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Zhang B, Xiao Q, Ma Q, Han L. Clinical treatment for persistent inflammation, immunosuppression and catabolism syndrome in patients with severe acute pancreatitis (Review). Exp Ther Med 2023; 26:495. [PMID: 37753297 PMCID: PMC10519614 DOI: 10.3892/etm.2023.12194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Accepted: 07/28/2023] [Indexed: 09/28/2023] Open
Abstract
Severe acute pancreatitis (SAP) is a severe disease with a high prevalence and a 3-15% mortality worldwide, and premature activation of zymogen for any reason is the initial factor for the onset of SAP. Gallstone disease and heavy alcohol consumption are the two most common etiologies of SAP. Persistent inflammation, immunosuppression and catabolism syndrome (PICS) is a life-threatening illness, and there are no effective treatments. The relapse state of PICS mainly leads to high mortality due to septic shock or severe trauma, both of which are dangerous and challenging conditions for clinicians. Thus, it is important for medical staff to identify patients at high risk of PICS and to master the prevention and treatment of PICS in patients with SAP. The present review aims to increase the understanding of the pathogenesis of PICS, produce evidence for PICS diagnosis and highlight clinical treatment for PICS in patients with SAP. With this information, clinical workers could implement standardized and integrated measures at an early stage of SAP to stop its progression to PICS.
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Affiliation(s)
- Bo Zhang
- Department of Hepatobiliary Surgery, The First Affiliated Hospital, Xi'an Jiaotong University, Xi'an, Shaanxi 710061, P.R. China
| | - Qigui Xiao
- Department of Hepatobiliary Surgery, The First Affiliated Hospital, Xi'an Jiaotong University, Xi'an, Shaanxi 710061, P.R. China
| | - Qingyong Ma
- Department of Hepatobiliary Surgery, The First Affiliated Hospital, Xi'an Jiaotong University, Xi'an, Shaanxi 710061, P.R. China
| | - Liang Han
- Department of Hepatobiliary Surgery, The First Affiliated Hospital, Xi'an Jiaotong University, Xi'an, Shaanxi 710061, P.R. China
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2
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Crosignani A, Spina S, Marrazzo F, Cimbanassi S, Malbrain MLNG, Van Regenemortel N, Fumagalli R, Langer T. Intravenous fluid therapy in patients with severe acute pancreatitis admitted to the intensive care unit: a narrative review. Ann Intensive Care 2022; 12:98. [PMID: 36251136 PMCID: PMC9576837 DOI: 10.1186/s13613-022-01072-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Accepted: 10/11/2022] [Indexed: 11/26/2022] Open
Abstract
Patients with acute pancreatitis (AP) often require ICU admission, especially when signs of multiorgan failure are present, a condition that defines AP as severe. This disease is characterized by a massive pancreatic release of pro-inflammatory cytokines that causes a systemic inflammatory response syndrome and a profound intravascular fluid loss. This leads to a mixed hypovolemic and distributive shock and ultimately to multiorgan failure. Aggressive fluid resuscitation is traditionally considered the mainstay treatment of AP. In fact, all available guidelines underline the importance of fluid therapy, particularly in the first 24–48 h after disease onset. However, there is currently no consensus neither about the type, nor about the optimal fluid rate, total volume, or goal of fluid administration. In general, a starting fluid rate of 5–10 ml/kg/h of Ringer’s lactate solution for the first 24 h has been recommended. Fluid administration should be aggressive in the first hours, and continued only for the appropriate time frame, being usually discontinued, or significantly reduced after the first 24–48 h after admission. Close clinical and hemodynamic monitoring along with the definition of clear resuscitation goals are fundamental. Generally accepted targets are urinary output, reversal of tachycardia and hypotension, and improvement of laboratory markers. However, the usefulness of different endpoints to guide fluid therapy is highly debated. The importance of close monitoring of fluid infusion and balance is acknowledged by most available guidelines to avoid the deleterious effect of fluid overload. Fluid therapy should be carefully tailored in patients with severe AP, as for other conditions frequently managed in the ICU requiring large fluid amounts, such as septic shock and burn injury. A combination of both noninvasive clinical and invasive hemodynamic parameters, and laboratory markers should guide clinicians in the early phase of severe AP to meet organ perfusion requirements with the proper administration of fluids while avoiding fluid overload. In this narrative review the most recent evidence about fluid therapy in severe AP is discussed and an operative algorithm for fluid administration based on an individualized approach is proposed.
