Early differential diagnosis of the severity of acute pancreatitis

Abstract

There is a great need for early verification of the severity of acute pancreatitis (AP). The early stage of pathogenesis of AP is characterized by endothelial dysfunction which could be determined by wavelet analysis of skin temperature (WAST) technique. The aim is to investigate whether the dysregulation of microvascular tone caused by endothelial dysfunction and detected by WAST can be a significant indicator in early differential diagnosis of AP severity. The WAST performed in the frequency range of 0.0095-0.02 Hz during the contralateral cold test. Forty nine patients with AP aged 19-65 participated in this study. The control group included 12 healthy volunteers aged 20-65. Dysregulation of vascular tone during the contralateral cold test was observed in all patients with AP. The basal amplitudes of skin temperature oscillations in patients with AP were much lower than in healthy volunteers and progressively decreased as the disease severity increased. In patients with mild and moderate AP only the vasodilator component is destroyed, but vasoconstriction still operates. In patients with severe AP both mechanisms of endothelial vascular tone regulation are destroyed. Patients with AP have abnormal microvascular reactions related to the endothelial mechanism of vascular tone regulation. Based on the initial values of amplitudes and the indices of vasoconstriction and postcold vasodilatation, the WAST method makes it possible to evaluate two related but different characteristics of the endothelial dysfunction in patients with AP on admission which can be a significant indicator in early differential diagnosis of AP severity.

Development of a Score for Predicting Severe Acute Pancreatitis at Admission

“…The production of inflammatory mediators in the systemic circulation induces global endothelial dysfunction and increases vascular permeability. Popov et al 19 cold test, and the degree of endothelial dysfunction was correlated with the severity of the disease. Oxygen saturation at admission is an indirect indication of PaO 2 (arterial oxygen pressure).…”

“…The production of inflammatory mediators in the systemic circulation induces global endothelial dysfunction and increases vascular permeability. Popov et al 19 demonstrated the impairment of microvascular function in patients with severe acute pancreatitis by measuring cutaneous temperature changes in response to a cold test, and the degree of endothelial dysfunction was correlated with the severity of the disease.…”

Limulus and heart rhythm

“…In invertebrates, whether or not there are comparable age‐dependent changes in both aorta and aortic valve functions as in humans (Reinöhl et al, ) is not precisely addressed. However, the two important and opposing functions of vasculature—vasoconstriction and vasodilatation—are directly or indirectly dependent on the properties of the endothelium (Popov, Ershova, Podtaev, Frick, & Zubareva, ).…”