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Yang N, Hao J, Zhang D. Antithrombin III and D-dimer levels as indicators of disease severity in patients with hyperlipidaemic or biliary acute pancreatitis. J Int Med Res 2017; 45:147-158. [PMID: 28222624 PMCID: PMC5536593 DOI: 10.1177/0300060516677929] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Objective To assess changes in anticoagulation and fibrinolytic systems between biliary and hyperlipidaemic acute pancreatitis (AP). Methods Patients with biliary or hyperlipidaemic AP were enrolled. Demographic and clinical data were collected, and antithrombin III (ATIII), protein C, protein S, and D-dimer levels were investigated. Results A total of 45 patients with biliary AP and 50 patients with hyperlipidaemic AP were included (68 with mild AP and 27 with moderately-severe AP). ATIII and protein C levels in the mild AP group were significantly higher, but prothrombin time and D-dimer were significantly lower, versus the moderately-severe AP group. ATIII and D-dimer were found to be risk factors for moderately-severe AP. ATIII could predict AP severity, particularly in patients with biliary AP. D-dimer was a sensitive and specific predictor for disease severity in patients with AP, particularly in patients with hyperlipidaemic AP. Conclusion ATIII and protein C levels decreased as severity of AP increased, particularly in cases of biliary AP. D-dimer levels increased with severity of AP, particularly in hyperlipidaemic AP. ATIII and D-dimer may be useful biomarkers for assessing AP severity in patients with biliary and hyperlipidaemic AP, respectively.
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Affiliation(s)
- Ning Yang
- 1 Department of Endocrinology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Jianyu Hao
- 2 Department of Gastroenterology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Donglei Zhang
- 2 Department of Gastroenterology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
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Emergent Triglyceride-lowering Therapy With Early High-volume Hemofiltration Against Low-Molecular-Weight Heparin Combined With Insulin in Hypertriglyceridemic Pancreatitis: A Prospective Randomized Controlled Trial. J Clin Gastroenterol 2016; 50:772-8. [PMID: 27574886 DOI: 10.1097/mcg.0000000000000552] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVES To compare the value of emergent triglyceride (TG)-lowering therapies between early high-volume hemofiltration (HVHF) and low-molecular-weight heparin (LMWH) combined with insulin (LMWH+insulin) as well as their effects on the outcomes of hypertriglyceridemic pancreatitis (HTGP) patients. METHODS In this randomized controlled trial, 66 HTGP patients presenting within 3 days after the onset of symptoms from August 2011 to October 2013 were assigned randomly to receive either HVHF or LMWH+insulin as an emergent TG-lowering therapy. Thirty-three patients were included in each group, and the therapy was started as soon as possible after admission. TG levels, clinical outcomes, and inflammatory biomarkers were compared between the 2 groups. RESULTS Thirty-two individuals in the HVHF group and 34 in the LMWH+insulin group were included in the final analysis. Characteristics of the patients in both groups were roughly comparable. HVHF could remove TG from the plasma and achieve its target (<500 mg/dL) in approximately 9 hours, whereas the target was not achieved within 48 hours in patients receiving the LMWH+insulin treatment (P<0.05). However, no differences were found in terms of the majority of the clinical outcomes, including local pancreatic complications (P>0.05), the requirement of surgical intervention (P=0.49), mortality (P=0.49), and the duration of hospitalization (P=0.144). Furthermore, an unexpectedly higher incidence of persistent organ failure was observed in the HVHF group compared with the LMWH+insulin group (risk ratio with HVHF, 2.42; 95% confidence interval, 1.15-5.11; P=0.01). Hospital charges for patients in the HVHF group were approximately 2-fold higher than those for patients in the LMWH+insulin group (5.20±4.90 vs. 2.92±3.21, P=0.03). We selected a systemic inflammatory response syndrome score of at least 2 at baseline as a predictor of SAP patients, and the subgroup analyses showed that HVHF cannot improve the prognosis of the predicted SAP patients compared with the LMWH+insulin group. CONCLUSIONS HVHF can lower TG levels more efficiently than LMWH+insulin therapy, but it is not superior in terms of clinical outcomes and costs. Further multicenter studies with large samples are required to clarify the feasibility of administering the HVHF treatment to HTGP patients (ChiCTR-TRC-13003274).
