Akut Biliyer Pankreatit’li Hastalarda Apache II, Ranson ve Balthazar Skorlama Sistemlerinin Morbidite Tahminindeki Rolü

GİRİŞ ve AMAÇ: Akut pankreatit tanısı alan hastaların tedavisinin planlanması hastalığın şiddetinin belirlenmesine bağlıdır. Akut pankreatit şiddetinin belirlenmesi, klinik komplikasyonların öngörülmesi ve potansiyel ölüm riskinin saptanması için çok önemlidir. Akut biliyer pankreatitli hastalarda pankreatit şiddetini belirlemek ve hastaların takiplerinde kullanılmak üzere APACHE II, Ranson ve Balthazar skorlama sistemlerinin morbidite tahminindeki etkinliklerini ve varsa birbirlerine üstünlüklerini araştırmayı amaçladık. YÖNTEM ve GEREÇLER: 2009 - 2011 yılları arasında kliniğimize başvuran 131 akut biliyer pankreatitli hasta prospektif araştırıldı. Hastaların APACHE II, Ranson ve Balthazar şiddet skorları belirlendi. BULGULAR: Hastaların 51’inde (%38.9) lokal, 68’inde (%51.9) sistemik komplikasyon olmak üzere toplam 77 hastada (%58.8) morbidite geliştiği gözlendi. APACHE II skoruna göre 61 (%46.6), Ranson skoruna göre 77 (%58.8), Balthazar skoruna göre 58 (%44.3) hastada şiddetli pankreatit saptandı. TARTIŞMA ve SONUÇ: APACHE II, Ranson ve Balthazar skorlama sistemlerinin akut biliyer pankreatit hastalarının morbidite tahmininde etkin olduğu ancak Balthazar skorlama sisteminin morbidite ve lokal komplikasyon tahmininde, APACHE II skorlama sisteminin ise sistemik komplikasyon tahmininde diğer skorlama sistemlerinden daha etkin olduğu saptandı.

The Role of Apache II, Ranson and Balthazar Scoring Systems on Morbitidy in Patients with Acute Biliary Pancreatitis

INTRODUCTION: The treatment of patients diagnosed with acute pancreatitis depends on the severity of the disease. The severity of acute pancreatitis is very important for predicting clinical complications and for identifying potential risk of death. OBJECTİVE:We aimed to investigate the efficacy of APACHE II, Ranson and Balthazar scoring systems on morbidity estimation and their superiority to each other in order to determine the severity of pancreatitis in patients with acute biliary pancreatitis. METHODS: We prospective investigated 131 consecutive patients with acute biliary pancreatitis between 2009 and 2011. APACHE II, Ranson and Balthazar severity scores were determined. RESULTS: We observed totally 77 of the patients ( % 58.8 ) with complications, ın turn, 51 of the patients ( %38.9 )were local and 68 ( % 51.9 ) had systemic complications. We determined patients with severe pancreatitis according of the APACHE II, Ranson and Balthazar scores respectively, 61 (%46.6), 77 (%58.8), göre 58 (%44.3). DISCUSSION AND CONCLUSION: APACHE II, Ranson and Balthazar scoring systems were found to be effective in predicting morbidity of patients with acute biliary pancreatitis but Balthazar scoring system was found to be more effective in predicting morbidity and local complications, and APACHE II scoring system was more effective in predicting systemic complications than other scoring systems.

PDF

___

1. Yeo, CJ., Cameron, J. Acute pancreatitis., Shackelford's surgery of the alimentary tract, GD Zuidema, Philadelphia, Saunders Company. 1991;19-36.
2. William E. Fisher, Dana K. Anderson, Richard H. Bell Jr., Ashok K. Saluja and F. Charles Brunicardi, Pancreas, Schwartz’s Prıncıples of Surgery, Ninth edition. Mc Graw Hill. 2009;Chapter 33:1167-1243.
3. Şahin M, Yol S, Ciftci E, Baykan M, Ozer Ş, Akoz M, Yılmaz O, Kuru C. Does Large Bowel Enema Reduce Septic Complications in Acute Pancreatitis? Am J Surg. 1998;176:331-334.
4. Milani R Jr, Perreiria PM, Dolhnikoff M, Saldiva PH, Martins MA. Respiratory Mechanics and Lung Morphometry in Severe Pancreatitis Associated with Lung Injury in Rats. Crit Care Med. 1995;23:1882-1889.
5. Andersson R, Wang X, Ihse I. The influence of abdominal sepsis on acute pancreatitis in rats: a study on mortality, permability, arterial pressure and intestinal blood flow. Pancreas. 1995;11:365-373.
6. Company L, Saez J, Martinez J, Aparicio JR, Laveda R, Grino P, et al. Factors predicting mortality in severe acute pancreatitis. Pancreatology. 2003;3:144-148.
7. Osvaldt AB, Viero P, Borges da Costa MS, Wendt LR, Bersch VP, Rohde L. Evaluation of Ranson, Glasgow, APACHE-II, and APACHE-O criteria to predict severity in acute biliary pancreatitis. Int Surg. 2001;86:158-161.
8. Balthazar EJ, Ranson JH, Naidich DP, Megibow AJ, Caccavale R, Cooper MM. Acute pancreatitis: prognostic value of CT. Radiology. 2001;156:767-772.
9. Casas JD, Díaz R, Valderas G, Mariscal A, Cuadras P. Prognostic value of CT in the early assessment of patients with acute pancreatitis. AJR Am J Roentgenol. 2004;182:569-574.
10. Gürleyik G, Emir S, Kiliçoglu G, Arman A, Saglam A., Computed tomography severity index, APACHE II score, and serum CRP concentration for predicting the severity of acute pancreatitis. JOP. J Pancreas (Online). 2005;6(5):562-567.
11. Yeon Soo Kim, Byung Seok Lee, Seok Hyun Kim, Jae Kyu Seong, Hyun Yong Jeong, Heon Young Lee. Is there correlation between pancreatic enzyme and radiological severity in acute pancreatitis?. World J Gastroenterol. 2008 April 21;14(15):2401-2405.
12. Toouli J, Brooke-Smith M, Bassi C, Carr Locke D, Telford J, Freeny P, et al. Guidelines for the management of acute pancreatitis. J Gastroenterol Hepatol. 2002;17 Suppl:15-39.
13. Bradley EL 3rd. A clinically based classification system for acute pancreatitis. Summary of the International Symposium on acute pancreatitis, Atlanta, GA, September 11 trough 13 1992. Arch Surg. 1993;128:586-590.
14. Larvin M. Assessment of clinical severity and prognosis. In: Beger HG, Warshaw AL, Buchler MW, et al, eds. The Pancreas. Blackwell Science: New York,1998:489-502.
15. Triester SL, Kowdley KV. Prognostic factorsin acute pancreatitis. J Clin Gastroenterol. 2002;34:167-716.
16. Leung TK, Lee CM, Lin SY, Chen HC, Wang HJ, Shen LK, Chen YY., Balthazar computed tomography severity index is superior to Ranson criteria and APACHE II scoring system in predicting acute pancreatitis outcome. World J Gastroenterol. 2005 Oct 14;11(38):6049-6052.
17. Koizumi M, Takada T, Kawarada Y, Hirata K, Mayumi T, Yoshida M, et al. JPN Guidelines for the management of acute pancreatitis: diagnostic criteria for acute pancreatitis. J Hepatobiliary Pancreat Surg. 2006;13(1):25-32.
18. Timothy B Gardner, Brian S Berk, Julian Katz, Acute Pancreatitis, Medscape. http://emedicine.medscape.com/article/181364- overview. 2011.