The Ranson criteria form a clinical prediction rule for predicting the prognosis and mortality risk of acute pancreatitis. They were introduced in by the. Early prediction of acute pancreatitis: prospective study comparing computed tomography scans, Ranson, Glascow, Acute Physiology and. Revised Atlanta Criteria for Acute Pancreatitis Severity. Aka: Revised Atlanta Ranson score 3 or greater; APACHE II Score 8 or greater.
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Corelation among clinical, biochemical and tomographic criteria in order to evaluate the severity in acute pancreatitis. Services of 3 Internal Medicine and 4 Clinical Nutrition.
To all the Gastroenterology medical staff of Mexico’s General Hospital for their invaluable support. There exist few studies that correlate these parameters. There were included patients of any gender above the age of 18, with diagnosis of acute pancreatitis of any etiology, who had ransoj an abdominal tomography 72 hours after the beginning of the clinical condition in order to stage the pancreatic damage.
The diagnosis of acute pancreatitis was established with 2 of the 3 following criteria: In order to make the correlation, the Pearson or the Spearman tests were used according to the distribution of the variables.
Balthazar score | Radiology Reference Article |
The most frequent etiology was due to alcohol The age average was Fifty per cent ranon the patients had acute severe pancreatitis according to the Atlanta criteria. Ninety-two point nine per cent of the patients had less than 3 Ranson criteria of which The acute pancreatitis AP keeps on being one of the gastrointestinal pathologies with more incidence and that can unchain a significative mortality.
Due to the seriousness that an AP condition implicates, different prognosis methods have been developed that can indicate us in a specific way the most likely outcome of each patient. Pancfeatitis the daily clinical practice we often watch that the different severity scales have certain discrepancies.
Ranson criteria – Wikipedia
Until the present day there are few studies in literature that try to correlate these pancreattis, this is why we have focused on the performance of a study in our hospital, criteriow to observe how frequent is the discrepancy between the severity degree and the tomographic finds according to the Balthazar classification. The evaluation of the severity is one of the most important discussions on the AP handling. Approximately half of the deaths happen during the first week due to multi-organ systemic failure Recently the hemo-concentration has been identified as a strong risk factor and an early marker for necrotic pancreatitis and organ failure.
The radiologic image is used to confirm or exclude the clinical diagnosis, establish the cause, evaluate the severity, detect complications and provide a guide for therapy 9. The computed tomography CT is recommended as the standard criterlos diagnosis method for AP For a better determination of the disease’s severity, it must be performed 2 to 3 days after the beginning of the symptoms.
The inflammation’s severity can be graduated according to the Balthazar classification from A to E. In terms of organ failure and development of pancreatic necrosis, the most pajcreatitis acute pancreatitis happen at the E Balthazar degree 1,2.
The objective of this study was to correlate the severity degree of the acute pancreatitis according to the Ranson, APACHE-II criteria, and the determination of the serous hematocrit at the moment of admission, with the local pancreatic complications according to the tomographic Balthazar criteria, in order to give a better prognosis value to the tomographic finds in relation with the AP severity.
A retrospective, observational and analytic study was made. There were included files from patients of any gender admitted to the Gastroenterology Service of Mexico’s General Hospital from January to Decemberwith AP diagnosis of any etiology. In order to see the staging of pancreatic damage, these patients had performed an abdominal tomography 72 hours after the beginning of the symptoms. The AP diagnosis was performed to the patients that had at least 2 of the 3 following criteria: The tomographic evaluation was performed by Mexico’s General Hospital radiologists and was reported according to the A and E degree of the tomographic Balthazar criteria.
Central tendency measurements and dispersion for the quantitative variables were used; the frequencies are expressed in proportion terms and written between parentheses. The Sperman coefficients of correlation were calculated in order to associate the different scales.
The SPSS version The data are presented in summary measurements: During the research period, there was an admission of 1, patients to the Gastroenterology Service of Mexico’s General Hospital, in which 65 4. Of this 65 patients, 28 fulfilled the criteria of inclusion, the rest of the patients were excluded because either they had slight pancreatitis, didn’t count with tomographic evaluation or were monitored on external consult.
