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Does obesity confer an increased risk and/or more severe course of post-ERCP pancreatitis?: a retrospective, multicenter study. J Clin Gastroenterol 2008; 42:1103-9. [PMID: 18936645 DOI: 10.1097/mcg.0b013e318159cbd1] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Pancreatitis is the most common major complication of endoscopic retrograde cholangiopancreatography (ERCP). Recent studies have suggested that obesity may serve as a prognostic indicator of poor outcome in non-ERCP-induced acute pancreatitis. However, to our knowledge, no one has ever investigated the potential association of obesity and ERCP-induced pancreatitis. Thus, the purpose of our study was to determine whether obesity conferred an increased risk and/or more severe course of post-ERCP pancreatitis. METHODS A 160 variable database was prospectively collected by a defined protocol on patients undergoing diagnostic or therapeutic ERCP at 15 centers in the Midwest Pancreaticobiliary Group and participating in a randomized controlled study, evaluating whether prophylactic corticosteroids reduces the incidence of post-ERCP pancreatitis. Body mass indices (BMIs) were available on 964 of the 1115 patients from the original study. A BMI > or = 30 kg/m2 was defined as obese (World Health Organization) and used as a cutoff point in this study. BMIs were analyzed in a retrospective fashion to determine whether obesity confers an increased risk and/or more severe course of post-ERCP pancreatitis. Data were collected before the ERCP, at the time of procedure, and 24 to 72 hours after discharge. Standardized criteria were used to diagnose and grade the severity of postprocedure pancreatitis. RESULTS Nine hundred sixty four patients were enrolled in the study. Pancreatitis occurred in 149 patients (15.5%) and was graded as mild in 101 (67.8%), moderate in 42 (28.2%), and severe in 6 (4.0%). The patients were categorized by BMI (kg/m2) using the following breakdowns: BMI < 20, 20 to < 25, 25 to < 30, and > or = 30, as well as BMI < 30 or > or = 30. The groups were similar with respect to the patient and procedure risk factors for post-ERCP pancreatitis except the group with BMI > or = 30 had a higher frequency of females, were younger, had less frequent chronic pancreatitis, a lower number of pancreatic duct injections, and fewer patients received more than 2 pancreatic duct injections. Of the patients with a BMI < 30, 119 (16.4%) developed post-ERCP pancreatitis compared with 30 (12.5%) of those with a BMI > or = 30 (P=0.14). There was no association between the presence of obesity and the severity of pancreatitis (P=0.74). Patients with a BMI < 20, 20 to < 25, 25 to < 30, and > or = 30 had a similar incidence of post-ERCP pancreatitis. CONCLUSIONS Obesity did not seem to confer an increased risk for ERCP-induced pancreatitis. A statistically significant association between obesity and the severity of ERCP-induced pancreatitis was not apparent.
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Napier S, Thomas M. 36 year old man presenting with pancreatitis and a history of recent commencement of Orlistat case report. Nutr J 2006; 5:19. [PMID: 16938137 PMCID: PMC1560153 DOI: 10.1186/1475-2891-5-19] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2006] [Accepted: 08/28/2006] [Indexed: 01/28/2023] Open
Abstract
Background Orlistat is an anti-obesity drug licensed in the United Kingdom for 7 years. We present a case of a patient who developed pancreatitis four days after commencing orlistat. Case presentation A 36 year old man presented to hospital with acute severe pancreatitis four days after starting a course of Orlistat, a lipase inhibitor used in the treatment of obesity. A diagnosis of drug related pancreatitis was made by exclusion of other causes of pancreatitis; he was a teetotaller, had a normal serum calcium, had no family history of pancreatitis or hyperlipidaemia, no history of trauma and had no evidence of gallstones on Computerised Tomography scan (CT). Conclusion Orlistat was the only drug that had been started recently and has been associated with pancreatitis previously. We found no case reports of similar cases, however 99 cases of orlistat related pancreatitis have been reported to the Food and Drug Administration (FDA), but no causative link has been found in clinical trials by the drug company. It is therefore not on the list of possible complications or side effects of the drug.
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Affiliation(s)
- Sarah Napier
- Bristol Royal Infirmary, Marlborough Street, Bristol, BS2 8HW, UK
| | - Matthew Thomas
- Bristol Royal Infirmary, Marlborough Street, Bristol, BS2 8HW, UK
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Frossard JL, Morel P, Kwak B, Pastor C, Berney T, Buhler L, Von Laufen A, Demulder S, Mach F. Soluble CD40 ligand in prediction of acute severe pancreatitis. World J Gastroenterol 2006; 12:1613-6. [PMID: 16570356 PMCID: PMC4124296 DOI: 10.3748/wjg.v12.i10.1613] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM: To assess the early predictability of the soluble CD40L (sCD40L) in pancreatitis severity.
METHODS: Between February 2000 and February 2003, 279 consecutive patients with acute pancreatitis were prospectively enrolled in our study. In this report, 40 patients with mild and 40 patients with severe pancreatitis were randomly studied. sCD40L concentrations were measured 48 hours after admission.
RESULTS: sCD40L levels were significantly higher 48 hours after admission in severe pancreatitis than in mild pancreatitis. Using a cutoff of 1 000 pg/L, the sensitivity and specificity of sCD40L to detect a severe course of the disease were 78% and 62% respectively compared to 72% and 81% for CRP. Logistic regression analysis found that CRP was the only statistically significant marker able to detect a severe course of the disease.
CONCLUSION: These findings indicate that CRP remains a valuable marker to determine the severity and prognosis of acute pancreatitis whereas sCD40L levels should be assessed in further studies.
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Affiliation(s)
- Jean Louis Frossard
- Division of Gastroenterology, Geneva University Hospital, 1211 Genève 14, Switzerland.
