Disorders of hemostasis during the surgical management of severe necrotizing pancreatitis.
OBJECTIVE
Several clinical studies of severe necrotizing pancreatitis (SNP) suggest profound activation of coagulation as well as activation of the fibrinolytic system. The aim of this study was to evaluate the hemostatic derangements in patients who were managed for SNP.


METHODS
Forty-one operated-on patients with SNP were analyzed regarding clinical outcome and activation of the coagulation systems. Serial measurement of coagulation, anticoagulation, and fibrinolysis parameters: prothrombin time (PT), activated partial thromboplastin time (APTT), fibrinogen, antithrombin III (AT III), protein C, plasminogen activator inhibitor-1 (PAI-1), d-dimer, alpha2-antiplasmin, and plasminogen were performed on days 1, 3, 5, 7, 10, and 14 after the initial operation. According to treatment outcome at the end of study, groups of 26 survivors and 15 nonsurvivors were compared.


RESULTS
Nonsurvivors had significantly lower levels of activity of protein C and AT III, and higher concentrations of d-dimer and PAI-1 than survivors. The other measured parameters did not show significant differences between the compared groups of patients.


CONCLUSIONS
Changes in protein C, AT III, d-dimer and PAI-1 levels indicate exhaustion of fibrinolysis and coagulation inhibitors in patients with poor outcome during the course of SNP.
Radenković
Dejan
D
Center of Emergency Surgery, Clinical Center of Serbia and School of Medicine, University of Belgrade, Belgrade, Serbia and Montenegro. dejanr@sbb.co.yu
Bajec
Djordje
D
Karamarkovic
Aleksandar
A
Stefanovic
Branislav
B
Milic
Natasa
N
Ignjatović
Svetlana
S
Gregoric
Pavle
P
Milicevic
Miroslav
M
D018806:APACHE; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000990:Antithrombin III / Q000032:analysis; D001779:Blood Coagulation Factors / Q000032:analysis; D001780:Blood Coagulation Tests; D001798:Blood Proteins / Q000032:analysis*; D005260:Female; D005338:Fibrin Fibrinogen Degradation Products / Q000032:analysis; D005342:Fibrinolysis; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D009102:Multiple Organ Failure / Q000209:etiology / Q000401:mortality; D010180:Pancreatectomy / Q000379:methods*; D019283:Pancreatitis, Acute Necrotizing / Q000097:blood / Q000150:complications / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D017395:Plasminogen Activator Inhibitor 1 / Q000032:analysis; D011446:Prospective Studies; D020151:Protein C Deficiency / Q000097:blood / Q000209:etiology; D018805:Sepsis / Q000209:etiology / Q000401:mortality; D018746:Systemic Inflammatory Response Syndrome / Q000209:etiology / Q000401:mortality; D019851:Thrombophilia / Q000097:blood / Q000209:etiology*; D016896:Treatment Outcome
D001779:Blood Coagulation Factors; D001798:Blood Proteins; D005338:Fibrin Fibrinogen Degradation Products; D017395:Plasminogen Activator Inhibitor 1; C036309:fibrin fragment D; D000990:Antithrombin III