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Abstract
Acute pancreatitis (AP) is an inflammatory disorder of the pancreas that, when classified as severe, is associated with high morbidity and mortality. Promptly identifying the severity of AP is of extreme importance for improving clinical outcomes. The aim of this study was to compare the prognostic value of serological biomarkers, ratios, and multifactorial scores in patients with acute biliary pancreatitis and to identify the best predictors. In this observational and prospective study, the biomarkers, ratios and multifactorial scores were evaluated on admission and at 48 h of the symptom onset. On admission, regarding the AP severity, the white blood count (WBC) and neutrophil–lymphocyte ratio (NLR), and regarding the mortality, the WBC and the modified Marshall score (MMS) showed the best predictive values. At 48 h, regarding the AP severity, the hepcidin, NLR, systemic inflammatory response index (SIRI) and MMS and regarding the mortality, the NLR, hepcidin and the bedside index for severity in AP (BISAP) score, showed the best predictive values. The present study enabled the identification, for the first time, of SIRI as a new prognostic tool for AP severity, and validated hepcidin and the NLR as better prognostic markers than C-reactive protein (CRP) at 48 h of symptom onset.
Highlights
Acute pancreatitis (AP) is an inflammatory disorder of the pancreas with a multifactorial pathogenesis, in which enzyme activation plays a central role in local pancreatic damage, causing systemic and peripancreatic tissue involvement [1]
After applying the exclusion criteria, a total of 75 patients with acute biliary pancreatitis were included in this study
There was no statistical significance between the different severity groups related to age, gender, body mass index (BMI) and Charlson index (Table 1)
Summary
Acute pancreatitis (AP) is an inflammatory disorder of the pancreas with a multifactorial pathogenesis, in which enzyme activation plays a central role in local pancreatic damage, causing systemic and peripancreatic tissue involvement [1]. Several studies have shown that the first 48 h after the symptom onset is very important to identify those patients at risk of developing complications or death. This period is important to outline an appropriate approach based on fluid resuscitation, pain control and nutritional support. Early identification is based on multifactorial scores as Ranson, acute physiology and chronic health evaluation (APACHE-II), bedside index for severity in AP (BISAP), systemic inflammatory response syndrome (SIRS) and modified Marshall score (MMS) and several biochemical markers such C-reactive protein (CRP), white blood count (WBC), neutrophils and procalcitonin (PCT)— all are associated with several limitations [7,10]. The early identification of patients at risk of developing severe AP remains a great challenge
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