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Gűnșahin D, Edu AV, Pahomeanu MR, Mitu TȘ, Ghiță AI, Odorog AS, Preda CM, Negreanu L. Alcoholic Acute Pancreatitis, a Retrospective Study about Clinical Risk Factors and Outcomes-A Seven-Year Experience of a Large Tertiary Center. Biomedicines 2024; 12:1299. [PMID: 38927504 PMCID: PMC11201127 DOI: 10.3390/biomedicines12061299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2024] [Revised: 06/08/2024] [Accepted: 06/10/2024] [Indexed: 06/28/2024] Open
Abstract
(1) Background: Alcohol consumption is one of the main causes of acute pancreatitis. (2) Material and Methods: In this unicentric retrospective cohort study, we selected 1855 patients from the Bucharest Acute Pancreatitis Index (BUC-API) who presented with acute pancreatitis. We investigated correlations between Alcoholic Acute Pancreatitis (AAP) and the rate of complications, cost, length of hospitalization and rate of recurrence. (3) Results: We found a moderately strong association between AAP and recurrence (p < 0.01) and observed that the disease is likelier to evolve with pseudocysts and walled-off necrosis than other forms of AP. Patients with AAP are less likely to have a morphologically normal pancreas than patients suffering from AP of other causes (p < 0.01), but a low probability of requiring intensive care unit admission (p < 0.01) significantly lowers daily cost (Md = 154.7 EUR compared to Md = 204.4 EUR) (p < 0.01). (4) Conclusions: This study's data show that patients with AAP have a greater rate of pseudocyst occurrence, lower intensive care unit admittance rate and lower cost of hospitalization than patients with AP of other causes. Typical Sketch: A middle-aged male tobacco smoker with recurrent AP, lower risk of in-hospital mortality and complications such as pseudocysts; treated in a gastroenterological ward and discharged at-will.
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Affiliation(s)
- Deniz Gűnșahin
- Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, B-dul. Eroii Sanitari, 8, 050474 Bucharest, Romania (C.M.P.)
- Gastroenterology Department, Emergency Clinical Hospital Bucharest, Calea Floreasca, 8, 014461 Bucharest, Romania
| | - Andrei Vicențiu Edu
- Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, B-dul. Eroii Sanitari, 8, 050474 Bucharest, Romania (C.M.P.)
- Internal Medicine & Gastroenterology Department, University Emergency Hospital of Bucharest, Splaiul Independenței, 169, 050098 Bucharest, Romania
| | - Mihai Radu Pahomeanu
- Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, B-dul. Eroii Sanitari, 8, 050474 Bucharest, Romania (C.M.P.)
- Internal Medicine & Gastroenterology Department, University Emergency Hospital of Bucharest, Splaiul Independenței, 169, 050098 Bucharest, Romania
| | - Tudor Ștefan Mitu
- Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, B-dul. Eroii Sanitari, 8, 050474 Bucharest, Romania (C.M.P.)
| | - Andreea Irina Ghiță
- Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, B-dul. Eroii Sanitari, 8, 050474 Bucharest, Romania (C.M.P.)
| | - Anamaria Simona Odorog
- Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, B-dul. Eroii Sanitari, 8, 050474 Bucharest, Romania (C.M.P.)
| | - Carmen Monica Preda
- Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, B-dul. Eroii Sanitari, 8, 050474 Bucharest, Romania (C.M.P.)
- Gastroenterology Department, Fundeni Clinical Insititute, Soseaua Fundeni, 258, 022328 Bucharest, Romania
| | - Lucian Negreanu
- Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, B-dul. Eroii Sanitari, 8, 050474 Bucharest, Romania (C.M.P.)
