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Mei LF, Gan Q, Hu J, Li YX, Tian R, Shi CJ. Assessment of early factors for identification or prediction severe acute pancreatitis in pregnancy. World J Clin Cases 2024; 12:5502-5512. [DOI: 10.12998/wjcc.v12.i24.5502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2024] [Revised: 05/25/2024] [Accepted: 06/20/2024] [Indexed: 07/11/2024] Open
Abstract
BACKGROUND Acute pancreatitis in pregnancy (APIP) is a rare and serious condition, and severe APIP (SAPIP) can lead to pancreatic necrosis, abscess, multiple organ dysfunction, and other adverse maternal and infant outcomes. Therefore, early identification or prediction of SAPIP is important.
AIM To assess factors for early identification or prediction of SAPIP.
METHODS The clinical data of patients with APIP were retrospectively analyzed. Patients were classified with mild acute pancreatitis or severe acute pancreatitis, and the clinical characteristics and laboratory biochemical indexes were compared between the two groups. Logical regression and receiver operating characteristic curve analyses were performed to assess the efficacy of the factors for identification or prediction of SAPIP.
RESULTS A total of 45 APIP patients were enrolled. Compared with the mild acute pancreatitis group, the severe acute pancreatitis group had significantly increased (P < 0.01) heart rate (HR), hemoglobin, neutrophil ratio (NEUT%), and neutrophil–lymphocyte ratio (NLR), while lymphocytes were significantly decreased (P < 0.01). Logical regression analysis showed that HR, NEUT%, NLR, and lymphocyte count differed significantly (P < 0.01) between the groups. These may be factors for early identification or prediction of SAPIP. The area under the curve of HR, NEUT%, NLR, and lymphocyte count in the receiver operating characteristic curve analysis was 0.748, 0.732, 0.821, and 0.774, respectively. The combined analysis showed that the area under the curve, sensitivity, and specificity were 0.869, 90.5%, and 70.8%, respectively.
CONCLUSION HR, NEUT%, NLR, and lymphocyte count can be used for early identification or prediction of SAPIP, and the combination of the four factors is expected to improve identification or prediction of SAPIP.
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Affiliation(s)
- Li-Fen Mei
- Department of Critical Care Medicine, Maternal and Child Health Hospital of Hubei Province, Wuhan 430000, Hubei Province, China
| | - Quan Gan
- Department of Critical Care Medicine, Maternal and Child Health Hospital of Hubei Province, Wuhan 430000, Hubei Province, China
| | - Jing Hu
- Department of Critical Care Medicine, Maternal and Child Health Hospital of Hubei Province, Wuhan 430000, Hubei Province, China
| | - Yun-Xiang Li
- Department of Critical Care Medicine, Maternal and Child Health Hospital of Hubei Province, Wuhan 430000, Hubei Province, China
| | - Rui Tian
- Department of Biliary-Pancreatic Surgery, Tongji Hospital of Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, Hubei Province, China
| | - Cheng-Jian Shi
- Department of Biliary-Pancreatic Surgery, Tongji Hospital of Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, Hubei Province, China
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Tang X, Chen Y, Huang S, Jiang J, Luo B, Ren W, Zhou X, Shi X, Zhang W, Shi L, Zhong X, Lü M. Acute Pancreatitis in Pregnancy: A Propensity Score Matching Analysis and Dynamic Nomogram for Risk Assessment. Dig Dis Sci 2024; 69:2235-2246. [PMID: 38602621 DOI: 10.1007/s10620-024-08415-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2023] [Accepted: 03/27/2024] [Indexed: 04/12/2024]
Abstract
BACKGROUND Acute pancreatitis is easily confused with abdominal pain symptoms, and it could lead to serious complications for pregnant women and fetus, the mortality was as high as 3.3% and 11.6-18.7%, respectively. However, there is still lack of sensitive laboratory markers for early diagnosis of APIP and authoritative guidelines to guide treatment. OBJECTIVE The purpose of this study was to explore the risk factors of acute pancreatitis in pregnancy, establish, and evaluate the dynamic prediction model of risk factors in acute pancreatitis in pregnancy patients. STUDY DESIGN Clinical data of APIP patients and non-pregnant acute pancreases patients who underwent regular antenatal check-ups during the same period were collected. The dataset after propensity matching was randomly divided into training set and verification set at a ratio of 7:3. The model was constructed using Logistic regression, least absolute shrinkage and selection operator regression, R language and other methods. The training set model was used to construct the diagnostic nomogram model and the validation set was used to validate the model. Finally, the accuracy and clinical practicability of the model were evaluated. RESULTS A total of 111 APIP were included. In all APIP patients, hyperlipidemic pancreatitis was the most important reason. The levels of serum amylase, creatinine, albumin, triglyceride, high-density lipoprotein cholesterol, and apolipoprotein A1 were significantly different between the two groups. The propensity matching method was used to match pregnant pancreatitis patients and pregnant non-pancreatic patients 1:1 according to age and gestational age, and the matching tolerance was 0.02. The multivariate logistic regression analysis of training set showed that diabetes, triglyceride, Body Mass Index, white blood cell, and C-reactive protein were identified and entered the dynamic nomogram. The area under the ROC curve of the training set was 0.942 and in validation set was 0.842. The calibration curve showed good predictive in training set, and the calibration performance in the validation set was acceptable. The calibration curve showed the consistency between the nomogram model and the actual probability. CONCLUSION The dynamic nomogram model we constructed to predict the risk factors of acute pancreatitis in pregnancy has high accuracy, discrimination, and clinical practicability.
