1
|
Amri F, Rahaoui M, Aissaoui H, Elmqaddem O, Koulali H, Zazour A, Abda N, Ismaili Z, Kharrasse G. Is serum albumin a pivotal biomarker in anticipating acute pancreatitis outcomes? BMC Gastroenterol 2024; 24:234. [PMID: 39048942 PMCID: PMC11267779 DOI: 10.1186/s12876-024-03314-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2024] [Accepted: 07/03/2024] [Indexed: 07/27/2024] Open
Abstract
This study aimed to assess the significance of serum albumin levels within 24 h of patient admission in correlation with the incidence of outcomes and mortality in patients diagnosed with acute pancreatitis. A retrospective study was conducted over a 5-year period, from January 2018 to December 2023, at the Mohammed VI University Hospital in Oujda, Morocco. The study included 371 patients diagnosed with acute pancreatitis. Hypoalbuminemia (≤ 30 g/L) was observed in 124 patients (33.4% of cases), and these patients had a higher mean age compared to those with normal albumin levels (P = 0.003). Hypoalbuminemia was significantly associated with persistent Systemic Inflammatory Response Syndrome (SIRS) (70.8% vs. 29.2%, P = 0.000), a higher BISAP score (66.7% vs. 33.3%, P = 0.000), and a higher CTSI score (51.7% vs. 48.3%, P = 0.000). Hypoalbuminemia was also associated with the presence of pleural effusion (P = 0.000). The mortality in the sample was 4.6%, and it was significantly associated with hypoalbuminemia (76.5%, P = 0.000). In conclusion, serum albumin levels within 24 h of patient admission appear to be a significant prognostic biomarker in acute pancreatitis, particularly in anticipating persistent organ failure and mortality.
Collapse
Affiliation(s)
- Fakhrddine Amri
- Department of Hepato-Gastroenterology, Mohammed VI University Hospital, Oujda, Morocco.
- Digestive Diseases Research Laboratory (DSRL), Faculty of Medicine and Pharmacy, Mohammed First University, Oujda, Morocco.
| | - Maissae Rahaoui
- Department of Hepato-Gastroenterology, Mohammed VI University Hospital, Oujda, Morocco
- Digestive Diseases Research Laboratory (DSRL), Faculty of Medicine and Pharmacy, Mohammed First University, Oujda, Morocco
| | - Hanane Aissaoui
- Laboratory of Epidemiology, Clinical Research, and Public Health, Faculty of Medicine and Pharmacy, Mohammed First University, Oujda, Morocco
| | - Ouiam Elmqaddem
- Department of Hepato-Gastroenterology, Mohammed VI University Hospital, Oujda, Morocco
- Digestive Diseases Research Laboratory (DSRL), Faculty of Medicine and Pharmacy, Mohammed First University, Oujda, Morocco
| | - Hajar Koulali
- Department of Hepato-Gastroenterology, Mohammed VI University Hospital, Oujda, Morocco
- Digestive Diseases Research Laboratory (DSRL), Faculty of Medicine and Pharmacy, Mohammed First University, Oujda, Morocco
| | - Abdelkrim Zazour
- Department of Hepato-Gastroenterology, Mohammed VI University Hospital, Oujda, Morocco
- Digestive Diseases Research Laboratory (DSRL), Faculty of Medicine and Pharmacy, Mohammed First University, Oujda, Morocco
| | - Naima Abda
- Laboratory of Epidemiology, Clinical Research, and Public Health, Faculty of Medicine and Pharmacy, Mohammed First University, Oujda, Morocco
| | - Zahi Ismaili
- Department of Hepato-Gastroenterology, Mohammed VI University Hospital, Oujda, Morocco
- Digestive Diseases Research Laboratory (DSRL), Faculty of Medicine and Pharmacy, Mohammed First University, Oujda, Morocco
| | - Ghizlane Kharrasse
- Department of Hepato-Gastroenterology, Mohammed VI University Hospital, Oujda, Morocco
- Digestive Diseases Research Laboratory (DSRL), Faculty of Medicine and Pharmacy, Mohammed First University, Oujda, Morocco
| |
Collapse
|
2
|
Dejonckheere M, Antonelli M, Arvaniti K, Blot K, CreaghBrown B, de Lange DW, De Waele J, Deschepper M, Dikmen Y, Dimopoulos G, Eckmann C, Francois G, Girardis M, Koulenti D, Labeau S, Lipman J, Lipovestky F, Maseda E, Montravers P, Mikstacki A, Paiva J, Pereyra C, Rello J, Timsit J, Vogelaers D, Blot S. Epidemiology and risk factors for mortality in critically ill patients with pancreatic infection. JOURNAL OF INTENSIVE MEDICINE 2024; 4:81-93. [PMID: 38263964 PMCID: PMC10800767 DOI: 10.1016/j.jointm.2023.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Revised: 06/16/2023] [Accepted: 06/23/2023] [Indexed: 01/25/2024]
Abstract
Background The AbSeS-classification defines specific phenotypes of patients with intra-abdominal infection based on the (1) setting of infection onset (community-acquired, early onset, or late-onset hospital-acquired), (2) presence or absence of either localized or diffuse peritonitis, and (3) severity of disease expression (infection, sepsis, or septic shock). This classification system demonstrated reliable risk stratification in intensive care unit (ICU) patients with intra-abdominal infection. This study aimed to describe the epidemiology of ICU patients with pancreatic infection and assess the relationship between the components of the AbSeS-classification and mortality. Methods This was a secondary analysis of an international observational study ("AbSeS") investigating ICU patients with intra-abdominal infection. Only patients with pancreatic infection were included in this analysis (n=165). Mortality was defined as ICU mortality within 28 days of observation for patients discharged earlier from the ICU. Relationships with mortality were assessed using logistic regression analysis and reported as odds ratio (OR) and 95% confidence interval (CI). Results The overall mortality was 35.2% (n=58). The independent risk factors for mortality included older age (OR=1.03, 95% CI: 1.0 to 1.1 P=0.023), localized peritonitis (OR=4.4, 95% CI: 1.4 to 13.9 P=0.011), and persistent signs of inflammation at day 7 (OR=9.5, 95% CI: 3.8 to 23.9, P<0.001) or after the implementation of additional source control interventions within the first week (OR=4.0, 95% CI: 1.3 to 12.2, P=0.013). Gram-negative bacteria were most frequently isolated (n=58, 49.2%) without clinically relevant differences in microbial etiology between survivors and non-survivors. Conclusions In pancreatic infection, a challenging source/damage control and ongoing pancreatic inflammation appear to be the strongest contributors to an unfavorable short-term outcome. In this limited series, essentials of the AbSeS-classification, such as the setting of infection onset, diffuse peritonitis, and severity of disease expression, were not associated with an increased mortality risk.ClinicalTrials.gov number: NCT03270345.