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Affiliation(s)
- Andrea Crosignani
- School of Medicine and Surgery, University of Milan-Bicocca, Milan, Italy.,Department of Anaesthesia and Critical Care, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Stefano Spina
- School of Medicine and Surgery, University of Milan-Bicocca, Milan, Italy.,Department of Anaesthesia and Critical Care, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Francesco Marrazzo
- School of Medicine and Surgery, University of Milan-Bicocca, Milan, Italy.,Department of Anaesthesia and Critical Care, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Stefania Cimbanassi
- General Surgery and Trauma Team, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy.,Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - Manu L N G Malbrain
- First Department of Anaesthesia and Intensive Therapy, Medical University of Lublin, Lublin, Poland.,International Fluid Academy, Lovenjoel, Belgium
| | - Niels Van Regenemortel
- Department of Intensive Care Medicine, Antwerp University Hospital, Antwerp, Belgium.,Department of Intensive Care Medicine, Ziekenhuis Netwerk Antwerpen Campus Stuivenberg, Antwerp, Belgium
| | - Roberto Fumagalli
- School of Medicine and Surgery, University of Milan-Bicocca, Milan, Italy.,Department of Anaesthesia and Critical Care, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Thomas Langer
- School of Medicine and Surgery, University of Milan-Bicocca, Milan, Italy. .,Department of Anaesthesia and Critical Care, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy.
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3
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Hong W, Lu Y, Zhou X, Jin S, Pan J, Lin Q, Yang S, Basharat Z, Zippi M, Goyal H. Usefulness of Random Forest Algorithm in Predicting Severe Acute Pancreatitis. Front Cell Infect Microbiol 2022; 12:893294. [PMID: 35755843 PMCID: PMC9226542 DOI: 10.3389/fcimb.2022.893294] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Accepted: 04/29/2022] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND AND AIMS This study aimed to develop an interpretable random forest model for predicting severe acute pancreatitis (SAP). METHODS Clinical and laboratory data of 648 patients with acute pancreatitis were retrospectively reviewed and randomly assigned to the training set and test set in a 3:1 ratio. Univariate analysis was used to select candidate predictors for the SAP. Random forest (RF) and logistic regression (LR) models were developed on the training sample. The prediction models were then applied to the test sample. The performance of the risk models was measured by calculating the area under the receiver operating characteristic (ROC) curves (AUC) and area under precision recall curve. We provide visualized interpretation by using local interpretable model-agnostic explanations (LIME). RESULTS The LR model was developed to predict SAP as the following function: -1.10-0.13×albumin (g/L) + 0.016 × serum creatinine (μmol/L) + 0.14 × glucose (mmol/L) + 1.63 × pleural effusion (0/1)(No/Yes). The coefficients of this formula were utilized to build a nomogram. The RF model consists of 16 variables identified by univariate analysis. It was developed and validated by a tenfold cross-validation on the training sample. Variables importance analysis suggested that blood urea nitrogen, serum creatinine, albumin, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, calcium, and glucose were the most important seven predictors of SAP. The AUCs of RF model in tenfold cross-validation of the training set and the test set was 0.89 and 0.96, respectively. Both the area under precision recall curve and the diagnostic accuracy of the RF model were higher than that of both the LR model and the BISAP score. LIME plots were used to explain individualized prediction of the RF model. CONCLUSIONS An interpretable RF model exhibited the highest discriminatory performance in predicting SAP. Interpretation with LIME plots could be useful for individualized prediction in a clinical setting. A nomogram consisting of albumin, serum creatinine, glucose, and pleural effusion was useful for prediction of SAP.
