Kapoor Karan, Repas Kathryn, Singh Vikesh K, Conwell Darwin L, Mortele Koenraad J, Wu Bechien U, Banks Peter A
University of Medicine and Dentistry of New Jersey, New Jersey Medical School, Newark, NJ, USA.
JOP. 2013 Mar 10;14(2):171-5. doi: 10.6092/1590-8577/1283.
In a prior report involving patients with hemoconcentration at admission, those with necrotizing pancreatitis presented significantly earlier than those with interstitial disease suggesting that duration of abdominal pain prior to presentation may have prognostic significance in acute pancreatitis.
The aim of the present study was to determine whether the duration of abdominal pain prior to admission influences the severity of acute pancreatitis.
During a five-year period, all patients presenting directly to our hospital with their first episode of acute pancreatitis were enrolled in a cohort study. We analyzed data obtained from records of all such patients and performed a separate analysis on those with hemoconcentration (hematocrit equal to, or greater than, 44%) at presentation to determine whether duration of abdominal pain prior to presentation was associated with severity of acute pancreatitis. Duration of abdominal pain was categorized as persisting for either less than 12 h or 12 h or more prior to arrival. Prognostic markers of severity included admission hematocrit and blood urea nitrogen (BUN), as well as the development of systemic inflammatory response syndrome (SIRS) during the initial 24 h of hospitalization. Outcome measures included pancreatic necrosis based on contrast-enhanced CT scanning, need for intensive care, length of hospitalization, and death. Radiologic severity of peripancreatic inflammatory changes was assessed within 48 h of admission in accordance with the Balthazar-Ranson scoring system (A-E).
Among a total of 318 patients, there were 62 (19.5%) with hemoconcentration at admission. Among the 318 patients, there was no significant difference in the prevalence of pancreatic necrosis when comparing the less than 12 h group to the 12 h or more group. Among the 62 patients with hemoconcentration, those admitted within 12 h compared to those admitted 12 h or more following the onset of abdominal pain had an increased radiologic severity of acute pancreatitis (Balthazar-Ranson grade D or E: 83.3% vs. 40.0%; P=0.006) and an increased prevalence of pancreatic necrosis (21.1% vs. 2.3%; P=0.028).
Duration of abdominal pain prior to admission impacts the severity of acute pancreatitis only among patients with hemoconcentration at presentation.
在之前一项涉及入院时血液浓缩患者的报告中，坏死性胰腺炎患者比间质性疾病患者出现症状的时间明显更早，这表明就诊前腹痛持续时间可能对急性胰腺炎具有预后意义。
本研究旨在确定入院前腹痛持续时间是否会影响急性胰腺炎的严重程度。
在五年期间，所有直接到我院就诊的首次发作急性胰腺炎患者均纳入队列研究。我们分析了所有这些患者记录中获得的数据，并对就诊时出现血液浓缩（血细胞比容等于或大于44%）的患者进行了单独分析，以确定就诊前腹痛持续时间是否与急性胰腺炎的严重程度相关。腹痛持续时间分为到达前持续少于12小时或12小时及以上。严重程度的预后指标包括入院时的血细胞比容和血尿素氮（BUN），以及住院最初24小时内全身炎症反应综合征（SIRS）的发生情况。结局指标包括基于增强CT扫描的胰腺坏死、重症监护需求、住院时间和死亡情况。入院48小时内根据巴尔萨泽-兰森评分系统（A - E）评估胰腺周围炎症变化的放射学严重程度。
在总共318例患者中，有62例（19.5%）入院时出现血液浓缩。在318例患者中，比较少于12小时组和12小时及以上组时，胰腺坏死的患病率无显著差异。在62例血液浓缩患者中，腹痛发作后12小时内入院的患者与12小时及以上入院的患者相比，急性胰腺炎的放射学严重程度增加（巴尔萨泽-兰森分级D或E：83.3%对40.0%；P = 0.006），胰腺坏死的患病率增加（21.1%对2.3%；P = 0.028）。
入院前腹痛持续时间仅对就诊时出现血液浓缩的急性胰腺炎患者的严重程度有影响。
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