Optimization of Diagnosis of Ascorbic Acid Hypovitaminosis in Patients with Chronic Pancreatitis Using a Prognostic Model

Chronic pancreatitis (CP) is characterized by disorders of the exocrine and endocrine functions of the pancreas. One of the manifestations of trophic insufficiency in patients with CP is endogenous and exogenous hypovitaminosis, in particular, ascorbic acid (vitamin C) deficiency. Unlike most animals, humans are unable to synthesize vitamin C endogenously due to the lack of the enzyme L-gulonolactone oxidase, which is necessary for the last step of ascorbic acid biosynthesis. Development of a mathematical prognostic model for predicting hypovitaminosis of ascorbic acid in patients with CP based on established predictive factors is an urgent task today. The objective: to develop a formula for predicting ascorbic acid deficiency in patients with CP based on established predictive factors. Materials and methods. 112 patients with CP and 30 practically healthy individuals were included in the study. During the study, the main clinical indicators affecting the course of CP were determined for the patients. Univariate regression analysis was performed to identify factors that could potentially affect ascorbic acid levels. A multivariate regression analysis was also performed, resulting in a multiple regression formula that identified a cohort of patients potentially with low ascorbic acid levels. Results. During the univariate correlation analysis, such indicators were established as the age of the patient with CP (R=–0.457) (р<0.05), the duration of CP (R=–0.478) (р<0.05), the functional capacity of the pancreas according to the point index of the coprogram (R=–0.372) (р<0.05), as well as the structural and morphological functional state of the pancreas according to ultrasound criteria expressed in points (R=–0.398) (р<0.05), total protein (R=0.370) (р<0.05), erythrocyte level (R=0.377) (р<0.05), ALT (R=–0.403) (р<0.05) and AST (R=–0.391) (p<0.05), which are predictors of vitamin deficiency for patients with CP. A multivariate regression analysis was performed to create a formula for predicting the level of ascorbic acid. Conclusions. The presence of ascorbic acid hypovitaminosis in patients with CP (p<0.001) indicates the need to study the level of this indicator for timely diagnosis and the appointment of appropriate treatment. For the personalized prediction of ascorbic acid deficiency in patients with CP the formulas are proposed that take into account the parameters of the course of CP, available for determination in the practice of primary care doctors: age of patients, duration of the disease, level of erythrocytes, quantitative value of ultrasound criteria, determination of coprogram criteria expressed in points.