scales were evaluated in this groups. Results and discussion. On the admission day, the levels of erythrocytes and hemoglobin in patients in both groups were within normal limits. All patients had leukocytosis. All subjects had high LII rates. In the dynamics of treatment leukocytosis significantly decreased in the second group. Changes in clinical blood tests, urinalysis, ALT, AST, bilirubin, urea, creatinine were not significant. Conclusions. Postoperative mortality was 27.2 %. 67 % of patients had parapancreatitis. It was revealed, that reliable early markers of severity of acute necrotizing pancreatitis are: level of WBC, leucocyte intoxication index, intoxication indicator, organism`s resistance index, reactive neutrophilic response, C-reactive protein and level of calcium. It was proved, that evaluation of patient`s condition by scales ASSES, SAPS II and Ranson objectively reflects the patient`s condition during the course of treatment.

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Efficacy of presepsin, procalcitonin, Il-6 and C-reactive protein for diagnosis of system and local infection in patients with acute necrotizing pancreatitis

HPB ◽

10.1016/j.hpb.2018.06.310 ◽

2018 ◽

Vol 20 ◽

pp. S305

Author(s):

O. Rotar ◽

I. Khomiak ◽

G. Petrovsky ◽

M. Nazarchuck ◽

V. Rotar ◽

...

Keyword(s):

Necrotizing Pancreatitis ◽

Acute Necrotizing Pancreatitis ◽

Local Infection ◽

C Reactive Protein ◽

Reactive Protein ◽

Acute Necrotizing

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ARROSIVE BLEEDING WITH PANCREATIC NECROSIS — TACTICAL APPROACHES

Kharkiv Surgical School ◽

10.37699/2308-7005.1.2020.12 ◽

2020 ◽

pp. 85-88 ◽

Cited By ~ 1

Author(s):

V. V. Mishchenko ◽

P. I. Pustovoit ◽

R. Yu. Vododyuk ◽

V. V. Velichko ◽

V. V. Goryachy

Keyword(s):

Minimally Invasive ◽

Pancreatic Necrosis ◽

Necrotizing Pancreatitis ◽

Acute Necrotizing Pancreatitis ◽

Stent Grafts ◽

Invasive Treatment ◽

Results Of Treatment ◽

Hemorrhagic Complications ◽

Necrotic Pancreatitis ◽

Acute Necrotizing

Summary. The problem of hemorrhagic complications of destructive pancreatitis is relevant. The aim of the study was to study the frequency and sources of hemorrhagic complications in patients with pancreatic necrosis, to evaluate the tactics of diagnosis and the effectiveness of methods to stop bleeding. Materials and methods. A study of the results of treatment of 40 patients with acute necrotizing pancreatitis was conducted. Results and its discussion. In 67.5 % of patients with acute necrotizing pancreatitis, hemorrhagic complications in the form of arrosive bleeding were observed. A method of endovascular occlusion of vessels using Gianturco spirals or stent grafts to stop arrosive bleeding in acute necrotizing pancreatitis has been introduced in the clinic. In 37.0 % of cases, repeated signs of arrosive bleeding were observed. In acute necrotizing pancreatitis complicated by arrosive bleeding, mortality was 44.4 %. Conclusions. The main cause of hemorrhagic complications in acute necrotic pancreatitis is acute necrotic changes, during infection of which arrosia of adjacent vessels occurs. The predominant tactic in case of bleeding from the retroperitoneal space against the background of minimally invasive treatment is clamping of drains, endovascular hemostasis using Gianturco spirals or stent grafts and the use of hemostatic soluble gauze (hemostop). Mortality in the development of arrosive bleeding in acute necrotic pancreatitis is 44.4 %.

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Comparison of sensitivity and specificity of serum poly-C avid ribonuclease activity and C-reactive protein concentration in detection of mild and severe acute pancreatitis

Clinical Chemistry and Laboratory Medicine (CCLM) ◽

10.1515/cclm.2004.093 ◽

2004 ◽

Vol 42 (5) ◽

Cited By ~ 5

Author(s):

Beata Kuśnierz-Cabala ◽

Jerzy W. Naskalski ◽

Boguslaw Kędra ◽

Józefa Panek

Keyword(s):