Collapse
Affiliation(s)
- Marie Dejonckheere
- Department of Internal Medicine and Pediatrics, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Massimo Antonelli
- Department of Anesthesiology, Intensive Care and Emergency Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Università Cattolica del Sacro Cuore, Rome, Italy
| | - Kostoula Arvaniti
- Intensive Care Unit, Papageorgiou University Affiliated Hospital, Thessaloníki, Greece
| | - Koen Blot
- Department of Internal Medicine and Pediatrics, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
- Department of Epidemiology and Public Health, Sciensano, Ixelles, Belgium
| | - Ben CreaghBrown
- Surrey Perioperative Anaesthetic Critical Care Collaborative Research Group (SPACeR), Royal Surrey County Hospital, Guildford, UK
- Department of Clinical and Experimental Medicine, University of Surrey, Guildford, UK
| | - Dylan W. de Lange
- Department of Intensive Care Medicine, University Medical Center Utrecht, University Utrecht, Utrecht, the Netherlands
| | - Jan De Waele
- Department of Internal Medicine and Pediatrics, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
- Department of Intensive Care Medicine, Ghent University Hospital, Ghent, Belgium
| | - Mieke Deschepper
- Data Science Institute, Ghent University Hospital, Ghent, Belgium
| | - Yalim Dikmen
- Department of Anesthesiology and Reanimation, Cerrahpasa School of Medicine, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - George Dimopoulos
- 3rd Department of Critical Care, “EVGENIDIO” Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Christian Eckmann
- Department of General, Visceral and Thoracic Surgery, Klinikum Hannoversch-Muenden, Goettingen University, Göttingen, Germany
| | - Guy Francois
- Division of Scientific Affairs-Research, European Society of Intensive Care Medicine, Brussels, Belgium
| | - Massimo Girardis
- Anesthesia and Intensive Care Department, University Hospital of Modena, Modena, Italy
| | - Despoina Koulenti
- UQ Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia
- 2nd Critical Care Department, Attikon University Hospital, Athens, Greece
| | - Sonia Labeau
- Department of Internal Medicine and Pediatrics, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
- Department of Nursing, Faculty of Education, Health and Social Work, University College Ghent, Ghent, Belgium
| | - Jeffrey Lipman
- Jamieson Trauma Institute, The University of Queensland, Brisbane, QLD, Australia
- Nimes University Hospital, University of Montpellier, Nimes, France
| | - Fernando Lipovestky
- Critical Care Department, Hospital of the Interamerican Open University (UAI), Buenos Aires, Argentina
| | - Emilio Maseda
- Surgical Critical Care, Department of Anesthesia, Hospital Universitario La Paz-IdiPaz, Madrid, Spain
| | - Philippe Montravers
- Université de Paris, INSERM, UMR-S 1152-PHERE, Paris, France
- Anesthesiology and Critical Care Medicine, Bichat-Claude Bernard University Hospital, HUPNSV, AP-HP, Paris, France
| | - Adam Mikstacki
- Faculty of Health Sciences, Poznan University of Medical Sciences, Poznan, Poland
- Department of Anaesthesiology and Intensive Therapy, Regional Hospital in Poznan, Poznan, Poland
| | - JoseArtur Paiva
- Intensive Care Department, Centro Hospitalar Universitario S. Joao, Faculty of Medicine, University of Porto, Grupo Infecao e Sepsis, Porto, Portugal
| | - Cecilia Pereyra
- Intensive Care Unit from Hospital Interzonal General de Agudos “Prof Dr Luis Guemes”, Buenos Aires, Argentina
| | - Jordi Rello
- Ciberes and Vall d'Hebron Institute of Research, Barcelona, Spain
| | - JeanFrancois Timsit
- Université Paris-Cité, IAME, INSERM 1137, Paris, France
- AP-HP, Hôpital Bichat, Medical and Infection Diseases ICU (MI2), Paris, France
| | - Dirk Vogelaers
- Department of Internal Medicine and Pediatrics, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
- Department of General Internal Medicine and Infectious Diseases, AZ Delta, Roeselare, Belgium
| | - Stijn Blot
- Department of Internal Medicine and Pediatrics, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
- UQ Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia
| | | |
Collapse
|
3
|
Hou S, Wang S, You Y, Yang L, Dou M, Zhang Y. New model for predicting the development of pancreatic pseudocyst secondary to acute pancreatitis. Medicine (Baltimore) 2023; 102:e36102. [PMID: 38013294 PMCID: PMC10681386 DOI: 10.1097/md.0000000000036102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Accepted: 10/23/2023] [Indexed: 11/29/2023] Open
Abstract
