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Serum interleukin-35 and pentraxin-3 levels in patients with mild acute pancreatitis. GASTROENTEROLOGY REVIEW 2019; 14:48-54. [PMID: 30944677 PMCID: PMC6444112 DOI: 10.5114/pg.2019.83425] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/02/2018] [Accepted: 10/11/2018] [Indexed: 01/21/2023]
Abstract
Introduction Interleukin-35 (IL-35) is a newly defined potent anti-inflammatory cytokine that is predominantly produced by regulatory T cells, and pentraxin-3 belongs to the acute-phase proteins. Aim To measure the serum IL-35 and pentraxin-3 levels in the early phase of mild acute pancreatitis (AP). Material and methods Eighty-three patients with mild AP and 30 healthy controls were included in the study. The serum levels of IL-35 and pentraxin-3 were measured by enzyme-linked immunosorbent assay upon admission and at the 48th hour after diagnosis. Results The mean value of serum IL-35 levels in patients with mild acute pancreatitis at admission was 5.91 ng/ml (4.21–7.90) and was significantly lower than those in healthy controls (25.53 ng/ml (12.79–54.73, p < 0.001)) and 48-hour value were (6.79 ng/ml (4.42–9.62) (p = 0.015)). The mean value of serum pentraxin-3 levels in patients at the time of admission was 6.75 ng/ml (4.42–9.62) and there was no significant difference from healthy controls, at 7.64 ng/ml (6.58–8.62, p > 0.05). Also there was no significant difference between the mean value at admission and the mean value at 48-hour, 6.75 ng/ml (4.74–9.06, p > 0.05). Conclusions Interleukin-35 can be used in diagnosis and follow-up in patients with mild AP.
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Iranmahboob AK, Kierans AS, Huang C, Ream JM, Rosenkrantz AB. Preliminary investigation of whole-pancreas 3D histogram ADC metrics for predicting progression of acute pancreatitis. Clin Imaging 2017; 42:172-177. [DOI: 10.1016/j.clinimag.2016.12.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2016] [Revised: 11/23/2016] [Accepted: 12/14/2016] [Indexed: 12/24/2022]
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Role of Biomarkers in Diagnosis and Prognostic Evaluation of Acute Pancreatitis. J Biomark 2015; 2015:519534. [PMID: 26345247 PMCID: PMC4541003 DOI: 10.1155/2015/519534] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2015] [Revised: 07/14/2015] [Accepted: 07/15/2015] [Indexed: 02/07/2023] Open
Abstract
Acute pancreatitis is a potentially life threatening disease. The spectrum of severity of the illness ranges from mild self-limiting disease to a highly fatal severe necrotizing pancreatitis. Despite intensive research and improved patient care, overall mortality still remains high, reaching up to 30–40% in cases with infected pancreatic necrosis. Although little is known about the exact pathogenesis, it has been widely accepted that premature activation of digestive enzymes within the pancreatic acinar cell is the trigger that leads to autodigestion of pancreatic tissue which is followed by infiltration and activation of leukocytes. Extensive research has been done over the past few decades regarding their role in diagnosis and prognostic evaluation of severe acute pancreatitis. Although many standalone biochemical markers have been studied for early assessment of severity, C-reactive protein still remains the most frequently used along with Interleukin-6. In this review we have discussed briefly the pathogenesis and the role of different biochemical markers in the diagnosis and severity evaluation in acute pancreatitis.
