Determinants of Prognosis in Acute Pancreatitis: Contribution to clinical practice based on scientific evidence

Trabalho de Projeto do Mestrado Integrado em Medicina apresentado à Faculdade de MedicinaAcute pancreatitis (AP) is defined as an acute inflammatory process of the pancreas that can be limited to this organ, extend to the peripancreatic tissue or reach several other organs, resulting in multiorgan failure or even death. The main goal of the present study is to investigate, among several clinical, biochemical and imaging factors, as well as among some multifactorial scores of severity, those that can aid in the early determination of the prognosis of these patients.A sample of 109 patients admitted in the Department of Gastroenterology of CHUC, between January 2010 and December 2014, with diagnosis of AP, was evaluated by several clinical, biochemical and imaging parameters, at the hospital admission and after 24 and 48 hours of hospitalization, which allowed the measurement of serum levels of C-reactive protein (CPR) and Blood Urine Nitrogen (BUN), as well as the calculation of BISAP, RANSON and Balthazar (CTSI) scores. The predictive capacity of each of these markers was assessed by sensitivity, specificity and accuracy relative to the degree of AP severity.Of the 109 patients, 86 developed mild AP, 21 moderately severe AP, and 2 severe AP.The prognostic determinants that contributed more to the diference between the evolution for mild and moderately severe AP, with statistical significance (p <0.05), were the value of CRP at 24 and 48 hours, the value of BUN at admission , the BISAP score and the Balthazar score, with area under the curve (AUC) of 0.66, 0.65, 0.65, 0.59 and 0.77, respectively, with a higher predictive weight in favor of evolution for moderately severe PA.After analysis by logistic regression it is possible to conclude that, of the multifactorial scores evaluated, the one of Balthazar was the one for which a greater acuity was obtained. CRP and BUN were also good prognostic indicators when obtained in the first 24 and 48 hours and at admission, respectively.A Pancreatite Aguda (PA) é definida como um processo inflamatório agudo do pâncreas que pode limitar-se a este órgão, estender-se ao tecido peripancreático ou atingir vários outros órgãos, resultando em falência multiorgânica ou mesmo em morte. O presente estudo tem como principal objetivo investigar, entre diversos fatores clínicos, bioquímicos e imagiológicos, bem como entre alguns scores multifatoriais de gravidade, aqueles que podem auxiliar na determinação precoce do prognóstico destes doentes.Perante uma amostra de 109 doentes com internamento no Serviço de Gastrenterologia do CHUC, entre Janeiro de 2010 e Dezembro de 2014, com diagnóstico de PA, foram avaliados diversos parâmetros clínicos, bioquímicos e imagiológicos, aquando da admissão hospitalar e após 24 e 48 horas de internamento, o que permitiu a mensuração dos níveis séricos de Proteína C- Reativa (PCR) e Blood Urine Nitrogen (BUN), bem como o cálculo dos scores BISAP, RANSON e Balthazar (CTSI). A capacidade preditiva de cada um destes marcadores foi avaliada através da sensibilidade, especificidade e acuidade relativamente ao grau de severidade da PA.Dos 109 doentes, 86 desenvolveram PA ligeira, 21 PA moderadamente grave e 2 PA grave. Os determinantes de prognóstico que, de forma estatisticamente significativa (p