Pancreatic pseudocyst (PPC) increases the risk of a poor prognosis in in patients with acute pancreatitis (AP). Currently, an efficient tool is not available for predicting the risk of PPC in patients with AP. Therefore, this research aimed to explore the risk factors associated with PPC secondary to AP and to develop a model based on clinical information for predicting PPC secondary to AP. This study included 400 patients with acute pancreatitis and pancreatic pseudocyst secondary to acute pancreatitis admitted to the emergency department and gastroenterology department of The First Affiliated Hospital of the University of Science and Technology of China from January 2019 to June 2022. Participants were divided into no PPCs (321 cases) and PPCs (79 cases). Independent factors of PPC secondary to AP were analyzed using univariate and multivariate logistic regression. The nomogram model was constructed based on multivariate logistic regression analyses, which included all risk factors, and evaluated using R. We enrolled 400 eligible patients and allocated 280 and 120 to the training and test sets, respectively. Clinical features, including severe pancreatitis history [odds ratio (OR) = 4.757; 95% confidence interval (CI): 1.758-12.871], diabetes mellitus (OR = 6.919; 95% CI: 2.084-22.967), history of biliary surgery (OR = 9.232; 95% CI: 3.022-28.203), hemoglobin (OR = 0.974; 95% CI: 0.955-0.994), albumin (OR = 0.888; 95% CI: 0.825-0.957), and body mass index (OR = 0.851; 95% CI: 0.753-0.962), were significantly associated with the incidence of PPC after AP in the training sets. Additionally, the individualized nomogram demonstrated good discrimination in the training and validation samples with good calibration, The area under the curve and 95% CI of the nomogram were 0.883 (0.839-0.927) in the training dataset and 0.839 (0.752-0.925) in the validation set. We developed a nomogram model of PPC secondary to AP using R Studio. This model has a good predictive value for PPC in patients with AP and can help improve clinical decision-making.
Collapse
Affiliation(s)
- Shanbing Hou
- Department of Emergency, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui, China
| | - Senlin Wang
- Graduate College of Wannan Medical College, Wuhu, Anhui, China
| | - Yuetong You
- Department of Emergency, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui, China
| | - Lanlan Yang
- Department of Emergency, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui, China
| | - Ming Dou
- Department of Emergency, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui, China
| | - Ying Zhang
- Department of Emergency, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui, China
| |
Collapse
|
4
|
Barrera Gutierrez JC, Greenburg I, Shah J, Acharya P, Cui M, Vivian E, Sellers B, Kedia P, Tarnasky PR. Severe Acute Pancreatitis Prediction: A Model Derived From a Prospective Registry Cohort. Cureus 2023; 15:e46809. [PMID: 37954725 PMCID: PMC10636501 DOI: 10.7759/cureus.46809] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/10/2023] [Indexed: 11/14/2023] Open
Abstract
Background Severe acute pancreatitis (SAP) has a mortality rate as high as 40%. Early identification of SAP is required to appropriately triage and direct initial therapies. The purpose of this study was to develop a prognostic model that identifies patients at risk for developing SAP of patients managed according to a guideline-based standardized early medical management (EMM) protocol. Methods This single-center study included all patients diagnosed with acute pancreatitis (AP) and managed with the EMM protocol Methodist Acute Pancreatitis Protocol (MAPP) between April 2017 and September 2022. Classification and regression tree (CART®; Professional Extended Edition, version 8.0; Salford Systems, San Diego, CA), univariate, and logistic regression analyses were performed to develop a scoring system for AP severity prediction. The accuracy of the scoring system was measured by the area under the receiver operating characteristic curve. Results A total of 516 patients with mild (n=436) or moderately severe and severe (n=80) AP were analyzed. CART analysis identified the cutoff values: creatinine (CR) (1.15 mg/dL), white blood cells (WBC) (10.5 × 109/L), procalcitonin (PCT) (0.155 ng/mL), and systemic inflammatory response system (SIRS). The prediction model was built with a multivariable logistic regression analysis, which identified CR, WBC, PCT, and SIRS as the main predictors of severity. When CR and only one other predictor value (WBC, PCT, or SIRS) met thresholds, then the probability of predicting SAP was >30%. The probability of predicting SAP was 72% (95%CI: 0.59-0.82) if all four of the main predictors were greater than the cutoff values. Conclusions Baseline laboratory cutoff values were identified and a logistic regression-based prognostic model was developed to identify patients treated with a standardized EMM who were at risk for SAP.