Acute Pancreatitis ◽

Severe Acute Pancreatitis ◽

Clinical Course ◽

Function Analysis ◽

Necrotizing Pancreatitis ◽

Ribonuclease P ◽

C Reactive Protein ◽

Reactive Protein ◽

Acute Necrotizing ◽

Mild Acute Pancreatitis

AbstractThe aim of this study was to compare diagnostic performance of C-reactive protein (CRP) and poly-C avid ribonuclease (P-RNase) levels in the prediction of a severe clinical course of acute pancreatitis (AP). The study included 36 patients with mild and 20 with severe AP. CRP concentration was measured by an immunonephelometric method and P-RNase activity by the rate of polycytidylate hydrolysis at pH 7.8. At the time of admission, both P-RNase and CRP levels were significantly increased in all patients when compared to healthy subjects (29.2 vs. 18.7 U/l and 91.1 vs. 2.89 mg/l; p<0.001). Up to days 3 and 4 a further increase in P-RNase was observed. On the other hand, the increase in CRP continued only through days 2 and 3 (p<0.001). Severe acute pancreatitis (SAP) and mild acute pancreatitis (MAP) differed significantly with respect to P-RNase levels on all days studied; whereas CRP levels differed significantly on days 2–5 but did not differ at admission. Receiver operating characteristic (ROC) curve function analysis yielded the best sensitivity of SAP detection for P-RNase, equaling 72.2%, at the cut-off point value 65.3 U/l on day 3 after admission. The sensitivity of CRP for detection of SAP was 85.0% at 125.7 mg/l on the 2nd day after admission. Both parameters studied were significantly associated with the severity of the AP clinical course; however, on days 1 and 2 postadmission, P-RNase was more specific for detection of SAP than CRP (94.4% vs. 77.1% on the 1st day and 94.4% vs. 55.5% on the 2nd day). In conclusion, P-RNase has shown an excellent performance for early differentiation of acute necrotizing pancreatitis.

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TRANSCUTANEOUS MINI INVASIVE INTERVENTIONS IN TREATMENT OF PURULENT SEPTIC COMPLICATIONS OF ACUTE NECROTIZING PANCREATITIS

Clinical anatomy and operative surgery ◽

10.24061/1727-0847.19.1.2020.15 ◽

2020 ◽

Vol 19 (1) ◽

pp. 89-92

Author(s):

I. Khomiak ◽

O. Rotar ◽

I. Tereshkevych ◽

V. Rotar ◽

A. Khomiak ◽

...

Keyword(s):

Necrotizing Pancreatitis ◽

Postoperative Mortality ◽

Acute Necrotizing Pancreatitis ◽

Intensive Care Treatment ◽

Septic Complications ◽

Results Of Treatment ◽

Acute Necrotizing ◽

Operation Duration ◽

Complications And Mortality ◽

Methods Of Treatment

Aim. To estimate efficacy of mini invasive transcutaneous interventions in treatment of purulent septic complications of acute necrotizing pancreatitis. Material and methods. We analyzed results of treatment of 85 patients with purulent septic complications of acute necrotizing pancreatitis in whom mini invasive transcutaneous interventions were applied during 2014-2019. New onset of organ failure after operation, duration of intensive care treatment, postoperative complications and mortality rates have been studied. Results and discussion. Transcutaneous punctions and drainages were definitive methods of treatment at 74.1 % of patients with infectioned pathological lesions, at 25.9 % of patients – as a stage for preparation for open necrosequestrectomy that promoted to reduce postoperative mortality to 4.5 %. Conclusion. Transcutaneous mini invasive interventions are effective methods of step-up treatment of purulent septic complications of acute necrotizing pancreatitis, reduce necessary for wide laparotomic necrosectomies and reduce level of postoperative mortality.

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Inflammatory cytokines, C reactive protein, and procalcitonin as early predictors of necrosis infection in acute necrotizing pancreatitis

Surgery ◽

10.1067/msy.2003.70 ◽

2003 ◽

Vol 133 (3) ◽

pp. 257-262 ◽

Cited By ~ 81

Author(s):

Florence C. Riché ◽

Bernard P. Cholley ◽

Marie-Josèphe C. Laisné ◽

Eric Vicaut ◽

Yves H. Panis ◽

...

