Vinish Doraiswami Babu, Abishek Vishnu, Sujatha K, Arulprakash S, Solomon Rajkumar, Ganesh P
Institute of Gastroenterology, SRM Institutes for Medical Sciences, 1 Jawaharlal Nehru Road, Vadapalani, Chennai, 600 026, India.
Department of Gastroenterology, St. Johns Medical College, Sarjapur Road, Bengaluru, 560 034, India.
Indian J Gastroenterol. 2017 Jan;36(1):43-49. doi: 10.1007/s12664-017-0728-6. Epub 2017 Feb 9.
Acute pancreatitis is a disease with variable outcome; the course of the disease can be modified by early aggressive management in patients with severe pancreatitis. Easily calculable pancreatic scores and investigations can help to triage these patients. We aimed to determine the role of bedside index for severity in acute pancreatitis (BISAP), harmless acute pancreatitis score (HAPS), and systemic inflammatory response syndrome (SIRS) scores on day of admission and C-reactive protein (CRP) at 48 h for predicting the presence of pancreatic fluid collection (PFC) and necrosis on CT scans done at 72 h.
Of a total of 114 consecutively seen patients of pancreatitis, 64 with acute pancreatitis were enrolled in the study. All individuals had the pancreatitis predicting scores calculated at the time of admission, CRP at 48 h, and contrast-enhanced computed tomography (CECT) abdomen at 72 h from admission.
The study population of 64 (55 male) had a mean (+SD) age of 37.7 ± 13 years. Alcohol was the most common (68.8%) etiology in these patients. Based on CECT, patients were divided into 2 groups; group 1 with 41 patients who had mild pancreatitis and group 2 with 23 patients who had pancreatic fluid collection with or without necrosis (PFCN). PFCN were seen in 19 (29.7%) of patients with 2 or more SIRS criteria, 17 (26.6%) of patients with BISAP score ≥3, and 16 patients (25.0%) with HAPS >0 respectively. All three scores were able to predict PFCN significantly. CRP >150 mg/L was noted in 23 patients and was able to predict the presence of fluid collections (p=0.0002) and pancreatic necrosis (p = 0.0004) on CT.
BISAP, HAPS, and SIRS scores and CRP of 150 mg/L all correlated significantly with the occurrence of fluid collections and pancreatic necrosis on CT at 72 h. None of the scores was superior to the other in this respect.
急性胰腺炎是一种预后不一的疾病；对于重症胰腺炎患者，早期积极治疗可改变疾病进程。易于计算的胰腺评分和检查有助于对这些患者进行分类。我们旨在确定入院当天的急性胰腺炎严重程度床边指数（BISAP）、无害急性胰腺炎评分（HAPS）、全身炎症反应综合征（SIRS）评分以及48小时时的C反应蛋白（CRP）对预测72小时时CT扫描显示的胰腺液体积聚（PFC）和坏死的作用。
在总共114例连续就诊的胰腺炎患者中，64例急性胰腺炎患者纳入研究。所有患者在入院时计算胰腺炎预测评分，48小时时检测CRP，并在入院72小时时进行腹部增强CT（CECT）检查。
64例研究对象（55例男性）的平均（±标准差）年龄为37.7±13岁。酒精是这些患者中最常见的病因（68.8%）。根据CECT，患者分为两组；第1组41例为轻度胰腺炎患者，第2组23例为有或无坏死的胰腺液体积聚（PFCN）患者。分别有19例（29.7%）符合2项或更多SIRS标准的患者、17例（26.6%）BISAP评分≥3的患者以及16例（25.0%）HAPS>0的患者出现PFCN。所有三项评分均能显著预测PFCN。23例患者CRP>150mg/L，其能够预测CT上液体积聚的存在（p=0.0002）和胰腺坏死（p=0.0004）。
BISAP、HAPS和SIRS评分以及150mg/L的CRP均与72小时时CT上液体积聚和胰腺坏死的发生显著相关。在这方面，没有一项评分优于其他评分。
