Prajapati Ramlal, Manay Priyadarshini, Sugumar Kavin, Rahandale Vinay, Satoskar Rajeev
Department of Surgery, University Hospitals, Seidman Cancer Center, Cleveland, United States.
Department of Transplant Surgery, University of Iowa Hospitals & Clinics, Iowa City, United States.
Turk J Surg. 2021 Mar 22;37(1):13-21. doi: 10.47717/turkjsurg.2021.5072. eCollection 2021 Mar.
Several predictive scoring systems are used in the prognostication of acute pancreatitis (AP). However, the quantity of evidence of these prognostic systems in the Indian population remains sparse. The aim of our study was to evaluate the usefulness of such prognostic scores to predict mortality, incidence of pancreatic necrosis and intervention in AP.
This was an observational study of patients diagnosed with AP between June 2012 and November 2013 in a tertiary referral center in India. Vital signs, biochemical tests and CT-findings were recorded to identify SIRS, Ranson's score and CT-severity index at diagnosis. Chi square test was used to compare incidence of mortality, pancreatic necrosis, and intervention between mild versus severe acute pancreatitis groups.
A total of 100 patients with AP were treated during out study period. Ranson's score more than 7 and presence of pancreatic necrosis were significantly associated with increased mortality (p <0.05). SIRS, CTSI score more than 7, inotropic support, and complications were more frequently associated with patients with necrosis. Prophylactic antibiotics did not decrease mortality, but decreased intervention rate (p <0.05). Presence of systemic inflammatory response syndrome (SIRS), Ranson's score > 7, necrosis, inotropic support and presence of complications were associated with a greater rate of interventions including surgery and percutaneous procedures (p <0.05).
We validate SIRS, Ranson's, and CTSI score as prognostic markers for AP in the Indian population. These predictors, when used in combination, can direct early monitoring and aggressive management in order to decrease mortality associated with severe AP.
几种预测评分系统用于急性胰腺炎（AP）的预后评估。然而，这些预后系统在印度人群中的证据数量仍然稀少。我们研究的目的是评估此类预后评分对预测AP患者死亡率、胰腺坏死发生率及干预措施的有用性。
这是一项对2012年6月至2013年11月在印度一家三级转诊中心诊断为AP的患者进行的观察性研究。记录生命体征、生化检查及CT检查结果，以确定诊断时的全身炎症反应综合征（SIRS）、兰森评分及CT严重指数。采用卡方检验比较轻度与重度急性胰腺炎组之间的死亡率、胰腺坏死发生率及干预措施的差异。
在我们的研究期间共治疗了100例AP患者。兰森评分大于7及存在胰腺坏死与死亡率增加显著相关（p<0.05）。SIRS、CTSI评分大于7、使用血管活性药物支持及并发症在胰腺坏死患者中更常见。预防性使用抗生素并未降低死亡率，但降低了干预率（p<0.05）。存在全身炎症反应综合征（SIRS）、兰森评分>7、胰腺坏死、使用血管活性药物支持及存在并发症与包括手术及经皮操作在内的更高干预率相关（p<0.05）。
我们验证了SIRS、兰森评分及CTSI评分在印度人群中作为AP预后标志物的有效性。这些预测指标联合使用时，可指导早期监测及积极治疗，以降低与重症AP相关的死亡率。
