Gökhan TAZEGÜL, Mete AKIN, Bülent YILDIRIM

Akut biliyer pankreatitli hastalarda prognozu öngörmede çeşitli skorlama sistemlerinin karşılaştırmalı değerlendirilmesi

Giriş ve Amaç: Bu çalışmada, (i) akut biliyer pankreatitli hastalarda pankreatitin şiddetini belirlemek, (ii) revize edilmiş Atlanta sınıflandırmasına göre şiddet ile klinik ve laboratuvar bulgular ve prognostik skorlama sistemlerinin uyumunun değerlendirilmesi amaçlanmıştır. Gereç ve Yöntem: Çalışmada, biliyer pankreatit tanısı almış toplam altmış altı hasta revize Atlanta sınıflandırması ile değerlendirilmiştir. Ranson skoru, Glasgow-Imrie skoru, Yatak Başı Akut Pankreatit Şiddet İndeksi (Bedside Index of Severity in Acute Pancreatitis), Zararsız Akut Pankreatit Skoru, Japon Şiddet Skoru, Akut Fizyoloji ve Kronik Sağlık Değerlendirme (Acute Physiology and Chronic Health Evaluation-II), Ardışık Organ Yetmezliği Değerlendirmesi (Sequential Organ Failure Assessment) skoru ve albümin-bilirübin skoru değerlendirilmiş; klinik ve laboratuvar bulguları ile karşılaştırılmıştır. Analizde, SPSS Windows sürüm 23.0 ve Medcalc 19.2 kullanılmıştır. Bulgular: Yatak Başı Akut Pankreatit Şiddet İndeksi, orta ve şiddetli pankreatiti ayırt etmede en yüksek korelasyon katsayısına sahipti. Glasgow-Imrie, albümin-bilirübin skoru (48 saat), Japon Şiddet Skoru skoru ve Ardışık Organ Yetmezliği Değerlendirmesi skoru da orta derecede korelasyona sahipti. Albümin-bilirübin skoru (başvuru) ve Zararsız Akut Pankreatit Skoru zayıf bir şekilde korele saptandı. Ranson skoru ve Akut Fizyoloji ve Kronik Sağlık Değerlendirme skoru ile pankreatit şiddeti arasında herhangi bir korelasyon bulunmadı. 48. saatte albümin-bilirübin grade 3 varlığı, orta ve şiddetli pankreatit riskini 17 kat arttırmaktaydı. Antibiyotik kullanım gerekliliğinin riski 6.6 kat, Yatak Başı Akut Pankreatit Şiddet İndeksi skoru pozitifliğinin ise riski 4.7 kat arttırmakta olduğu gösterilmiştir. Sonuç: Skorlama sistemlerinin çoklu kullanılması veya laboratuvar verileri ile beraber değerlendirilmesi, klinik kararların duyarlılığını ve özgüllüğünü arttırabilir. Yatak Başı Akut Pankreatit Şiddet İndeksi ve antibiyoterapi gerekliliğinin kombine kullanımı, orta ve şiddetli pankreatiti tahmin etmeye aday bir çoklu kullanım örneğidir. Özellikle akut biliyer pankreatitte albümin-bilirübin skoru ile ilgili daha ileri çalışmalar gereklidir.

Anahtar Kelimeler:

Pankreatit, biliyer pankreatit, prognoz, prognostik skorlar

Comparative evaluation of various scoring systems to predict prognosis in patients with acute biliary pancreatitis

Background and Aims: To identify the severity of pancreatitis in patients diagnosed with acute biliary pancreatitis, and it also seeks to assess the congruence between the revised Atlanta classification and clinical and laboratory findings and prognostic scoring systems. Materials and Methods: A total of sixty-six patients with biliary pancreatitis were evaluated with revised Atlanta classification. Ranson score, Glasgow-Imrie score, Bedside Index of Severity in Acute Pancreatitis, Harmless Acute Pancreatitis Score, Japanese Severity Score, Acute Physiology and Chronic Health Evaluation-II, Sequential Organ Failure Assessment score, albumin-bilirubin grade were evaluated and compared, along with clinical and laboratory findings. SPSS Windows version 23.0 and Medcalc 19.2 were used in the analysis. Results: Bedside Index of Severity in Acute Pancreatitis had the highest correlation coefficient in differentiating moderate and severe pancreatitis. Glasgow-Imrie, albumin-bilirubin grade (48 h) and Japanese Severity Score score and Sequential Organ Failure Assessment score were also moderately correlated. Albumin-bilirubin grade (admission) and Harmless Acute Pancreatitis Score were weakly correlated. No correlation was found with the Ranson score and Acute Physiology and Chronic Health Evaluation score. The presence of albumin-bilirubin grade 3 at 48th hour increases the risk of moderate and severe pancreatitis by 17 times. Presence of antibiotic use increases the risk 6.6 times and positive Bedside Index of Severity in Acute Pancreatitis score increases the risk 4.7 times. Conclusion: The use of multiple scoring systems or co-evaluation of laboratory data can increase the sensitivity and specificity of clinical decisions. Combined use of Bedside Index of Severity in Acute Pancreatitis and antibiotherapy requirement is a candidate for predicting moderate and severe pancreatitis. Further studies on albumin-bilirubin grade, especially in acute biliary pancreatitis, are necessary.

Keywords:

Pancreatitis, biliary pancreatitis, prognosis, prognostic scores,

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