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Affiliation(s)
- Wandong Hong
- Department of Gastroenterology and Hepatology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
- *Correspondence: Wandong Hong,
| | - Yajing Lu
- Department of Gastroenterology and Hepatology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Xiaoying Zhou
- School of the First Clinical Medical Sciences, Wenzhou Medical University, Wenzhou, China
| | - Shengchun Jin
- School of the First Clinical Medical Sciences, Wenzhou Medical University, Wenzhou, China
| | - Jingyi Pan
- School of the First Clinical Medical Sciences, Wenzhou Medical University, Wenzhou, China
| | - Qingyi Lin
- School of the First Clinical Medical Sciences, Wenzhou Medical University, Wenzhou, China
| | - Shaopeng Yang
- School of the First Clinical Medical Sciences, Wenzhou Medical University, Wenzhou, China
| | - Zarrin Basharat
- Jamil-ur-Rahman Center for Genome Research, Dr. Panjwani Centre for Molecular Medicine and Drug Research, International Center for Chemical and Biological Sciences, University of Karachi, Karachi, Pakistan
| | - Maddalena Zippi
- Unit of Gastroenterology and Digestive Endoscopy, Sandro Pertini Hospital, Rome, Italy
| | - Hemant Goyal
- Department of Medicine, The Wright Center for Graduate Medical Education, Scranton, PA, United States
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4
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The impact of fluid resuscitation via colon on patients with severe acute pancreatitis. Sci Rep 2021; 11:12488. [PMID: 34127776 PMCID: PMC8203607 DOI: 10.1038/s41598-021-92065-7] [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: 03/24/2021] [Accepted: 06/04/2021] [Indexed: 11/09/2022] Open
Abstract
Severe acute pancreatitis (SAP) is a life-threatening disease. Fluid Resuscitation Via Colon (FRVC) may be a complementary therapy for early controlled fluid resuscitation. But its clinical application has not been reported. This study aims to explore the impact of FRVC on SAP. All SAP patients with the first onset within 72 h admitted to the hospital were included from January 2014 to December 2018 through electronic databases of Ruijin hospital and were divided into FRVC group (n = 103) and non-FRVC group (n = 78). The clinical differences before and after the therapy between the two groups were analyzed. Of the 181 patients included in the analysis, the FRVC group received more fluid volume and reached the endpoint of blood volume expansion ahead of the non-FRVC group. After the early fluid resuscitation, the inflammation indicators in the FRVC group were lower. The rate of mechanical ventilation and the incidence of hypernatremia also decreased significantly. Using pure water for FRVC was more helpful to reduce hypernatremia. However, Kaplan–Meier 90-day survival between the two groups showed no difference. These results suggest that the combination of FRVC might benefit SAP patients in the early stage of fluid resuscitation, but there is no difference between the prognosis of SAP patients and that of conventional fluid resuscitation. Further prospective study is needed to evaluate the effect of FRVC on SAP patients.
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5
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Humaloja J, Skrifvars MB, Raj R, Wilkman E, Pekkarinen PT, Bendel S, Reinikainen M, Litonius E. The Association Between Arterial Oxygen Level and Outcome in Neurocritically Ill Patients is not Affected by Blood Pressure. Neurocrit Care 2021; 34:413-422. [PMID: 33403587 PMCID: PMC8128839 DOI: 10.1007/s12028-020-01178-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Accepted: 12/04/2020] [Indexed: 11/27/2022]
Abstract
Background In neurocritically ill patients, one early mechanism behind secondary brain injury is low systemic blood pressure resulting in inadequate cerebral perfusion and consequent hypoxia. Intuitively, higher partial pressures of arterial oxygen (PaO2) could be protective in case of inadequate cerebral circulation related to hemodynamic instability. Study purpose We examined whether the association between PaO2 and mortality is different in patients with low compared to normal and high mean arterial pressure (MAP) in patients after various types of brain injury. Methods We screened the Finnish Intensive Care Consortium database for mechanically ventilated adult (≥ 18) brain injury patients treated in several tertiary intensive care units (ICUs) between 2003 and 2013. Admission diagnoses included traumatic brain injury, cardiac arrest, subarachnoid and intracranial hemorrhage, and acute ischemic stroke. The primary exposures of interest were PaO2 (recorded in connection with the lowest measured PaO2/fraction of inspired oxygen ratio) and the lowest MAP, recorded during the first 24 h in the ICU. PaO2 was grouped as follows: hypoxemia (< 8.2 kPa, the lowest 10th percentile), normoxemia (8.2–18.3 kPa), and hyperoxemia (> 