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Halonen KI, Leppäniemi AK, Lundin JE, Puolakkainen PA, Kemppainen EA, Haapiainen RK. Predicting fatal outcome in the early phase of severe acute pancreatitis by using novel prognostic models. Pancreatology 2004; 3:309-15. [PMID: 12890993 DOI: 10.1159/000071769] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2002] [Accepted: 02/20/2003] [Indexed: 12/11/2022]
Abstract
BACKGROUND/AIMS Survival in acute pancreatitis and particularly in severe acute and necrotizing pancreatitis is a combination of therapy-associated and patient-related factors. There are only few relevant methods for predicting fatal outcome in acute pancreatitis. Scores such as Ranson, Imrie, Blamey, and APACHE II are practical in assessing the severity of the disease, but are not sufficiently validated for predicting fatal outcome among patients with severe acute pancreatitis. The aim of this study was to construct a novel prediction model for predicting fatal outcome in the early phase of severe acute pancreatitis (SAP) and to compare this model with previously reported predictive systems. METHODS Hospital records of 253 patients with SAP were retrospectively analyzed. 234 patients with adequate data were included to the test set to construct five logistic regression and three artificial neural network (ANN) models. Two models were tested in an independent prospective validation set of 60 consecutive patients with SAP and compared with previously reported predictive systems. RESULTS The prediction model considered optimal was a logistic model with four variables: age, highest serum creatinine value within 60-72 h from primary admission, need for mechanical ventilation, and chronic health status. In the validation set, the predictive accuracy, determined by the area under the receiver operating characteristic curve value, was 0.862 for the chosen model, 0.847 for the ANN model using eight variables, 0.817 for APACHE II, 0.781 for multiple organ dysfunction score, 0.655 for Ranson, and 0.536 for Imrie scores. CONCLUSIONS Ranson and Imrie scores are inaccurate indicators of the mortality in SAP. A novel predictive model based on four variables can reach at least the same predictive performance as the APACHE II system with 14 variables.
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Affiliation(s)
- Kimmo I Halonen
- Department of Gastroenterological and General Surgery, Meilahti Hospital, Helsinki University Central Hospital, Helsinki, Finland
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Fernández Castroagudín J, Iglesias Canle J, Domínguez Muñoz J. Estratificación del riesgo: marcadores bioquímicos y escalas pronósticas en la pancreatitis aguda. Med Intensiva 2003. [DOI: 10.1016/s0210-5691(03)79876-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Abstract
An ideal laboratory test in the evaluation of a patient with acute pancreatitis (AP) should, in addition to accurately establishing the diagnosis of AP, provide early assessment of its severity and identify the etiology. None of the tests available today meet all these criteria, and presently there is no biochemical test that can be considered the "gold standard" for the diagnosis and assessment of severity of AP. In the diagnosis of AP, serum amylase and lipase remain important tests. Advantages of amylase estimation are its technical simplicity, easy availability, and high sensitivity. However, its greatest disadvantage is its low specificity. A normal amylase would usually exclude the diagnosis of AP, with the exception of AP secondary to hyperlipidemia, acute exacerbation of chronic pancreatitis, and when the estimation of amylase is delayed in the course of the disease. The major advantage of lipase is an increased sensitivity in acute alcoholic pancreatitis and in patients who initially present to the emergency room days after the onset of the disease, as lipase remains elevated longer than amylase. Although once considered to be specific for AP, nonspecific elevations of lipase have been reported in almost as many disorders as amylase, thus decreasing its specificity. Simultaneous estimation of amylase and lipase does not improve the accuracy. Other enzymes for the diagnosis of AP--pancreatic isoamylase, immunoreactive trypsin, and elastase--are more cumbersome and expensive and have no clear role in the diagnosis of AP. No enzyme assay has a predictive role in determining the severity or etiology of AP. Once the diagnosis of AP is established, daily measurements of enzymes have no value in assessing the clinical progress of the patient or ultimate prognosis and should be discouraged. A host of new serological and urinary markers have been investigated in the last few years. Their main use is in predicting the severity of AP. At present, serum C-reactive protein at 48 h is the best available laboratory marker of severity. Urinary trypsinogen activation peptides within 12-24 h of onset of AP are able to predict the severity but are not widely available. Serum interleukins 6 and 8 seem promising but remain experimental.
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Affiliation(s)
- Dhiraj Yadav
- Department of Surgery, Our Lady of Mercy University Medical Center, New York Medical College, Bronx 10466, USA
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Robert JH, Frossard JL, Mermillod B, Soravia C, Mensi N, Roth M, Rohner A, Hadengue A, Morel P. Early prediction of acute pancreatitis: prospective study comparing computed tomography scans, Ranson, Glascow, Acute Physiology and Chronic Health Evaluation II scores, and various serum markers. World J Surg 2002; 26:612-9. [PMID: 12098056 DOI: 10.1007/s00268-001-0278-y] [Citation(s) in RCA: 68] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
The aim of this study was to assess the predictability of the outcome of acute pancreatitis using the Ranson, Glascow, and Acute Physiology and Chronic Health Evaluation (APACHE) II scores, the computed tomography (CT) scan, and several serum markers. Altogether, 137 consecutive patients with acute pancreatitis confirmed by CT scan were prospectively included. Blood samples were obtained daily for 6 days. The predictive value of each parameter was studied by univariate and multivariate analyses comparing mild and severe pancreatitis. A total of 111 attacks were graded as mild (81%) and 26 as severe (19%). Ranson (p = 0.3) and APACHE II (p = 0.049) scores appeared insufficiently predictive in the univariate analysis. Pancreatic imaging by CT scan was insufficiently predictive (p > 0.05), whereas the presence of extrapancreatic fluid collections was more indicative of outcome (p <0.05). With the univariate analysis, the four most reliable serum markers were pancreatic amylase (p <0.001), neutrophil elastase (p <0.05), albumin (p <0.002), and C-reactive protein (p <0.001). Results became homogeneous when the CT results were added; serum albumin plus extrapancreatic fluid collections (negative predictive value 92%-96% and positive predictive value 67%-100%) comprised the best indicator of severity. None of the parameters tested achieved sufficient predictability when used alone. Serum albumin plus extrapancreatic fluid collections comprise the best indicator of severity at the time of admission.