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Affiliation(s)
- Xiaowei Tang
- Department of Gastroenterology, the Affiliated Hospital of Southwest Medical University, Street Taiping No.25, Region Jiangyang, Luzhou, 646099, Sichuan, China
- Nuclear Medicine and Molecular Imaging Key Laboratory of Sichuan Province, Luzhou, China
| | - Yuan Chen
- Department of Gastroenterology, the Affiliated Hospital of Southwest Medical University, Street Taiping No.25, Region Jiangyang, Luzhou, 646099, Sichuan, China
- Nuclear Medicine and Molecular Imaging Key Laboratory of Sichuan Province, Luzhou, China
| | - Shu Huang
- Department of Gastroenterology, Lianshui County People' Hospital, Huaian, China
- Department of Gastroenterology, Lianshui People' Hospital of Kangda College Affiliated to Nanjing Medical University, Huaian, China
| | - Jiao Jiang
- Department of Gastroenterology, the Affiliated Hospital of Southwest Medical University, Street Taiping No.25, Region Jiangyang, Luzhou, 646099, Sichuan, China
- Nuclear Medicine and Molecular Imaging Key Laboratory of Sichuan Province, Luzhou, China
| | - Bei Luo
- Department of Gastroenterology, the Affiliated Hospital of Southwest Medical University, Street Taiping No.25, Region Jiangyang, Luzhou, 646099, Sichuan, China
- Nuclear Medicine and Molecular Imaging Key Laboratory of Sichuan Province, Luzhou, China
| | - Wensen Ren
- Department of Gastroenterology, the Affiliated Hospital of Southwest Medical University, Street Taiping No.25, Region Jiangyang, Luzhou, 646099, Sichuan, China
- Nuclear Medicine and Molecular Imaging Key Laboratory of Sichuan Province, Luzhou, China
| | - Xueqin Zhou
- Department of Gastroenterology, the Affiliated Hospital of Southwest Medical University, Street Taiping No.25, Region Jiangyang, Luzhou, 646099, Sichuan, China
- Nuclear Medicine and Molecular Imaging Key Laboratory of Sichuan Province, Luzhou, China
| | - Xiaomin Shi
- Department of Gastroenterology, the Affiliated Hospital of Southwest Medical University, Street Taiping No.25, Region Jiangyang, Luzhou, 646099, Sichuan, China
- Nuclear Medicine and Molecular Imaging Key Laboratory of Sichuan Province, Luzhou, China
| | - Wei Zhang
- Department of Gastroenterology, the Affiliated Hospital of Southwest Medical University, Street Taiping No.25, Region Jiangyang, Luzhou, 646099, Sichuan, China
- Nuclear Medicine and Molecular Imaging Key Laboratory of Sichuan Province, Luzhou, China
| | - Lei Shi
- Department of Gastroenterology, the Affiliated Hospital of Southwest Medical University, Street Taiping No.25, Region Jiangyang, Luzhou, 646099, Sichuan, China
- Nuclear Medicine and Molecular Imaging Key Laboratory of Sichuan Province, Luzhou, China
| | - Xiaolin Zhong
- Department of Gastroenterology, the Affiliated Hospital of Southwest Medical University, Street Taiping No.25, Region Jiangyang, Luzhou, 646099, Sichuan, China
- Nuclear Medicine and Molecular Imaging Key Laboratory of Sichuan Province, Luzhou, China
| | - Muhan Lü
- Department of Gastroenterology, the Affiliated Hospital of Southwest Medical University, Street Taiping No.25, Region Jiangyang, Luzhou, 646099, Sichuan, China.
