Prediction of fatal pancreatogenic shock in the first phase of the disease in patients with hyperergic inflammatory process in acute pancreatitis

Relevance. Acute pancreatitis occupies one of the leading places among acute surgical diseases, second in prevalence only to acute cholecystitis and appendicitis. This is one of the most difficult problems in emergency surgery. The overall mortality rate in acute pancreatitis varies from 5 to 10% depending on the proportion of its severe forms. Unfortunately, over the past 40 years, no significant results have been achieved in the treatment of this disease. Predicting fatal pancreatogenic shock in the first phase of the disease from the onset of acute pancreatitis is an important task for doctors, as it allows identifying patients at high risk of death and taking the necessary measures to stabilize the patient’s condition and improve the prognosis of his survival.

Purpose of the study. To study clinical and biochemical parameters that can be predictors of fatal pancreatogenic shock. To determine the most effective methods of diagnostics and monitoring of patients with acute pancreatitis for timely detection of the risk of developing pancreatogenic shock. To study possible risk factors that can influence the development of fatal pancreatogenic shock in patients with acute pancreatitis in the first phase of the disease before the development of purulent complications. To develop a method for predicting fatal pancreatogenic shock using known prognostic scales based on the data obtained. The aim of the study was also to examine the effectiveness of predicting the hyperergic course of acute pancreatitis using common scales for assessing the severity of patients APACHE II, SAPS, MODS and SOFA, as well as to examine the effectiveness of the new scale developed by the authors of IDAP.

Conclusions. A hyperergic reaction of the body to acute inflammation of the pancreas is likely if the degree of severity on the IDAP and APACH II scales is more than 9.0 and the ratio of severity in points to blood leukocytosis in SI units is >1.5. The applied scales for assessing the severity of acute pancreatitis adequately reflect changes in the severity of a patient with acute pancreatitis in the first phase of the disease and must be used without fail when planning treatment for patients.

1. Bagnenko S.F., Goltsov V.R., Savello V.E., Vashetko R.V. Classification of acute pancreatitis: current state of the problem. Grekov Surgery Bulletin. 2015;174(5):86-92. (In Russ). https://doi.org/10.24884/0042-4625-2015-174-5-86-92

2. Dzhumabekov A.T., Abuov S.M., Zharmenov S.M., Kalymbetov R.B., Zhoraev T.S., Artykbaev A.Zh., Zeidulla A.B. Prediction of the development of complications and fatal outcome in acute destructive pancreatitis. Bulletin of the Almaty State Institute for Advanced Medical Studies. 2014;3:85-93. (In Russ).

3. Kadzhaeva S.Z., Beslekoev U.S., Asatryan A.S. On the issues of diagnostics of acute pancreatitis. Kuban Scientific Medical Bulletin. 2014;(3):58-61. (In Russ).

4. Anishchenko V.V., Kim D.A., Baram G.I., Astanin A.I., Morozov V.V., Kovgan Yu.M. Predictors of early surgical intervention in patients with severe acute pancreatitis. Acta Biomedica Scientifica. 2017;2(6):86-91. (In Russ). https://doi.org/10.12737/article_5a0a87c0892982.08507194

5. Avakimyan S.V., Avakimyan V.A., Didigov M.T., Babenko E.S. Choice of treatment method for acute pancreatitis depending on the prognosis of the disease. Grekov Surgery Bulletin. 2016;175(1):37- 41. (In Russ). https://doi.org/10.24884/0042-4625-2016-175-1-37-41

6. Vinnik Yu.S., Dunaevskaya S.S., Antyufrieva D.A. Diagnostic value of integral scales in assessing the severity of acute pancreatitis and the patient's condition. Bulletin of the Russian Academy of Medical Sciences. 2015;70(1):90-94. (In Russ).

7. Titova G.P. Structural manifestations of pharmacodynamics, antienzymes, cytostatics and neuropeptides in the treatment of experimental pancreatic necrosis. Acute pancreatitis: collection of scientific papers of the N.F. Sklifosofsky Research Institute for Emergency Medicine. 1986; 14–20. (In Russ).

8. Valeev A. A. Evaluation of the severity of the condition of patients with acute destructive pancreatitis when choosing treatment tactics. Kazan Medical Journal. 2013; 94 (5): 633-635. (In Russ).

