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Authors
Advisor(s)
Abstract(s)
Introdução
A pancreatite aguda é um estado inflamatório agudo não-bacteriano resultante da
ativação precoce de enzimas digestivas no interior das células acinares com
comprometimento variável do pâncreas, dos tecidos circundantes ou de outros órgãos e cuja
incidência tem aumentado. Divide-se em três graus de gravidade: ligeira, moderadamente
grave e grave. Em 80% dos casos apresenta-se como ligeira, no entanto, a forma grave
associa-se a uma elevada morbimortalidade. Apesar dos avanços tecnológicos, a identificação
precoce dos doentes com pancreatite aguda grave ainda é um desafio.
Objetivo
Neste sentido, o objetivo deste estudo é analisar vários scores de gravidade da
pancreatite aguda, bem como proteínas inflamatórias como marcadores preditivos de doença
grave.
Métodos
Avaliou-se o doente clinica e analiticamente na admissão (definida pelas primeiras 24
horas de internamento) e às 48 horas, permitindo o cálculo dos scores: BISAP, Glasgow-Imrie e
HAPS; juntamente com a medição dos valores da proteína C reativa e procalcitonina. O score
radiológico de Balthazar foi avaliado a partir da tomografia computorizada efetuada nas
primeiras 72 horas.
A capacidade preditiva destes sistemas de classificação foi medida através da
sensibilidade, especificidade e acuidade quanto à gravidade da pancreatite aguda.
Resultados e Discussão
Os scores obtiveram as seguintes capacidades preditivas: o BISAP às 24 horas
evidenciou uma sensibilidade de 87.1%, uma especificidade de 59.6%, com uma acuidade de
69.3%; e nas 48 horas de 80.6%, 73.7% e 76.1%, respetivamente. O índice de Glasgow-Imrie à
admissão apresentou uma sensibilidade de 85.7%, uma especificidade de 70.6% e uma
acuidade de 75.0%; enquanto, às 48 horas os valores foram de 66.7%, 82.4% e 75.9%,
respetivamente. O HAPS à admissão não foi avaliado por ausência de diferenças
estatisticamente significativas. O HAPS às 48 horas e o Balthazar não tiveram poder
suficientemente discriminativo (AUC de 0.545 (p>0.05) e de 0.636 (p>0.05), respetivamente).
A proteína C reativa à admissão obteve uma sensibilidade de 82.1%, uma especificidade de
73.2% e uma acuidade de 76.2%; e às 48 horas, os valores foram 90.3%, 69.1% e 76.7%, respetivamente. A procalcitonina à admissão obteve uma sensibilidade de 92.9%, uma
especificidade de 61.5% e uma acuidade de 72.5%; às 48 horas, apresentou uma sensibilidade
de 81.3%, uma especificidade de 75.0%, com uma acuidade de 77.3%.
Conclusão
Dos scores multifatoriais avaliados, o BISAP e o Glasgow-Imrie são aqueles que
obtiveram um maior poder discriminativo. Também a proteína C reativa e procalcitonina
constituíram um bom indicador de prognóstico quando obtidos nas primeiras 24 e 48 horas.
