Экскреция азота с мочой в раннюю фазу острого тяжелого панкреатита

Abstract

Aim. To study urinary nitrogen excretion at the early stage of severe acute pancreatitis. Materials and methods. Prospective, single-center, cohort study. Inclusion criteria: diagnosis of acute pancreatitis and presence of at least one of the predictors of severe course. Among all patients (n = 72), a cohort of patients with severe acute pancreatitis (n = 32) was allocated. Three groups were formed in it: the first one – all patients, the second one – survivors (n = 24), the third one – deceased (n = 8). Urinary nitrogen excretion was determined using the Deacon formula. Measurements were performed on the first, third and fifth days of the disease. Statistical processing of the material was carried out by the SPSS software package. The null hypothesis was rejected at p < 0.05. Results. In the first week of the disease in all groups, the maximum urinary nitrogen excretion occurs on the 3rd day. When comparing the results of the second and third groups, it was found that the urinary nitrogen excretion on the first and fifth days did not have a statistically significant difference between the groups (respectively, p = 0.138, p = 0.572), and the results of the third day have (p = 0.014). A similar pattern remains when recalculating the nitrogen loss in the urine to the ideal weight; for the third day, the differences between the second and third groups were statistically significant (p = 0.007). ROC analysis of urinary nitrogen excretion of the third day calculated to the ideal body weight showed an area under the curve of 0.813 (p < 0.009). The value at the cut-off point is defined as 0.65 g/kg/day. The sensitivity of the model was 0.75%, specificity – 0.83%. Conclusion. If in a patient with acute pancreatitis, there is urinary nitrogen excretion on the third day from the onset of the disease, calculated to an ideal body weight of ≥ 0.65 g/kg/day, an unfavorable outcome of the disease is predicted.