- Internal Medicine & Gastroenterology Department, University Emergency Hospital of Bucharest, Splaiul Independenței, 169, 050098 Bucharest, Romania
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Lin W, Huang Y, Zhu J, Sun H, Su N, Pan J, Xu J, Chen L. Machine learning improves early prediction of organ failure in hyperlipidemia acute pancreatitis using clinical and abdominal CT features. Pancreatology 2024; 24:350-356. [PMID: 38342660 DOI: 10.1016/j.pan.2024.02.003] [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: 04/30/2023] [Revised: 01/24/2024] [Accepted: 02/05/2024] [Indexed: 02/13/2024]
Abstract
BACKGROUND This study aimed to investigate and validate machine-learning predictive models combining computed tomography and clinical data to early predict organ failure (OF) in Hyperlipidemic acute pancreatitis (HLAP). METHODS Demographics, laboratory parameters and computed tomography imaging data of 314 patients with HLAP from the First Affiliated Hospital of Wenzhou Medical University between 2017 and 2021, were retrospectively analyzed. Sixty-five percent of patients (n = 204) were assigned to the training group and categorized as patients with and without OF. Parameters were compared by univariate analysis. Machine-learning methods including random forest (RF) were used to establish model to predict OF of HLAP. Areas under the curves (AUCs) of receiver operating characteristic were calculated. The remaining 35% patients (n = 110) were assigned to the validation group to evaluate the performance of models to predict OF. RESULTS Ninety-three (45.59%) and fifty (45.45%) patients from the training and the validation cohort, respectively, developed OF. The RF model showed the best performance to predict OF, with the highest AUC value of 0.915. The sensitivity (0.828) and accuracy (0.814) of RF model were both the highest among the five models in the study cohort. In the validation cohort, RF model continued to show the highest AUC (0.820), accuracy (0.773) and sensitivity (0.800) to predict OF in HLAP, while the positive and negative likelihood ratios and post-test probability were 3.22, 0.267 and 72.85%, respectively. CONCLUSIONS Machine-learning models can be used to predict OF occurrence in HLAP in our pilot study. RF model showed the best predictive performance, which may be a promising candidate for further clinical validation.
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Affiliation(s)
- Weihang Lin
- Department of Hepatopancreatobiliary Surgery, The First Affiliated Hospital of Wenzhou Medical University, China
| | - Yingbao Huang
- Department of Radiology, The First Affiliated Hospital of Wenzhou Medical University, China
| | - Jiale Zhu
- School of the First Clinical Medical Sciences, Wenzhou Medical University, China
| | - Houzhang Sun
- Department of Radiology, The First Affiliated Hospital of Wenzhou Medical University, China
| | - Na Su
- Department of Radiology, The First Affiliated Hospital of Wenzhou Medical University, China
| | - Jingye Pan
- Intensive Care Unit, The First Affiliated Hospital of Wenzhou Medical University, China; Key Laboratory of Intelligent Treatment and Life Support for Critical Diseases of Zhejiang Province, China; Collaborative Innovation Center for Intelligence Medical Education, China; Zhejiang Engineering Research Center for Hospital Emergency and Process Digitization, China
| | - Junkang Xu
- Intensive Care Unit, The First Affiliated Hospital of Wenzhou Medical University, China; Key Laboratory of Intelligent Treatment and Life Support for Critical Diseases of Zhejiang Province, China; Collaborative Innovation Center for Intelligence Medical Education, China; Zhejiang Engineering Research Center for Hospital Emergency and Process Digitization, China
| | - Lifang Chen
- Department of Radiology, The First Affiliated Hospital of Wenzhou Medical University, China.