Keyword(s):

Inflammatory Cytokines ◽

Necrotizing Pancreatitis ◽

Acute Necrotizing Pancreatitis ◽

C Reactive Protein ◽

Reactive Protein ◽

Early Predictors ◽

Acute Necrotizing

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MORPHOLOGICAL AND FUNCTIONAL CHANGES OF INTESTINAL MUCOSA AT ACUTE NECROTIZING PANCREATITIS

Clinical anatomy and operative surgery ◽

10.24061/1727-0847.17.2.2018.7 ◽

2018 ◽

Vol 17 (2) ◽

pp. 37-41

Author(s):

O V. Rotar

Keyword(s):

Intestinal Mucosa ◽

Necrotizing Pancreatitis ◽

Intestinal Barrier ◽

Acute Necrotizing Pancreatitis ◽

Triple P ◽

Protective Function ◽

Functional Changes ◽

Necrotic Pancreatitis ◽

Mucosal Layer ◽

Acute Necrotizing

The purpose - to investigate the morphological and functional changes of the intestinal mucosa during acute necrotic pancreatitis and their effect on the translocation of bacteria and endotoxin. Material and methods. The conditions of the intestinal barrier were studied at 74 patients in clinics and 60 white rats in experiment during acute necrotic pancreatitis. The morphological and histological changes of the mucosal layer of the intestine, its enzyme activity, the microflora and its permeability for the endotoxin were studied. Results and discussion. During the early phase of acute necrotic pancreatitis barrier function of the intestine has been disturbed by increasing the activity of lysosomal enzymes (β-galactosidase double and N-acetyl-β-glucosaminidase triple, p <0.05), which caused the qualitative and quantitative changes of composition of glycoproteins in the epithelial layer of the mucosa shells. Disorders of the intestinal barrier were accompanied by bacterial translocation to the internal organs in 57.4% of patients who were operated early (up to 4 weeks) of the disease and in 90% of the animals after 72 hours of the experiment. High concentrations of endotoxin (over than 0.30EO/ml) delivered from the intestine have activated a specific proinflammatory cascade through the membrane receptor of monocytes/macrophages CD14, which was accompanied by the development of a systemic inflammatory response syndrome and multiple organ failure. Conclusions. During acute necrotizing pancreatitis the structure and protective function of the pre-epithelial mucosal layer are disordered, colonization of intestine by pathogenic and conditionally pathogenic gram-negative microflora is occurred which promoted migration of bacteria and transport of endotoxin into systemic blood circulation.

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Bacterial overgrowth syndrome of upper parts of gastrointestinal tract in acute necrotizing pancreatitis

Herald of Pancreatic Club ◽

10.33149/vkp.2020.04.05 ◽

2020 ◽

Vol 49 (4) ◽

pp. 55-58

Author(s):

O. V. Rotar ◽

I. V. Khomiak ◽

V. P. Polioviy ◽

V. I. Rotar

Keyword(s):

Small Intestine ◽

Digestive Tract ◽

Necrotizing Pancreatitis ◽

Bacterial Overgrowth ◽

Population Level ◽

Acute Necrotizing Pancreatitis ◽

Gram Negative ◽

White Rats ◽

Necrotic Pancreatitis ◽

Acute Necrotizing

Aim: to study the changes in the microflora of the upper part of digestive tract during acute necrotizing pancreatitis. Material and methods. Acute necrotizing pancreatitis was induced in 42 white rats; changes in the mucous microflora of the upper part of digestive tract were studied. Bacteriological examination of the contents of the proximal small intestine was performed in 42 patients with acute necrotic pancreatitis during gastrofibroscopy. Results and discussion. Induction of acute necrotic pancreatitis was accompanied by impaired colonization resistance of the intestinal mucosa due to the elimination of bifidobacteria and lactobacilli: the frequency of their growth from the mucosa decreased threefold (p<0.01), and the population level, respectively, by 25% (p<0.05) and by 36% (p<0.02). The mucosa was actively colonized by gram-negative pathogenic and conditionally pathogenic enterobacteria at high population level (3.07‒5.39 lg CFU/g), which allowed this microflora to overcome the damaged intestinal barrier and translocate. Pathogenic Escherichia spp. and Proteus spp. were cultivated from the mesenteric lymph nodes in 24 hours; Enterobacteria spp. and Staphylococci spp. were isolated from portal blood, pancreatic tissue, and peritoneal cavity 48 hours after induction of acute pancreatitis. Eight strains of gram-negative microorganisms were identified in small intestine in 69% of patients before surgery. Similar microflora was cultivated from pathological foci in 57.4% of patients after surgery. Conclusion. Severe deficiency of autochthonous anaerobic microflora occurred in the upper parts of the digestive tract in acute necrotizing pancreatitis, causing excessive colonization by pathogenic and conditionally pathogenic microorganisms and promoting bacterial translocation.

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