Retrospective Study
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Surg. Jan 27, 2022; 14(1): 64-77
Published online Jan 27, 2022. doi: 10.4240/wjgs.v14.i1.64
Routine laboratory parameters in patients with necrotizing pancreatitis by the time of operative pancreatic debridement: Food for thought
Yaroslav M Susak, Kristina Opalchuk, Olexandr Tkachenko, Mariia Rudyk, Larysa Skivka
Yaroslav M Susak, Department of Surgery with the Course of Emergency and Vascular Surgery, O.O. Bogomolet’s National Medical University, Kyiv 01601, Ukraine
Kristina Opalchuk, Department of Surgery, Anesthesiology and Intensive Care Postgraduate Education, O.O. Bogomolet’s National Medical University, Kyiv 01601, Ukraine
Olexandr Tkachenko, Department of Surgery N2, Kyiv City Clinical Emergency Hospital, Kyiv City Clinical Emergency Hospital, Kyiv 02000, Ukraine
Mariia Rudyk, Larysa Skivka, Department of Microbiology and Immunology, Educational and Scientific Center “Institute of Biology and Medicine”, Taras Shevchenko National University of Kyiv, Kyiv 01033, Ukraine
Author contributions: Susak YM was chief surgeon and performed the surgeries on patients included in this study; Opalchuk K was a surgeon and assisted with surgeries on patients who are included in this study and was involved with data collection; Tkachenko O was a supervisor and participated in design of the study; Rudyk M assisted with statistical analysis of the data; Skivka L drafted the manuscript, performed statistical analysis, and participated in design of the study; All authors have read and approved the final manuscript.
Institutional review board statement: The project has been reviewed and approved by the Committee on Human Rights Related to Research Involving Human Subjects of Kyiv City Clinical Emergency Hospital (Kyiv, Ukraine), based on the Declaration of Helsinki.
Informed consent statement: All subjects gave their written informed consent prior to study inclusion.
Conflict-of-interest statement: The authors declare that they have no conflicts of interest.
Data sharing statement: There is no additional data available.
STROBE statement: The authors have read the STROBE Statement—checklist of items, and the manuscript was prepared and revised according to the STROBE Statement—checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Corresponding author: Mariia Rudyk, PhD, Associate Professor, Department of Microbiology and Immunology, Educational and Scientific Center “Institute of Biology and Medicine”, Taras Shevchenko National University of Kyiv, 2 Hlushkova Avenue, Kyiv 03127, Ukraine.
Received: May 18, 2021
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
Research background

Timing on invasive intervention in patients with acute necrotizing pancreatitis is linked to the degree of encapsulation in necrotic collections. Assessment of the degree of encapsulation of necrotic collections is influenced by imaging and clinical features. However, the pathophysiology and time course of necrotic collection walling-off are not fully understood and vary significantly between patients.

Research motivation

Additional markers of necrosis encapsulation might assist decision-making on the timing of surgical intervention. The search for these markers should be based on current knowledge of the biology of necrotic tissue encapsulation. In our opinion, it is logical to search for such markers among routine laboratory parameters traditionally used in acute necrotizing pancreatitis (ANP) patients, considering simplicity and cost-efficacy of routine laboratory methodologies.

Research objectives

To evaluate laboratory variables in ANP patients in the preoperative period for the purpose of their use for the timing of surgery.

Research methods

This was a retrospective study of 53 ANP patients undergoing operative pancreatic debridement (OPD). Dynamic changes of routine hematological and biochemical indices were examined in the preoperative period. Patients were divided into survivors and non-survivors. Survivors were further divided into a subgroup with short and long post-surgery length of stay (LOS) in hospital. Correlation analysis was used to evaluate the association of laboratory variables with LOS. Logistic regression was used to assess risk factors for patient mortality.

Research results

Progressive increase of platelet count in the preoperative period was associated with shortened total and post-surgery LOS. Increased aspartate aminotransferase and direct bilirubin (DB) levels the day before the OPD as well as the absence of substantial decrease of DB level in preoperative period were reliable predictors for ANP patient mortality.

Research conclusions

Multifactorial analysis of dynamic changes of routine laboratory variables can be useful for a person-tailored timing of surgical intervention in ANP patients.

Research perspectives

Comprehensive sex-centered evaluation of routine laboratory variables should be performed considering sex differences in the course of inflammation. Dynamic changes of serum levels of cytokines associated with fibro granulation tissue formation should also be studied for the person-tailored invasive intervention timing.