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Affiliation(s)
- John H Robert
- Department of Digestive Surgery, Geneva University Hospitals, Rue Micheli du Crest, 1211 Geneva 14, Switzerland
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Mantke R, Pross M, Kunz D, Ebert M, Kahl S, Peters B, Malfertheiner P, Lippert H, Schulz HU. Soluble thrombomodulin plasma levels are an early indication of a lethal course in human acute pancreatitis. Surgery 2002; 131:424-32. [PMID: 11935133 DOI: 10.1067/msy.2002.122379] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND The potential to predict severe disease and lethality by using plasma soluble thrombomodulin (sTM) and C-reactive protein (CRP) levels in 73 patients with acute pancreatitis was analyzed in a prospective 5-year investigation performed at a single institution. METHODS According to the Atlanta criteria, pancreatitis was classified as mild in 23 patients and as severe in 50 patients. Blood was collected on days 1, 3, 5, 7, 10, 14, 21, and 28 after the onset of pain and analyzed for sTM and CRP. RESULTS During the period between days 3 and 10 of acute pancreatitis when most of the admissions occurred, sTM levels at a cutoff of 75 ng/mL on day 3 (sensitivity, 100%; specificity, 77%; positive predictive value, 38%; negative predictive value, 100%) and 71 ng/mL on day 10 (sensitivity, 100%; specificity, 77%; positive predictive value, 41%; negative predictive value, 100%) were predictive of a lethal outcome. With sTM levels, it was not possible to differentiate patients with mild pancreatitis from those with severe pancreatitis (Atlanta classification). In contrast, CRP levels at a cutoff of 113 mg/L on day 3 differentiated severe from mild courses with a diagnostic sensitivity of 84%, a specificity of 60%, a positive predictive value of 78%, and a negative predictive value of 69%. CRP levels at a cutoff of 122 mg/L on day 10 differentiated mild from severe courses (nonsurvivors) with a diagnostic sensitivity of 72%, a specificity of 72%, a positive predictive value of 86%, and a negative predictive value of 53%. In contrast, differentiation of mild forms of acute pancreatitis from severe pancreatitis (survivors) on day 10 was not possible. CONCLUSIONS CRP is a valuable marker of disease severity in acute pancreatitis especially in the first period of pancreatitis, whereas sTM identifies early those patients with the most severe courses and a high risk of dying (negative predictive value, 100%). Determination of sTM in addition to CRP offers the opportunity of identifying early those patients who require intensive care most urgently. Of course, further investigations of sTM in acute pancreatitis are indicated to confirm our results.
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Affiliation(s)
- Rene Mantke
- Department of Surgery, Institute for Biometry and Medical Informatics, Otto-von-Guericke-University of Magdeburg, Leipziger Strasse 44, D-39120 Magdeburg, Germany
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de Las Heras Castaño G, Castro Senosiain B. [Prognostic factors for acute pancreatitis]. GASTROENTEROLOGIA Y HEPATOLOGIA 2001; 24:357-64. [PMID: 11481073 DOI: 10.1016/s0210-5705(01)70194-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- G de Las Heras Castaño
- Servicio de Aparato Digestivo, Hospital Universitario Marqués de Valdecilla, Santander, Spain
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Halonen KI, Leppaniemi AK, Puolakkainen PA, Lundin JE, Kemppainen EA, Hietaranta AJ, Haapiainen RK. Severe acute pancreatitis: prognostic factors in 270 consecutive patients. Pancreas 2000; 21:266-71. [PMID: 11039471 DOI: 10.1097/00006676-200010000-00008] [Citation(s) in RCA: 104] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Acute pancreatitis (AP) is a common abdominal disorder with severity varying from mild to fatal disease. Predicting a patient's outcome remains problematic. The aim of this study was to analyze a large consecutive series of patients with severe AP and to identify prognostic factors for hospital mortality. Between 1989 and 1997, a consecutive series of 270 patients with severe AP were included in the study. All patients fulfilled the criteria of Atlanta classification for severe AP. Retrospectively and prospectively collected data included age, gender, etiology, number of previous episodes of pancreatitis, medication history, type of admission, body-mass index (BMI), respiratory failure, renal failure, need for pressor support, and abdominal surgery performed during hospitalization. The overall mortality rate was 24.4%. In univariate survival analysis advanced age, history of continuous medication, patient transferred from other hospital, high BMI, respiratory or renal failure, need for pressor support, and need for abdominal surgery were significant prognostic factors for hospital mortality. In a multivariate stepwise logistic regression analysis, the need of pressor support, renal failure requiring dialysis, advanced age, history of continuous medication and need for abdominal surgery were identified as independent prognostic factors for mortality. A logistic regression analysis of variables available on admission (the first seven above mentioned variables) showed that transferral admission, advanced age, and history of continuous medication were independent prognostic factors for mortality. In patients with severe AP, advanced age, history of continuous medication, and need for dialysis, mechanical ventilator support, and pressor support predict fatal outcome and thus should be taken into account in clinical evaluation.
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Affiliation(s)
- K I Halonen
- Department of Surgery, Helsinki University Central Hospital, Huch, Finland.
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Dervenis C, Johnson CD, Bassi C, Bradley E, Imrie CW, McMahon MJ, Modlin I. Diagnosis, objective assessment of severity, and management of acute pancreatitis. Santorini consensus conference. INTERNATIONAL JOURNAL OF PANCREATOLOGY : OFFICIAL JOURNAL OF THE INTERNATIONAL ASSOCIATION OF PANCREATOLOGY 1999; 25:195-210. [PMID: 10453421 DOI: 10.1007/bf02925968] [Citation(s) in RCA: 187] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
BACKGROUND The diagnosis, early assessment, and management of severe acute pancreatitis remain difficult clinical problems. This article presents the consensus obtained at a meeting convened to consider the evidence in these areas. The aim of the article is to provide outcome statements to guide clinical practice, with an assessment of the supporting evidence for each statement. METHOD Working groups considered the published evidence in the areas of diagnosis, assessment of severity, nonoperative treatment, and surgical treatment of severe acute pancreatitis. Outcome statements were defined to summarize the conclusions on each point considered. The findings were discussed and agreed on by all participants. A careful assessment was made of the strength of the available evidence (proven, probable, possible, unproven, or inappropriate). FINDINGS AND CONCLUSIONS There is reliable evidence to support much current practice. Clear guidance can be given in most areas examined, and several areas were identified where further investigation would be helpful. Diagnosis using plasma concentrations of pancreatic enzymes is reliable. Rapid advances are taking place in the assessment of severity. Several new therapeutic strategies show real promise for the reduction of morbidity and mortality rates. Surgical debridement is required for infected pancreatic necrosis, but is less often necessary for sterile necrosis.
