PREDICTORS OF EARLY SURGICAL INTERVENTION IN PATIENTS WITH SEVERE ACUTE PANCREATITIS

Background. Acute pancreatitis is an important and unsolved problem of surgery. The most important subject of discussions in the treatment of acute pancreatitis is the choice of the timing of surgical intervention. Aim. To develop clinical and diagnostic criteria for early surgical interventions in patients with severe acute pancreatitis. Materials and methods. The study consisted of two stages: a retrospective study, including an analysis of the treatment of 20 patients, operated in early terms for 2-4 days and a prospective study, including analysis of human serum samples by HPLC method. Results. We determined that intra-abdominal pressure, indicators of APACHE 11 and B1SAP scores and CRP level correlate and their peak values are indicative for early surgical intervention. Using the HPLC method we isolated the group of 13 pathological and a group of 7 normal metabolites, characteristic of severe acute pancreatitis. These are specific markers of severe acute pancreatitis. Conclusions. Early surgical intervention with persistent and progressive 1AH significantly reduces the scores of the integral scales, the level of CRP which reflects the regression of MOF phenomena and reduces the risk of adverse outcome. Using the HPLC method we showed a principal possibility of predicting severe course of pancreatitis in early periods.

acute pancreatitis, acute severe pancreatitis, necrotizing pancreatitis, intraabdominal hypertension, abdominal compartment syndrome, HPLC

1. Винник Ю.С., Миллер С.В., Онзуль Е.В. Объективная оценка тяжести больных острым панкреатитом с помощью прогностических шкал // Сибирское медицинское обозрение. - 2010. - Т. 66, № 6. - С. 13-17. Vinnik YS, Miller SV, Onzul EV. (2010). Objective assessment of the severity of condition of patients with acute pancreatitis using prognostic scales [Objektivnaya otsenka tyazhesti bol’nykh ostrym pankreatitom s pomoshch’yu prognosticheskikh shkal]. Sibirskoe meditsinskoe obozre-nie, 66 (6), 13-17.

2. Мерзликин Н.В., Бражникова Н.А., Цхай В.Ф. Панкреатит. - М., 2014. - C. 528. Merzlikin NV, Brazhnikova NA, Tskhay VF. (2014). Pancreatitis [Pankreatit]. Moskva, 528 p.

3. Пацай Д.И, Блахов Н.Ю. Диагностическая и прогностическая значимость С-реактивного белка и сывороточного ферритина при остром панкреатите // Военная медицина. - 2008. - № 4. - С. 32-36. Patsay DI, Blakhov NY. (2008). Diagnostic and prognostic significance of C-reactive protein and serum ferritin in acute pancreatitis [Diagnosticheskaya i prognosticheskaya znachimost S-reaktivnogo belka i syvorotochnogo ferritina pri ostrom pankreatite]. Voennaya meditsina, (4), 32-36.

4. Abu-Zidan F.M., Bonham M.J., Windsor J.A. (2000). Severity of acute pancreatitis. Br J Surg, 8, 1019-1023.

5. Cardoso F.S., Ricardoa L.B., Oliveira A.M., Horta D.A., Papoila A.L., Deus J.R., Canena J. (2015). C-reactive protein at 24 hours after hospital admission may have relevant prognostic accuracy in acute pancreatitis: A retrospective cohort study. GE Port J Gastroenterol, 22 (5), 187-189.

6. Deanne B., Margaret K., Stephen P. (2014). Acute pancreatitis. Medicine, 43, 174-181.

7. Ince A.T., Baysal B. (2014). Pathophysiology, classification and available guidelines of acute pancreatitis. Turk J Gastroenterol, 4, 351-357.

8. Johnson C.D., Toh S.K.C., Campbell M.J. (2004). Combination of APACHE-II score and an obesity score (APACHE) for the prediction of severe acute pancreatitis. Pancreatology, 1, 1-6.

9. Ke L., Tong Z., Li W.Q., Wu C., Li N. (2014). Predictors of critical acute pancreatitis: a prospective cohort study. Medicine, 93, 108.

10. Kumar A., Heaton J.C., McCalley D.V. (2013). Practical investigation of the factors that affect the selectivity in hydrophilic interaction chromatography. J Chromatogr, 1276, 33-46.

11. Lankisch P.G. (2008). Conservative therapy of acute pancreatitis. The Pancreas: an Integrated Textbook of Basic Science, Medicine and Surgery, 273-280.

12. Michael L.C. (2009). Abdominal compartment syndrome: pathophysiology and definitions. Scand J Trauma Resusc Emerg Med, 10, 1-11.

13. Neoptolemos J.P., Kemppainen E., Mayer J., Fitzpatrick J., Raraty M., Slavin J., Beger H.C., Hietaranta A., Puolakkainen P. (2000). Early prediction of severity in acute pancreatitis by urinary trypsinogen activation peptide: a multicenter study. Lancet, 12, 1955-1960.

14. Rafferty J.L., Siepmann J.I., Schure M.R. (2012). A molecular simulation study of the effects of stationary phase and solute chain length in reversed-phase liquid chromatography. J Chromatogr, 1223, 24-34.

15. UK Working Party on Acute Pancreatitis. (2005). UK guidelines for the management of acute pancreatitis. Gut, 54, 1-9.

16. Van Brunschot S., Schut A.J., Bouwense S.A., Besselink M.G., Bakker O.J. (2014). Abdominal compartment syndrome in acute pancreatitis a systematic review. Pancreas, 43, 665-674.

17. Wu C., Ke L., Tong Z., Li B., Zou L. (2015). Hypertriglyceridemia is a risk factor for acute kidney injury in the early phase of acute pancreatitis. Pancreas, 43, 1312-1316.