- Nuclear Medicine and Molecular Imaging Key Laboratory of Sichuan Province, Luzhou, China.
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Wang Y, Qu G, Wu Z, Tian D, Yang W, Li H, Lu Y, Meng G, Zhang H. Early predictive value of scoring systems and routine laboratory tests in severity and prognosis of acute pancreatitis in pregnancy. Therap Adv Gastroenterol 2023; 16:17562848231167277. [PMID: 37113191 PMCID: PMC10126706 DOI: 10.1177/17562848231167277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Accepted: 03/14/2023] [Indexed: 04/29/2023] Open
Abstract
Background Currently, no guidelines specifically recommend scoring systems and biomarkers for early evaluation of the severity and prognosis of acute pancreatitis in pregnancy (APIP). Objectives This study aimed to explore the early predictive value of scoring systems and routine laboratory tests on APIP severity and maternofetal prognosis. Design This study retrospectively analyzed 62 APIP cases in a 6-year period. Methods The predictive value of scoring systems and routine laboratory tests that were collected 24 h and 48 h after admission, for APIP severity and fetal loss, were analyzed. Results To detect severe acute pancreatitis (SAP), a 24-h Bedside Index for severity in acute pancreatitis (BISAP) achieved a higher area under the curve (AUC) value of 0.910 than the Acute Physiology and Chronic Health Evaluation II (AUC = 0.898) and Ranson score (AUC = 0.880). The combination of BISAP, glucose, neutrophil-to-lymphocyte ratio (NLR), hematocrit (Hct), and serum creatinine (Scr) provided an AUC value of 0.984, which had greater predictive power than BISAP (p = 0.015). 24-h BISAP and Hct were independent risk factors for predicting SAP of APIP. The cutoff values of Hct and blood urea nitrogen (BUN) to predict SAP were 35.60% and 3.75 mmol/l in the APIP. Furthermore, 24-h BISAP had the highest predictive power (AUC = 0.958) for fetal loss. Conclusion BISAP is a convenient and reliable indicator for the early prediction of SAP and fetal loss in APIP. The combination of BISAP, glucose, NLR, Hct and Scr proved to be the optimal early markers for the prediction of SAP in APIP within 24 h after admission. In addition, Hct > 35.60% and BUN > 3.75 mmol/l may be suitable thresholds for predicting SAP in APIP.
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Affiliation(s)
- Yu Wang
- Department of Emergency Medicine, First
Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China
| | - Guangbo Qu
- Anhui Medical University, Hefei, Anhui,
China
| | - Zhangbi Wu
- Department of Emergency Medicine, First
Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China
| | - Dongmei Tian
- Department of Emergency Medicine, First
Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China
| | - Wenbei Yang
- Department of Emergency Medicine, First
Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China
| | - Hongye Li
- Department of Emergency Medicine, First
Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China
| | - Yu Lu
- Department of Emergency Medicine, First
Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China
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Mądro A. Pancreatitis in Pregnancy-Comprehensive Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:16179. [PMID: 36498253 PMCID: PMC9737239 DOI: 10.3390/ijerph192316179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Revised: 11/30/2022] [Accepted: 12/01/2022] [Indexed: 06/17/2023]
Abstract
Acute and chronic pancreatitis, until recently observed incidentally in pregnancy, has occurred much more frequently in the last 2-3 decades. Particularly severe complications for the mother and fetus may be a consequence of acute pancreatitis. Therefore, it is important to know more about the diagnostic and therapeutic possibilities of pancreatic diseases in the course of pregnancy. Epidemiology, causes, clinical characteristics, differential diagnosis, and complex management are presented in this review. Particular emphasis is on the prevention of acute pancreatitis (AP) through the proper diagnosis and treatment of cholelithiasis and hypertriglyceridemia, both before and during pregnancy. The most up-to-date reports and management strategies are presented. This publication contributes to a wide group of scientists and practitioners better understanding the discussed issues, and indicates the directions of research for the future.