The main etiology was due to alcohol in 15 patients The characteristics of the patients that were included on the study are shown on table I. In table IIwe can observe the characteristics of the patients according to the severity markers. In relation to the Ranson criteria, Concerning the hematocrit value, 57 and According to the Balthazar tomographic degree and the AP severity of clinical and biochemical criteria, of the patients that were classified within slight disease, none was classified within the A Balthazar degree, We found a similar distribution between the slight and severe disease: A poor correlation among the results of the different scales was documented.
The correlation coefficients for the Balthazar scale were: On this study we found that in our hospital service we have a low frequency of the disease. This maybe explained because it is a third level concentration center in which most of the AP patients are looked after in second level centers, therefore our results cannot be extrapolated to the population in general; it would be important to perform this analysis on these kind of attention centers.
It is proved that we can have patients who are classified with slight disease by means of the Ranson, APACHE-II or hematocrit criteria, however while performing the computed tomography, we found advanced Balthazar degrees, which indicate us that these scales must not be the only parameter to be taken into account to make the decision of performing or not this radiologic study in patients with slight acute pancreatitis.
It must be pointed out that the optimal time to perform the tomographic study is 48 to 72 hours after the symptomatology has begun. The previous statement was carried out in all of our patients. If the CT is performed before this period, the results may be lower Balthazar degrees. As it is pointed in some studies, the APACHE-II scale at the moment of admission is not to be trusted to neither diagnose pancreatic necrosis nor severe pancreatitis It has been proved that the free intraperitoneal fluid and peripancreatic fat finds are associated with worse results The previous statement takes relevance due to the fact that our study points out that there is no correlation between the Balthazar degree and the hematocrit level, therefore it is essential to perform the CT in order to point out advanced degrees of Balthazar with necrosis, independently of the hematocrit level and the Ranson and APACHE-II scales.
An important consideration was the impossibility to correlate the tomographic finds with the serum concentration of reactive C proteins, which is considered until the present moment the best prognosis indicator of AP. It was not possible on our second study to measure it on all of the patients, but in a posterior study it would be of great importance to correlate these parameters in order to look for a better indicator to make the decision of performing or not a tomographic study in patients with slight AP.
The number of patients of this study does not allow us to conclude in a categorical way the absence of correlation between the tomographic Balthazar finds and the clinical and biochemical scales previously mentioned, how-ever it encourages us to carry on with this research.
It can be suggested that there does not exist a statistically meaningful correlation between the APACHE-II scale of seriousness and the advanced Balthazar degrees due to the report of a poor correlation between Pearson and Spearman’s, therefore it is likely to find very ransn patients with an A or B Balthazar and on the other hand patients with slight acute pancreatitis with D o E Balthazar.
Therefore, to have or not an advanced Balthazar does not necessarily represent a serious pancreatic disease or a systemic inflammatory response, and on the other hand to have a slight disease by means arnson clinical and biochemical criteria does not mean a lower degree on the tomographic Balthazar classification.
Until this moment, there are needed higher prospective and multi-centric studies that correlate the tomographic with the clinical and biochemical scales. Within them, the measurement of reactive C protein must be taken into account. Let us hope that in a future we can point out our finds in a more concrete pancreatitiz. Practice guidelines in acute pancreatitis. Am Gastroenterol ; Rev Med Int Med Crit ; 1: Early onset of organ failure is the best predictor pancreatitjs mortality in acute pancreatitis.
Rev Esp Enferm Dig ; A critical evaluation of laboratory tests in acute pancreatitis. Am J Gastroenterol ; Hemoconcentration is an early marker for organ failure and necrotizing pancreatitis. Am Fam Physician pancgeatitis Pancreatic disease group, Chinese society of gastroenterology and Chinese medical association.
Consensus on the diagnosis and treatment of acute pancreatitis. Chin J Dig Dis ; 6: Med Intensiva ; UK guidelines for the management of acute pancreatitis.
Introduction The acute pancreatitis AP keeps on being one of the gastrointestinal pathologies with more incidence and that can unchain a significative mortality. Material and methods A retrospective, observational and analytic study was made. Results During the research period, there was pzncreatitis admission of 1, patients to the Gastroenterology Service of Mexico’s General Hospital, in which 65 4.
Discussion On this study we found that in our hospital service we have a low frequency of the disease.