18.3 kPa, the highest 10th percentile), and MAP was divided into equally sized tertiles (< 60, 60–68, and > 68 mmHg). The primary outcome was 1-year mortality. We tested the association between hyperoxemia, MAP, and mortality with a multivariable logistic regression model, including the PaO2, MAP, and interaction of PaO2*MAP, adjusting for age, admission diagnosis, premorbid physical performance, vasoactive use, intracranial pressure monitoring use, and disease severity. The relationship between predicted 1-year mortality and PaO2 was visualized with locally weighted scatterplot smoothing curves (Loess) for different MAP levels. Results From a total of 8290 patients, 3912 (47%) were dead at 1 year. PaO2 was not an independent predictor of mortality: the odds ratio (OR) for hyperoxemia was 1.16 (95% CI 0.85–1.59) and for hypoxemia 1.24 (95% CI 0.96–1.61) compared to normoxemia. Higher MAP predicted lower mortality: OR for MAP 60–68 mmHg was 0.73 (95% CI 0.64–0.84) and for MAP > 68 mmHg 0.80 (95% CI 0.69–0.92) compared to MAP < 60 mmHg. The interaction term PaO2*MAP was nonsignificant. In Loess visualization, the relationship between PaO2 and predicted mortality appeared similar in all MAP tertiles. Conclusions During the first 24 h of ICU treatment in mechanically ventilated brain injured patients, the association between PaO2 and mortality was not different in patients with low compared to normal MAP. Supplementary Information The online version of this article (10.1007/s12028-020-01178-w) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Jaana Humaloja
- Department of Emergency Care and Services, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Markus B Skrifvars
- Department of Emergency Care and Services, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
| | - Rahul Raj
- Department of Neurosurgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Erika Wilkman
- Division of Intensive Care Medicine, Department of Anesthesiology, Intensive Care and Pain Medicine, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Pirkka T Pekkarinen
- Division of Intensive Care Medicine, Department of Anesthesiology, Intensive Care and Pain Medicine, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Stepani Bendel
- Department of Anesthesiology and Intensive Care, Kuopio University Hospital & University of Eastern Finland, Kuopio, Finland
| | - Matti Reinikainen
- Department of Anesthesiology and Intensive Care, Kuopio University Hospital & University of Eastern Finland, Kuopio, Finland
| | - Erik Litonius
- Division of Anesthesiology, Department of Anesthesiology, Intensive Care and Pain Medicine, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
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6
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Zhao Z, Yu Y, Xie R, Yang K, Xu D, Li L, Lin J, Zheng L, Zhang C, Xu X, Chen Y, Xu Z, Chen E, Luo M, Fei J. Prognostic value of the creatinine-albumin ratio in acute pancreatitis debridement. BMC Surg 2020; 20:322. [PMID: 33298030 PMCID: PMC7727165 DOI: 10.1186/s12893-020-00991-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Accepted: 11/29/2020] [Indexed: 12/20/2022] Open
Abstract
Background Increases in the levels of serum C-reactive protein (CRP) and creatinine (Cr) and decreases in those of albumin (Alb) are commonly observed in acute pancreatitis (AP). We aimed to evaluate the efficacy of the Cr/Alb and CRP/Alb ratios in the prediction of surgical treatment effect in AP patients. Methods This study retrospectively analyzed clinical data obtained from 140 AP patients who underwent debridement from January 2008 to November 2018 in Shanghai Ruijin Hospital. The Cr/Alb and CRP/Alb ratios at admission and before surgery were assessed in the analysis of clinical statistics, prediction of prognoses, and logistic regression analysis. Results The admission Cr/Alb had the best predictive value of the four ratios. This value was significantly higher in patients with re-operation and those who died (P < 0.05) and was correlated with the Acute Physiology and Chronic Health Evaluation (APACHE II) score, admission CRP/Alb, preoperative Cr/Alb, and post-operative complications. The admission Cr/Alb could predict the risk of AP-related re-operation and mortality with sensitivities, specificities and areas under the curve of 86.3%, 61.7% and 0.824, and 73.4%, 81.3% and 0.794, respectively. At a cut-off value of 3.43, admission Cr/Alb values were indicative of a worse clinical state, including impaired laboratory test values, APACHE II scores, rates of post-operative complications and re-operation, and mortality (P < 0.05). In the logistic regression analysis, admission Cr/Alb values were independently related to the APACHE II score, post-operative renal failure, and mortality. Conclusion Cr/Alb is a novel but promising, easy-to-measure, reproducible, non-invasive prognostic score for the prediction of the effect of debridement in AP patients.
