Chhabra Puneet, Rana Surinder S, Sharma Vishal, Sharma Ravi, Bhasin Deepak K
Department of Gastroenterology, Fortis Hospital, Mohali, Punjab (Puneet Chhabra, Deepak K. Bhasin), India.
Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh (Surinder S. Rana, Vishal Sharma, Ravi Sharma), India.
Ann Gastroenterol. 2016 Apr-Jun;29(2):214-20. doi: 10.20524/aog.2016.0015.
Hypocalcemia is a marker of poor prognosis in acute pancreatitis (AP) but the prognostic significance of hypocalcemic tetany in patients with AP has not been studied. We aimed to determine the prognostic significance of hypocalcemic tetany in patients with AP.
Consecutive patients of AP who presented within 7 days of symptoms were included. Serum calcium levels were measured on admission and the patients were divided into two groups based on the presence (group 1) or absence of hypocalcemia (group 2). Chvostek and Trousseau signs were sought in all patients with hypocalcemia and the outcome measures were compared between patients with normocalcemia, asymptomatic and symptomatic hypocalcemia (tetany). The outcome parameters assessed were persistent organ failure (POF), need for intervention, and mortality.
Of 105 patients (53 male; mean age 37.34±12.62 years), 37 (35.2%) had hypocalcemia (group 1) and 68 (64.8%) had normal corrected serum calcium levels (group 2). Patients with hypocalcemia had significantly higher frequency of POF, mortality and need for intervention (P<0.05). Twelve of 37 (32.4%) patients with hypocalcemia had tetany. Patients with tetany had significantly lower serum corrected calcium and ionized calcium levels compared with patients with asymptomatic hypocalcemia (P<0.05). Patients with tetany had significantly higher mortality rates compared with patients with asymptomatic hypocalcemia (100% vs. 8%; P=0.00001) as well as POF (100% vs. 32%; P=0.000006).
Presence of hypocalcemic tetany in AP patients bears a poor prognosis and is associated with increased mortality.
低钙血症是急性胰腺炎（AP）预后不良的一个指标，但AP患者中低钙性手足搐搦的预后意义尚未得到研究。我们旨在确定AP患者中低钙性手足搐搦的预后意义。
纳入症状出现7天内就诊的连续AP患者。入院时测定血清钙水平，并根据是否存在低钙血症（第1组）将患者分为两组，不存在低钙血症的为第2组。对所有低钙血症患者检查Chvostek征和Trousseau征，并比较血钙正常、无症状低钙血症和有症状低钙血症（手足搐搦）患者的结局指标。评估的结局参数包括持续性器官衰竭（POF）、干预需求和死亡率。
105例患者（53例男性；平均年龄37.34±12.62岁）中，37例（35.2%）有低钙血症（第1组），68例（64.8%）校正血清钙水平正常（第2组）。低钙血症患者的POF、死亡率和干预需求频率显著更高（P<0.05）。37例低钙血症患者中有12例（32.4%）出现手足搐搦。与无症状低钙血症患者相比，手足搐搦患者的校正血清钙和离子钙水平显著更低（P<0.05）。与无症状低钙血症患者相比，手足搐搦患者的死亡率显著更高（100%对8%；P=0.00001），POF发生率也显著更高（100%对32%；P=0.000006）。
AP患者中出现低钙性手足搐搦预后不良，且与死亡率增加相关。