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Yang N, Zhang DL, Hao JY. Coagulopathy and the prognostic potential of D-dimer in hyperlipidemia-induced acute pancreatitis. Hepatobiliary Pancreat Dis Int 2015; 14:633-41. [PMID: 26663012 DOI: 10.1016/s1499-3872(15)60376-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND Coagulopathy and its association with disease severity in hyperlipidemia (HL)- and non-hyperlipidemia (NHL)-induced acute pancreatitis (AP) are not clear. The present study was to evaluate the relationship between coagulation homeostasis and AP. METHODS This study included 106 AP patients admitted to our hospital between October 2011 and January 2013. Stratified by disease severity, the patients were divided into two groups: a mild AP (MAP) group (n=69); and a moderately severe AP (MSAP) group (n=37). Based on disease etiology, there were 31 HL-induced AP (HLP) cases and 75 NHL-induced AP (NHLP) cases. The HLP and NHLP groups were compared for parameters of coagulation homeostasis, lipid metabolism, and disease severity. Correlations between disease severity and levels of D-dimer and protein C were investigated, and the prognostic potential of D-dimer was evaluated. RESULTS Compared with MAP patients, MSAP patients showed higher levels of D-dimer and lower levels of protein C. HLP patients had higher protein C levels than NHLP patients. Both D-dimer and protein C levels were significantly associated with the disease severity, not the disease etiology. D-dimer levels correlated positively with low density lipoprotein cholesterol levels and performed well as a sensitive and specific predictor of disease severity in AP patients, especially in HLP patients. CONCLUSIONS The coagulation homeostasis is different between HLP and NHLP patients, and HL may be a contributing factor for thrombosis and fibrinolysis in HLP. D-dimer may be a robust marker of disease severity in HLP.
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Affiliation(s)
- Ning Yang
- Department of Gastroenterology, Beijing Chaoyang Hospital, Capital Medical University, Beijing 100020, China.
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Michelena J, Altamirano J, Abraldes JG, Affò S, Morales-Ibanez O, Sancho-Bru P, Dominguez M, García-Pagán JC, Fernández J, Arroyo V, Ginès P, Louvet A, Mathurin P, Mehal WZ, Caballería J, Bataller R. Systemic inflammatory response and serum lipopolysaccharide levels predict multiple organ failure and death in alcoholic hepatitis. Hepatology 2015; 62:762-72. [PMID: 25761863 PMCID: PMC4549175 DOI: 10.1002/hep.27779] [Citation(s) in RCA: 198] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2014] [Accepted: 03/09/2015] [Indexed: 12/12/2022]
Abstract
UNLABELLED Alcoholic hepatitis (AH) frequently progresses to multiple organ failure (MOF) and death. However, the driving factors are largely unknown. At admission, patients with AH often show criteria of systemic inflammatory response syndrome (SIRS) even in the absence of an infection. We hypothesize that the presence of SIRS may predispose to MOF and death. To test this hypothesis, we studied a cohort including 162 patients with biopsy-proven AH. The presence of SIRS and infections was assessed in all patients, and multivariate analyses identified variables independently associated with MOF and 90-day mortality. At admission, 32 (19.8%) patients were diagnosed with a bacterial infection, while 75 (46.3%) fulfilled SIRS criteria; 58 patients (35.8%) developed MOF during hospitalization. Short-term mortality was significantly higher among patients who developed MOF (62.1% versus 3.8%, P < 0.001). The presence of SIRS was a major predictor of MOF (odds ratio = 2.69, P = 0.025) and strongly correlated with mortality. Importantly, the course of patients with SIRS with and without infection was similar in terms of MOF development and short-term mortality. Finally, we sought to identify serum markers that differentiate SIRS with and without infection. We studied serum levels of high-sensitivity C-reactive protein, procalcitonin, and lipopolysaccharide at admission. All of them predicted mortality. Procalcitonin, but not high-sensitivity C-reactive protein, serum levels identified those patients with SIRS and infection. Lipopolysaccharide serum levels predicted MOF and the response to prednisolone. CONCLUSION In the presence or absence of infections, SIRS is a major determinant of MOF and mortality in AH, and the mechanisms involved in the development of SIRS should be investigated; procalcitonin serum levels can help to identify patients with infection, and lipopolysaccharide levels may help to predict mortality and the response to steroids.