Collapse
Affiliation(s)
| | - Ian Greenburg
- Gastroenterology Fellowship Program, Methodist Health System, Dallas, USA
| | - Jimmy Shah
- Methodist Digestive Institute, Methodist Health System, Dallas, USA
| | - Priyanka Acharya
- Clinical Research Institute, Methodist Health System, Dallas, USA
| | - Mingyang Cui
- Methodist Digestive Institute, Methodist Health System, Dallas, USA
| | - Elaina Vivian
- Performance Improvement, Methodist Health System, Dallas, USA
| | | | | | | |
Collapse
|
5
|
Wu Q, Zheng Y, Yu J, Ying X, Gu X, Tan Q, Tu W, Lou X, Yang G, Li M, Jiang S. Electroacupuncture alleviates neuropathic pain caused by SNL by promoting M2 microglia polarization through PD-L1. Int Immunopharmacol 2023; 123:110764. [PMID: 37573685 DOI: 10.1016/j.intimp.2023.110764] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Revised: 07/26/2023] [Accepted: 08/02/2023] [Indexed: 08/15/2023]
Abstract
As a common clinical disease, neuropathic pain is difficult to be cured with drugs. The occurrence and progression of pain is closely related to the response of spinal microglia. Aspartof the regulation of microglialactivity,PD-L1 playsacriticalrole. Loss of PD-L1 promoted the polarization of M1-like microglia. Increased expression of PD-L1 promoted M2-like polarization. Electroacupuncture has a significant analgesic effect in clinical practice, but its specific mechanism remains to be further explored. In this study, we verified the role of PD-L1 in EA analgesia and the underlying molecular mechanism through spinal nerve ligation (SNL) in rats and lipopolysaccharide (LPS)-treated BV2 microglial cells. Forbehavioralstudiesofrats,mechanical withdrawal threshold (MWT) and thermal withdrawal latency (TWL) were measured, and spinal cord neuros were examined under transmission electron microscopyto determine changes to their myelin structure. The expression levels of PD-L1 and M1/M2-specific markers in rat spinal cord and BV2 microglial cells were measured by enzyme-linked immunosorbent assay, flow cytometry, immunofluorescence staining and Western blot analysis. Our study showed that EA increased the pain threshold, reduced the destruction of myelin structure, promoted the expression of PD-L1 and PD-1, inhibited the MAPK signaling pathway, and promoted the conversion of microglial polarization from the M1 phenotype to the M2 phenotype in SNL rats. PD-L1 knockdown reversed these effects of EA. In addition, PD-L1 knockdown activated the MAPK signaling pathway, promoted microglial polarization to the M1 phenotype, decreased the expression of anti-inflammatory mediators and increased the expression of proinflammatory factors in LPS-stimulated BV2 microglial cells. Our results showed that EA may regulate the excitability of primary afferent neurons through PD-L1 and then inhibit the MAPK signaling pathway to promote the transformation of activated M1 microglia into M2 microglia, reduce inflammatory reactions, and finally achieve analgesic effects. A therapy targeting PD-L1 may be an effective strategy for treating neuropathic pain.
Collapse
Affiliation(s)
- Qiaoyun Wu
- Department of Physical Medicine and Rehabilitation, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang 325027, China; Integrative & Optimized Medicine Research Center, China-USA Institute for Acupuncture and Rehabilitation, Wenzhou Medical University, Wenzhou, Zhejiang 325027, China; The Wenzhou Key Laboratory for Rehabilitation Research, The Provincial Key Laboratory for Acupuncture and Rehabilitation in Zhejiang Province, China
| | - Yujun Zheng
- Department of Physical Medicine and Rehabilitation, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang 325027, China; Integrative & Optimized Medicine Research Center, China-USA Institute for Acupuncture and Rehabilitation, Wenzhou Medical University, Wenzhou, Zhejiang 325027, China; The Wenzhou Key Laboratory for Rehabilitation Research, The Provincial Key Laboratory for Acupuncture and Rehabilitation in Zhejiang Province, China
| | - Jiaying Yu
- Department of Physical Medicine and Rehabilitation, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang 325027, China; Integrative & Optimized Medicine Research Center, China-USA Institute for Acupuncture and Rehabilitation, Wenzhou Medical University, Wenzhou, Zhejiang 325027, China; The Wenzhou Key Laboratory for Rehabilitation Research, The Provincial Key Laboratory for Acupuncture and Rehabilitation in Zhejiang Province, China
| | - Xinwang Ying
- Department of Physical Medicine and Rehabilitation, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang 325027, China; Integrative & Optimized Medicine Research Center, China-USA Institute for Acupuncture and Rehabilitation, Wenzhou Medical University, Wenzhou, Zhejiang 325027, China; The Wenzhou Key Laboratory for Rehabilitation Research, The Provincial Key Laboratory for Acupuncture and Rehabilitation in Zhejiang Province, China
| | - Xiaoxue Gu
- Department of Physical Medicine and Rehabilitation, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang 325027, China; Integrative & Optimized Medicine Research Center, China-USA Institute for Acupuncture and Rehabilitation, Wenzhou Medical University, Wenzhou, Zhejiang 325027, China; The Wenzhou Key Laboratory for Rehabilitation Research, The Provincial Key Laboratory for Acupuncture and Rehabilitation in Zhejiang Province, China
| | - Qianqian Tan
- Department of Physical Medicine and Rehabilitation, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang 325027, China; Integrative & Optimized Medicine Research Center, China-USA Institute for Acupuncture and Rehabilitation, Wenzhou Medical University, Wenzhou, Zhejiang 325027, China; The Wenzhou Key Laboratory for Rehabilitation Research, The Provincial Key Laboratory for Acupuncture and Rehabilitation in Zhejiang Province, China
| | - Wenzhan Tu
- Department of Physical Medicine and Rehabilitation, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang 325027, China; Integrative & Optimized Medicine Research Center, China-USA Institute for Acupuncture and Rehabilitation, Wenzhou Medical University, Wenzhou, Zhejiang 325027, China; The Wenzhou Key Laboratory for Rehabilitation Research, The Provincial Key Laboratory for Acupuncture and Rehabilitation in Zhejiang Province, China
| | - Xinfa Lou
- Integrative & Optimized Medicine Research Center, China-USA Institute for Acupuncture and Rehabilitation, Wenzhou Medical University, Wenzhou, Zhejiang 325027, China
| | - Guanhu Yang
- Department of Physical Medicine and Rehabilitation, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang 325027, China; Integrative & Optimized Medicine Research Center, China-USA Institute for Acupuncture and Rehabilitation, Wenzhou Medical University, Wenzhou, Zhejiang 325027, China; The Wenzhou Key Laboratory for Rehabilitation Research, The Provincial Key Laboratory for Acupuncture and Rehabilitation in Zhejiang Province, China
| | - Ming Li
- School of Basic Medical Science, Wenzhou Medical University, Wenzhou, Zhejiang 325027, China
| | - Songhe Jiang
- Department of Physical Medicine and Rehabilitation, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang 325027, China; Integrative & Optimized Medicine Research Center, China-USA Institute for Acupuncture and Rehabilitation, Wenzhou Medical University, Wenzhou, Zhejiang 325027, China; The Wenzhou Key Laboratory for Rehabilitation Research, The Provincial Key Laboratory for Acupuncture and Rehabilitation in Zhejiang Province, China.