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Affiliation(s)
- C Dervenis
- Konstantopoulion, Agia Olga Hospital, Athens, Greece.
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Talamini G, Uomo G, Pezzilli R, Rabitti PG, Billi P, Bassi C, Cavallini G, Pederzoli P. Serum creatinine and chest radiographs in the early assessment of acute pancreatitis. Am J Surg 1999; 177:7-14. [PMID: 10037300 DOI: 10.1016/s0002-9610(98)00296-7] [Citation(s) in RCA: 58] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
BACKGROUND We previously identified serum creatinine values >2 mg/dL (176.8 micromol/L) and pathological chest radiographs due to the presence of pleural effusions or pulmonary densifications as two early prognostic factors of life-threatening acute pancreatitis (AP). The aim of the present study was to validate their prognostic efficacy in combination. METHODS We analyzed as prognostic factors only the data obtained within 24 hours of admission in 539 cases of AP, including 163 patients (30.2%) with acute necrotizing pancreatitis (NP). Eleven patients (2%) presented with infected pancreatic necrosis, and 20 patients (3.7%) died. RESULTS One hundred and nine cases (20.2%) presented pathological chest radiographs: 32 (5.9%) pulmonary densifications and 77 (14.3%) pleural effusions (18 right, 25 left, 34 bilateral). Fifty-one patients (9.5%) had serum creatinine values >2 mg/dL. Pathological chest radiographs and serum creatinine values >2 mg/dL were significantly associated both with mortality risk (P <0.00001), with a diagnosis of NP (P <0.00001), and with risk of developing infected necrosis (P <0.0001). Considering positivity of either or both tests, the mortality risk sensitivity was 90% (95% confidence interval [CI] 70.7 to 98.3) with a specificity of 76% (CI 72.5 to 79.8), for the NP diagnosis the sensitivity was 60% (CI 52.5 to 67.4) and the specificity 88% (CI 85.0-91.5), whereas for the risk of infected necrosis the sensitivity was 73% (CI 42.2 to 92.6) and specificity 75% (CI 70.1 to 78.4). These data are comparable to those obtained with the Ranson or Glasgow scores at 24 hour in this patient group, with a cut-off > or =3. CONCLUSIONS Serum creatinine and chest radiographs are two indices capable of identifying, within 24 hour of admission, a subgroup of acute pancreatitis patients with a more severe or adverse clinical course.
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Affiliation(s)
- G Talamini
- Gastroenterological Department, University of Verona, Italy
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Suazo-Baráhona J, Carmona-Sánchez R, Robles-Díaz G, Milke-García P, Vargas-Vorácková F, Uscanga-Domínguez L, Peláez-Luna M. Obesity: a risk factor for severe acute biliary and alcoholic pancreatitis. Am J Gastroenterol 1998; 93:1324-8. [PMID: 9707059 DOI: 10.1111/j.1572-0241.1998.442_l.x] [Citation(s) in RCA: 88] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVE In this study we evaluate the association between obesity and complication development in patients with a first-attack acute pancreatitis (AP), and investigate the influence of comorbid factors on this association. METHODS Medical records of 150 patients with AP were reviewed. General data, AP etiology, admission AP prognostic criteria, and occurrence of complications were recorded. Patients were classified according to body mass index (BMI) as obese (BMI > 25 kg/m2) and nonobese (BMI < or = 25 kg/m2). RESULTS Prevalence of obesity was 57%. Thirty-eight percent of the obese patients developed complications as compared with 21% of the nonobese (RR=1.74; 95% CI, 1-2.9). The risk for severe AP increased according to the degree of obesity. Pancreatic and peripancreatic necrosis was more common in obese patients (17.6% vs 6%), as was the incidence of infectious complications. The risk for severe AP was highest in obese patients with either alcoholic (RR=5.3; 95% CI, 1.2-23) or biliary etiology (RR=5.2, 95% CI, 1-26). CONCLUSION Obesity may predispose to a complicated course of AP, especially if it is secondary to alcohol or gallstones. Further studies are needed to establish the precise prognostic value of obesity in AP, as well as the pathogenic mechanisms involved in the process.
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Affiliation(s)
- J Suazo-Baráhona
- Department of Gastroenterology, Instituto Nacional de la Nutrición Salvador Zubirán, México City, México
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Hedström J, Sainio V, Kemppainen E, Haapiainen R, Kivilaakso E, Schröder T, Leinonen J, Stenman UH. Serum complex of trypsin 2 and alpha 1 antitrypsin as diagnostic and prognostic marker of acute pancreatitis: clinical study in consecutive patients. BMJ (CLINICAL RESEARCH ED.) 1996; 313:333-7. [PMID: 8760740 PMCID: PMC2351744 DOI: 10.1136/bmj.313.7053.333] [Citation(s) in RCA: 65] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To estimate the usefulness of serum concentrations of the complex of trypsin 2 and alpha 1 antitrypsin in diagnosing and assessing the severity of acute pancreatitis in comparison with serum C reactive protein, amylase, and trypsinogen 2 concentrations (reference markers). DESIGN Markers were measured in consecutive patients admitted with acute abdominal pain that was either due to pancreatitis or to other disease unrelated to the pancreas (controls). SETTING Department of surgery of a teaching hospital in Helsinki. SUBJECTS 110 patients with acute pancreatitis and 66 with acute abdominal diseases of extrapancreatic origin. On the basis of the clinical course, acute pancreatitis was classified as mild (82 patients) or severe (28 patients). MAIN OUTCOME MEASURES Clinical diagnosis of acute pancreatitis and severity of the disease. RESULTS At admission all patients with acute pancreatitis had clearly raised concentrations of trypsin 2-alpha 1 antitrypsin complex (32 micrograms/l), whereas only three of the controls had such values. Of the markers studied, trypsin 2-alpha 1 antitrypsin complex had the largest area under the receiver operating curve, both in differentiating acute pancreatitis from extrapancreatic disease and in differentiating mild from severe disease. CONCLUSIONS Of the markers studied, trypsin 2-alpha 1 antitrypsin complex was the most accurate in differentiating between acute pancreatitis and extrapancreatic disease and in predicting a severe course for acute pancreatitis.
