PROSPECTIVE RESEARCH OF HEMOSTASIS DISORDERS IN THE I PHASE OF SERIOUS ACUTE PANCREATITIS

Background: Acute pancreatitis is one of the most common surgical abdominal diseases. The development of trypsin autoaggression which provokes hemostasis disorders play significant role for pathogenesis of severe acute pancreatitis. The study of biochemical hemostasis-related markers and general homocysteine as a marker of endothelium damage at acute pancreatitis and their influence on development of heavy complications of the I phase of a disease is actual and relevant task. These complications are the reason for about 40% of lethal outcomes.

Aims: To study hemostasis disorders and homocysteine as marker of damage of endothelial cells in patients with acute pancreatitis during the initial period of a disease depending on disease severity, the volume of injury of a pancreas, and development of complications.

Materials and methods: 127 patients who were divided into two groups: with severe AP and not severe AP. We investigated variables and indicators of hemostasis system: activated partial thromboplastin time (APTT), prothrombin time (PT), thrombin time (TT), international normalized ratio (INR) fibrinogen, and homocysteine.

Results: The most expressed hemostasis disorders and level of the general homocysteine were registered on 3rd day from the disease onset. On the 7th day, the tendency to decrease in indexes of a coagulative link of a hemostasis and decrease in level of the general homocysteine was registered in patients with severe acute pancreatitis. There were correlative communications of high and average degree between the volume of a pancreatonecrosis and violation of a hemostasis on 3rd day from the disease onset, and the level of the general homocysteine rS=0.94 (p1=0.001). In patients with severe pancreatitis, systemic complications of different degree of expressiveness were observed in 69.57% of cases. There were average and high correlations between violation of system of a hemostasis on the 3rd day and systemic complications development, as well as high direct correlation between increase in level of the general homocysteine and systemic complications development rS=0.77, p1=0.001.

Conclusions: Hemostasis disorders and the level of general homocysteine correlated with volume of pancreas and retroperitoneal cellular tissue affection and system complications development at the 1-th phase of severe acute pancreatitis.