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Affiliation(s)
- Agnieszka Mądro
- Department of Gastroenterology with Endoscopic Unit, Medical University, 20-059 Lublin, Poland
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Lin H, Yu T, Xu R, Li X. Mean corpuscular hemoglobin predicts the length of hospital stay independent of severity classification in patients with acute pancreatitis. Open Med (Wars) 2022; 17:1449-1454. [PMID: 36128446 PMCID: PMC9449682 DOI: 10.1515/med-2022-0559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Revised: 08/18/2022] [Accepted: 08/19/2022] [Indexed: 11/22/2022] Open
Abstract
Mean corpuscular hemoglobin (MCH) is a common blood routine test index. To explore the relationship between MCH and length of hospital stay in patients with acute pancreatitis (AP), we included 273 patients with AP without coronary heart disease, diabetes, hypertension and anemia in this study. All data were separated into three groups according to the length of hospital stay. Gender (p = 0.017) and severity classification (p < 0.001) were significantly correlated with length of hospital stay among three groups. Notably, MCH level was significant different among three groups (p = 0.009). Thus, all data were separated into two groups according to MCH level, and significant increases in the length of hospital stay were observed between two groups (p = 0.030). A positive correlation between length of hospital stay and MCH was observed (r = 0.172, p = 0.004). Multiple linear regression analysis showed that MCH was independent correlated with the length of hospital stay, no matter whether severity classification of AP was included (beta = 0.248, p < 0.001; beta = 0.212, p < 0.001). Our results demonstrated that the length of hospital stay was correlated with MCH level in patients with AP, and MCH level at admission may predict the length of hospital stay independent of severity classification in AP. These results may provide a potential evaluation basis for the management of patients with AP.
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Affiliation(s)
- Hao Lin
- Department of Clinical Science and Research, Zhongda Hospital, School of Medicine, Southeast University , Nanjing , 210009 , China
| | - Ting Yu
- Department of Gastroenterology, Zhongda Hospital, School of Medicine, Southeast University , Nanjing , China
| | - Rong Xu
- Department of Clinical Science and Research, Zhongda Hospital, School of Medicine, Southeast University , Nanjing , 210009 , China
| | - Xing Li
- Department of Quality Management, Zhongda Hospital, School of Medicine, Southeast University , Nanjing , China
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Zhang T, Wang G, Cao Z, Huang W, Xiao H, Wei H, Lu J, Liu R, Yin C. Acute pancreatitis in pregnancy: a 10-year, multi-center, retrospective study in Beijing. BMC Pregnancy Childbirth 2022; 22:414. [PMID: 35581621 PMCID: PMC9115992 DOI: 10.1186/s12884-022-04742-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Accepted: 05/03/2022] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVE Acute pancreatitis in pregnancy (APIP) is a rare and serious complication during pregnancy. It has acute onset and is difficult to diagnose and treat. The aim of the present study was to describe the etiology, clinical manifestations, and maternofetal outcomes of APIP. METHODS We retrospectively reviewed 32 pregnant women who were treated at three tertiary care hospitals in Beijing, China. The correlation between the causes of APIP, severity, laboratory indices, and outcomes was analyzed. RESULTS The most common causes of APIP were hypertriglyceridemia (56.2%,18/32) and gallstones (28.1%, 9/32). Hypertriglyceridemia-induced APIP was associated with a higher rate of severe acute pancreatitis (P = 0.025). Serum level of triglycerides showed a positive correlation with the severity of APIP (P = 0.039). The most frequent presentation of APIP was abdominal pain (93.7%, 30/32). There were no maternal or fetal deaths in our study. Apgar scores at 1 min, 5 min, and 10 min of the premature neonates was correlated with the severity of APIP of the mother (P = 0.022; 0.002; 0.002). CONCLUSION High level of triglycerides may serve as a useful marker of the severity of APIP. The severity of APIP was associated with higher risk of neonate asphyxia. Appropriate timing of termination of pregnancy is a key imperative for APIP patients.
