A Study Management Ofacute Pancreatitis; Role Ofrecent Criteria In Prognosis and Management Of Acute Pancreatitis

Indian Journal of Applied Basic Medical Sciences
Year: 2019, Volume: 21(A), Issue. (1), January
First page: (69) Last page: (93)
Online ISSN: 2249-7935
Print ISSN: 0975-8917
doi

A Study Management Ofacute Pancreatitis; Role Ofrecent Criteria In Prognosis and Management Of Acute Pancreatitis
Kaushal D. Suthar1, Sruja D. Narola2*, Jay Pandya3 , Kush Shah 4
1Associate professor, 2 2nd year surgery resident, 32nd year surgery resident, 4 1st year resident of onco surgery. Vadilal Sarabhai Hospital, Ahmedabad
Corresponding author email id:sruja.narola@gmail.com

Online Published on 02-Jan-2019

ABSTRACT

Aim : To compare APACHE-II scoring, C-Reactive Protein (CRP), Interleukin-6 (IL estimation and Contrast Enhanced Computed Tomography in assessing the severity of acute pancreatitis and prognosis of the condition. To determine the role of these investigations and the most accurate investigation for the detection of severity of acute pancreatitis and prognosis at 72 hours. Method: The present study was conducted at the Department of General Surgery, V.S. General Hospital, Ahmedabad. The Study population consisted of first50 cases of acute pancreatitis fulfilling the inclusion criteria. It was a prospective study. Results: Apache II scoring done at admission predicted severe pancreatitis in 8 cases out of 10 cases which turned out to be severe on Atlantic classification. So, there was 2 false negative cases in severe group. Apache II score at admission predicted 38patients as mild pancreatitis thus giving false positive result in 2 cases. Pearson Chi-square test of significance was applied for the analysis of the data. This clinical scoring done at admission had a sensitivity of 80%,specificity of 95%, positive predictive value of 80%, negative predictive value of 95% and accuracy of 92%. Serum CRP level of the patients at admission predicted 7 as severe pancreatitis out of 10 actual cases of severe pancreatitis thus giving false negative result in 3 cases. This biochemical assay labeled 26 cases as mild at admission thus giving false positive rate in 14 cases. Statistical analysis of the data yielded a p value of 0.07 (Pearson Chi-square test) indicating that the data was statistically insignificant. Estimation of serum CRP level at admission had sensitivity of 70%, specificity of 65%, PPV of 33.33%, NPV of 89.65% and accuracy of 66%. Serum IL-6 level of the patients at admission predicted 8 as severe pancreatitis out of 10 actual cases of severe pancreatic thus giving false negative result in 2 cases. This biochemical assay labelled 36 cases as mild at admission thus giving false positive rate in 4 cases. Estimation of serum IL-6 level at admission had sensitivity of 80%, specificity of 90%, PPV of 66.67%, NPV of 94.74% and accuracy of 88%. Conclusion: Evaluation of the different prognostic indications for the detection of severity at admission showed that Apache II score as well as serum IL-6 were the best indicators of severity. However, due to the complex nature of the calculation, the Apache II score might prove to be cumbersome. Whereas serum IL-6 being costly and not being easily available in the setup is its main drawback. Serum CRP estimation at the time of admission was not accurate to determine prognosis and severity of AP as raised CRP level are dependent of hepatic synthesis secondary to circulating cytokines (IL- 6) which usually takes 2-3 days after the onset of disease. Evaluation of the above score again at 72 hours, along with the CTSI score produced an equivocal result. However, when CTSI was compared with Apache II score, IL-6 and CRP for the best possible indicator for detection of severity at 72 hours, CTSI emerged as a favorable prognostic indicator owing to the relative case of calculation

Keywords

APACHE-II scoring, C-Reactive Protein (CRP), Interleukin-6 (IL-6) estimation, Contrast Enhanced Computed Tomography, assessing the severity of acute pancreatitis.

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