| |
Collapse
|
6
|
Muacevic A, Adler JR. Prognostic Significance of the Red Cell Distribution Width/Albumin Ratio in the Prediction of the Severity of Acute Biliary Pancreatitis: A Preliminary Report. Cureus 2022; 14:e30183. [PMID: 36238420 PMCID: PMC9552954 DOI: 10.7759/cureus.30183] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/10/2022] [Indexed: 11/19/2022] Open
Abstract
Objective Acute pancreatitis (AP) is a common inflammatory disease that should be considered in the etiology of patients presenting to the emergency department with abdominal pain. AP manifests with a clinical picture that can lead to organ failure and even death; therefore, early diagnosis and treatment are essential. In this study, we aimed to evaluate the red cell distribution width (RDW)/albumin ratio (RAR), which, we consider, can be used to determine the clinical course of acute biliary pancreatitis (ABP). Material and method The study included 166 patients with ABP. The patient's demographic information, blood values at the time of the first presentation to the emergency department, and radiological results were recorded by screening them retrospectively. Using the Atlanta criteria, the cases were classified into mild, moderately severe, and severe AP groups (MAP, MSAP, and SAP, respectively) and compared. Results Of the patients, 121 (72.9%) patients had MAP, 40 (24.1%) had MSAP, and five (3%) had SAP. There was no statistically significant difference between the three groups regarding gender and age. The SAP group had significantly higher median values for the length of hospital stay [19 (4-31) days], white blood cell (WBC) count [20.4 x109/L (9.1-23.3 x109/L)], and creatinine (Cre) [1.4 mg/dL (0.7-3.4 mg/dL)] (p<0.001, p=0.003, and p=0.014, respectively). The RDW and albumin values of all the groups were within normal ranges. RAR was higher in the SAP group but did not statistically significantly different between the groups. In the receiver operating characteristic (ROC) analysis of RAR, the area under the curve (AUC) value was determined as 0.75, sensitivity as 80%, specificity as 70.2%, and positive likelihood ratio as 2.1 (p=0.05). Conclusion It is considered that RAR may be a helpful method in determining the course of ABP attacks, but there is a need for studies with a larger series, including all pancreatitis cases.
Collapse
|
7
|
Bardakcı O, Akdur G, Das M, Sıddıkoğlu D, Akdur O, Beyazit Y. Comparison of different risk stratification systems for prediction of acute pancreatitis severity in patients referred to the emergency department of a tertiary care hospital. ULUS TRAVMA ACIL CER 2022; 28:967-973. [PMID: 35775674 PMCID: PMC10493842 DOI: 10.14744/tjtes.2021.51892] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Accepted: 04/01/2021] [Indexed: 11/20/2022]
Abstract
BACKGROUND Prognostic prediction and estimation of severity at early stages of acute pancreatitis (AP) are crucial to reduce the complication rates and mortality. The objective of the present study is to evaluate the predicting ability of different clinical and radiological scores in AP. METHODS We retrospectively collected demographic and clinical data from 159 patients diagnosed with AP admitted to Canakkale Onsekiz Mart University Hospital between January 2017 and December 2019. Bedside index for severity AP (BISAP), and acute phys-iology and chronic health evaluation II (APACHE II) score at admission, Ranson and modified Glasgow Prognostic Score (mGPS) score at 48 h after admission were calculated. Modified computed tomography severity index (CTSI) was also calculated for each patient. Area under the curve (AUC) was calculated for each scoring system for predicting severe AP, pancreatic necrosis, length of hospital stay, and mortality by determining optimal cutoff points from the (ROC) curves. RESULTS mGPS and APACHE II had the highest AUC (0.929 and 0.823, respectively) to predict severe AP on admission with the best specificity and sensitivity. In predicting mortality BISAP (with a sensitivity, specificity, negative predictive value (NPV), and positive predictive value (PPV) of 75.0%, 70.9%, 98.2%, and 12.0%, respectively, [AUC: 0.793]) and APACHE II (with a sensitivity, specificity, NPV and PPV of 87.5%, 86.1%, 99.2%, and 25.0%, respectively, [AUC: 0.840]). CONCLUSION mGPS can be a valuable tool in predicting the patients more likely to develop severe AP and maybe somewhat better than BISAP score, APACHE II Ranson score, and mCTSI.