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Affiliation(s)
- J Hedström
- Department of Clinical Chemistry, Helsinki University Central Hospital, Finland
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Widdison AL, Karanjia ND, Reber HA. Routes of spread of pathogens into the pancreas in a feline model of acute pancreatitis. Gut 1994; 35:1306-10. [PMID: 7959243 PMCID: PMC1375713 DOI: 10.1136/gut.35.9.1306] [Citation(s) in RCA: 73] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
The routes of spread of pathogens into the pancreas in acute pancreatitis were investigated. Four experiments were performed: (1) cats with and without acute pancreatitis were given 10(7) Escherichia coli (E coli) intravenously, (2) in cats with acute pancreatitis 10(8) E coli was placed in the colon. In half of them the colon was then enclosed in an impermeable bag to prevent transmural spread. (3) E coli (10(4)) was placed in the pancreatic duct in cats with and without acute pancreatitis. (4) In cats with acute pancreatitis 10(5) E coli was placed in the gall bladder. In half of them the common bile duct was ligated to prevent biliary-pancreatic reflux. After 24 hours, intravenous E coli infected the pancreas in six of nine cats with acute pancreatitis and three of 10 controls. After 72 hours E coli spread to the pancreas from the colon in six of nine cats with acute pancreatitis. This was prevented by enclosing the colon in an impermeable bag (p = 0.02). In five of six cats with acute pancreatitis and five of six controls E coli placed in the pancreatic duct colonised the pancreas within 24 hours. Pancreatic colonisation from the gall bladder occurred in five of six cats with a patent common bile duct and in three of six with an obstructed common bile duct. In conclusion, in cats E coli can spread to the pancreas by the blood stream, transmurally from the colon, and by reflux into the pancreatic duct.
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Affiliation(s)
- A L Widdison
- Department of Surgery, VA Medical Center, Sepulveda, California
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Salomone T, Guariento A, Lamedica R, Pezzilli R, Billi P, Morselli Labate AM, Romboli M, Sprovieri G, Miglioli M. Quantitative and qualitative evaluation of reticulocytes in acute pancreatitis. Curr Ther Res Clin Exp 1994. [DOI: 10.1016/s0011-393x(05)80529-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
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Abstract
PURPOSE (1) To test the hypothesis that the clinical features of patients with acute pancreatitis could be used to construct a new prognostic staging system, and (2) to compare the new system with the results of the existing Ranson system based on age and laboratory data. PATIENTS AND METHODS We obtained an inception cohort of 162 persons with 176 episodes of acute pancreatitis admitted to Yale-New Haven Hospital from January 1, 1987, to March 31, 1989. RESULTS The main adverse outcome events, death and/or complications, occurred in 22% of episodes. Acute pancreatitis severity was classified in three stages, reflecting the presence of only primary features (no ileus or peritonitis), or the occurrence of secondary features that could be mild (mild ileus) or severe (severe ileus and/or peritonitis). In these 3 stages, the respective rates for outcome events were 13% (17 of 133), 43% (13 of 30), and 62% (8 of 13). The severity of comorbidity was classified according to Charlson's comorbidity index. For the 3 comorbidity stages, the outcome event rates were: minimal: 13% (12 of 92); intermediate: 22% (11 of 49); and severe: 43% (15 of 35). When the acute pancreatitis severity stages and comorbidity stages were conjoined to form the composite staging system, the corresponding outcome event rates were stage I: 8 of 107 (7%); stage II: 24 of 60 (40%); and stage III: 6 of 9 (67%). The composite staging system produced sharper gradients for the outcome events than Ranson's system, and was more readily applicable to all patients, particularly when the requisite special laboratory tests had not been ordered. CONCLUSIONS The clinical and comorbid features of patients with acute pancreatitis can be used to construct a clinically "sensible" composite staging system. The stages are easy to use, require no additional or special laboratory tests, and predict more accurately than Ranson's system.
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Affiliation(s)
- L Rabeneck
- Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut
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19
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Beechey-Newman N. Controlled trial of high-dose octreotide in treatment of acute pancreatitis. Evidence of improvement in disease severity. Dig Dis Sci 1993; 38:644-7. [PMID: 8462363 DOI: 10.1007/bf01316794] [Citation(s) in RCA: 25] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Nineteen consecutive patients with acute pancreatitis were sequentially allocated to treatment with high-dose octreotide (N = 9) or to act as controls (N = 10). All other aspects of treatment were similar and were according to a strict treatment protocol. There was no significant difference between the two groups on admission with regard to recognized criteria of poor prognosis. The octreotide-treated group required significantly less analgesia and after 48 hr developed significantly fewer poor prognostic indicators, including falls in hematocrit of > 10%, in serum albumin to < 32 g/liter, and in serum calcium to < 2.00 mmol/liter. Falls in arterial PO2 to < 10 kPa, in serum albumin of > 20%, and in hemoglobin of > 2 g/dl were also significantly less frequent. There was a trend towards improvement in the octreotide-treated group in every other physiological and radiological indicator of disease severity. High-dose octreotide may reduce the severity of acute pancreatitis.
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Affiliation(s)
- N Beechey-Newman
- Department of Surgery, Wycombe General Hospital, Buckinghamshire, England
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20
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Abstract
Pancreatic infection is the leading cause of death from acute pancreatitis. Patients with severe necrotizing pancreatitis are most at risk. Early computed tomography and percutaneous fine-needle aspiration microbiology of areas of pancreatic necrosis enable early diagnosis. Pancreatic infection should be treated surgically, although sterile necrosis may be managed conservatively. The role of antimicrobial drugs is uncertain.