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Fu H, Li P, Xing Q, Jiang H, Sui H. Cutoff Value of Psoas Muscle Area as Reduced Muscle Mass and Its Association with Acute Pancreatitis in China. Int J Gen Med 2023; 16:2733-2751. [PMID: 37408848 PMCID: PMC10319281 DOI: 10.2147/ijgm.s413308] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Accepted: 06/14/2023] [Indexed: 07/07/2023] Open
Abstract
Objective The Global Leadership Initiative on Malnutrition (GLIM) has proposed criteria for the diagnosis of malnutrition, one of which is reduced muscle mass. Computed tomography (CT) assessment of psoas muscle area (PMA) has been used to estimate muscle mass in patients, including those with acute pancreatitis (AP). The present study aimed to define the cutoff value of PMA indicative of reduced muscle mass in patients with AP and to assess the impact of reduced muscle mass on the severity and early complications of AP. Methods Clinical data of 269 patients with AP were analyzed retrospectively. The severity of AP was determined according to the revised Atlanta classification. PMA was evaluated by CT and used to calculate the psoas muscle index (PMI). Cutoff values for reduced muscle mass were calculated and validated. Logistic regression analysis was performed to assess the relationship between PMA and the severity of AP. Results PMA was a better indicator of reduced muscle mass than PMI, with cutoff values of 11.50 cm2 for men and 8.22 cm2 for women. Rates of local complications, splenic vein thrombosis, and organ failure were significantly higher in AP patients with low than high PMA (all p < 0.05). PMA showed good ability to predict splenic vein thrombosis in women, with an area under the receiver operating characteristic curve of 0.848 (95% confidence interval 0.768-0.909, sensitivity 100%, specificity 83.64%). Multivariate logistic regression revealed that PMA was an independent risk factor for moderately severe plus severe AP (odds ratio 5.639, p = 0.001) and severe AP (odds ratio 3.995, p = 0.038). Conclusion PMA is a good predictor of the severity and complications of AP. The PMA cutoff value is a good indicator of reduced muscle mass.
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Affiliation(s)
- Hao Fu
- Nutrition Department, Affiliated Hospital of Chengde Medical University, Chengde, Heibei, People’s Republic of China
| | - Ping Li
- Gastroenterology, Affiliated Hospital of Chengde Medical University, Chengde, HeibeiPeople's Republic of China
| | - Qianchao Xing
- Radiology Department, Affiliated Hospital of Chengde Medical University, Chengde, Heibei, People's Republic of China
| | - Hui Jiang
- Nutrition Department, Affiliated Hospital of Chengde Medical University, Chengde, Heibei, People’s Republic of China
| | - Hangshuo Sui
- Nutrition Department, Chengde Central Hospital, Chengde, Heibei, People’s Republic of China
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Li J, Chen Z, Li L, Lai T, Peng H, Gui L, He W. Interleukin-6 is better than C-reactive protein for the prediction of infected pancreatic necrosis and mortality in patients with acute pancreatitis. Front Cell Infect Microbiol 2022; 12:933221. [PMID: 36467730 PMCID: PMC9716459 DOI: 10.3389/fcimb.2022.933221] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2022] [Accepted: 09/12/2022] [Indexed: 09/16/2023] Open
Abstract
INTRODUCTION This study aimed to identify whether interleukin-6 (IL-6) is better than C-reactive protein (CRP) for the prediction of severe acute pancreatitis (SAP), infected pancreatic necrosis (IPN), and mortality. METHODS Sixty-seven patients with acute pancreatitis (AP) who were hospitalized within 48 h of onset and received serum CRP and IL-6 tests from September 2018 to September 2019 were included. Spearman's correlation was performed to assess their associations with severity. The areas under the curve (AUCs) for the prediction of SAP, organ failure, pancreatic necrosis, IPN, and mortality were estimated using receiver operating characteristic curves. RESULT Serum CRP and IL-6 levels were significantly positively correlated with the severity of AP (p < 0.05). The AUC for the prediction of SAP based on the CRP level was 0.78 (95% CI, 0.66-0.89) and that based on the IL-6 level was 0.69 (95% CI, 0.56-0.82). For the prediction of organ failure and pancreatic necrosis, CRP was more accurate than IL-6 (AUC 0.80 vs. 0.72 and 0.75 vs. 0.68, respectively). However, CRP was less accurate than IL-6 for predicting mortality and IPN (AUC 0.70 vs. 0.75 and 0.65 vs. 0.81, respectively). Systemic inflammatory response syndrome plus CRP was more accurate than systemic inflammatory response syndrome plus IL-6 (AUC 0.79 vs. 0.72) for the prediction of SAP. CONCLUSIONS IL-6 was more accurate than CRP for predicting mortality and IPN in patients with AP.
