Prediction of Surgical Treatment in Acute Pancreatitis Using Biochemical and Clinical Parameters

Background

Deep Acute pancreatitis (AP) is an urging cause of hospitalization in the gastroenterology due to different causes and an unpredictable outcome. Known causes are grouped into four main groups: metabolic, mechanical, vascular and infectious.

Objective

To determine the role of certain biochemical or radiological parameters as predictors of an involvement of other organs in AP different pathological staging and the surgical outcome in the treatment of AP.

Methods

Ninety-seven AP patients hospitalized in General Hospital "Prim.dr Abdulah Nakaš" Sarajevo, in a period between 2016 and 2021 for both sexes, were divided according to the etiological factors of AP into four groups: nutritional factors, biliary concernments, alcohol and morphological changes of the pancreas. Beside laboratory tests, the imaging methods of abdomen (transabdominal ultrasound, abdominal computed tomography) used in determining morphological changes in the pancreas and other organs were analyzed in relation to parameters that predict the need for surgical outcomes.

Results

AP etiological factors of patients differ significantly by gender and showed the dominance of dietary factors in female subjects (51%), followed by the presence of concernments in the biliary tract in 36% of cases, and alcohol consumption in male subjects in 28% of cases. The only variable correlated with the indicator of necessity for surgery is the existence of pleural effusion (coefficient of correlation was 0.38; risk ratio was 5.5) resulting that patients with pleural effusion have a 5.5 times higher chance of surgery indication than other patients.

Conclusion

The application of simple parameters such as creatinine value with the values of amylases in serum and urine and the presence of pleural effusion confirmed by radiological imaging of the lungs opens the possibility of a simple and effective selection of patients for surgical treatment with a more severe form of AP.

CRP/HDL-C and Monocyte/HDL-C ratios as Predictors of Metabolic Syndrome in Patients With Type 2 Diabetes Mellitus

Background

Metabolic syndrome (MetS) denotes a cluster of co-occurring medical conditions associated with regulating hyperglycemia and acute cardiovascular events and complications. The escalating frequency of MetS among individuals afflicted with type 2 diabetes mellitus (T2DM) underscores its burgeoning significance as a critical public health concern and a complex clinical conundrum. Timely identification is imperative to avert the expedited progression of diabetic complications.

Objective

To investigate the role of CRP/HDL-C and Monocyte/HDL ratios in predicting MetS in T2DM individuals.

Methods

The study was designed as a two-year prospective study and included 80 T2DM patients divided into MetS and non-MetS groups based on MetS development over two years. The patients' serums were analyzed for complete blood count parameters, lipid profile, and C-reactive protein (CRP). Based on the laboratory test results, Monocyte/HDL-C and CRP/HDL-C ratios were calculated and analyzed. The receiver operating characteristic (ROC) curve and their corresponding areas under the curve (AUC) were used to determine prognostic accuracy.

Results

Monocyte/HDL-C ratio and CRP/HDL-C ratio were significantly higher in MetS-T2DM2 than in nonMetS-T2DM (p=0.003 and p=0.029, respectively). The results of ROC curve analysis have shown that the CRP/HDL-C ratio (AUC of 0.695) and Monocytes/HDL-C ratio (AUC of 0.645) can serve as good predictors of MetS in T2DM patients.

Conclusion

This study confirms the reliability of the Monocytes/HDL-C and CRP/HDL-C ratios as novel, simple, low-cost, and valuable predictors of MetS development in T2DM.

Diagnostic Potential of Ratio Between Creatine Kinase and Amylase in Acute Pancreatitis

Background

Acute pancreatitis (AP) is an acute inflammatory illness of the pancreas representing a true question in diagnostic process. Laboratory markers of the hepatobiliary tract such as liver transaminases with pancreatic enzymes give a true hint of a hidden diagnosis together with urea, creatinine and creatine kinase (CK).

Objective

This clinical study aims to show whether there is any correlation between alpha-amylase and CK or their ratio examining hospitalized patients with AP diagnosis.

Methods

From total number of 99 patients with a clinical picture of AP, 71 patients in this retrospective analysis (including both genders) were included according to the presence of two biochemical markers in collected laboratory analysis at admission and 72 hours later on a laboratory check-up: CK and alpha-amylase.

Results

The median CK value of AP cases was 92 (41.75 - 207.25) in the acute period and 73 (37 - 159) after 72h staying in the hospital without statistical significant (p=0.521; p<0.05). However, there was a statistically significant correlation between the parameters of CK at admission and creatine kinase after 72h staying in the hospital. The median value of CK/Amylase ratio in the acute period was 0.168 (0.069 - 0.532) and 0.386 (0.12 - 1.12) after 72 hours of staying in the hospital. There was a statistically significant difference between values of CK/amylase ratio in these two groups (p=0.000; p<0.01).

Conclusion

In conclusion, a connection between CK and alpha-amylase needs to be elucidated in further studies and its existence must be researched both in physiological and pathophysiological conditions, and it is two-way and very complex. This study helped us obtain significant information about the perspective of AP in the potential relation to other non-standard laboratory markers for some diseases.