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Affiliation(s)
- A L Widdison
- Department of Surgery, Frenchay Hospital, Bristol, UK
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21
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Fan ST, Lai EC, Mok FP, Lo CM, Zheng SS, Wong J. Early treatment of acute biliary pancreatitis by endoscopic papillotomy. N Engl J Med 1993; 328:228-32. [PMID: 8418402 DOI: 10.1056/nejm199301283280402] [Citation(s) in RCA: 548] [Impact Index Per Article: 17.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
BACKGROUND Most patients with acute biliary pancreatitis have stones in the biliary tract or ampulla of Vater. Because these stones may be passed spontaneously soon after a patient is admitted to the hospital, the importance of early operative removal is not known. We tested the hypothesis that endoscopic papillotomy within 24 hours of admission decreased the incidence of complications in patients with acute biliary pancreatitis. METHODS We studied 195 patients with acute pancreatitis who were randomly assigned to one of two groups: 97 patients underwent within 24 hours after admission emergency endoscopic retrograde cholangiopancreatography (ERCP) followed by endoscopic papillotomy for ampullary and common-bile-duct stones, and 98 patients received initial conservative treatment and selective ERCP with or without endoscopic papillotomy only if their condition deteriorated. RESULTS One hundred twenty-seven patients ultimately proved to have biliary stones. Emergency ERCP with or without endoscopic papillotomy resulted in a reduction in biliary sepsis as compared with conservative treatment (0 of 97 patients vs. 12 of 98 patients, P = 0.001). The decrease in biliary sepsis occurred both in patients predicted to have mild pancreatitis (0 of 56 patients in the group that received emergency ERCP vs. 4 of 58 patients in the conservative-treatment group, P = 0.14) and in patients predicted to have severe pancreatitis (0 of 41 patients vs. 8 of 40 patients, P = 0.008). In all patients who had unrelenting biliary sepsis, persistent ampullary or common-bile-duct stones were identified. There were no major differences in the incidence of local complications (10 patients in the group that received emergency ERCP vs. 12 patients in the conservative-treatment group) or systemic complications (10 patients vs. 14 patients) of acute pancreatitis between the two groups, but the hospital mortality rate was slightly lower in the group undergoing emergency ERCP with or without endoscopic papillotomy (5 patients vs. 9 patients, P = 0.4). CONCLUSIONS Emergency ERCP with or without endoscopic papillotomy is indicated in the treatment of patients with acute pancreatitis.
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Affiliation(s)
- S T Fan
- Department of Surgery, University of Hong Kong, Queen Mary Hospital
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22
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Al-Qasabi QO, Alam MK, Haque MM, Sebayel MI, Al-Faqih S, Al-Kraida A. Assessment of severity in acute pancreatitis: Use of prognostic factors. Ann Saudi Med 1991; 11:551-5. [PMID: 17590792 DOI: 10.5144/0256-4947.1991.551] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
This prospective study evaluates the value of Ranson's prognostic factors in predicting severity of acute pancreatitis. One hundred-fourteen patients with 124 attacks of acute pancreatitis were studied duringa 4-year period at Riyadh Central Hospital. The majority of patients were Saudi males, their mean age being 46.5 years. Cholelithiasis was the leading cause of pancreatitis. Ranson's 11 prognostic factors were estimated within 48 hours of admission. Sixty-six percent of the cases were graded as mild pancreatitis with less than 3 Ranson's factors present, whereas 34% were classified as severe pancreatitis with 3 or more of Ransosn's factors present. Prognostic factors correctly predicted severity in 6% of patients, but only 36% from the severe group developed severe disease (complications and/or death). Overall mortality was 5.3%. Ranson's prognostic factors help in identifying severe pancreatitis but their accuracy may be improved by the use of modern imaging techniques.
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Affiliation(s)
- Q O Al-Qasabi
- Department of Surgery, King Khalid University Hospital, and Department of Surgery, Riyadh Central Hospital, Riyadh, Saudi Arabia
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23
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Nankivell BJ, Gillies AH. Acute pancreatitis and rhabdomyolysis: a new association. AUSTRALIAN AND NEW ZEALAND JOURNAL OF MEDICINE 1991; 21:414-7. [PMID: 1953530 DOI: 10.1111/j.1445-5994.1991.tb01342.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Fourteen cases of acute severe pancreatitis complicated by non-traumatic rhabdomyolysis are described and compared to case controls. Pancreatitis of various aetiologies was confirmed by surgical diagnosis, laparotomy, abdominal paracentesis, CAT scan and post mortem. Pancreatitis was severe with a high Ranson prognostic score (7.4 +/- 0.5 vs controls 1.9 +/- 0.4, p less than 0.001), longer ICU admission and a mortality of 79%. Rhabdomyolysis occurred two to 19 days after the onset of pancreatitis (with a median CPK peak at 6.5 days) and was accompanied by multiple organ failure in 93% of cases. Severe rhabdomyolysis and myoglobinuric renal failure occurred in three patients out of 12 with acute renal failure. Hypocalcaemia was common (93%), severe (with a mean minimum value of 1.79 +/- 0.07 vs 2.34 +/- 0.04mmol/L, p less than 0.01) and prolonged (remaining abnormal for 5.2 +/- 0.8 vs 0.07 +/- 0.07 days, p less than 0.001). Intravenous calcium supplements were required in 50% of patients. Plasma phosphate, potassium, urate and anion gap were elevated (all p less than 0.05) and accompanying clinical features included fever, ascites, leucocytosis, hypoalbuminaemia and abnormal liver function tests. Rhabdomyolysis is associated with acute several pancreatitis, appearing as a late phenomenon in the context of severe prolonged hypocalcaemia, multiple organ failure and a poor outcome.