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Huang LY, Chen P, Xu LX, Zhou YF, Li WG, Yuan YZ. Fractalkine as a marker for assessment of severe acute pancreatitis. J Dig Dis 2012; 13:225-31. [PMID: 22435508 DOI: 10.1111/j.1751-2980.2012.00580.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVE The aim of this study was to study the role of fractalkine (FKN) in the development of severe acute pancreatitis (SAP) in animal model. METHODS Serum FKN levels in rat model (control, SAP6 h, 16 h, 24 h and 48 h) were determined by enzyme-linked immunosorbent assay. FKN mRNA and protein levels in the pancreas tissue were measured by reverse transcription polymerase chain reaction (RT-PCR), Western blot and immunohistochemistry. RESULTS Serum FKN level in the SAP rat increased significantly (P < 0.05 compared with the control group). FKN mRNA and protein levels in pancreas and lung increased significantly and reached the peak at 16 h after the induction of SAP, while those in kidney reached the peak at 48 h. Immunohistochemistry showed the overexpression of FKN in pancreas, lung and kidney tissue. CONCLUSION FKN involves in the progression of SAP and might be a valuable marker for the assessment of SAP.
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Affiliation(s)
- Li Ya Huang
- Department of Gastroenterology, Ruijin Hospital, Shanghai Jiao-Tong University School of Medicine, China
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Treatment of severe acute pancreatitis through retroperitoneal laparoscopic drainage. Front Med 2011; 5:302-5. [DOI: 10.1007/s11684-011-0145-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2011] [Accepted: 06/29/2011] [Indexed: 01/07/2023]
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Serum profiles of C-reactive protein, interleukin-8, and tumor necrosis factor-alpha in patients with acute pancreatitis. HPB SURGERY : A WORLD JOURNAL OF HEPATIC, PANCREATIC AND BILIARY SURGERY 2010; 2009:878490. [PMID: 20130823 PMCID: PMC2814374 DOI: 10.1155/2009/878490] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/10/2009] [Revised: 07/28/2009] [Accepted: 11/16/2009] [Indexed: 12/22/2022]
Abstract
Background-Aims. Early prediction of the severity of acute pancreatitis would lead to prompt intensive treatment resulting in improvement of the outcome. The present study investigated the use of C-reactive protein (CRP), interleukin IL-8 and tumor necrosis factor-α (TNF-α) as prognosticators of the severity of the disease.
Methods. Twenty-six patients with acute pancreatitis were studied. Patients with APACHE II score of 9 or more formed the severe group, while the mild group consisted of patients with APACHE II score of less than 9. Serum samples for measurement of CRP, IL-8 and TNF-α were collected on the day of admission and additionally on the 2nd, 3rd and 7th days.
Results. Significantly higher levels of IL-8 were found in patients with severe acute pancreatitis compared to those with mild disease especially at the 2nd and 3rd days (P = .001 and P = .014, resp.). No significant difference for CRP and TNF-α was observed between the two groups. The optimal cut-offs for IL-8 in order to discriminate severe from mild disease at the 2nd and 3rd days were 25.4 pg/mL and 14.5 pg/mL, respectively.
Conclusions. IL-8 in early phase of acute pancreatitis is superior marker compared to CRP and TNF-α for distinguishing patients with severe disease.
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Greer SE, Burchard KW. Acute pancreatitis and critical illness: a pancreatic tale of hypoperfusion and inflammation. Chest 2010; 136:1413-1419. [PMID: 19892682 DOI: 10.1378/chest.08-2616] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Since it was first widely recognized at the end of the 19th century, acute pancreatitis has proven a formidable clinical challenge, frequently resulting in management within critical care settings. Because the early assessment of severity is difficult, the recognition of severe acute pancreatitis (SAP) and the implementation of critical care treatment precepts often are delayed. Although different management strategies for life-threatening features of SAP have been debated for decades, there has been little recent reduction in mortality rates, which can be as high as 30%. This article discusses severity designation at the time of diagnosis, reviews the pathophysiologic mechanisms so well characterized by the noxious combination of severe systemic inflammation and hypoperfusion, and provides a management algorithm that parallels current critical care strategies.
