Prasada Raghavendra, Dhaka Narendra, Bahl Ajay, Yadav Thakur Deen, Kochhar Rakesh
Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, 160 012, India.
Department of Cardiology, Postgraduate Institute of Medical Education and Research, Chandigarh, 160 012, India.
Indian J Gastroenterol. 2018 Mar;37(2):113-119. doi: 10.1007/s12664-018-0826-0. Epub 2018 Mar 21.
Organ failure (OF) is the most important predictor of outcome in severe acute pancreatitis (SAP). Cardiovascular failure (CVSF) occurs in a variable proportion of patients with SAP. We aimed to study myocardial dysfunction in acute pancreatitis (AP) and its impact on the outcome.
In this prospective study between January 2011 and July 2012, consecutive eligible patients of AP were enrolled. Myocardial function was assessed by measuring CK-MB (creatine phosphokinase isoenzyme) and echocardiography at admission. Electrocardiography (ECG) findings at admission were noted. Patients were managed in a high dependency unit using a step-up approach and followed up during hospital stay for their outcome. The outcome variables were computed tomography severity index (CTSI), the severity of AP, infection, need for intervention, length of hospital stay, and mortality.
Of the 65 patients (mean age 39.55 ± 13.14 years; 67.7% males; etiology: alcohol 47.7%, gallstone disease 43.1%, and others 3%), 28 (43%) had organ failure. Respiratory failure was present in 21 (32.3%) patients, acute kidney injury (AKI) in 11 (16.9%) patients, and cardiovascular dysfunction was present in 4 (6.2%) patients. ECG changes were present in 26 (40%) patients with ST segment depression with T wave inversion being the most common (n = 22, 85%). Elevated CK-MB level (more than two times normal) was seen in 18 (27.7%) patients and was associated with increased necrosis (odds ratio = 2.44, 95% confidence interval = 0.5-12.3, p = 0.021), CTSI (7.7 ± 2.7 vs. 5.0 ± 3.0, p = 0.002), severity of AP (p = 0.05), CVSF (p = 0.005), hospital stay (19.3 ± 12.3 vs. 12.3 ± 7.0, p = 0.006), and mortality (odds ratio = 6.42, 95% confidence interval = 1.0-38.9, p = 0.045). Left ventricular systolic dysfunction (left ventricular ejection fraction [LVEF] < 55%) was seen in 9 (13.8%) patients, all of whom had mild systolic dysfunction and left ventricular diastolic dysfunction (LVDD) was seen in 17 (26.2%) patients. There was no association between poor LVEF or LVDD and necrosis, severity of AP, infection, need for intervention, duration of hospital stay, and mortality.
Elevated CK-MB levels were associated with increased necrosis, higher CTSI, the severity of AP, cardiovascular failure, prolonged hospital stay, LVDD, and mortality. Echocardiographic findings namely left ventricular systolic and diastolic dysfunctions were not associated with severity or outcome of AP.
器官衰竭（OF）是重症急性胰腺炎（SAP）预后的最重要预测指标。心血管衰竭（CVSF）在不同比例的SAP患者中出现。我们旨在研究急性胰腺炎（AP）中的心肌功能障碍及其对预后的影响。
在这项2011年1月至2012年7月的前瞻性研究中，纳入了连续符合条件的AP患者。入院时通过测量肌酸磷酸激酶同工酶（CK-MB）和超声心动图评估心肌功能。记录入院时的心电图（ECG）表现。患者在高依赖病房采用逐步升级的方法进行管理，并在住院期间对其预后进行随访。预后变量包括计算机断层扫描严重指数（CTSI）、AP的严重程度、感染、干预需求、住院时间和死亡率。
65例患者（平均年龄39.55±13.14岁；男性占67.7%；病因：酒精性47.7%，胆石症43.1%，其他3%）中，28例（43%）出现器官衰竭。21例（32.3%）患者出现呼吸衰竭，11例（16.9%）患者出现急性肾损伤（AKI），4例（6.2%）患者出现心血管功能障碍。26例（40%）患者出现ECG改变，其中ST段压低伴T波倒置最为常见（n = 22，85%）。18例（27.7%）患者肌酸磷酸激酶同工酶水平升高（超过正常两倍），且与坏死增加相关（比值比 = 2.44，95%置信区间 = 0.5 - 12.3，p = 0.021）、CTSI升高（7.7±2.7对5.0±3.0，p = 0.002）、AP严重程度（p = 0.05）、CVSF（p = 0.005）、住院时间（19.3±12.3对12.3±7.0，p = 0.006）和死亡率（比值比 = 6.42，95%置信区间 = 1.0 - 38.9，p = 0.045）。9例（13.8%）患者出现左心室收缩功能障碍（左心室射血分数[LVEF]<55%），所有这些患者均有轻度收缩功能障碍，17例（26.2%）患者出现左心室舒张功能障碍（LVDD）。左心室射血分数降低或左心室舒张功能障碍与坏死、AP严重程度、感染、干预需求、住院时间和死亡率之间无关联。
肌酸磷酸激酶同工酶水平升高与坏死增加、CTSI升高、AP严重程度、心血管衰竭、住院时间延长、左心室舒张功能障碍和死亡率相关。超声心动图显示的左心室收缩和舒张功能障碍与AP的严重程度或预后无关。
