Prognostic value of increased B type natriuretic peptide in cases with acute pancreatitis

Elevated CK-MB levels are associated with adverse clinical outcomes in acute pancreatitis: a propensity score-matched study

Aim

Cardiac injury, reflected by the measured concentrations of chemicals released from injured cardiac muscle, is common in acute pancreatitis (AP). However, there is no adequate evidence assessing the impact of cardiac injury on AP-related outcomes. Creatine kinase-myocardial band (CK-MB) mainly exists in the myocardium. Therefore, we sought to evaluate the relationship between the increase in CK-MB and the adverse clinical outcomes of AP.

Methods

This propensity score-matched study analyzed AP patients admitted to the Department of Gastroenterology in the First Affiliated Hospital of Nanchang University from June 2017 to July 2022. Propensity score matching and multivariate logistic regression analysis were used to explore the relationship between CK-MB elevation and AP outcome variables.

Results

A total of 5,944 patients were screened for eligibility, of whom 4,802 were ultimately enrolled. Overall, 896 (18.66%) of AP patients had elevated (>24 U/ml) CK-MB levels, and 895 (99.89%) were paired with controls using propensity score matching. The propensity score-matched cohort analysis demonstrated that mortality (OR, 5.87; 95% CI, 3.89-8.84; P < 0.001), severe acute pancreatitis (SAP) (OR, 2.74; 95% CI, 2.23-3.35; P < 0.001), and infected necrotizing pancreatitis (INP) (OR, 3.40; 95% CI, 2.34-4.94; P < 0.001) were more frequent in the elevated CK-MB (>24 U/ml) group than in the normal CK-MB (≤ 24 U/ml) group. Using the multivariate logistic regression analysis, elevated CK-MB levels were independently associated with increased mortality (OR, 2.753, 95% CI, 2.095-3.617, P < 0.001), SAP incidence (OR, 2.223, CI, 1.870-2.643, P < 0.001), and INP incidence (OR, 1.913, 95% CI, 1.467-2.494, P < 0.001). CK-MB elevation was an independent risk factor for adverse clinical outcomes in AP patients.

Conclusion

CK-MB elevation was significantly related to adverse outcomes in AP patients, which makes it a potentially useful laboratory parameter for predicting adverse clinical outcomes of AP.

The Impact of Type 2 Myocardial Infarction in Acute Pancreatitis: Analysis of 1.1 Million Hospitalizations and Review of the Literature

Introduction  Acute pancreatitis (AP) is a common inflammatory disorder with acute onset and rapid progression. Studies have reported cardiac injury in patients with AP. It is often thought that stress cardiomyopathy can induce these changes leading to type 2 myocardial infarction (type 2 MI) in AP. Our study aims to assess the prevalence as well as the impact of type 2 MI on outcomes in patients with AP.  Methods National Inpatient Sample (NIS) 2016-2020 was used to identify adult patients (age>18) with acute pancreatitis. We excluded patients with STEMI, NSTEMI, pancreatic cancer, or chronic pancreatitis. Patients with missing demographics and mortality were also excluded. Patients were stratified into two groups, based on the presence of type 2 MI. Multivariate logistic regression analysis was performed to assess the impact of concomitant type 2 MI on mortality, sepsis, acute kidney injury (AKI), ICU admission, deep venous thrombosis (DVT), and pulmonary embolism (PE) after adjusting for patient demographics, hospital characteristics, etiology of AP and the Elixhauser comorbidities.  Results Of the 1.1 million patients in the study population, only 2315 patients had type 2 MI. The majority of the patients in the type 2 MI group were aged >65 years (49.2%, p<0.001), males (54.6%, p=0.63), White (67.6%, p=0.19), had Medicare insurance (55.5%, p<0.001), and were in the lowest income quartile (34.8%, p=0.12). Patients in the type 2 MI group had a higher incidence of mortality (5.4% vs 0.6%, p<0.001), sepsis (7.1% vs 3.7%, p<0.001), shock (9.3% vs 0.9%, p<0.001), AKI (42.9% vs. 11.8%, p<0.001) and ICU admission (12.1% vs 1.4%, p<0.001). After adjusting for confounding factors, patients in the type 2 MI group were noted to be at higher odds of mortality (aOR=2.4; 95% CI 1.5-3.8, p<0.001). Patients in the type 2 MI group had a longer length of stay (adjusted coefficient=2.1 days; 95% CI 1.4-2.8; p<0.001) and higher total hospitalization charges (adjusted coefficient=$45,088; 95% CI $30,224-$59,952; p<0.001).  Conclusion Although the prevalence of type 2 MI in AP is low, the presence of type 2 MI is associated with increased mortality and worse outcomes. Physicians should be aware of this association and these patients should be monitored carefully to prevent worse outcomes.