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Affiliation(s)
- B J Nankivell
- Department of Medicine, Royal Newcastle Hospital, Newcastle, NSW, Australia
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24
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Gough DB, Boyle B, Joyce WP, Delaney CP, McGeeney KF, Gorey TF, Fitzpatrick JM. Free radical inhibition and serial chemiluminescence in evolving experimental pancreatitis. Br J Surg 1990; 77:1256-9. [PMID: 1701329 DOI: 10.1002/bjs.1800771119] [Citation(s) in RCA: 49] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Oxygen free radical activity and inhibition were examined in experimental pancreatitis. Twenty-five rats were randomized to five groups: controls received intravenous saline, to simulate pancreatitis one group received intravenous caerulein (5 micrograms kg-1 h-1), and three groups received sodium taurocholate via the pancreatic duct (0.2 ml, 5 per cent), either alone, following allopurinol or immediately before superoxide dismutase. Chemiluminescence (a phenomenon based on the emission of light during chemical reactions and which is dependent on oxygen free radical activity) was used as an index of oxygen free radical activity and was measured in tissue samples at 5-min intervals following induction of pancreatitis. The control mean(s.e.m.) serum amylase level 1 h after induction of pancreatitis was 635(13) units. It was significantly elevated in caerulein-induced pancreatitis, 1833(118) units (P less than 0.05) and exceeded 3000 units in all taurocholate-infused animals. Mean(s.e.m.) chemiluminescence ranged from 44 (8) mV 100 mg-1 at time zero to 404(113) mV 100 mg-1 at 1 h in controls. In caerulein-induced pancreatitis mean(s.e.m.) chemiluminescence peaked at 20 min (1399(239) mV 100 mg-1, P less than 0.02) and in taurocholate-induced pancreatitis at 15 min (2316(95) mV 100 mg-1, P less than 0.004). Superoxide dismutase significantly reduced chemiluminescence and hyperamylasaemia in taurocholate groups. Increasing oxygen free radical activity paralleled evolving pancreatitis. Superoxide dismutase may have a therapeutic role in pancreatitis.
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Affiliation(s)
- D B Gough
- Department of Surgery, Mater Misericordiae Hospital and University College Dublin, Ireland
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25
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Windsor JA. Gallstone pancreatitis: a proposed management strategy. THE AUSTRALIAN AND NEW ZEALAND JOURNAL OF SURGERY 1990; 60:589-94. [PMID: 2202282 DOI: 10.1111/j.1445-2197.1990.tb07437.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
It has been usual practice to manage gallstone pancreatitis conservatively over the acute phase and to perform an elective cholecystectomy after an interval of 2-3 months. Because of the risks of recurrent pancreatitis, and in an effort to reduce the high morbidity and mortality associated with severe pancreatitis, there has been a trend towards early surgical intervention and, more recently, endoscopic sphincterotomy. From the Greenlane Hospital experience during 1979-1987, and from a review of recent literature, a strategy is proposed for the management of acute gallstone pancreatitis.
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Affiliation(s)
- J A Windsor
- Department of Surgery, Greenlane Hospital, Auckland, New Zealand
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26
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Barale F, Clément C. [Acute necrotizing hemorrhagic pancreatitis]. ANNALES FRANCAISES D'ANESTHESIE ET DE REANIMATION 1990; 9:253-60. [PMID: 2196840 DOI: 10.1016/s0750-7658(05)80182-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
There is no etiologic treatment for acute necrotizing pancreatitis. Advances in intensive care resulted in a reduction in early death rate by a better control of systemic complications. Delayed death rate from infection is high (20-60%). Diagnostic problems are an important cause, in spite of the aid of computed tomography and echography. The prognosis will further be improved by earlier diagnosis, a better definition of surgical treatment when complications arise, and constant medicosurgical collaboration.
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Affiliation(s)
- F Barale
- Service d'Anesthésie-Réanimation, CHU 25030 Besançon
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27
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Abstract
This review examines the lack of improvement in terms of mortality and outcome in patients with acute pancreatitis. Energetic fluid replacement is the only treatment of proven value. There is a strong case for identification of patients with severe disease who may benefit from early operative intervention. Eradication of gallstones may prevent further attacks in patients with gallstone pancreatitis. The benefits of pancreatic resection and necrosectomy still require full evaluation.
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Affiliation(s)
- G J Poston
- Department of Surgery, Royal Postgraduate Medical School, Hammersmith Hospital, London
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28
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Clavien PA, Burgan S, Moossa AR. Serum enzymes and other laboratory tests in acute pancreatitis. Br J Surg 1989; 76:1234-43. [PMID: 2691011 DOI: 10.1002/bjs.1800761205] [Citation(s) in RCA: 67] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
This review evaluates selective enzymes and blood tests available for the diagnosis and prognosis of acute pancreatitis. It is concluded that serum amylase and lipase measurements represent the best available diagnostic methods. Newer alternative assays still require careful evaluation.
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Affiliation(s)
- P A Clavien
- Department of Digestive Surgery, University Hospital, Geneva, Switzerland
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29
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Abstract
Admission laboratory data of 203 patients suffering from acute pancreatitis were analysed to search for a simpler method of prediction of severity than the traditional multifactor prognostic scoring system. By discriminant analysis, admission serum urea and plasma glucose were identified to be factors with independent significance in predicting severity. If the presence of either factor higher than the cutoff point (urea greater than 7.4 mmol/l, glucose greater than 11.0 mmol/l) was considered as an indication of severe disease, then the sensitivity of this method was 75.0%, specificity 80.3% and the accuracy 79.3%. The predictive ability of this method was comparable with the Glasgow multifactor scoring system when the latter was also used to grade severity of our patients. It has the advantage, however, of simplicity and the ability of predicting severity at the time of admission.
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Affiliation(s)
- S T Fan
- Department of Surgery, University of Hong Kong, Queen Mary Hospital
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30
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Abstract
The value of the Acute Physiology and Chronic Health Enquiry (APACHE-II) score, the Simplified Acute Physiology score, and the Medical Research Council (MRC) sepsis score were compared with clinical assessment and Ranson and Imrie scores in the evaluation and monitoring of acute pancreatitis in 290 attacks. Attacks were graded mild (231) if uncomplicated, or severe (59) when major organ failure or a pancreatic collection occurred. Only APACHE-II scores were available at the time of admission; they correctly predicted outcome in 77% of attacks and identified 63% of severe attacks, compared with 44% achieved by clinical assessment. After 48 h, APACHE-II was most accurate, and correctly predicted outcome in 88% of attacks, compared with 69% for Ranson and 84% for Imrie scores. APACHE-II predicted 73% of pancreatic collections at 48 h, compared with 65% for Ranson and 58% for Imrie scores. In acute pancreatitis, APACHE-II may facilitate rapid selection of patients for intensive therapy or clinical trials, improve comparison between groups of patients, and indicate that a pancreatic collection is probable.
