Published online Jan 27, 2022. doi: 10.4240/wjgs.v14.i1.64
Peer-review started: May 18, 2021
First decision: June 15, 2021
Revised: June 29, 2021
Accepted: December 22, 2021
Article in press: December 22, 2021
Published online: January 27, 2022
Timing of invasive intervention such as operative pancreatic debridement (OPD) in patients with acute necrotizing pancreatitis (ANP) is linked to the degree of encapsulation in necrotic collections and controlled inflammation. Additional markers of these processes might assist decision-making on the timing of surgical intervention. In our opinion, it is logical to search for such markers among routine laboratory parameters traditionally used in ANP patients, considering simplicity and cost-efficacy of routine laboratory methodologies.
To evaluate laboratory variables in ANP patients in the preoperative period for the purpose of their use in the timing of surgery.
A retrospective analysis of routine laboratory parameters in 53 ANP patients undergoing OPD between 2017 and 2020 was performed. Dynamic changes of routine hematological and biochemical indices were examined in the preoperative period. Patients were divided into survivors and non-survivors. Survivors were divided into subgroups with short and long post-surgery length of stay (LOS) in hospital. Correlation analysis was used to evaluate association of laboratory variables with LOS. Logistic regression was used to assess risk factors for patient mortality.
Seven patients (15%) with severe acute pancreatitis (SAP) and 46 patients (85%) with moderately SAP (MSAP) were included in the study. Median age of participants was 43.2 years; 33 (62.3%) were male. Pancreatitis etiology included biliary (15%), alcohol (80%), and idiopathic/other (5%). Median time from diagnosis to OPD was ≥ 4 wk. Median postoperative LOS was at the average of 53 d. Mortality was 19%. Progressive increase of platelet count in preoperative period was associated with shortened LOS. Increased aspartate aminotransferase and direct bilirubin (DB) levels the day before the OPD along with weak progressive decrease of DB in preoperative period were reliable predictors for ANP patient mortality.
Multifactorial analysis of dynamic changes of routine laboratory variables can be useful for a person-tailored timing of surgical intervention in ANP patients.
Core Tip: This is a retrospective study to evaluate laboratory variables in patients with acute necrotizing pancreatitis in the preoperative period for their use in the timing of operative pancreatic debridement (OPD). We demonstrated that progressive increase in platelet counts correlate with shortened length of hospital stay. It can indicate granulation tissue formation, and can be considered as an additional marker for OPD timing. Persistent hepatic malfunction, which is indicated by a weak progressive decrease of the direct bilirubin and increased aspartate aminotransferase level can signify a high risk of post-operative mortality. Multifactorial analysis of dynamic changes of laboratory variables can be useful for person-tailored timing of OPD.