Susak YM, Opalchuk K, Tkachenko O, Rudyk M, Skivka L. Routine laboratory parameters in patients with necrotizing pancreatitis by the time of operative pancreatic debridement: Food for thought. World J Gastrointest Surg 2022; 14(1): 64-77 [PMID: 35126864 DOI: 10.4240/wjgs.v14.i1.64]
Corresponding Author of This Article
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. rosiente@gmail.com
Research Domain of This Article
Surgery
Article-Type of This Article
Retrospective Study
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (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: http://creativecommons.org/licenses/by-nc/4.0/
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: https://creativecommons.org/Licenses/by-nc/4.0/
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. rosiente@gmail.com
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 Processing time: 245 Days and 18.7 Hours
Abstract
BACKGROUND
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.
AIM
To evaluate laboratory variables in ANP patients in the preoperative period for the purpose of their use in the timing of surgery.
METHODS
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.
RESULTS
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.
CONCLUSION
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.