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Affiliation(s)
- Zhifeng Zhao
- Department of General Surgery, Shanghai Ninth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, No.639, Zhizaoju Road, Huangpu District, Shanghai, People's Republic of China.,Pancreatic Treatment Center, Ruijin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, No. 197, Ruijin No.2 Road, Huangpu District, Shanghai, People's Republic of China
| | - Yeping Yu
- School of Clinical Medicine, Ruijin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, People's Republic of China.,Pancreatic Treatment Center, Ruijin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, No. 197, Ruijin No.2 Road, Huangpu District, Shanghai, People's Republic of China
| | - Rongli Xie
- Luwan Branch, Ruijin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, People's Republic of China.,Pancreatic Treatment Center, Ruijin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, No. 197, Ruijin No.2 Road, Huangpu District, Shanghai, People's Republic of China
| | - Kaige Yang
- Pancreatic Treatment Center, Ruijin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, No. 197, Ruijin No.2 Road, Huangpu District, Shanghai, People's Republic of China
| | - Dan Xu
- Pancreatic Treatment Center, Ruijin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, No. 197, Ruijin No.2 Road, Huangpu District, Shanghai, People's Republic of China
| | - Li Li
- Luwan Branch, Ruijin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, People's Republic of China.,Pancreatic Treatment Center, Ruijin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, No. 197, Ruijin No.2 Road, Huangpu District, Shanghai, People's Republic of China
| | - Jiayun Lin
- Department of General Surgery, Shanghai Ninth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, No.639, Zhizaoju Road, Huangpu District, Shanghai, People's Republic of China.,Pancreatic Treatment Center, Ruijin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, No. 197, Ruijin No.2 Road, Huangpu District, Shanghai, People's Republic of China
| | - Lei Zheng
- Department of General Surgery, Shanghai Ninth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, No.639, Zhizaoju Road, Huangpu District, Shanghai, People's Republic of China.,Pancreatic Treatment Center, Ruijin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, No. 197, Ruijin No.2 Road, Huangpu District, Shanghai, People's Republic of China
| | - Chihao Zhang
- Department of General Surgery, Shanghai Ninth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, No.639, Zhizaoju Road, Huangpu District, Shanghai, People's Republic of China.,Pancreatic Treatment Center, Ruijin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, No. 197, Ruijin No.2 Road, Huangpu District, Shanghai, People's Republic of China
| | - Xin Xu
- Department of General Surgery, Shanghai Ninth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, No.639, Zhizaoju Road, Huangpu District, Shanghai, People's Republic of China.,Pancreatic Treatment Center, Ruijin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, No. 197, Ruijin No.2 Road, Huangpu District, Shanghai, People's Republic of China
| | - Ying Chen
- Pancreatic Treatment Center, Ruijin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, No. 197, Ruijin No.2 Road, Huangpu District, Shanghai, People's Republic of China. .,Department of Emergency, Ruijin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, No. 197, Ruijin No.2 Road, Huangpu District, Shanghai, People's Republic of China.
| | - Zhiwei Xu
- Pancreatic Treatment Center, Ruijin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, No. 197, Ruijin No.2 Road, Huangpu District, Shanghai, People's Republic of China
| | - Erchen Chen
- Pancreatic Treatment Center, Ruijin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, No. 197, Ruijin No.2 Road, Huangpu District, Shanghai, People's Republic of China.,Department of Emergency, Ruijin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, No. 197, Ruijin No.2 Road, Huangpu District, Shanghai, People's Republic of China
| | - Meng Luo
- Department of General Surgery, Shanghai Ninth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, No.639, Zhizaoju Road, Huangpu District, Shanghai, People's Republic of China. .,Pancreatic Treatment Center, Ruijin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, No. 197, Ruijin No.2 Road, Huangpu District, Shanghai, People's Republic of China.
| | - Jian Fei
- Pancreatic Treatment Center, Ruijin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, No. 197, Ruijin No.2 Road, Huangpu District, Shanghai, People's Republic of China.
