PREDICTING INFECTIOUS COMPLICATIONS IN ACUTE PANCREATITIS COMPLICATED BY ASCITIS AND PERITONITIS

Ascites and peritonitis are fairly common complications of acute pancreatitis in the early stage of the disease. At the beginning of acute severe pancreatitis, in most cases, death occurs as a result of multiple organ failure, and starting from the second week, infectious complications can play a more serious and adverse role. However, the diagnosis of infected pancreatitis is difficult as the clinical picture does not differ from the inflammatory reaction caused by pancreatitis itself. Although the peak of infectious complications is observed mainly from the second to the fourth week since the onset of the disease, the timing of infection in pancreatic necrosis is variable and unpredictable. The aim of the study was to analyze the prognostic potential of procalcitonin in predicting the development of infectious complications in the dynamic course of acute pancreatitis complicated by ascites and peritonitis. We analyzed the findings obtained from a comprehensive examination and treatment of 18 patients with acute pancreatitis complicated by enzymatic ascites and peritonitis, including 13 patients who were treated at the surgical department of M. Sklifosovskiy Poltava Regional Clinical Hospital, and 5 patients at other emergency care settings in Poltava for 2017 – 2019. In addition to standards examination methods, procalcitonin was assessed as a biomarker to predict the adverse course of the disease in the early period. Statistical analysis of the findings was performed by the program "STATISTICA 10.0" (StatSoft, Inc., USA); methods of descriptive statistics to calculate qualitative indicators as frequencies and their percentages in the study groups were applied. The statistical significance of differences was determined by a nonparametric method between the indicators of independent groups using Fisher's exact test. Differences at p <0.05 were considered statistically significant. Infectious complications in the dynamics of the disease occurred in 39% of patients in the study group. 86% of them demonstrated an increased procalcitonin concentration at admission to the hospital. A significant difference was found (p = 0.005) when comparing differences in the occurrence of infectious complications in the dynamics of the disease in the patients of the study group depending on the presence of elevated concentrations of procalcitonin or its absence at the time of hospital admission. We can suggest that measuring procalcitonin to predict the occurrence of infectious complications in the dynamics of the disease will allow us to detect patients in who reduced risk of flora translocation by parenteral drugs being tropic to pancreatic tissue and early oral antibiotic prophylaxis may lessen the incidence of septic complications.