Predicting severity of acute pancreatitis

被引：44

作者：

Rau B.M. ^{[1
]}

机构：

[1] Department of General, Visceral, and Vascular Surgery, University of the Saarland, 66421 Homburg, Saar, Kirrberger Strasse

来源：

Current Gastroenterology Reports | 2007年 / 9卷 / 2期

关键词：

Acute Pancreatitis; Organ Failure; Severe Acute Pancreatitis; Procalcitonin; Activation Peptide;

D O I：

10.1007/s11894-007-0004-5

中图分类号：

学科分类号：

摘要：

Severity stratification is a critical issue in acute pancreatitis that strongly influences diagnostic and therapeutic decision making. According to the widely used Atlanta classification, "severe" disease comprises various local and systemic complications that are associated with an increased risk of mortality. However, results from recent clinical studies indicate that these complications vary in their effect on outcome, and many are not necessarily life threatening on their own. Therefore, "severe," as defined by Atlanta, must be distinguished from "prognostic, aiming at nonsurvival. In the first week after disease onset, pancreatitis-related organ failure is the preferred variable for predicting severity and prognosis because it outweighs morphologic complications. Contrast-enhanced CT and MRI allow for accurate stratification of local severity beyond the first week after symptom onset. Among the biochemical markers, C-reactive protein is still the parameter of choice to assess attack severity, although prognostic estimation is not possible. Other markers, including pancreatic protease activation peptides, interleukins-6 and -8, and polymorphonuclear elastase are useful early indicators of severity. Procalcitonin is one of the most promising single markers for assessment of major complications and prognosis throughout the disease course. Copyright © 2007 by Current Medicine Group LLC.

引用

页码：107 / 115

页数：8

共 65 条

[11] Rau B.M., Bothe A., Kron M., Beger H.G., Role of early multisystem organ failure as major risk factor for pancreatic infections and death in severe acute pancreatitis, Clin Gastroenterol Hepatol, 4, pp. 1053-1061, (2006)
[12] Mofidi R., Duff M.D., Wigmore S.J., Et al., Association between early systemic inflammatory response, severity of multiorgan dysfunction and death in acute pancreatitis, Br J Surg, 93, pp. 738-744, (2006)
[13] Le Mee J., Paye F., Sauvanet A., Et al., Incidence and reversibility of organ failure in the course of sterile or infected necrotizing pancreatitis, Arch Surg, 136, pp. 1386-1390, (2001)
[14] Flint R., Windsor J.A., Early physiological response to intensive care as a clinically relevant approach to predicting the outcome in severe acute pancreatitis, Arch Surg, 139, pp. 438-443, (2004)
[15] Satoh A., Miura T., Satoh K., Et al., Human leukocyte antigen-DR expression on peripheral monocytes as a predictive marker of sepsis during acute pancreatitis, Pancreas, 25, pp. 245-250, (2002)
[16] Mentula P., Kylanpaa-Back M.L., Kemppainen E., Et al., Decreased HLA (human leucocyte antigen)-DR expression on peripheral blood monocytes predicts the development of organ failure in patients with acute pancreatitis, Clin Sci (Lond), 105, pp. 409-417, (2003)
[17] Ho Y.P., Sheen I.S., Chiu C.T., Et al., A strong association between down-regulation of HLA-DR expression and the late mortality in patients with severe acute pancreatitis, Am J Gastroenterol, 101, pp. 1117-1124, (2006)
[18] Kylanpaa M.L., Mentula P., Kemppainen E., Et al., Monocyte anergy is present in patients with severe acute pancreatitis and is significantly alleviated by granulocyte-macrophage colony-stimulating factor and interferon-gamma in vitro, Pancreas, 31, pp. 23-27, (2005)
[19] Leger L., Chiche B., Louvel A., Pancreatic necrosis and acute pancreatitis, World J Surg, 5, pp. 315-317, (1981)
[20] Jimenez H., Aldrete J.S., Clinical implications derived from the morphological classification of 89 patients with acute pancreatitis, J Clin Gastroenterol, 5, pp. 137-142, (1983)

← 1 2 3 4 5 6 7 →