급성 췌장염의 중증도 평가
Severity Assessment of Acute Pancreatitis
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급성 췌장염의 중증에 대한 위험인자들로는 고령, 비만, 그리고 장기부전이다. 입원 당시 경미한 경우와 중증 급성 췌장염과 감별하는 데 도움을 주는 검사들에는 APACHE-II 점수가 8점 이상, 혈청 헤마토크리트(< 44는 경미한 췌장염을 의미)가 있다. APACHE-II 점수가 입원 후 첫 48시간 이내에 계속 증가하는 것은 중증급성 췌장염으로의 발전을 의미한다. 첫 72시간 이내에 CRP가 150 mg/dL 이상인 것은 췌장괴사가 존재함을 의미한다. 중증급성 췌장염에 대한 중요한 지표는 장기부전(특히 다기관 장기부전)과 췌장괴사이다. 조영증강 CT는 간질성 췌장염과 괴사성 췌장염을 구분하는 데 가장 유용한 검사로서 특이 발병 후 2-3일 뒤 가장 유용하다. 괴사성 췌장염과 동반된 지속성 다기관 장기 부전의 사망률은 36% 이상으로 높다. 그러므로 지속되는 장기부전이 있거나 심한췌장염을 의미하는 징후 즉, 소변감소, 지속성빈맥, 그리고 힘든 호흡증 등이 있다면 중환자실로 전원하여 집중적 치료가 필요하다. 이와 같이 급성 췌장염 환자에서의 중증도 파악 및 평가는 매우 중요하다.
Abstract
Older age (> 55), obesity (BMI > 30), organ failure at admission, and pleural effusion and/or infiltrates are risk factors for severity that should be noted at admission. Tests at admission that are also helpful in distinguishing mild from severe acute pancreatitis include APACHE-II score ≥ 8 and serum hematocrit (a value < 44 strongly suggests mild acute pancreatitis). An APACHE-II score that continues to increase for the first 48 h strongly suggests the development of severe acute pancreatitis. In general, an APACHE-II score that increases during the first 48 h is strongly suggestive of the development of severe pancreatitis. Contrast-enhanced CT scan is the best available test to distinguish interstitial from necrotizing pancreatitis, particularly after 2-3 days of illness. Mortality of sustained multisystem organ failure in association with necrotizing pancreatitis is generally > 36%. Transfer to an intensive care unit is recommended if there is sustained organ failure or if there are other indications that the pancreatitis is severe including oliguria, persistent tachycardia, and labored respiration. The early severity assessment is very important to appropriate treatment of acute pancreatitis.
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