Cardiovascular abnormalities in dogs with acute pancreatitis

BACKGROUND

The prevalence and clinical importance of cardiac abnormalities in dogs with acute pancreatitis (AP) is unknown.

ANIMALS

Twelve dogs with AP and 60 archived serum samples from dogs with suspected AP.

METHODS

Two-phase study.

PHASE I

Analysis of archived serum samples from dogs with clinical signs of AP and high Spec cPL concentrations. High sensitivity troponin I (TnIH) and N-terminal pro-B-type natriuretic peptide (NT-proBNP) concentrations were measured in achieved serum samples.

PHASE II

Prospective observational study. Dogs with AP underwent echocardiography and Holter monitoring. Serum cardiac troponin I (cTnI) and plasma NT-proBNP concentrations were measured. Previously described disease severity indices were calculated for each dog.

RESULTS

Phase I: 41 of 60 dogs suspected of having AP had abnormally high TnIH concentrations and 13 of 60 had abnormally high serum NT-proBNP concentrations. Higher TnIH concentrations were observed in dogs with Spec cPL concentration >2000 μg/L as compared to those with concentrations of 1000-2000 μg/L.

PHASE II

11 of 12 dogs diagnosed with pancreatitis had abnormal cTnI concentrations (median: 0.384 ng/mL, range: 0.041-2.966 ng/mL, RI: ≤0.06 ng/mL) and 7 of 12 dogs had plasma NT-proBNP concentrations above the reference interval (median: 971 pmol/L, range: 250-2215 pmol/L, RI: ≤900 pmol/L). Supraventricular and ventricular ectopic beats occurred in 3 dogs. Echocardiographic abnormalities were detected in 5 dogs. Cardiovascular variables were not associated with indices of disease severity.

CONCLUSIONS AND CLINICAL IMPORTANCE

Myocardial injury is common in dogs with AP, but clinical consequences appeared to be uncommon in our small cohort. Cardiac biomarkers should be interpreted with caution in dogs with AP.

Cardiac indicator CK-MB might be a predictive marker for severity and organ failure development of acute pancreatitis

Background

The prediction of severe acute pancreatitis (SAP) is the key to providing timely and targeted intensive care for acute pancreatitis (AP). The heart is one of multiple organs involved in the early stage of SAP, but the predictive ability of cardiac dysfunction for SAP remains elusive. We sought to determine if the serum levels of three cardiac indicators (CI) including N-terminal pro-brain natriuretic peptide (NT-proBNP), cardiac troponin I (cTNI), and creatine kinase myocardial band (CK-MB) at admission could predict the occurrence of SAP and the development of related organ failure (OF).

Methods

A retrospective, single-center cohort study was conducted on the files of patients presenting to the emergency intensive care unit and medical ward of a regional hospital in Shanghai. Patients diagnosed as having AP and who met the 2012 Atlanta guideline were admitted within 48 hours after disease onset.

Results

Of the 670 AP patients screened, 238 were enrolled into the study and divided into mild acute pancreatitis (MAP) (n=59), moderate severe acute pancreatitis (MSAP) (n=123), and SAP (n=56) groups. No significant difference was found in baseline age, gender, duration from disease onset to admission, comorbidity, or substance abuse. As the levels of three CIs were significantly higher in the SAP group than in the MAP and MSAP groups, the enrolled patients were regrouped into non-SAP and SAP groups for predictive evaluation. Multivariate analysis and nomogram modelling showed that CK-MB, but not cTNI or NT-proBNP predicted the occurrence of SAP [area under curve (AUC) =0.805, confidence interval (CI): 0.794–0.905]. Specifically, 89 patients with OF (Modified Marshall score ≥2) upon admission were selected and CK-MB was shown to predict (AUC =0.805, CI: 0.794–0.905) persistent OF (n=48, duration of OF >48 hours) compared to transient organ failure (TOF) (n=41, duration of OF <48 hours).