Collapse
Affiliation(s)
- Okan Bardakcı
- Department of Emergency Medicine, Çanakkale Onsekiz Mart University Faculty of Medicine, Çanakkale-Türkiye
| | - Gökhan Akdur
- Department of Emergency Medicine, Çanakkale Onsekiz Mart University Faculty of Medicine, Çanakkale-Türkiye
| | - Murat Das
- Department of Emergency Medicine, Çanakkale Onsekiz Mart University Faculty of Medicine, Çanakkale-Türkiye
| | - Duygu Sıddıkoğlu
- Department of Biostatistic, Çanakkale Onsekiz Mart University Faculty of Medicine, Çanakkale-Türkiye
| | - Okhan Akdur
- Department of Emergency Medicine, Çanakkale Onsekiz Mart University Faculty of Medicine, Çanakkale-Türkiye
| | - Yavuz Beyazit
- Department of Internal Medicine, Çanakkale Onsekiz Mart University Faculty of Medicine, Çanakkale-Türkiye
| |
Collapse
|
8
|
Alberti P, Pando E, Mata R, Cirera A, Fernandes N, Hidalgo N, Gomez-Jurado MJ, Vidal L, Dopazo C, Blanco L, Gómez C, Caralt M, Balsells J, Charco R. The role of procalcitonin as a prognostic factor for acute cholangitis and infections in acute pancreatitis: a prospective cohort study from a European single center. HPB (Oxford) 2022; 24:875-884. [PMID: 34802942 DOI: 10.1016/j.hpb.2021.10.016] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Revised: 10/16/2021] [Accepted: 10/27/2021] [Indexed: 12/12/2022]
Abstract
BACKGROUND Infection in acute pancreatitis will worsen the disease prognosis. The aim of our study was to analyze the role of procalcitonin as a prognostic biomarker for infections and clinical severity. METHOD A prospective single-cohort observational study of patients diagnosed of acute pancreatitis (n = 152) was designed. PCT determination was tested on admission (first 72 h). Infections (biliary, extrapancreatic and infected pancreatic necrosis), need for antibiotics, urgent ERCP and severity scores for acute pancreatitis was assessed. ROC curves were designed and the area under the curve was calculated. Logistic regression for multivariate analysis was performed to evaluate the association between procalcitonin optimal cut-off level and major complications. RESULTS PCT >0.68 mg/dL had higher incidence of global infection, acute cholangitis, bacteraemia, infected pancreatic necrosis, use of antibiotics in general, and need for urgent ERCP. In the multivariate regressions analysis, PCT >0.68 mg/dL at admission demonstrated to be a strong risk factor for complications in acute pancreatitis. DISCUSSION PCT levels can be used as a reliable laboratory test to predict infections and the clinical severity of acute pancreatitis. High levels of PCT predict antibiotics prescription as well as the need for urgent ERCP in patients with concomitant clinically severe cholangitis.
Collapse
Affiliation(s)
- Piero Alberti
- Hepato-Pancreato-Biliary and Transplantation Department, Hospital Val D'Hebron, Barcelona, Spain
| | - Elizabeth Pando
- Hepato-Pancreato-Biliary and Transplantation Department, Hospital Val D'Hebron, Barcelona, Spain.
| | - Rodrigo Mata
- Hepato-Pancreato-Biliary and Transplantation Department, Hospital Val D'Hebron, Barcelona, Spain
| | - Arturo Cirera
- Hepato-Pancreato-Biliary and Transplantation Department, Hospital Val D'Hebron, Barcelona, Spain
| | - Nair Fernandes
- Hepato-Pancreato-Biliary and Transplantation Department, Hospital Val D'Hebron, Barcelona, Spain
| | - Nils Hidalgo
- Hepato-Pancreato-Biliary and Transplantation Department, Hospital Val D'Hebron, Barcelona, Spain
| | - María J Gomez-Jurado
- Hepato-Pancreato-Biliary and Transplantation Department, Hospital Val D'Hebron, Barcelona, Spain
| | - Laura Vidal
- Hepato-Pancreato-Biliary and Transplantation Department, Hospital Val D'Hebron, Barcelona, Spain
| | - Cristina Dopazo
- Hepato-Pancreato-Biliary and Transplantation Department, Hospital Val D'Hebron, Barcelona, Spain
| | - Laia Blanco
- Hepato-Pancreato-Biliary and Transplantation Department, Hospital Val D'Hebron, Barcelona, Spain
| | - Concepción Gómez
- Hepato-Pancreato-Biliary and Transplantation Department, Hospital Val D'Hebron, Barcelona, Spain
| | - Mireia Caralt
- Hepato-Pancreato-Biliary and Transplantation Department, Hospital Val D'Hebron, Barcelona, Spain
| | - Joaquim Balsells
- Hepato-Pancreato-Biliary and Transplantation Department, Hospital Val D'Hebron, Barcelona, Spain
| | - Ramón Charco
- Hepato-Pancreato-Biliary and Transplantation Department, Hospital Val D'Hebron, Barcelona, Spain
| |
Collapse
|
9
|
Hypoalbuminemia affects one third of acute pancreatitis patients and is independently associated with severity and mortality. Sci Rep 2021; 11:24158. [PMID: 34921151 PMCID: PMC8683470 DOI: 10.1038/s41598-021-03449-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Accepted: 11/23/2021] [Indexed: 12/08/2022] Open
Abstract
The incidence and medical costs of acute pancreatitis (AP) are on the rise, and severe cases still have a 30% mortality rate. We aimed to evaluate hypoalbuminemia as a risk factor and the prognostic value of human serum albumin in AP. Data from 2461 patients were extracted from the international, prospective, multicentre AP registry operated by the Hungarian Pancreatic Study Group. Data from patients with albumin measurement in the first 48 h (n = 1149) and anytime during hospitalization (n = 1272) were analysed. Multivariate binary logistic regression and Receiver Operator Characteristic curve analysis were used. The prevalence of hypoalbuminemia (< 35 g/L) was 19% on admission and 35.7% during hospitalization. Hypoalbuminemia dose-dependently increased the risk of severity, mortality, local complications and organ failure and is associated with longer hospital stay. The predictive value of hypoalbuminemia on admission was poor for severity and mortality. Severe hypoalbuminemia (< 25 g/L) represented an independent risk factor for severity (OR 48.761; CI 25.276–98.908) and mortality (OR 16.83; CI 8.32–35.13). Albumin loss during AP was strongly associated with severity (p < 0.001) and mortality (p = 0.002). Hypoalbuminemia represents an independent risk factor for severity and mortality in AP, and it shows a dose-dependent relationship with local complications, organ failure and length of stay.