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Affiliation(s)
- Sarah E Greer
- Department of Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, NH
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Unnecessary investigations in patients with acute pancreatitis: arterial blood sampling and serum biochemistry. Surgeon 2008; 6:282-7. [PMID: 18939375 DOI: 10.1016/s1479-666x(08)80052-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND Most patients admitted with acute pancreatitis undergo arterial blood gas sampling (ABG) to calculate the modified Glasgow score (MGS) and serum amylase and liver function tests (LFTs) are requested frequently during admission. This study aims to assess the necessity of these investigations. MATERIALS & METHODS A retrospective study of all patients attending a district general hospital with a diagnosis of acute pancreatitis (AP) between November 2005 and November 2006 was performed. Patients were identified from clinical coding data, excluding those with serum amylase levels of < 5501 U/l thereby increasing the likelihood of correct diagnosis. Demographic data and ABC reports were retrieved from the case notes. Criteria were defined for necessity of amylase and LFT requests. RESULTS Data were retrieved for 63 patients with 227 amylase requests, 329 LFT requests, 95 ABGs and 80 MGSs. Eight ABGs were found to have PaO2 values less than 8kPa, a result that could be predicted in all cases by pulse oximeter-derived oxygen saturations of less than 95%. When the MGS excluding the PaO2 parameter was two, only one patient out of 22 (4.5%) was upgraded to a score of three due to a PaO2 of less than 8 kPa and this could have been predicted by pulse oximeter-derived oxygen saturations of 92%. The MGS excluding the PaO2 parameter was always three or more in cases where acid-base disturbance exhibited more than a mild metabolic acidosis. One hundred and sixty-two unnecessary amylase requests and 168 unnecessary LFT requests were made according to our defined criteria, equating to 2.6 unnecessary amylase requests and 2.7 unnecessary LFT requests per admission at a cost of pounds 83.40 (pounds 1.32 per admission). CONCLUSIONS We propose not performing ABGs if the MCS excluding the PaO2 component totals two or less. Clinical judgment would have to be exercised. Unnecessary serum biochemistry requests are frequent but at little financial expense.
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Navarro S, Amador J, Argüello L, Ayuso C, Boadas J, de Las Heras G, Farré A, Fernández-Cruz L, Ginés A, Guarner L, López Serrano A, Llach J, Lluis F, de Madaria E, Martínez J, Mato R, Molero X, Oms L, Pérez-Mateo M, Vaquero E. [Recommendations of the Spanish Biliopancreatic Club for the Treatment of Acute Pancreatitis. Consensus development conference]. GASTROENTEROLOGIA Y HEPATOLOGIA 2008; 31:366-87. [PMID: 18570814 DOI: 10.1157/13123605] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- Salvador Navarro
- Servicio de Gastroenterología, Institut de Malalties Digestives i Metabóliques, Hospital Clínic, Barcelona, Spain.
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Is early endoscopic retrograde cholangiopancreatography useful in the management of acute biliary pancreatitis? A meta-analysis of randomized controlled trials. Dig Liver Dis 2008; 40:379-85. [PMID: 18243826 DOI: 10.1016/j.dld.2007.12.001] [Citation(s) in RCA: 60] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2007] [Revised: 11/14/2007] [Accepted: 12/03/2007] [Indexed: 02/07/2023]
Abstract
AIMS To compare early endoscopic retrograde cholangiopancreatography with conservative management for the treatment of acute biliary pancreatitis: a meta-analysis of prospective randomized trials. METHOD Pertinent studies were selected from the Medline, Embase, and the Cochrane Library Databases, references from published articles and reviews. Conventional meta-analysis according to DerSimonian and Laird method was used for the pooling of the results. The rate difference (95% CI) and the number needed to treat were used as a measure of the therapeutic effect. RESULTS Five prospective randomized trials including 702 patients were selected. Overall complications and mortality rates were 31% and 6%, respectively. In predicted severe pancreatitis the pooled rate difference for complications in early endoscopic retrograde cholangiopancreatography was 38.5% (95% CI -53% to -23.9%); p < 0.0001; number needed to treat = 3. In predicted mild pancreatitis the pooled rate difference for complications in early endoscopic retrograde cholangiopancreatography was 1.8% (95% CI -5.6% to 9.3%); p = 0.6. No mortality was observed in predicted mild pancreatitis. In predicted severe pancreatitis the pooled rate difference for mortality in the early endoscopic retrograde cholangiopancreatography group was 4.3% (95% CI -16% to 7.5%); p < 0.24. CONCLUSIONS Early endoscopic retrograde cholangiopancreatography reduces pancreatits-related complications in patients with predicted severe pancreatitis although mortality rate is not affected. In predicted mild pancreatitis early endoscopic retrograde cholangiopancreatography has no advantage compared to conservative management.