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Affiliation(s)
| | | | | | | | | | | | - Wenhua He
- Pancreatic Disease Centre, Department of Gastroenterology, The First Affiliated Hospital of Nanchang University, Nanchang, China
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Han C, Yang HY, Lv YW, Dong ZQ, Liu Y, Li ZS, Wang D, Hu LH. Global status of acute pancreatitis research in the last 20 years: A bibliometric study. Medicine (Baltimore) 2022; 101:e31051. [PMID: 36254012 PMCID: PMC9575756 DOI: 10.1097/md.0000000000031051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Acute pancreatitis (AP) is a common digestive disease encountered in Emergency Departments that carries a heavy socioeconomic burden. This study was conducted to determine the global status of AP research. Articles related to AP published in 1999 to 2018 were retrieved from the Web of Science (WOS) database and the 20 highest-output countries or regions were determined based on the total number of publications. Correlation analysis of AP research output and the gross domestic product (GDP) of each country or region was conducted. The quantity and quality of research of these 20 highest-output countries were compared to the total output, outputs per capita, and average impact factor (IF). All annual data were analyzed using time-trend analysis. A keyword co-occurrence analysis was conducted to determine the highlights in AP research. In total, 17,698 publications were retrieved, and 16,461 papers (93.0%) of them were from the 20 highest-output countries. A significantly positive correlation was identified between AP research output and the GDP (R = 0.973, P < .001). The 5 highest-output countries were the USA (24.9%), China (12.3%), Germany (7.5%), Japan (6.7%), and the UK (6.1%). Finland ranked 1st in the number of publication per capita, the USA had the highest accumulated IF (25,432.758) and total citations (104,592), Switzerland had the highest average IF (6.723), and Netherland had the highest average citations (51.90). Genetic research and AP-related hyperglycemia were research highlights. Analysis of the global output of research of AP research showed signs of growth. Research output was positively correlated with GDP. For the most productive countries, research quality was stable. Although developing countries lagged behind in output per capita and quality, great progress has been made in the past 2 decades.
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Affiliation(s)
- Chao Han
- Department of Gastroenterology, First Affiliated Hospital of Navy Medical University, Shanghai, China
| | - Huai-Yu Yang
- Department of Gastroenterology, First Affiliated Hospital of Navy Medical University, Shanghai, China
| | - Yan-Wei Lv
- Department of Gastroenterology, First Affiliated Hospital of Navy Medical University, Shanghai, China
| | - Zhi-Qi Dong
- Department of Gastroenterology, Shanghai Fourth People’s Hospital, Tongji University School of Medicine, Shanghai, China
| | - Yu Liu
- Department of Gastroenterology, Jinling Hospital, Medical School of Nanjing University, Nanjing, China
| | - Zhao-Shen Li
- Department of Gastroenterology, First Affiliated Hospital of Navy Medical University, Shanghai, China
| | - Dan Wang
- Department of Gastroenterology, First Affiliated Hospital of Navy Medical University, Shanghai, China
| | - Liang-Hao Hu
- Department of Gastroenterology, First Affiliated Hospital of Navy Medical University, Shanghai, China
- * Correspondence: Liang-Hao Hu, Department of Gastroenterology, First Affiliated Hospital of Navy Medical University, 168 Changhai Road, Shanghai, China (e-mail: )
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Protective effects of HTD4010, a Reg3a/PAP-derived peptide, in a mouse model of hypertriglyceridemic acute pancreatitis: Involvement of TLR4/NF-kappa B. Biochem Biophys Res Commun 2022; 630:118-124. [PMID: 36155057 DOI: 10.1016/j.bbrc.2022.09.047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2022] [Revised: 09/03/2022] [Accepted: 09/11/2022] [Indexed: 11/24/2022]
Abstract
Acute pancreatitis (AP) is an inflammatory disorder of pancreas and common digestive diseases, effective drug for AP is few. As an analog of active center of Reg3α, the biological activities of HTD4010 are similar to Reg3α. This study aimed to explore whether HTD4010 could decrease the inflammatory response and pancreatic injury in hypertriglyceridemic-AP (HTG-AP), and explore underlying mechanisms. This study was shown that the administration of HTD4010 could decrease the inflammatory response, reduce acinar cell injury (both apoptosis and necroptosis) and damage of lung tissue in HTG-AP. Moreover, HTD4010 down-regulated the expression of TLR4 and NF-κB protein. These results showed that HTD4010 could alleviate the severity of AP possibly by TLR4/NF-κB signaling pathway in HTG-AP.
