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

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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