ACUTE PANCREATITIS GRAVITY PREDICTIVE FACTORS: WHICH AND WHEN TO USE THEM?Abstracts
Introduction: Acute pancreatitis has as its main causes lithiasic biliary disease and alcohol abuse. Most of the time, the disease shows a self-limiting course, with a rapid recovery, only with supportive treatment. However, in a significant percentage of cases, it runs with important local and systemic complications associated with high mortality rates.
Aim: To present the current state of the use of these prognostic factors (predictive scores) of gravity, as the time of application, complexity and specificity.
Method: A non-systematic literature review through 28 papers, with emphasis on 13 articles published in indexed journals between 2008 and 2013 using Lilacs, Medline, Pubmed.
Results: Several clinical, laboratory analysis, molecular and image variables can predict the development of severe acute pancreatitis. Some of them by themselves can be determinant to the progression of the disease to a more severe form, such as obesity, hematocrit, age and smoking. Hematocrit with a value lower than 44% and serum urea lower than 20 mg/dl, both at admission, appear as risk factors for pancreatic necrosis. But the PCR differentiates mild cases of serious ones in the first 24 h. Multifactorial scores measured on admission and during the first 48 h of hospitalization have been used in intensive care units, being the most ones used: Ranson, Apache II, Glasgow, Iget and Saps II.
Conclusion: Acute pancreatitis is a disease in which several prognostic factors are employed being useful in predicting mortality and on the development of the severe form. It is suggested that the association of a multifactorial score, especially the Saps II associated with Iget, may increase the prognosis accuracy. However, the professional's preferences, the experience on the service as well as the available tools, are factors that have determined the choice of the most suitable predictive score.
Acute pancreatitis; Prognosis; Disease severity index
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Adapted from Campos T, heck JG, Assef JC, Rizoli S, B Nascimento, Fraga GP. Severity Ratings in acute pancreatitis. Rev Col Bras Cir. [serial on the Internet] 2013; 40 (2). Available at URL: http: // www.scielo.br/rcbc
Adapted from Feldman M, Friedman L, Brandt L. Sleisenger and Fordtran's Gastrointestinal and Liver Disease, Ninth Edition 2010. GB=total leukocytes; LDH=lactate dehydrogenase; AST=aspartate aminotransferase; BUN=blood urea; PO2=partial pressure of oxygen in arterial blood.
Adapted from Knaus WA; Draper EA; Wagner DP, Zimmerman JE. Apache II: a severity of disease classification system. Crit care Med 1985; 13(10): 818-29. T rectal=rectal temperature; MAP=mean arterial pressure; HR=heart rate; RR=respiratory rate; SpO2=oxygen saturation; pH art=arterial pH; Na=plasma sodium; K=plasma potassium; Cr=creatinine; Ht=hematocrit; GB=total leukocyte
Adapted from Bouch DC, Thompson JP. Severity scoring systems in the critically ill . Continuing Education in Anaesthesia, Critical Care & Pain. 2008; 8(5): 181-185. *CPAP=continuous positive airway pressure; ** PaO 2=partial pressure of oxygen in arterial blood; *** FiO 2=fraction of inspired oxygen
Adapted from Delrue L. J; Waele J. J; Duyck P. O. Acute pancreatitis: radiologic scores in predicting severity and outcome . 2010; 35(3):349-61Adapted from de Ledesma-Heyer JP, Amaral JA.Pancreatitis aguda . Medicina Interna de México. (2009; 25(4): 285-294). *PaO 2=partial pressure of oxygen in arterial blood; **DHL=lactate dehydrogenase; ***AST=aspartate aminotransferase; ALT=alanine aminotransferase
*Some studies suggest a moderate accuracy of SAPS II concerning the prognosis of acute pancreatitis; ** lower reproducibility for the extension of the definition of pancreatic necrosis has no effect on the calculation of Iget reproducibility; *** tomographic studies show early findings misconceptions related to ischemia of the gland which according to Balthazar, examinations after three days have higher diagnostic accuracy, and staging of acute pancreatitis, CT should only be carried out after 48-72 h from start of clinical condition.