Association Between Coagulation Parameters And The Severity Of Acute Pancreatitis

Background:Coagulation disorder is an early event in the development of acute pancreatitis1-3, which might be associated with the severity of acute pancreatitis.Objectives:This study mainly focuses on the relationship between coagulation parameters and the severity of acute pancreatitis according to the determinant-based classification while no study focused on it.Methods:From Jan,2008 to Dec,2012, a consecutive series of patients with AP admitted to the surgical intensive care unit of the institute of General Surgery, Jinling Hospital within 72h from the onset of the disease were studied. Patients were excluded if there was a known history of receiving anticoagulant within one week, primary hepatic inadequacy, cancer, regeneration dysfunction, pregnancy on admission or age younger than 18.Classification:Determinant-based classification Reclassification Atlanta classificationData collection:Baseline data including age, sex, etiology, SOFA score, Ranson score and APACHE ⅡI score were recorded on admission. In all patients, coagulation parameters including PT, TT, FIB, D-dimer, APTT and INR were recorded, as well as platelet level on admission.Statistical analysisData were analyzed using SPSS 17.0 for Windows (SPSS, Chicago, IL, USA). All statistical tests were two-tailed, and significance level was set at P<0.05. The receiver operating characteristics curve was adopted to compare the predictive value of mortality between coagulation parameters and traditional markers. Kruskal Wallis Test was adopted to analyses the differences of coagulation parameters among the four groups and were expressed as mean ± SD. While Chi-square Test was adopted to analyses hospital mortality as well as other clinical outcomes between the four group and were expressed as percentage.Results:The levels of the coagulation parameters at admission were significantly associated with the severity of acute pancreatitis according to the DBC and according to the RAC. Significantly differences were observed in PT, INR, APTT, D-dimer and PLT levels (p<0.05), while not in TT and FIB(P>0.05). But, analyses of correction with the stage of determinant-based classification by Somer’s D showed that APACHE Ⅱ, Ranson and Sofa score showed better Somer’s D values than coagulation parameters(Table 5, p<0.05). However, PT and INR levels showed better area under the receiver operating characteristics curve values compared with Ranson score (0.925 and 0.920 VS.0.735, P=0.029 and P=0.037). In addition, the AUC values of PT and INR were also better than APACHE Ⅱ score and Sofa score regarding severity, though both not statistically different(p>0.05). An PT value of 14.95s was the best cut-off value to predict hospital mortality(sensitivity,0.875; specificity,0.853) and INR value of 1.295s was the best cut-off value to predict hospital mortality(sensitivity,0.875; specificity,0.853).Conclusions:Significantly differences were observed in coagulation parameters among different classifications of AP according to the determinant-based classification and according to the reclassification Atlanta classification. Though traditional score system regarding severity showed better correction with the stage of DBC and RAC compared with coagulation parameters, coagulation parameters were better markers for mortality prediction.