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Affiliation(s)
- Tingting Zhang
- Department of Internal Medicine, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing, China
| | - Guoxing Wang
- Department of Emergency Medicine, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Zheng Cao
- Department of Clinical Laboratory, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing, China
| | - Wenyang Huang
- Department of Obstetrics and Gynecology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Hongli Xiao
- Department of Emergency Medicine, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Hongtao Wei
- Department of Gastroenterology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Junli Lu
- Department of Obstetrics and Gynecology, Beijing Chao-Yang Hospital, Capital Medical University, 8 Gongren Tiyuchang Nanlu, Chaoyang District, Beijing, 100020, People's Republic of China.
| | - Ruixia Liu
- Department of Central Laboratory, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, 251 Yaojiayuan Road, Chaoyang District, Beijing, 100026, People's Republic of China.
| | - Chenghong Yin
- Department of Internal Medicine, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, 251 Yaojiayuan Road, Chaoyang District, Beijing, 100026, People's Republic of China.
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Khan NA, Haider Kazmi SJ, Asghar MS, Singh M, Iqbal S, Jawed R, Muhammad L, Kirmani TA, Ahmed Khan S, Rajput IA. Hematological Indices Predicting the Severity of Acute Pancreatitis Presenting to the Emergency Department: A Retrospective Analysis. Cureus 2021; 13:e16752. [PMID: 34513375 PMCID: PMC8405398 DOI: 10.7759/cureus.16752] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/30/2021] [Indexed: 12/13/2022] Open
Abstract
Introduction Acute pancreatitis is defined as inflammation of the pancreas. The body responds to inflammation by producing excessive neutrophils and causing programmed cell death of lymphocytes. This leads to immunological instability, which increases the severity of the disease and mortality rate. Recent data suggest that markers of systemic inflammation are able to predict the prognosis of various diseases. Our study aims to assess the severity of acute pancreatitis in conjunction with these hematological markers of systemic inflammation. Materials and methods Our study was carried out in the emergency medicine department of a tertiary care hospital among patients diagnosed with acute pancreatitis. It was a retrospective study done by reviewing the hospital's medical records. Hematological indices such as hemoglobin levels, packed cell volume (PCV), red blood cell (RBC) count, mean corpuscular volume (MCV), mean corpuscular hemoglobin (MCH), mean corpuscular hemoglobin concentration (MCHC), total leukocyte count (TLC), neutrophil count, lymphocyte count, monocyte count, platelet count, neutrophil to lymphocyte count ratio (NLR), lymphocyte to monocyte ratio (LMR), and platelet to lymphocyte ratio (PLR) were observed to be associated with severity of pancreatitis. Those with computed tomography (CT) severity score >=7 were termed as severe pancreatitis, while those below 7 were considered mild to moderate. Results A total of 154 patients were included in the final analysis. The mean age of those patients was 48.47 ± 16.71 years. There were 94 male and 60 female patients. There was no difference found among the study groups with respect to mean hemoglobin levels, RBC count, PCV, MCV, MCH, MCHC, lymphocytes, and platelet counts. TLC (p<0.001), neutrophils (p<0.001), monocytes (p=0.008), NLR (p<0.001), and PLR (p=0.006) were found higher in severe pancreatitis, while LMR was found lower in severe pancreatitis (p=0.003). A linear relationship between the hematological indices and CT severity score has shown that TLC (p=0.015), neutrophils (p=0.005), NLR (p=0.001), and PLR (p<0.001) were positively correlated with severity while lymphocyte count (p=0.004) and LMR (p=0.005) were negatively correlated with severe pancreatitis. TLC and LMR were independent predictors of severe pancreatitis with an adjusted odds ratio of 12.80 and 5.47, respectively, on multivariable regression analysis. Conclusion Many markers correlated with the CT severity score, but few of them were able to demonstrate statistical significance on receiver operating characteristic (ROC) analysis.
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Affiliation(s)
- Noman A Khan
- General Surgery, Liaquat National Hospital and Medical College, Karachi, PAK
| | | | | | - Manjeet Singh
- Internal Medicine, Liaquat National Hospital and Medical College, Karachi, PAK
| | - Shahid Iqbal
- Forensic Medicine, Bacha Khan Medical College, Mardan, PAK
| | - Rumael Jawed
- Internal Medicine, Liaquat National Hospital and Medical College, Karachi, PAK
| | - Lal Muhammad
- Internal Medicine, Liaquat National Hospital and Medical College, Karachi, PAK
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