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Frey C, Zhou H, Harvey D, White RH. Co-morbidity is a strong predictor of early death and multi-organ system failure among patients with acute pancreatitis. J Gastrointest Surg 2007; 11:733-42. [PMID: 17417710 DOI: 10.1007/s11605-007-0164-5] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
A small but significant percentage of patients with acute pancreatitis die within 2 weeks of hospitalization, usually with multiorgan system failure. To determine the effect of chronic medical comorbidities on early death, we conducted a retrospective analysis of all patients who were hospitalized in California with first-time pancreatitis between 1992 and 2002. Among 84,713 patients, 1514 (1.8%) died within 2 weeks. In a risk-adjusted multivariate model, the strongest predictors of early death were age 65 to 75 years (OR = 2.6, 95% CI: 2.2-3.1 versus <55 years), age over 75 years (OR = 5.2, 95% CI: 4.4-6.1), and the presence of either two chronic comorbid conditions (OR = 3.5, CI: 2.7-4.6) or three or more comorbidities (OR = 7.4, 95% CI: 5.7-9.5). Among the 14,280 patients younger than 55 years who had no chronic comorbid conditions, only 14 (0.1%) died in the first 14 days compared to 701 (5.9%) of 24,852 patients 64 years or older who had three or more comorbidities (RR = 29, 95% CI: 17-50). Comorbid conditions associated with early death included recent cancer, heart failure, renal disease, and liver disease. We conclude that advancing age and the number of chronic comorbid conditions are very strong predictors of early death among patients with acute pancreatitis.
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Affiliation(s)
- Charles Frey
- Department of Surgery, University of California-Davis, Davis, CA, USA
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Affiliation(s)
- Chris E Forsmark
- Division of Gastroenterology, Hepatology, and Nutrition, University of Florida, Gainesville, Florida, USA
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Abstract
To date, CRP remains the single standard biochemical marker for predicting the severity of AP. Because the combination of clinico-physiological scores and CRP provides good information at 48 hours, research has focused on the predictive ability of various markers when applied in the initial 24 hours after admission to the hospital. After detailed review of the literature, the authors conclude that there is no single tool that serves as the optimal predictor of severity. There are, however, data supporting the use of certain tests to improve upon the clinician's early predictive ability on the subsequent course of AP. These include an APACHE II score greater than seven, IL-6 at the time of admission, and urine TAP, urine trypsinogen-2,and serum PMN-elastase at 24 hours (Box 1). These markers will only be able to help the clinician's predictive ability if they can be performed locally and if the results can be available in a timely manner. Future research should focus on markers such as procalcitonin, IL-8, IL-I ra, sTNFR,CAPAP, PLA-2, novel markers, and the combined use of more than one marker. The conventional research approach in predicting severity used in the last15 years has limitations and appears to have reached its maximal potential. Novel conceptions and approaches, such as identification of genetic polymorphisms that predispose to severe course and complications of AP, are needed for a quantum step forward.
