Dolzhkovyy S. Prognostication and prophylaxis of purulent and septic complications among patients with severe acute pancreatitis

The dissertation is dedicated to the improvement of the patients' with severe acute pancreatitis (SAP) results of treatment with the help of prognostication and prophylaxis of purulent and septic complications' (PSC) development. Analysis of clinical course of 143 patients with SAP was made to obtain this aim. The study consisted of two stages. On the first (retrospective) stage the most significant predictors of PSC development were found out with the help of comparation of 40 patients with PSC and 58 patients with aseptic course of SAP. The multiple scoring system for predicting the development of PSC that consisted of 11 clinical, laboratorial and instrumental indexes was proposed. It can predict the development of PSC with sensitivity of 62,5 % and specificity of 87,93 %. After that the algorithm of differential surgical tactics of patients' with SAP treatment was proposed. On the second (prospective) stage the algorithm was used in the process of treatment of 45 patients with SAP. As a result the frequency of PSC was reduced on 18,6 % and the level of lethality was reduced to 11,11 % (р<0,05).