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 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.
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.
To evaluate laboratory variables in ANP patients in the preoperative period for the purpose of their use for the timing of surgery.
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.
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.
Multifactorial analysis of dynamic changes of routine laboratory variables can be useful for a person-tailored timing of surgical intervention in ANP patients.
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.