Conclusions

CIs including NT-proBNP, cTNI, and CK-MB were elevated in the early stage of AP. CK-MB might be used as an efficient predictive biomarker for SAP occurrence and OF development at admission.

Association of Meloxicam Use with the Risk of Acute Pancreatitis: A Case-Control Study

BACKGROUND AND OBJECTIVE

No sufficient research has focused on the relationship between meloxicam use and acute pancreatitis. This study aimed to explore this issue in Taiwan.

METHODS

This case-control study was conducted using the database of the Taiwan National Health Insurance Program. In all, there were 6780 cases aged 20-84 years who were newly diagnosed with acute pancreatitis during the period 1998-2011, and 21,393 control subjects without acute pancreatitis. Cases and controls were matched for sex, age and comorbidities. Odds ratios (ORs) and 95% confidence intervals (CIs) were measured to explore the associations between acute pancreatitis, meloxicam use and comorbidities, using a multivariable unconditional logistic regression model.

RESULTS

After controlling for potential confounding factors, the adjusted OR for acute pancreatitis was 1.76 (95% CI 1.30-2.40) for subjects with current use of meloxicam, in comparison with subjects who had never used meloxicam. The adjusted OR decreased to 1.29 (95% CI 0.82-2.03) for subjects with late use of meloxicam, but without statistical significance.

CONCLUSIONS

Current use of meloxicam is associated with increased odds of acute pancreatitis. Clinicians should consider the potential risk of acute pancreatitis when prescribing meloxicam.

Comparison of Predictive Systems in Severe Acute Pancreatitis According to the Revised Atlanta Classification

OBJECTIVES

We aimed to compare the prognostic value of various predictors and complex scoring systems for prediction of severe acute pancreatitis (SAP) according to the revised Atlanta classification.

METHODS

C-reactive protein (CRP) and procalcitonin were obtained on admission, and CRP level 24 hours after admission (CRP2) was measured. Various scoring systems including Ranson, Acute Physiology and Chronic Health Examination (APACHE II), the Bedside Index for Severity in Acute Pancreatitis, and Computed Tomography Severity Index (CTSI) were calculated.

RESULTS

There were 146 patients with acute pancreatitis (mean age, 50.6 ± 18.3 years; 63% male), of which 43 patients (29.5%) received a diagnosis of moderately severe AP, and 17 patients (11.6%) received a diagnosis of SAP. In patients with moderately severe acute pancreatitis to SAP, CTSI (odds ratio [OR], 10.46; 95% confidence interval [CI], 4.3-25.43; P < 0.001), APACHE II (OR, 3.87; 95% CI, 1.18-12.64; P = 0.025), and CRP2 (OR, 4.5; 95% CI, 1.53-13.1; P = 0.006) were strongly related to moderately severe acute pancreatitis and SAP. In patients with SAP compared with mild to moderately severe AP, procalcitonin (OR, 4.36; 95% CI, 1.01-18.96; P = 0.049) was the only factor strongly associated with SAP.

CONCLUSIONS

Procalcitonin was the best predictor for patients with SAP; CTSI, APACHE II, and CRP2 were valuable predictors for patients with moderately severe acute pancreatitis and SAP.

Chronic osteomyelitis correlates with increased risk of acute pancreatitis in a case-control study in Taiwan

OBJECTIVES

The objective of this study was to examine the relationship between chronic osteomyelitis and acute pancreatitis in Taiwan.

METHODS

This was a population-based case-control study utilizing the database of the Taiwan National Health Insurance Program. We identified 7678 cases aged 20-84 with newly diagnosed acute pancreatitis during the period of 1998 to 2011. From the same database, 30,712 subjects without diagnosis of acute pancreatitis were selected as controls. The cases and controls were matched with sex, age and index year of diagnosing acute pancreatitis. The odds ratio with 95% confidence interval of acute pancreatitis associated with chronic osteomyelitis was examined by the multivariable unconditional logistic regression analysis.

RESULTS

After adjustment for multiple confounders, the multivariable analysis showed that the adjusted odds ratio of acute pancreatitis was 1.93 for subjects with chronic osteomyelitis (95% confidence interval 1.01, 3.69), when compared with subjects without chronic osteomyelitis.

CONCLUSIONS

Chronic osteomyelitis correlates with increased risk of acute pancreatitis. Patients with chronic osteomyelitis should be carefully monitored about the risk of acute pancreatitis.