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Affiliation(s)
- M Larvin
- University Department of Surgery, General Infirmary, Leeds
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31
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Affiliation(s)
- M Keynes
- Department of Anatomy, Cambridge
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32
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Abstract
The influence of age on the mortality rate of 268 patients with acute pancreatitis was studied. The hospital mortality rate for patients aged below 50 years was 5.9 per cent. The figure increased to 21.3 per cent in patients aged over 75; the high mortality was accounted for by a higher incidence of deaths related to concomitant medical or surgical diseases in the same hospital admission rather than to complications resulting directly from the pathological process of acute pancreatitis. When only deaths due to complications of acute pancreatitis were analysed, the mortality rate was not significantly different between the young and elderly groups. Moreover, the complication rate and the proportion of patients having severe disease (judged by the number of prognostic signs) were not higher in the elderly. Thus acute pancreatitis was intrinsically not more serious were it not for the presence of concomitant diseases with advanced age.
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Affiliation(s)
- S T Fan
- Department of Surgery, University of Hong Kong, Queen Mary Hospital
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33
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Leese T, Shaw D. Comparison of three Glasgow multifactor prognostic scoring systems in acute pancreatitis. Br J Surg 1988; 75:460-2. [PMID: 3390678 DOI: 10.1002/bjs.1800750519] [Citation(s) in RCA: 51] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Modifications have been proposed in an attempt to improve the clinical value of the original nine-factor Glasgow prognostic scoring system for acute pancreatitis. These include the omission of age or serum transaminase, reducing the factors to eight. Debate exists as to which system should be employed. Assessment of the individual factors in 198 attacks of acute pancreatitis treated conventionally revealed that only serum transaminase did not differ significantly between mild and severe outcome groups. Multivariate analysis demonstrated four factors (Pa,O2, white cell count, lactic dehydrogenase, and urea) with independent significance in predicting severity, while serum glucose, albumin and transaminase were least useful. Findings were similar when considering only patients with gallstone aetiology. The reduction of the prognostic factors to eight by the omission of either age or transaminase improved the predictive value of the scoring system, both when considering all attacks and those of gallstone aetiology alone. We suggest that serum transaminase should be omitted because: it shows no significant difference between mild and severe outcome groups, while age has prognostic significance; the system has greater sensitivity than if age is omitted; and the number of factors requiring emergency laboratory measurement for immediate prognostication is reduced by one.
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Affiliation(s)
- T Leese
- Department of Surgery, University of Leicester, UK
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34
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Blake RL. Acute Pancreatitis. Prim Care 1988. [DOI: 10.1016/s0095-4543(21)01067-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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35
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Poston GJ, Adamson AS, Heeley AF, Heeley ME, Hughes E, Benjamin IS. Immunoreactive trypsin in acute pancreatitis: elevated levels do not correlate with hyperamylasaemia. Ann R Coll Surg Engl 1987; 69:205-8. [PMID: 2445236 PMCID: PMC2498571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Immunoreactive trypsin (IRT) was measured in the serum of patients presenting with acute pancreatitis (AP) and compared to serum amylase levels. Both were elevated beyond the normal range at presentation (mean IRT 557 +/- 252 micrograms/l, range 181-1000 micrograms/l, mean control IRT 42 +/- 14 micrograms/l, range 15-82 micrograms/l; mean amylase 4500 +/- 3200 IU/l, range 600-10,500 IU/l, control amylase mean 175 +/- 43 IU/l, range 48-320 IU/l). There was minimal correlation between IRT and amylase elevation but both returned to normal at the same rate in patients who recovered. In 2 patients with persistently elevated IRT levels, one was found to have a pancreatic pseudocyst and the other subsequently died from alcoholic haemorrhagic pancreatitis. IRT is no better than amylase as a single diagnostic assay in AP but may be greatly elevated when amylase elevation is minimal. The combination of the two may improve diagnostic accuracy and persistent elevation of IRT may be of prognostic importance.
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Affiliation(s)
- G J Poston
- Royal Postgraduate Medical School, London
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36
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Acute pancreatitis. West J Med 1987; 146:598-602. [PMID: 3590762 PMCID: PMC1307405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
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37
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Pancreatic Society of Great Britain and Ireland. 10th annual meeting. Bristol, 22 November 1985. Gut 1986; 27:A228-32. [PMID: 3949242 PMCID: PMC1433194 DOI: 10.1136/gut.27.2.a228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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38
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Bouchier IAD. Biochemical tests for acute pancreatitis. West J Med 1986. [DOI: 10.1136/bmj.292.6515.269-b] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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39
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40
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Isaacs PE. Biochemical tests for acute pancreatitis. BRITISH MEDICAL JOURNAL 1986; 292:269-70. [PMID: 3081098 PMCID: PMC1339227 DOI: 10.1136/bmj.292.6515.269-a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
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41
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Corfield AP, Cooper MJ, Williamson RC, Mayer AD, McMahon MJ, Dickson AP, Shearer MG, Imrie CW. Prediction of severity in acute pancreatitis: prospective comparison of three prognostic indices. Lancet 1985; 2:403-7. [PMID: 2863441 DOI: 10.1016/s0140-6736(85)92733-3] [Citation(s) in RCA: 120] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
The prognostic value of three predictive indices was compared in 436 attacks of acute pancreatitis in 418 patients. The outcome of an attack was graded as uncomplicated (324), complicated (70), or fatal (41); 1 attack was excluded because of puncture of the caecum. The overall mortality rate was 9.4%. Clinical assessment on admission identified only 34% of patients whose attack was severe (ie, complicated or fatal). Multiple laboratory criteria and peritoneal lavage were more sensitive (61% and 53%, respectively) while retaining diagnostic accuracy (79% and 74%). An erroneous diagnosis of pancreatitis was corrected by the findings on lavage in 5 patients. The major advantage of peritoneal lavage over multiple laboratory criteria was the shorter delay between admission to the study and determination of severity (median 4 v 24 h), but visceral puncture during insertion of the cannula occurred in 2 of 253 patients (0.8%). When used together, the three indices correctly predicted 82% of the attacks with a severe outcome and identified all patients destined to die within 10 days of admission.
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