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Wang L, Xu T, Wang R, Wang X, Wu D. Hypertriglyceridemia Acute Pancreatitis: Animal Experiment Research. Dig Dis Sci 2022; 67:761-772. [PMID: 33939144 DOI: 10.1007/s10620-021-06928-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Accepted: 02/26/2021] [Indexed: 12/09/2022]
Abstract
In recent years, the number of acute pancreatitis cases caused by hypertriglyceridemia has increased gradually, which has caught the attention of the medical community. However, because the exact mechanism of hypertriglyceridemic acute pancreatitis (HTG-AP) is not clear, treatment and prevention in clinical practice face enormous challenges. Animal models are useful for elucidating the pathogenesis of diseases and developing and testing novel interventions. Therefore, animal experiments have become the key research means for us to understand and treat this disease. We searched almost all HTG-AP animal models by collecting many studies and finally collated common animals such as rats, mice and included some rare animals that are not commonly used, summarizing the methods to model spontaneous pancreatitis and induce pancreatitis. We sorted them on the basis of three aspects, including the selection of different animals, analyzed the characteristics of different animals, different approaches to establish hypertriglyceridemic pancreatitis and their relative advantages and disadvantages, and introduced the applications of these models in studies of pathogenesis and drug therapy. We hope this review can provide relevant comparisons and analyses for researchers who intend to carry out animal experiments and will help researchers to select and establish more suitable animal experimental models according to their own experimental design.
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Affiliation(s)
- Lu Wang
- Department of Gastroenterology, The Fourth Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, China
| | - Ting Xu
- Department of Gastroenterology, The Fourth Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, China
| | - Ruifeng Wang
- Department of Gastroenterology, The Fourth Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, China.
| | - Xiaobing Wang
- Department of Gastroenterology, The First Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, China
| | - Dong Wu
- Department of Gastroenterology, Peking Union Medical College Hospital and Chinese Academy of Medical Sciences, Beijing, China
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Comparative analysis of epidemiology, etiology, and outcomes between elderly and young and middle-aged acute pancreatitis patients: a retrospective, single-center study. Eur J Gastroenterol Hepatol 2021; 33:1254-1259. [PMID: 33177384 DOI: 10.1097/meg.0000000000001993] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
OBJECTIVE The aim of this study was to analyze the etiology and epidemiology of the patients with first-attack acute pancreatitis of two-age groups. METHODS This is a retrospective comparative study of 2965 patients aged 18 years and older with first-attack acute pancreatitis between 2013 and 2018 in the Affiliated Hospital of Southwest Medical University. Patients divided into the elderly group (age > or = 60 years) and the young and middle-aged group (age <60 years). The etiology tendency and clinical characteristics were analyzed. RESULTS In the elderly group, the proportions of women to men was higher compared with the young and middle-aged group (1.48 vs. 0.69, P < 0.001). The primary etiology of acute pancreatitis in two groups were biliary tract diseases. The main etiology of the young and middle-aged group among men was alcohol and among women was biliary disease. Comparing with the young and middle-aged group, the elderly patients had a higher proportion of hypertension, ischemic heart disease, and cerebrovascular disease (P < 0.001). Meanwhile, the proportions of system inflammatory reaction syndrome, multiple organ dysfunction syndrome (MODS), and shock were also higher in the elderly group (P < 0.001). Mortality in the elderly group and the young and middle-aged group was 1.69 and 0.72%, respectively. CONCLUSIONS Biliary tract diseases were the predominant etiological factor in two groups. The two groups had different etiological proportions according to gender, complications, comorbidities, and outcomes. Furthermore, elderly patients are more likely to with complications, comorbidities, and highly mortality rate. We should pay more attention to realize the characteristics of acute pancreatitis at different ages.