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7
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Hong W, Lin S, Zippi M, Geng W, Stock S, Zimmer V, Xu C, Zhou M. High-Density Lipoprotein Cholesterol, Blood Urea Nitrogen, and Serum Creatinine Can Predict Severe Acute Pancreatitis. BIOMED RESEARCH INTERNATIONAL 2017; 2017:1648385. [PMID: 28904946 PMCID: PMC5585681 DOI: 10.1155/2017/1648385] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/26/2017] [Revised: 07/02/2017] [Accepted: 07/24/2017] [Indexed: 02/07/2023]
Abstract
BACKGROUND AND AIMS Early prediction of disease severity of acute pancreatitis (AP) would be helpful for triaging patients to the appropriate level of care and intervention. The aim of the study was to develop a model able to predict Severe Acute Pancreatitis (SAP). METHODS A total of 647 patients with AP were enrolled. The demographic data, hematocrit, High-Density Lipoprotein Cholesterol (HDL-C) determinant at time of admission, Blood Urea Nitrogen (BUN), and serum creatinine (Scr) determinant at time of admission and 24 hrs after hospitalization were collected and analyzed statistically. RESULTS Multivariate logistic regression indicated that HDL-C at admission and BUN and Scr at 24 hours (hrs) were independently associated with SAP. A logistic regression function (LR model) was developed to predict SAP as follows: -2.25-0.06 HDL-C (mg/dl) at admission + 0.06 BUN (mg/dl) at 24 hours + 0.66 Scr (mg/dl) at 24 hours. The optimism-corrected c-index for LR model was 0.832 after bootstrap validation. The area under the receiver operating characteristic curve for LR model for the prediction of SAP was 0.84. CONCLUSIONS The LR model consists of HDL-C at admission and BUN and Scr at 24 hours, representing an additional tool to stratify patients at risk of SAP.
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Affiliation(s)
- Wandong Hong
- 1Department of Gastroenterology, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
- 2Department of Gastroenterology and Hepatology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Suhan Lin
- 2Department of Gastroenterology and Hepatology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Maddalena Zippi
- 3Unit of Gastroenterology and Digestive Endoscopy, Sandro Pertini Hospital, Rome, Italy
| | - Wujun Geng
- 4Department of Anesthesiology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Simon Stock
- 5Department of Surgery, World Mate Emergency Hospital, Battambang, Cambodia
| | - Vincent Zimmer
- 6Department of Medicine II, Saarland University Medical Center, Kirrberger Str., 66421 Homburg, Germany
- 7Department of Medicine, Marienhausklinik St. Josef Kohlhof, Neunkirchen, Germany
| | - Chunfang Xu
- 1Department of Gastroenterology, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
- *Chunfang Xu: and
| | - Mengtao Zhou
- 8Department of Surgery, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
- *Mengtao Zhou:
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8
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Fernandes SR, Carvalho J, Santos P, Moura CM, Antunes T, Velosa J. Atlanta, revised Atlanta, and Determinant-based classification--application in a cohort of Portuguese patients with acute pancreatitis. Eur J Gastroenterol Hepatol 2016; 28:20-4. [PMID: 26545083 DOI: 10.1097/meg.0000000000000514] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
BACKGROUND Acute pancreatitis (AP) represents a complex and potentially fatal disease with a highly variable clinical course. Three classification systems for assessing the severity in AP have been validated for clinical use. AIMS The aim of the present study was to evaluate the performance of the Atlanta and Determinant-based classifications in predicting severe clinical outcomes in patients with AP. METHODS In this retrospective study we reviewed the treatment and follow-up records of 525 patients with AP admitted to our unit between the years of 2003 and 2014. Outcomes included mortality, admission to the ICU, need for interventional procedures or nutritional support, and duration of hospital and ICU stay. RESULTS The prevalence of organ failure and persistent organ failure in our cohort was 23.0 and 10.7%, respectively, and the mortality rate was 5.9%. Higher grades of severity were associated with worse outcomes in all classification systems. The revised Atlanta and Determinant-based classifications performed similarly in predicting outcomes, and both proved to be superior to the former classic Atlanta classification. CONCLUSION Recent classifications proved to be more accurate in predicting important clinical outcomes in patients with AP.