Introduction Acute pancreatitis is a non-bacterial acute inflammatory condition that results from the early activation of digestive enzymes within the acinar cells which leads to a variable impairment of the gland, surrounding tissues or other organs. It is divided into three degrees of severity: mild, moderately severe and severe. In 80% of the cases it appears as a mild form but the severe presentation is associated with high morbidity and mortality. Despite the technological advances nowadays, early identification of severe acute pancreatitis is still a challenge and its incidence is increasing. Goal This study’s objective is to analyze several scores of severity of acute pancreatitis and inflammatory proteins as predictive markers of severe disease. Methods At admission (defined by the first 24 hours of admission) it was evaluated the clinical and analytical aspects of the patient, and also at 48 hours, allowing the calculation of the scores BISAP, Glasgow-Imrie and HAPS, and the values of C-reactive protein and procalciconin were also obtained. The radiological score Balthazar was evaluated from the CT scan performed within 72 hours. The predictive capacity of these classification systems in the identification of the acute pancreatitis severity was measured by their sensitivity, specificity and accuracy. Results and Discussion The scores obtained the following predictive capacity: the BISAP at 24 hours showed a sensitivity of 87.1%, a specificity of 59.6% with an accuracy of 69.3%; and at 48 hours the values were 80.6%, 73.7% and 76.1%, respectively. The Glasgow-Imrie score at admission had a sensitivity of 85.7%, a specificity of 70.6% and an accuracy of 75.0%; while, at 48 hours the values were 66.7%, 82.4% and 75.9%, respectively. The HAPS at admission has not been evaluated because there were no statistically significant differences. The HAPS and Balthazar at 48 hours had not sufficiently discriminative power (AUC 0.545 (p> 0.05) and 0.636 (p> 0.05), respectively). The C-reactive protein at admission had a sensitivity of 82.1%, a specificity of 73.2% and an accuracy of 76.2%; and at 48 hours the values were 90.3%, 69.1% and 76.7%, respectively. The procalcitonin at admission had a sensitivity of 92.9%, a specificity of 61.5% and an accuracy of 72.5%; at 48 hours the values were 81.3%, 75.0% and 77.3%, respectively. Conclusion Of the multifactorial scores evaluated, BISAP and Glasgow-Imrie were those who had the highest discriminative power. On the other hand, C-reactive protein and procalcitonin are a good indicator of prognosis if obtained in the first 24 to 48 hours.
Introduction Acute pancreatitis is a non-bacterial acute inflammatory condition that results from the early activation of digestive enzymes within the acinar cells which leads to a variable impairment of the gland, surrounding tissues or other organs. It is divided into three degrees of severity: mild, moderately severe and severe. In 80% of the cases it appears as a mild form but the severe presentation is associated with high morbidity and mortality. Despite the technological advances nowadays, early identification of severe acute pancreatitis is still a challenge and its incidence is increasing. Goal This study’s objective is to analyze several scores of severity of acute pancreatitis and inflammatory proteins as predictive markers of severe disease. Methods At admission (defined by the first 24 hours of admission) it was evaluated the clinical and analytical aspects of the patient, and also at 48 hours, allowing the calculation of the scores BISAP, Glasgow-Imrie and HAPS, and the values of C-reactive protein and procalciconin were also obtained. The radiological score Balthazar was evaluated from the CT scan performed within 72 hours. The predictive capacity of these classification systems in the identification of the acute pancreatitis severity was measured by their sensitivity, specificity and accuracy. Results and Discussion The scores obtained the following predictive capacity: the BISAP at 24 hours showed a sensitivity of 87.1%, a specificity of 59.6% with an accuracy of 69.3%; and at 48 hours the values were 80.6%, 73.7% and 76.1%, respectively. The Glasgow-Imrie score at admission had a sensitivity of 85.7%, a specificity of 70.6% and an accuracy of 75.0%; while, at 48 hours the values were 66.7%, 82.4% and 75.9%, respectively. The HAPS at admission has not been evaluated because there were no statistically significant differences. The HAPS and Balthazar at 48 hours had not sufficiently discriminative power (AUC 0.545 (p> 0.05) and 0.636 (p> 0.05), respectively). The C-reactive protein at admission had a sensitivity of 82.1%, a specificity of 73.2% and an accuracy of 76.2%; and at 48 hours the values were 90.3%, 69.1% and 76.7%, respectively. The procalcitonin at admission had a sensitivity of 92.9%, a specificity of 61.5% and an accuracy of 72.5%; at 48 hours the values were 81.3%, 75.0% and 77.3%, respectively. Conclusion Of the multifactorial scores evaluated, BISAP and Glasgow-Imrie were those who had the highest discriminative power. On the other hand, C-reactive protein and procalcitonin are a good indicator of prognosis if obtained in the first 24 to 48 hours.
Description
Keywords
Atlanta Gravidade Pancreatite Aguda Scores