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Affiliation(s)
- Javier Michelena
- Liver Unit, Hospital Cliníc, Barcelona, Spain
- Institut d’Investigacions Biomèdiques August-Pi-Sunyer, University of Barcelona, Centro de Investigacion Biomédica en Red de Enfermedades Hepáticas y Digestivas, Barcelona, Spain
| | - José Altamirano
- Liver Unit, Hospital Cliníc, Barcelona, Spain
- Institut d’Investigacions Biomèdiques August-Pi-Sunyer, University of Barcelona, Centro de Investigacion Biomédica en Red de Enfermedades Hepáticas y Digestivas, Barcelona, Spain
- Liver Unit, Department of Internal Medicine, Vall d’Hebron Institut de Recerca, Barcelona, Spain
| | - Juan G. Abraldes
- Division of Gastroenterology, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Silvia Affò
- Liver Unit, Hospital Cliníc, Barcelona, Spain
- Institut d’Investigacions Biomèdiques August-Pi-Sunyer, University of Barcelona, Centro de Investigacion Biomédica en Red de Enfermedades Hepáticas y Digestivas, Barcelona, Spain
| | - Oriol Morales-Ibanez
- Liver Unit, Hospital Cliníc, Barcelona, Spain
- Institut d’Investigacions Biomèdiques August-Pi-Sunyer, University of Barcelona, Centro de Investigacion Biomédica en Red de Enfermedades Hepáticas y Digestivas, Barcelona, Spain
| | - Pau Sancho-Bru
- Liver Unit, Hospital Cliníc, Barcelona, Spain
- Institut d’Investigacions Biomèdiques August-Pi-Sunyer, University of Barcelona, Centro de Investigacion Biomédica en Red de Enfermedades Hepáticas y Digestivas, Barcelona, Spain
| | - Marlene Dominguez
- Servicio de Gastroenterología, Hospital Domingo Luciani, Caracas, Venezuela
| | - Juan Carlos García-Pagán
- Liver Unit, Hospital Cliníc, Barcelona, Spain
- Institut d’Investigacions Biomèdiques August-Pi-Sunyer, University of Barcelona, Centro de Investigacion Biomédica en Red de Enfermedades Hepáticas y Digestivas, Barcelona, Spain
- Hepatic Hemodynamic Laboratory, Hospital Clinic, Barcelona, Spain
| | - Javier Fernández
- Liver Unit, Hospital Cliníc, Barcelona, Spain
- Institut d’Investigacions Biomèdiques August-Pi-Sunyer, University of Barcelona, Centro de Investigacion Biomédica en Red de Enfermedades Hepáticas y Digestivas, Barcelona, Spain
| | - Vicente Arroyo
- Liver Unit, Hospital Cliníc, Barcelona, Spain
- Institut d’Investigacions Biomèdiques August-Pi-Sunyer, University of Barcelona, Centro de Investigacion Biomédica en Red de Enfermedades Hepáticas y Digestivas, Barcelona, Spain
| | - Pere Ginès
- Liver Unit, Hospital Cliníc, Barcelona, Spain
- Institut d’Investigacions Biomèdiques August-Pi-Sunyer, University of Barcelona, Centro de Investigacion Biomédica en Red de Enfermedades Hepáticas y Digestivas, Barcelona, Spain
| | - Alexandre Louvet
- INSERM U995, Universitè Lille Nord de France, Lille, France
- Service de Maladies de l’Apareil Digestif et de la Nutrition, Hôpital Claude Huriez, Lille, France
| | - Philippe Mathurin
- INSERM U995, Universitè Lille Nord de France, Lille, France
- Service de Maladies de l’Apareil Digestif et de la Nutrition, Hôpital Claude Huriez, Lille, France
| | | | - Juan Caballería
- Liver Unit, Hospital Cliníc, Barcelona, Spain
- Institut d’Investigacions Biomèdiques August-Pi-Sunyer, University of Barcelona, Centro de Investigacion Biomédica en Red de Enfermedades Hepáticas y Digestivas, Barcelona, Spain
| | - Ramón Bataller
- Institut d’Investigacions Biomèdiques August-Pi-Sunyer, University of Barcelona, Centro de Investigacion Biomédica en Red de Enfermedades Hepáticas y Digestivas, Barcelona, Spain
- Division of Gastroenterology and Hepatology, Departments of Medicine and Nutrition, University of North Carolina at Chapel Hill, Chapel Hill, NC
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