Collapse
|
10
|
Binicier OB, Binicier HC. Evaluation of 880 patients diagnosed with acute pancreatitis according to the Revised Atlanta Classification: A single-center experience. ACTA ACUST UNITED AC 2020; 66:643-648. [PMID: 32638960 DOI: 10.1590/1806-9282.66.5.643] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Accepted: 12/28/2019] [Indexed: 11/22/2022]
Abstract
OBJECTIVE The Revised Atlanta Classification (RAC) is increasingly used in the evaluation of patients diagnosed with acute pancreatitis (AP). In our study, we aimed to evaluate the etiology, disease severity, and mortality rates of patients diagnosed with AP in our center in the previous 6 years. METHODS Patients diagnosed with AP between 2013 and 2018 were evaluated. AP etiology, demographic data, disease severity, and mortality rates according to the RAC were evaluated. RESULTS A total of 880 patients were included in the study. Five hundred and eighteen (59%) patients were female and 362 (41%) were male. Regarding the etiology, 474 (53.9%) patients had biliary AP (BAP), 71 (8.1%) had hyperlipidemic AP (HAP), and 44 (5%) had alcoholic AP (AAP). According to the RAC, 561 (63.7%) patients were considered to be in the mild AP group (MAP), 268 (30.5%) in the moderately severe AP (MSAP), and 51 (5.8%) in the severe AP (SAP). The mortality rate was 4.8% in the MSAP group and 49% in the SAP group. Mortality was 2.3 times in patients over 65 years old and 3.7 times higher in patients with ischemic heart disease. CONCLUSIONS In our country, BAP is still the main etiology of acute pancreatitis. Over the years, we have seen a decrease in BAP and idiopathic AP cases, while there was an increase in HAP cases due to factors such as lifestyle changes and fatty nutrition. We found that mortality was associated with disease severity, advanced age (> 65 y), hypertension, and ischemic heart disease regardless of the etiology.
Collapse
Affiliation(s)
- Omer Burcak Binicier
- Department of Gastroenterology, Tepecik Education, Research Hospital, Izmir, Turkey
| | - Hatice Cilem Binicier
- Department of Gastroenterology, Faculty of Medicine, Dokuz Eylul University, Izmir, Turkey
| |
Collapse
|
11
|
Huang Y, Ge H, Zheng M, Cui Y, Fu Z, Wu X, Xia Y, Chen L, Wang Z, Wang S, Xie H. Serum tRNA-derived fragments (tRFs) as potential candidates for diagnosis of nontriple negative breast cancer. J Cell Physiol 2019; 235:2809-2824. [PMID: 31535382 DOI: 10.1002/jcp.29185] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2019] [Accepted: 08/23/2019] [Indexed: 12/13/2022]
Abstract
Breast cancer has become the most common cancer in women, and nontriple negative breast cancer (non-TNBC) accounts for 80-90% of all invasive breast cancers. Early detection, diagnosis, and treatment are considered key to a successful cure. Conventionally, breast imaging and needle core biopsy are used for detection and monitoring. However, small variations in volume might be ignored in imaging, and traditional biopsies are spatially and temporally limited, leading to a significant delay in cancer detection and thus prompting renewed focus on early and accurate diagnosis. In this article, we investigated whether there is an accurate molecule in peripheral blood that can help diagnose breast cancer. Similar to microRNAs, tRNA-derived fragments (tRFs) have been reported to be involved in many pathological processes in breast cancer, but whether they can serve as candidate biomarkers for breast cancer remains unclear. Using high-throughput sequencing technology, we identified 4,021 differentially expressed tRFs in normal and breast cancer cell lines, and eight tRFs were selected to establish a signature as a predictive biomarker of non-TNBC. Furthermore, quantitative reverse-transcriptase polymerase chain reaction was performed to verify the expression of the signature and analyze the correlation between dysregulated tRFs and breast cancer. The results indicated that tDR-7816, tDR-5334, and tDR-4733 might be promising biomarkers. Through further bioinformatics analysis, we predicted that tDR-7816 influences the xenobiotic metabolic processes that support the oncogenesis of breast cancer. In summary, our results provide a rationale for using circulating tDR-7816 expression as a novel potential biomarker for the diagnosis of patients with early non-TNBC.
