PROGNOSIS AND EARLY DIAGNOSIS OF GASTROINTESTINAL DYSFUNCTION IN PATIENTS WITH ACUTE NECROTIZING PANCREATITIS
Oleksandr Rotar*2, Oleksandr Rotar1, Igor Khomiak3, Michael Fishbach1, Oleh Polyanskyy1, Iuliia Migaichuk1
1General Surgery, Bukovinian State Medical University, Chernivtsi, Ukraine; 2University of Colorado Hospital, Aurora, CO; 3Shalimov National Institute of Surgery and Transplatology, Kyiv, Ukraine
Introduction: Acute necrotizing pancreatitis (ANP) is a potentially life threatening disease still. There is an upsurge in the incidence of ANP over the last few decades. Overall mortality rate in ANP is low, but in patients with infected necrosis it may reach 19.8-35.2%. Gastrointestinal dysfunction seems to play important role in bacterial seeding of necrotic pancreatic tissue via a number of potential routes.
Aim: To determine the frequency of gastrointestinal dysfunction during ANP and explore efficacy of biological markers for prognosis and early diagnosis of its development
Material: We performed a prospective observational cohort study of 151 patients with ANP which were admitted to single intensive care department. Gastrointestinal dysfunction was established according to ESICM recommendations. Clinical and laboratorial variables as well as plasma lipopolysaccharide, sCD14 receptors and citrulline concentrations were studied.
Results: Severe form of ANP was established at 34% of patients, moderately severe 56%. Different levels of gastrointestinal dysfunction were diagnosed in 141 (93.4%) of patients with ANP. Presence of 1st and 2nd degree of it did not influence on patients mortality whereas3rd and 4th were associated with negative outcome in patients with ANP (AUC ROC 0.887±0.0275, p=0.0001). Concentration of sCD14 receptors was significantly correlated with subsequent development of gastrointestinal dysfunction (AUC Roc 0.807±0.0215, p=0.045). Citrulline level below 12.5 μmol/l allowed to diagnose gastrointestinal dysfunction with the sensitivity of 90.4% and specificity of 84.6% after 4th day from onset (AUC ROC 0.905±0.0179, p=0.001).
Conclusion: sCD14 concentration at admission is useful prognostic marker, whereas citrulline level below 12.5 µmol/l – is an effective diagnostic criterion of gastrointestinal dysfunction during early phase of ANP. Its severe form is associated has unfavorable influence on survival of patients.
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