Comparative analysis of the dynamics of laboratory parameters and outcomes of acute pancreatitis in patients with concomitant liver damage

BACKGROUND: The evaluation of liver function and the extent of liver damage can be of high diagnostic significance in predicting outcomes of acute pancreatitis (AP). AIM: To evaluate the impact of the concomitant liver damage on the dynamics of laboratory parameters and outcomes in patients with acute pancreatitis. METHODS: A retrospective, cohort, single-center study involved 94 patients hospitalized in a surgical hospital for AP. The patients were divided into 2 groups: the main group with a significant liver damage (n = 48; mean age 51.7 ± 15.7 years; 57.0% men and 43.0% women), and the control group without such damage (n = 46; mean age 52.6 ± 16.2 years; 54.3% men and 45.7% women). RESULTS: On day 3 and 5, higher transaminase activity was recorded in the main group compared to the control group (a more pronounced cytolysis syndrome). On day 3, both groups were clinically comparable in bilirubin level (43.13 ± 6.93 µmol/l and 42.13 ± 6.55 µmol/l), despite the statistical significance of differences (p 0.001). By day 5, the bilirubin level in the control group significantly decreased (22.37 ± 3.82 µmol/l), but remained at higher level in the main group (30.27 ± 9.39 µmol/l, p 0.001). The levels of total serum protein, total serum cholesterol, and serum triglycerides did not show differences at the studied time points (for all comparisons p 0.05). Plasma fibrinogen in patients with AP showed no differences between the groups on day 1 of hospitalization, with the mean values within the reference range (200–400 mg/dl); on day 3, an increase was noted in both groups with the mean value exceeding the upper limit of the reference range and a tendency to forming difference between the groups. However, on day 5, a significant increase in fibrinogen level was noted in the main group — up to 647.86 ± 143.09 mg/dl, and up to 455.48 ± 147.00 mg/dl in the control group (p = 0.001). In 14 (29.16%) patients in the main group and 5 (10.87%) patients in the control group, moderate AP developed into severe. In addition, one case of death was recorded in each group. CONCLUSION: In some patients with AP, the underlying disease is complicated by hepatocytolysis and cholestasis syndromes. In these patients, the moderate-to-severe acute pancreatitis more often progresses to severe forms. The study confirmed the hypothesis that evaluation of the liver function and of the extent of liver damage may be of a high diagnostic significance in predicting the outcome of acute pancreatitis and can be used for studying the effectiveness of various treatment strategies for pancreatitis.