کد مقاله | کد نشریه | سال انتشار | مقاله انگلیسی | نسخه تمام متن |
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5725999 | 1609725 | 2017 | 8 صفحه PDF | دانلود رایگان |
ObjectivesDiagnosing acute pancreatitis (AP) may be challenging in patients with acute abdominal pain but missing threefold increased serum lipase levels (Lipâ). This studyaims both to characterize these patients using clinical, radiological and mortality data, and to assess the group of patients who need contrast-enhanced computed tomography (CECT).MethodsIn this retrospective, IRB approved study 234 consecutive patients with AP were investigated. Inclusion criteria were single (SAP) and recurrent attacks (RAP) of AP and CECT â¥72 h after onset of symptoms. Severity of AP was assessed by C-reactive protein at 48 h after hospital admission and using 3 CT-based scores (CTSI, mCTSI, EPIC) by 2 observers. Mortality rates from pancreatic and non-pancreatic causes were noted with regard to lipase increase. Results were compared with paired t-test and Wilcoxon signed-rank test.Results64/234 (27%) patients belonged to Lipâ group and 170/234 (73%) patients were allocated to Lip+ group. Significantly more male patients (78% in Lipâ vs. 63% in Lip+, p < 0.05) with RAP (63% in Lipâ vs. 21% in Lip+, p < 0.001) were observed in the Lipâ group. EPIC was significantly lower in Lipâ group compared to Lip+ group (3(IQR 2-5) vs. 2(IQR 1-3), p < 0.001). Mortality from pancreatic and non-pancreatic causes was comparable in Lipâ and Lip+ group (pancreatic causes: 9% vs. 6%, p = 0.60; nonpancreatic causes: 8% vs. 5%, p = 0.58).Conclusions27% of all patients with AP presented without threefold increase of lipase levels. Thus, they would be underdiagnosed without confirming CECT, which revealed significantly lower counts of pleural effusions and ascites. Male patients with RAP were found significantly more often among the Lipâ group. Hence, they would benefit the most from CECT for diagnosing AP.
Journal: European Journal of Radiology - Volume 95, October 2017, Pages 278-285