Clinical value of the measurement of intra-abdominal pressure, C-reactive protein, and procalcitonin in patients with acute pancreatitis in late pregnancy

• Main Author: LIAO Wenyan
• Format: Article
• Language: zho
• Published: Editorial Department of Journal of Clinical Hepatology 2019-08-01
• Series: Linchuang Gandanbing Zazhi
• Online Access: http://www.lcgdbzz.org/qk_content.asp?id=10205

Objective To investigate the clinical value of the measurement of intra-abdominal pressure (IAP), C-reactive protein (CRP), and procalcitonin (PCT) in patients with acute pancreatitis in late pregnancy. Methods A total of 80 patients with acute pancreatitis in late pregnancy (≥28 gestational weeks) who were hospitalized in Department of Obstetrics and Gynecology and Department of Hepatobiliary Surgery in The First Affiliated Hospital of Nanhua University from September 2008 to September 2018 were enrolled, and among these patients, 45 with mild or moderately severe acute pancreatitis were enrolled as control group, and 35 with severe acute pancreatitis were enrolled as observation group. Related clinical data were collected, including IAP, CRP, PCT, fetal distress, and neonatal Apgar score. The t-test was used for comparison of continuous data between two groups, and the chi-square test was used for comparison of categorical data between two groups. A Pearson correlation analysis was used to investigate the correlation of CRP, PCT, and IAP with the severity of pancreatitis and poor fetal outcomes (fetal distress and neonatal Apgar score at 1 minute after birth). The receiver operating characteristic (ROC) curve was used to calculate the optimal cut-off values of these indices for accurate diagnosis and corresponding sensitivity and specificity, in order to evaluate their value in predicting acute pancreatitis in late pregnancy. Results Compared with the control group, the observation group had significantly higher levels of CRP (185.92±23.59 mg/L vs 120.92±20.02 mg/L, t=13.318, P＜0.001), PCT (12.93±3.16 ng/ml vs 5.67±1.65 ng/ml, t=12.298, P＜0.001), and IAP (12.67±1.40 mm Hg vs 5.77±1.10 mm Hg, t=23.858, P＜0.001). Compared with the observation group, the control group had a significantly lower incidence rate of fetal distress (6/45 vs 15/35, χ2=8.864, P=0.003) and a significantly higher neonatal 1-minute Apgar score (8.22±0.67 vs 5.97±0.78, t=-13.817, P＜0.001). The correlation analysis showed that IAP was positively correlated with CRP, PCT, and Ranson score for pancreatitis in late pregnancy (r=0.814, 0.712, and 0.788, all P＜0.001) and was negatively correlated with neonatal 1-minute Apgar score (r=-0.820, P＜0.001). CRP had an area under the ROC curve (AUC) of 0.838 at the optimal cut-off value of 158.32 mg/L, with a sensitivity of 77.1% and a specificity of 93.3%; PCT had an AUC of 0.853 at the optimal cut-off value of 10.23 ng/L, with a sensitivity of 71.4% and a specificity of 97.8%; IAP had an AUC of 0.903 at the optimal cut-off value of 10.09 mm Hg, with a sensitivity of 82.9% and a specificity of 95.6%. Conclusion The measurement of IAP, CRP, and PCT has a good value in the early prediction of severe acute pancreatitis in pregnancy and can help to determine the severity of pancreatitis in late pregnancy and decide the timing of termination of pregnancy.