Akut Pankreatitte Risk Sınıflaması ve Prognoz
Özet
Akut pankreatit, genellikle safra taşları veya alkol kullanımıyla tetiklenen ve klinik seyri hafiften ölüme kadar uzanan geniş bir yelpazede seyreden inflamatuar bir hastalıktır. Tanı konulurken üst karın ağrısı, serum enzimlerinde üç kat artış ve görüntüleme bulguları temel alınmakta; hastalık ise revize Atlanta sınıflamasına göre erken ve geç fazlar ile hafif, orta ve şiddetli olmak üzere üç evreye ayrılmaktadır. Hastalığın şiddetini ve mortalite riskini öngörmek amacıyla Ranson, Glasgow-Imrie, APACHE II ve BISAP gibi çoklu değişkenli skorlama sistemlerinin yanı sıra BUN, hematokrit, CRP ve Prokalsitonin gibi tekil laboratuvar parametreleri de klinik pratikte yaygın olarak kullanılmaktadır. Özellikle başvurudan 48 saat sonra hesaplanabilen Ranson ve Glasgow skorlarına kıyasla BISAP ve BUN takibi, erken evrede hızlı değerlendirme imkanı sunmaktadır. Şiddetli pankreatit vakalarının erken tespiti ve yoğun bakım transferi, morbidite ve mortaliteyi anlamlı ölçüde azaltmaktadır.
Acute pancreatitis is an inflammatory disease of the pancreas triggered by gallstones or alcohol use, with a clinical course ranging from mild to fatal, and its diagnosis is based on typical abdominal pain, elevated serum enzymes, and imaging findings. According to the revised Atlanta classification, the disease is divided into early and late phases and categorized into mild, moderate, or severe stages based on the presence and duration of organ failure. Various multi-variable scoring systems such as Ranson, Glasgow-Imrie, APACHE II, and BISAP, along with individual laboratory markers like BUN, hematocrit, CRP, and Procalcitonin, are utilized to predict prognosis and risk. While some scores require 48 hours for full assessment, markers like BUN and the BISAP score provide valuable prognostic information at the time of admission. Ultimately, identifying risk factors early allows for close monitoring and timely transfer of severe cases to intensive care units, significantly reducing morbidity and mortality rates.
Referanslar
van Santvoort HC, Bakker OJ, Bollen TL, et al. A conservative and minimally invasive approach to necrotizing pancreatitis improves outcome. Gastroenterology. 2011;141(4):1254-1263.
Peery AF, Crockett SD, Murphy CC, et al. Burden and Cost of Gastrointestinal, Liver, and Pancreatic Diseases in the United States: Update 2018. Gastroenterology. 2019;156(1):254-272.e11.
Banks PA, Bollen TL, Dervenis C, et al. Classification of acute pancreatitis--2012: revision of the Atlanta classification and definitions by international consensus. Gut. 2013;62(1):102-111.
Singh VK, Wu BU, Bollen TL, et al. Early systemic inflammatory response syndrome is associated with severe acute pancreatitis. Clin Gastroenterol Hepatol Off Clin Pract J Am Gastroenterol Assoc. 2009;7(11):1247-1251.
Żorniak M, Beyer G, Mayerle J. Risk Stratification and Early Conservative Treatment of Acute Pancreatitis. Visc Med. 2019;35(2):82-89.
Crockett SD, Wani S, Gardner TB, Falck-Ytter Y, Barkun AN. American Gastroenterological Association Institute Guideline on Initial Management of Acute Pancreatitis. Gastroenterology. 2018;154(4):1096-1101.
Sternby H, Bolado F, Canaval-Zuleta HJ, et al. Determinants of Severity in Acute Pancreatitis: A Nation-wide Multicenter Prospective Cohort Study. Ann Surg. 2019;270(2):348-355.
Working Group IAP/APA Acute Pancreatitis Guidelines. IAP/APA evidence-based guidelines for the management of acute pancreatitis. Pancreatology. 2013;13(4 Suppl 2):e1-15.
Ranson JH, Rifkind KM, Roses DF, Fink SD, Eng K, Spencer FC. Prognostic signs and the role of operative management in acute pancreatitis. Surg Gynecol Obstet. 1974;139(1):69-81.
London NJ, Neoptolemos JP, Lavelle J, Bailey I, James D. Contrast-enhanced abdominal computed tomography scanning and prediction of severity of acute pancreatitis: a prospective study. Br J Surg. 1989;76(3):268-272.
Gravante G, Garcea G, Ong SL, et al. Prediction of mortality in acute pancreatitis: a systematic review of the published evidence. Pancreatol Off J Int Assoc Pancreatol . [et al]. 2009;9(5):601-614.
Wu BU, Johannes RS, Sun X, Tabak Y, Conwell DL, Banks PA. The early prediction of mortality in acute pancreatitis: a large population-based study. Gut. 2008;57(12):1698-1703.
Papachristou GI, Muddana V, Yadav D, et al. Comparison of BISAP, Ranson’s, APACHE-II, and CTSI scores in predicting organ failure, complications, and mortality in acute pancreatitis. Am J Gastroenterol. 2010;105(2):435-441; quiz 442.
Wu BU, Bakker OJ, Papachristou GI, et al. Blood urea nitrogen in the early assessment of acute pancreatitis: an international validation study. Arch Intern Med. 2011;171(7):669-676.
Brown A, Orav J, Banks PA. Hemoconcentration is an early marker for organ failure and necrotizing pancreatitis. Pancreas. 2000;20(4):367-372.
Khanna AK, Meher S, Prakash S, et al. Comparison of Ranson, Glasgow, MOSS, SIRS, BISAP, APACHE-II, CTSI Scores, IL-6, CRP, and Procalcitonin in Predicting Severity, Organ Failure, Pancreatic Necrosis, and Mortality in Acute Pancreatitis. HPB Surg. 2013;2013:367581.
Cardoso FS, Ricardo LB, Oliveira AM, et al. C-reactive protein prognostic accuracy in acute pancreatitis: timing of measurement and cutoff points. Eur J Gastroenterol Hepatol. 2013;25(7):784-789.
Purkayastha S, Chow A, Athanasiou T, et al. Does serum procalcitonin have a role in evaluating the severity of acute pancreatitis? A question revisited. World J Surg. 2006;30(9):1713-1721.