Collapse
Affiliation(s)
- Yue Huang
- Department of Breast Surgery, The First Affiliated Hospital, Nanjing Medical University, Nanjing, China
| | - Han Ge
- Department of Breast Surgery, The First Affiliated Hospital, Nanjing Medical University, Nanjing, China
| | - Mingjie Zheng
- Department of Breast Surgery, The First Affiliated Hospital, Nanjing Medical University, Nanjing, China
| | - Yangyang Cui
- Department of Breast Surgery, The First Affiliated Hospital, Nanjing Medical University, Nanjing, China
| | - Ziyi Fu
- Department of Oncology, The First Affiliated Hospital, Nanjing Medical University, Nanjing, China.,Nanjing Maternal and Child Health Medical Institute, Nanjing Maternity and Child Health Care Hospital, Obstetrics and Gynecology Hospital Affiliated to Nanjing Medical University, Nanjing, China.,Department of Obstetrics and Gynecology, Northwestern University, Illinois
| | - Xiaowei Wu
- Department of Breast Surgery, The First Affiliated Hospital, Nanjing Medical University, Nanjing, China
| | - Yiqin Xia
- Department of Breast Surgery, The First Affiliated Hospital, Nanjing Medical University, Nanjing, China
| | - Lie Chen
- Department of Breast Surgery, The First Affiliated Hospital, Nanjing Medical University, Nanjing, China
| | - Zhenghui Wang
- Department of Thyroid and Breast Surgery, The Second Hospital of Nanjing, Nanjing University of Chinese Medicine, Nanjing, China
| | - Shui Wang
- Department of Breast Surgery, The First Affiliated Hospital, Nanjing Medical University, Nanjing, China
| | - Hui Xie
- Department of Breast Surgery, The First Affiliated Hospital, Nanjing Medical University, Nanjing, China
| |
Collapse
|
12
|
Zhou H, Mei X, He X, Lan T, Guo S. Severity stratification and prognostic prediction of patients with acute pancreatitis at early phase: A retrospective study. Medicine (Baltimore) 2019; 98:e15275. [PMID: 31008971 PMCID: PMC6494233 DOI: 10.1097/md.0000000000015275] [Citation(s) in RCA: 72] [Impact Index Per Article: 14.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2018] [Revised: 12/14/2018] [Accepted: 03/22/2019] [Indexed: 12/11/2022] Open
Abstract
Severity stratification and prognostic prediction at early stage is crucial for reducing the rates of mortality of patients with acute pancreatitis (AP). We aim to investigate the predicting performance of neutrophil-lymphocyte ratio (NLR), platelet-lymphocyte ratio (PLR), and red-cell distribution width (RDW) combined with severity scores (sequential organ failure assessment [SOFA], bed-side index for severity of AP [BISAP], Ranson criteria, and acute physiology and chronic health evaluation II [APACHE II]) for severe AP (SAP) and mortality.A total of 406 patients diagnosed with AP admitted in a tertiary teaching hospital were enrolled. Demographic information and clinical parameters were retrospectively collected and analyzed. NLR, PLR, RDW, blood urea nitrogen (BUN), and AP severity scores (SOFA, BISAP, Ranson, and APACHE II) were compared between different severity groups and the survival and death group. Receiver-operating characteristic (ROC) curves for SAP and 28-day mortality were calculated for each predictor using cut-off values. Area under the curve (AUC) analysis and logistic regression models were performed to compare the performance of laboratory biomarkers and severity scores.Our results showed that NLR, PLR, RDW, glucose, and BUN level of the SAP group were significantly increased compared to the mild acute pancreatitis (MAP) group on admission (P < .001). The severity of AP increased as the NLR, SOFA, BISAP, and Ranson increased (P < .01). The AUC values of NLR, PLR, RDW, BUN, SOFA, BISAP, Ranson, and APACHE II to predict SAP were 0.722, 0.621, 0.787, 0.677, 0.806, 0.841, 0.806, and 0.752, respectively, while their AUC values to predict 28-day mortality were 0.851, 0.693, 0.885, 0.765, 0.968, 0.929, 0.812, and 0.867, respectively. BISAP achieved the highest AUC, sensitivity and NPV in predicting SAP, while SOFA is the most superior in predicting mortality. The combination of BISAP + RDW achieved the highest AUC (0.872) in predicting SAP and the combination of SOFA + RDW achieved the highest AUC (0.976) in predicting mortality. RDW (OR = 1.739), SOFA (OR = 1.554), BISAP (OR = 2.145), and Ranson (OR = 1.434) were all independent risk factors for predicting SAP, while RDW (OR = 7.361) and hematocrit (OR = 0.329) were independent risk factors for predicting mortality by logistic regression model.NLR, PLR, RDW, and BUN indicated good predictive value for SAP and mortality, while RDW had the highest discriminatory capacity. RDW is a convenient and reliable indicator for prediction not only SAP, but also mortality.
Collapse
Affiliation(s)
- Haijiang Zhou
- Department of Emergency Medicine, Beijing Chao-yang Hospital
| | - Xue Mei
- Department of Emergency Medicine, Beijing Chao-yang Hospital
| | - Xinhua He
- Department of Emergency Medicine, Beijing Chao-yang Hospital
| | - Tianfei Lan
- Department of Allergy, Beijing Shijitan Hospital, Capital Medical University, Beijing, China
| | - Shubin Guo
- Department of Emergency Medicine, Beijing Chao-yang Hospital
| |
Collapse
|