The role of the coagulation system in predicting multiorgan failure in acute pancreatitis – a pilot study in our department

Introduction: The early assessment of severity is an important issue in the management of acute pancreatitis (AP). Patients with severe AP associated with SIRS have a prolonged hospital stay and are the ones most likely to die from their disease process. A variety of predictive systems have been developed helping us in the management of AP, including measurements of markers in the serum and urine, CT scores and multiple factor scoring systems. Our aim was to detect some coagulation and inflammatory parameters in patients with AP at the admission and within 48 hours. Patients and methods: During a six-month period 60 patients were admitted to our department with AP (age: 24–99 ys). During the management of AP for prediction of severity and outcome we used Ranson's criteria, Apache II score, CT grade based on Balthazar score, SOFA scoring system. Two study groups comprising 14 patients with organ failure and 46 without organ failure were compared. In case of biliary pancreatitis (n=18) early endoscopic sphincterotomy followed by stone extraction if needed, was performed within 36hs. Enteral feeeding via nasojejunal tubes were started in 36 hours in most of the patients (n=44). Results: On admission the CRP-concentration was not significantly lower in pts without organ failure (mean: 18.1mg/l/0.1–59/vs 42.5/3.1–89/mg/l), while after 48 hs this value was significantly different between the compared groups (37.6/2.1–103/vs 182.7/106–379/mg/l). Elevated fibrinogen was detected in both groups. D-dimer was significantly lower on admission and after 24–48 hours in pts with AP without orgain failure (0.21/0.19–1.16/ug/ml) compared with pts with organ failure (4.83/1.97–8.46/µg/ml). Conclusion: The use of the parameters of coagulation, such as D-dimer and fibrinogen and inflammatory system paralelly has a potential importance in predicting the severity and organ failure in acute pancreatitis. To determine the diagnostic and predictive accuracy of the parameters of coagulation system warrant further clinical trials.