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Liu J, Niu Z, Zhang R, Peng Z, Wang L, Liu Z, Gao Y, Pei H, Pan L. MALAT1 shuttled by extracellular vesicles promotes M1 polarization of macrophages to induce acute pancreatitis via miR-181a-5p/HMGB1 axis. J Cell Mol Med 2021; 25:9241-9254. [PMID: 34448533 PMCID: PMC8500974 DOI: 10.1111/jcmm.16844] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Revised: 07/05/2021] [Accepted: 07/13/2021] [Indexed: 02/05/2023] Open
Abstract
Acute pancreatitis (AP) is a serious condition carrying a mortality of 25–40%. Extracellular vesicles (EVs) have reported to exert potential functions in cell‐to‐cell communication in diseases such as pancreatitis. Thus, we aimed at investigating the mechanisms by which EV‐encapsulated metastasis‐associated lung adenocarcinoma transcript‐1 (MALAT1) might mediate the M1 polarization of macrophages in AP. Expression patterns of MALAT1, microRNA‐181a‐5p (miR‐181a‐5p) and high‐mobility group box 1 protein (HMGB1) in serum of AP patients were determined. EVs were isolated from serum and pancreatic cells. The binding affinity among miR‐181a‐5p, MALAT1 and HMGB1 was identified. AP cells were co‐cultured with EVs from caerulein‐treated MPC‐83 cells to determine the levels of M1/2 polarization markers and TLR4, NF‐κB and IKBa. Finally, AP mouse models were established to study the effects of EV‐encapsulated MALAT1 on the M1 polarization of macrophages in AP in vivo. MALAT1 was transferred into MPC‐83 cells via EVs, which promoted M1 polarization of macrophages in AP. MALAT1 competitively bound to miR‐181a‐5p, which targeted HMGB1. Moreover, MALAT1 activated the TLR4 signalling pathway by regulating HMGB1. EV‐encapsulated MALAT1 competitively bound to miR‐181a‐5p to upregulate the levels of IL‐6 and TNF‐α by regulating HMGB1 via activation of the TLR4 signalling pathway, thereby inducing M1 polarization of macrophages in AP. In vivo experimental results also confirmed that MALAT1 shuttled by EVs promoted M1 polarization of macrophages in AP via the miR‐181a‐5p/HMGB1/TLR4 axis. Overall, EV‐loaded MALAT1 facilitated M1 polarization of macrophages in AP via miR‐181a‐5p/HMGB1/TLR4, highlighting a potential target for treating AP.
