Objectives: To evaluate outcome of therapeutic interventions for cases of acute
pancreatitis (AP) and to determine diagnostic yield and predictability of at
admission estimation of serum C-reactive protein (CRP), interleukin (IL)-6 and
cell free DNA (cfDNA) for such outcome.
Patients & Methods: The study included 67 AP patients. Ranson Criteria scoring
(RS) was used to assess AP severity as mild acute pancreatitis (MAP) (RS=C
points) and sever acute pancreatitis (SAP) (RS=>3 points). Contrast enhanced CT
(CECT) was performed 6-10 days after admission and Balthazar's CT severity
index (CTSI) was used to strati& the severity. Acute Physiology and Chronic
Health Evaluation (APACHE II) score was used to assess the impact of AP on
general condition and to help surgical decision making. Intevention policies
included conservative treatment for patients with APACHE II score of >10 and
surgical intervention either early (within 2 weeks) or late (after 2 weeks)according to the indications. At admission venous blood samples were obtained
for estimation of serum CRP, IL-6 and cfDNA. Survival rate was defined as the
primary outcome.
Results: According to Ranson's criteria 40 patients had MAP and 27 patients had
SAP. According to CTSI, 41 patients had 0-3 score, 20 patients had 4-6 score and
6 patients had score of >6. According to APACH II scoring, 23 patients had a
score of >10. In conservative treatment group, mortality rate (MR) was 13%,
while was 18.2% in surgical intervention group with non-significant difference. In
early surgical intervention group, MR was 17.6% and 15.4% in the late group with
non-significant difference. At admission serum levels of the three parameters were
significantly higher in SAP than in MAP cases. ROC defined at admission serum
level of cfDNA as the most significant early predictor and CTSI as the most
significantly specific diagnostic procedure for SAP. High serum IL-6 and cfDNA
could predict mortality with high specificity.
Conclusion: High at admission serum cfDNA and IL-6 levels could be used as
early predictors for severity of AP and its survival rates. Therapeutic intervention
modalities showed non-significant difference in MR. Proper case selection for
early surgical intervention improves outcome without deleterious effect on
survival rate. |