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Affiliation(s)
- Samuel R Fernandes
- Department of Gastroenterology and Hepatology, Centro Hospitalar Lisboa Norte, Lisbon, Portugal
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9
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Beneficial effects of fluid resuscitation via the rectum on hemodynamic disorders and multiple organ injuries in an experimental severe acute pancreatitis model. Pancreatology 2015; 15:626-34. [PMID: 26424226 DOI: 10.1016/j.pan.2015.09.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2015] [Revised: 08/21/2015] [Accepted: 09/07/2015] [Indexed: 12/11/2022]
Abstract
OBJECTIVES Exaggerated hydration is harmful for patients with severe acute pancreatitis (SAP), and it can increase mortality rate. In this study, we investigated the role of fluid resuscitation via the rectum (FRVR) on the hemodynamic state and compared FRVR with intravenous fluid resuscitation (IVFR) on resuscitation effect and organ function in an early stage of SAP. METHODS We studied whether FRVR corrects hemodynamic disorders at an early stage of SAP in Spraque-Dawley (SD) rats and whether it mitigates organ dysfunction and whether FRVR is superior to IVFR. RESULTS In both IVFR and FRVR groups, we observed a rebound in the mean arterial pressure (MAP) after 5 h and 6 h of administration (p < 0.05), respectively. MAP of the FRVR group reached the same level as the SHAM group at the end of the treatment, with hematocrit declining compared with the non-fluid resuscitation (NFR) group (p < 0.05). A concomitant increase in abdominal ascites and the lung wet/dry ratio by IVFR was depressed in the FRVR group (p < 0.05). Liver function was ameliorated in both fluid resuscitation groups (p < 0.05), consistent with histopathological improvement. TNF-α in serum and MPO in the lungs and jejunum of the FRVR group were lower than the IVFR group (p < 0.05). Pancreas histopathological injuries were ameliorated by both IVFR and FRVR (p < 0.05). CONCLUSIONS Our findings suggested FRVR is a potential supplementary method for fluid management in an early stage of SAP and FRVR should be studied further.
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Hua R. Effects of programed emergency care in patients with severe acute pancreatitis. Shijie Huaren Xiaohua Zazhi 2015; 23:1656-1659. [DOI: 10.11569/wcjd.v23.i10.1656] [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] [Indexed: 02/06/2023] Open
Abstract
AIM: To evaluate the effects of programed emergency care in patients with severe acute pancreatitis.
METHODS: Fifty-eight patients with severe acute pancreatitis treated from January 2013 to December 2013 at our hospital were included in an observation group to implement programed emergency care, and 55 patients with severe acute pancreatitis treated from January 2012 to December 2012 at our hospital were included in a control group to receive routine emergency care. The length of hospital stay after intervention, satisfaction to nursing care, Karnofsky performance status (KPS) and Spitzer quality of life score were compared for the two groups.
RESULTS: In the observation group, 39 (67.2%) cases were very satisfied, 18 (31.0%) satisfied, and 1 (1.7%) not satisfied with the nursing care. The corresponding figures in the control group were 23 (41.8%), 25 (45.5%), and 7 (12.7%), respectively. There were significant differences between the two groups (P < 0.05). The length of hospital stay was significantly shorter in the observation group than in the control group (15.4 d ± 2.2 d vs 21.4 d ± 4.6 d, P < 0.01). KPS score was significantly higher in the observation group (76.9 ± 14.3 vs 61.4 ± 10.2, P < 0.01), and the scores of all dimensions of the quality of life scale were significantly higher in the observation group (P < 0.01).
CONCLUSION: Implementation of programed emergency nursing care in patients with severe acute pancreatitis can significantly reduce hospital stay and improve patient's satisfaction to nursing work, patient's health status, and quality of life.
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