Clinical Significance Of Secondary Thrombocytosis In Severe Acute Pancreatitis And A Research Of The Related Factors

Background Secondary thrombocytosis(ST) appears in middle and late phase in severe acute pancreatitis(SAP), but whose clinical meaning and the related factors remain unclear.Aim This study aims at assessing the effects of ST on the prognoses of SAP patients and to investigate the related risk factors of ST.Methods 105 patients diagnosed with SAP treated in our ICU between Jan 1996 and Dec 2008 were included and divided into two groups according to the occurrence of ST. ST group included 33 patients(22 men and 11 women, average age 50.7±13.5 years, 12(36.4%) cases were biliary SAP, 8(24.2%) cases hyperlipidemic and 13(39.4%) cases others) and the control group included 72 patients(54 men and 18 women, average age 50.2±15.8 years, 37(51.3%) cases were biliary SAP, 6(8.33%) cases hyperlipidemic and 29(40.3%) cases others). Prognoses of the patients were respectively compared. Logistic regression analysis was used to detect the related risk factors and a predicting model was established. Receiver operating characteristic curve(ROC curve) was used to evaluate the efficiency of the model.Results Patients in ST group had obvious higher survival rate(97.0%) than the control group(80.6%)(p=0.03) but also higher incidence of pancreatic pseudocyst(27.3% VS 5.6%;P <0.01) and frequency of operations(1.56±0.87 VS 1.13±1.38;P <0.01). Incidences of operation(P=0.82), digestive fistula(P=0.65), digestive tract hemorrhage(P=0.23), embolism(*), diabetes mellitus(P=1.00), chronic diarrhea(p=0.27) and chronic pancreatitis(*) in both groups are of no difference. Hepatosis, sepsis and early stage eternal nutrition(EN) are the risk factors and continuous veno- venous hemofiltration(CVVH) the protective factor. The area under ROC curve was 0.788 and the prediction model had the best effect(sensitivity=0.833 and specificity=0.558) when the cut-off value was 0.14.Conclusion SAP patients with ST,compared to those who have not, have higher survival rate, incidence of pancreatic pseudocyst and frequency of operations. And they have no difference in their incidences of operation, digestive fistula, digestive tract hemorrhage, embolism, diabetes mel itus, chronic diarrhea and chronic pancreatitis. Hepatosis, sepsis and early stage EN have positive relationship and C VVH has negative relationship with ST.