engleski

Prognostic value of early computed tomography coupled with Ranson's score and C-reactive protein level in acute pancreatitis

Background: Acute pancreatitis is a multietyologic entity with rather variable clinical course. Grading of severity is of critical importance in guiding therapy and estimating prognosis. Aim: The aim of this study was to determined early prognostic factors for severe form of acute pancreatitis. Patients and methods: The study encompasses 119 patients (77 male and 42 female, aged 24-92 Ys) admitted with acute pancreatitis in the ICU of Clinical Hospital ŤMerkurť in Zagreb, Croatia, during the last five years. In all of them Ranson's signs, C-reactive protein level were daily measured and dynamic CT scans performed within 48 hours after admission and 10 days after the onset of an attack. The tomographic severity of pancreatitis was graduated in 5 degrees (A-E ; by Hill).For each of these parameters there are determinations of single and group correlations with severity of disease and accompanying complications. Results: The majority 94% of patients in whom CT showed changes (grades A and B), had three or less Ranson’s score and C-reactive protein less than 150 mg/l. In contrast, 92% of patients in whom CT showed more severe changes of pancreatitis (grades D and E ), had more than four Ranson’s score and C-reactive protein above 150 mg/l. The best values of sensitivity were obtained by C-reactive protein (100%) and CT findings (90, 3%) ; the best values of specificity by Ranson’s score (88, 5%) and of efficiency by CT (86, 1%). Severe form of acute pancreatitis was identified in 36 (30.25%) patients, 31 of them being alcoholics. 11 (9.24%) patients died, five of them from multisystem organ failure in the first five days after admission. Pancreatic sepsis was observed in all cases, demonstrated by culture of samples obtained by needle aspiration and at laparotomy. Conclusion: Ranson's score, C-reactive protein and CT has been proved an useful and reliable subset in discovering on time severe form of acute pancreatitis which is of critical importance in providing adequate therapy.

Pancreatitis; acute pancreatitis; computed tomography; Ranson's score; C-reactive protein

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