Hemocoagulation factors of hemorrhagic complications in acute pancreatitis

Abstract

A feature of the severe condition of acute pancreatitis is the high risk of complications occurring in 50% of patients. The most dangerous are thrombohemorrhagic complications and arrosive bleeding, with late diagnosis of which mortality can reach more than 85%. The aim of the study was to determine early diagnostic criteria for the onset and development of bleeding in acute pancreatitis. The results of treatment of 82 patients with severe acute pancreatitis were analyzed. The patients were divided into the main group (with bleeding) (30 people) and the comparison group (without bleeding) (52 people). The parameters of hemocoagulation, α-amylase activity in peritoneal exudate and intra-abdominal pressure were assessed. The tPA activity and the level of TAT in the main group were of normative value and are vital for the group of individuals who are in the range of norms, as well as candidates for early markers for the diagnosis of bleeding. From the ROC analysis, the analysis determined the informativeness of the proposed indicators in the predicted bleeding. For tPA activity, the area under the ROC-curve (AUROC) became 0.942 (95% CI 0.889-0.995), the point of change is 4,5 IU/ml, for the TAT area under the ROC-curve (AUROC) it became 0.945 (95% DI 0.871-0.998), the change point is 11.5 ng/ml. We conclude that in patients with severe acute pancreatitis, a tPA activity level ≥4.5 IU/ml (sensitivity 90.2%, specificity 83.3%) and/or a TAT level ≥ 11.5 ng/ml (sensitivity 92.2%, specificity 83.3%) can be considered as a possible predictor of bleeding. Кey words: acute pancreatitis; arrosive bleeding; coagulation disorders.