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Panminerva Medica 1999 March;41(1):39-42

Copyright © 2000 EDIZIONI MINERVA MEDICA

language: English

The use of the peripheral leukocyte count and chest X-rays in early assessment of the severity of acute pancreatitis in comparison with the Ranson score system

Pezzilli R., Billi P., Barakat B., Broccoli P., Morselli Labate A. M.

From the Emergency Department Sant’Orsola Hospital, Bologna, Italy


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Back­ground. To eval­u­ate the effi­ca­cy of the periph­er­al leu­ko­cyte ­count and ­chest X-­rays as an ­index ­which ­could be ­used in the ear­ly assess­ment of the sever­ity of ­acute pan­crea­titis in an Emer­gen­cy ­Room.
Meth­ods. We pros­pec­tive­ly eval­u­at­ed the periph­er­al leu­ko­cyte ­count and the find­ings of ­chest X-­rays in 181 con­sec­u­tive ­patients (102 ­males, 79 ­females, ­mean age 61 ­years, ­range 16-97) who ­were admit­ted to our Emer­gen­cy Depart­ment ­with ­acute pan­crea­titis. One hun­dred twen­ty six ­patients had ­mild pan­crea­titis and 55 had ­severe pan­crea­titis. The periph­er­al leu­ko­cyte ­count and the ­chest X-­rays ­were eval­u­at­ed in all ­patients ­upon admis­sion. The Ran­son cri­te­ria ­were ­also ­assessed.
­Results. ­Using a cut off val­ue of 13,000/mm3, 45% of the ­patients ­with ­severe pan­crea­titis and 17% of ­those ­with ­mild ­acute pan­crea­titis had a periph­er­al leu­ko­cyte ­count great­er ­than 13,000/mm3. Pleu­ral or pul­mo­nary alter­a­tions ­observed on ­chest X-ray ­were ­found in 66% of ­patients ­with ­severe pan­crea­titis and in 2% of ­those ­with ­mild ­acute pan­crea­titis. A periph­er­al leu­ko­cyte ­count great­er ­than 13,000/mm3 and/or pleu­ral or pul­mo­nary alter­a­tions ­present on ­chest X-ray ­were ­found in 78% of the ­patients ­with ­severe pan­crea­titis and in 19% of ­those ­with ­mild pan­crea­titis. The Ran­son cri­te­ria great­er ­than or ­equal to ­three ­were ­found in 45% of the ­patients ­with ­severe ­acute pan­crea­titis and in 16% of ­those ­with the ­mild ­form of the dis­ease. The pos­i­tive pre­dic­tive val­ue was 92% for the pres­ence of alter­a­tions on the ­chest X-­rays, 64% for the alter­a­tion of at ­least one of the abnor­mal find­ings on the ­chest X-ray and a periph­er­al leu­ko­cyte ­count great­er ­than 13,000/mm3, 56% for a periph­er­al leu­ko­cyte ­count great­er ­than 13,000/mm3, and 54% for the pres­ence of Ran­son cri­te­ria great­er ­than or ­equal to ­three. The neg­a­tive pre­dic­tive val­ues ­were sim­i­lar.
Con­clu­sions. The pres­ence of pleu­ral or pul­mo­nary alter­a­tions on ­chest X-­rays may be use­ful in the Emer­gen­cy ­Room for the ear­ly iden­tifi­ca­tion of ­patients ­with ­severe ­acute pan­crea­titis.

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