9. Skutova V.A., Danilov A.I., Feoktistova Zh.A. Acute pancreatitis: Current issues of diagnostics and complex treatment. Bulletin of the Smolensk State Medical Academy. 2016;15(2):78. (In Russ).

10. Shcherbyuk A.N., Dydykin S.S., Zhandarov K.A., Manuilov V.M., Averin A.A., Shcherbyuk A.A. Methodology for quantitative assessment of the severity of patients with mechanical jaundice. Clin. and Experimental. Surg. Zhurn. im. acad. B.V. Petrovsky. 2018;6(2):48-54. (In Russ).

11. Borovikov V.P., Borovikov I.P. Statistika. Statistical analysis and data processing in the Windows environment. Moscow, 1997:608. (In Russ).

12. Sekulic A., Marinkovic O., Malenkovic V., Trpkovic S., Pavlovic A. Application of APACHE II, SAPS II, SOFA and MODS scores in predicting outcome of severe acute pancreatitis (SAP): 12AP5-9. European Journal of Anaesthesiology. June 2014;3:209.

13. Hosseini M, Ramazani J. Evaluation of Acute Physiology and Chronic Health Evaluation II and sequential organ failure assessment scoring systems for prognostication of outcomes among Intensive Care Unit's patients. Saudi J Anaesth. 2016 Apr-Jun;10(2):168-173. https://doi.org/10.4103/1658-354X.168817; PMID: 27051367; PMCID: PMC4799608

14. Naqvi IH, Mahmood K, Ziaullaha S, Kashif SM, Sharif A. Better prognostic marker in ICU – APACHE II, SOFA or SAP II! Pak J Med Sci. 2016 Sep-Oct;32(5):1146-1151. https://doi.org/10.12669/pjms.325.10080; PMID: 27882011; PMCID: PMC5103123

15. Tolstoy A.D., Panov V.P., Zakharova E.V., Bekbausov S.A. Shock in acute pancreatitis. St. Petersburg: Skif Publishing House, 2004:64. (In Russ).

16. Volkov V.E. Acute pancreatitis. Cheboksary: Publishing house of Chuvashia University, 1993:140. (In Russ).

17. Nesterenko Yu.A., Shapovalyants S.G., Laptev V.V. Pancreatic necrosis (clinic, diagnosis, treatment). Moscow, 1994:264. (In Russ).

18. Ermolov A.S., Turko A.P., Zhdanovsky V.A. Analysis of mortality in non-operated patients with acute pancreatitis. Organizational, diagnostic, and therapeutic problems of emergency conditions. Moscow: Omsk, 2000:172–176. (In Russ).

19. Boger M.M. Pancreatitis (physiological and pathophysiological aspects) ed.: G.A. Morgunov. Novosibirsk: Nauka, 1984:216. (In Russ).

20. Chaplinsky V.V., Gnatyshak A.I. Acute pancreatitis: monograph. Moscow: Medicine, 1972:268. (In Russ).

21. Shott A.V. et al. Acute pancreatitis. Minsk. 1981:207. (In Russ).

22. Velbri S, Nutt H, Kasesalu G. Uber die Rolle immunologischer Mechanismen bei Pankreaserkrankungen [Immunologic mechanisms in pancreatic diseases]. Z Gesamte Inn Med. 1973 Apr 15;28(8):222-227. German. PMID: 4716919

23. Kochnev O.S., Fedorova N.V. Function of the adrenal glands in pancreatitis. Kazan Medical Journal. 1968;49(2):27-27. (In Russ). https://doi.org/10.17816/kazmj60212

24. Filin V.I. Acute diseases and injuries of the pancreas: a guide for doctors. L.: Medicine, 1982:247. (In Russ).

25. Shcherbyuk A.N. Acute pancreatitis. Moscow: Rus. doctor, 2007:325. (In Russ).

26. Shcherbyuk A.N., Semenov D.Yu., Morozov S.V., Lobakov A.I., Yunin A.S., Averin A.A., Levitskaya A.N., Levitskaya K.N., Shalamova S.V. Comparison of scales for assessing the severity of acute pancreatitis. Grekov Bulletin of Surgery. 2020;179(1):31-38. (In Russ).

27. Shcherbyuk A.N. Acute pancreatitis. M.: Russian doctor, 2007:326. (In Russ).