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Affiliation(s)
- Georgios I Papachristou
- Division of Gastroenterology, Hepatology and Nutrition, Department of Medicine, University of Pittsburgh, 200 Lothrop Street, Pittsburgh, PA 15213, USA
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Papachristou GI, Whitcomb DC. Predictors of severity and necrosis in acute pancreatitis. Gastroenterol Clin North Am 2004; 33:871-90. [PMID: 15528023 DOI: 10.1016/j.gtc.2004.07.004] [Citation(s) in RCA: 53] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/21/2023]
Abstract
C-reactive protein remains the single standard biochemical marker for predicting the severity of AP. Because the combination of clinical-physiological scores and CRP provide good information at 48 hours, research has focused on the predictive ability of various markers when applied in the initial 24 hours after admission to the hospital. After detailed review of the literature, the authors conclude that there is no single tool that serves as the optimal predictor of severity. There are, however, data that support the use of certain tests to improve upon the clinician's early predictive ability on the subsequent course of AP. These include an APACHE II score greater than 7 and IL-6 at the time of admission, and urine TAP, urine trypsinogen-2, and serum PMN elastase at 24 hours (Table 4). These markers only will be able to help the clinician's predictive ability if they can be performed locally and if the results can be available ina timely manner. Future research should focus on promising markers such as procalcitonin, IL-8, IL-I ra, sTNFR, CAPAP, PLA-2, novel markers, and the combined use of more than one marker. The conventional research approach in predicting severity used in the last 15 years has limitations and appears to have reached its maximal potential. Novel conceptions and approaches, such as identification of genetic polymorphisms that predispose to severe course and complications of AP or other approaches are needed for a quantum step forward.
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Affiliation(s)
- Georgios I Papachristou
- Division of Gastroenterology, Hepatology and Nutrition, Department of Medicine, University of Pittsburgh, 200 Lothrop Street, Pittsburgh, PA 15213, USA
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Koller EA, Cross JT, Doraiswamy PM, Malozowski SN. Pancreatitis associated with atypical antipsychotics: from the Food and Drug Administration's MedWatch surveillance system and published reports. Pharmacotherapy 2004; 23:1123-30. [PMID: 14524644 DOI: 10.1592/phco.23.10.1123.32759] [Citation(s) in RCA: 72] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
STUDY OBJECTIVE To investigate the relative numbers and clinical characteristics of pancreatitis in patients treated with the atypical antipsychotic agents, clozapine, olanzapine, and risperidone, versus the conventional neuroleptic, haloperidol. DESIGN Pharmacovigilance study of pooled, spontaneously reported adverse events. SETTING Government-affiliated drug evaluation center. PATIENTS One hundred ninety-two patients who developed pancreatitis during treatment with one or more antipsychotic agents. INTERVENTION Patients were identified with the Food and Drug Administration's MedWatch surveillance program and a MEDLINE search. MEASUREMENTS AND MAIN RESULTS Most cases of pancreatitis occurred within 6 months after the start of therapy with one or more antipsychotic agents. Of the reports of pancreatitis occurring in conjunction with these drugs, 40%, 33%, 16%, and 12% were in patients receiving treatment with clozapine, olanzapine, risperidone, and haloperidol, respectively. In 50% of the patients receiving haloperidol, an atypical antipsychotic was listed as a concomitant drug. Valproate was administered concomitantly in 23% of patients. Hyperglycemia and acidosis, although uncommon, developed with all the drugs except haloperidol. Twenty-two patients died. In contrast to patients who developed pancreatitis while receiving an atypical antipsychotic, those who developed the disease while receiving haloperidol were women and tended to be older. CONCLUSION The number of reports involving the three atypical antipsychotic agents and the relative paucity of reports involving haloperidol, despite its more extensive patient exposure, suggest that atypical antipsychotics may precipitate pancreatitis. However, the risk may not be the same with all agents; pancreatitis was reported most frequently with clozapine, followed by olanzapine, and then risperidone. The temporal relationship of the onset of pancreatitis with the start of drug therapy further supports a cause-and-effect relationship.
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Affiliation(s)
- Elizabeth A Koller
- Division of Metabolic and Endocrine Drug Products, Center for Drug Evaluation and Review, Food and Drug Administration, Rockville, Maryland, USA
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