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Affiliation(s)
- Jie Liu
- Department of Emergency Medicine, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Zequn Niu
- Department of Emergency Medicine, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Rui Zhang
- Department of Emergency Medicine, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Zhuo Peng
- Department of Emergency Medicine, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Liming Wang
- Department of Emergency Medicine, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Zhong Liu
- Department of Emergency Medicine, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Yanxia Gao
- Department of Emergency Medicine, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Honghong Pei
- Department of Emergency Medicine, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Longfei Pan
- Department of Emergency Medicine, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
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Factors Associated with Fluid Sequestration in Patients with Acute Pancreatitis: A Prospective Study in Tertiary Centre Hospital in Nepal. Gastroenterol Res Pract 2021; 2021:5579267. [PMID: 34257644 PMCID: PMC8253623 DOI: 10.1155/2021/5579267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2021] [Revised: 06/03/2021] [Accepted: 06/13/2021] [Indexed: 11/29/2022] Open
Abstract
Background Acute pancreatitis (AP) is associated with extensive fluid sequestration. The aim of this study was to determine association of fluid sequestration at 48 hours after hospital admission (FS48) in AP patients with demographics, clinical parameters, and outcomes of AP. Methods A prospective observational study was carried out on all adult patients with AP admitted to Tribhuvan University Teaching Hospital, Nepal, from January to September 2017. FS48 was calculated as the difference between fluid input and output in the first 48 hours of admission. The Kruskal-Wallis test with post hoc Dunn's test examined the difference in FS48 between mild AP, moderately severe AP, and severe AP. Linear regression analysis was used to evaluate association between FS48 with patients' characteristics and outcomes of AP. Outcomes of AP assessed included pancreatic necrosis, persistent organ failure, length of stay, and in-hospital mortality. Results Eighty patients (median age 44 years; 57% male) with a median FS48 of 1610 mL were evaluated. The median FS48 for mild AP, moderately severe AP, and severe AP were 1,180 mL, 2,380 mL, and 3,500 mL, respectively. There was a significant difference in pairwise comparisons between mild AP and moderately severe AP, along with mild AP and severe AP. Younger age, other etiology, and higher creatinine were independently associated with increased FS48. Increased FS48 was significantly associated with pancreatic necrosis, persistent organ failure, and in-hospital mortality. Conclusions In our study population, younger age and higher creatinine were predictors of increased FS48. Increased FS48 was associated with poorer outcomes of AP.
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Sun C, Li Z, Shi Z, Li G. Current diagnosis and treatment of acute pancreatitis in China: a real-world, multicenter study. BMC Gastroenterol 2021; 21:210. [PMID: 33964868 PMCID: PMC8105912 DOI: 10.1186/s12876-021-01799-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Accepted: 04/26/2021] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Efficacy of pancreatic enzyme inhibitors in acute pancreatitis (AP) is unclear in China. AIMS We aimed to present the current status of AP and evaluate the efficacy of pancreatic enzyme inhibitors in a larger population in China. METHOD A retrospective, cross-sectional, real-world, multicenter analysis of a large dataset of patients presenting with AP from four hospitals of China over a two-year period was performed. Data were collected from the existing clinical records and the patients were grouped into medication group (somatostatin or octreotide or somatostatin and octreotide) and no medication group. Pair wise propensity score matching was performed for comparing somatostatin, octreotide and somatostatin/octreotide. The end points were incidence of disease complications, organ failure, hospitalization duration, and recovery time taken (hours) for serum amylase/serum lipase to normalcy. RESULTS A total of 3900 patients were recruited and 2775 patients were included for analysis. A total of 1100, 661, 676 and 338 patients received either somatostatin or octreotide or somatostatin and octreotide or no medication, respectively. The incidence of complications (7.6% vs 13.6%), organ failure (4.5% vs 7.4%), and the instances of entering ICU (9.3% vs 13.3%) were higher in unmedicated group. Complications at discharge (2.91 times), organ failure (2.53 times), and hospitalization stay were higher in octreotide-treated patients compared with somatostatin-treated patients. In comparison to the octreotide group, the serum amylase/lipase recovery time was shorter in the somatostatin group. CONCLUSION This real-world study suggested that the use of pancreatic enzyme inhibitors was positively associated with greater clinical efficacy in AP patients and somatostatin might be more effective than octreotide in real-world settings in China.
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Affiliation(s)
- Chuandong Sun
- Department of Surgery, The Affiliated Hospital of Qingdao University, Shandong, People's Republic of China
| | - Zhu Li
- Department of Surgery, The Affiliated Hospital of Guizhou Medical University, Guizhou, People's Republic of China
| | - Zheng Shi
- Department of Surgery, The First Affiliated Hospital of Fujian Medical University, Fujian, People's Republic of China
| | - Guichen Li
- Department of Surgery, The First Hospital of China Medical University, No. 155 Najing North Street, Heping District, Shenyang, Liaoning Province, People's Republic of China.
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12
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Accurate prediction of acute pancreatitis severity with integrative blood molecular measurements. Aging (Albany NY) 2021; 13:8817-8834. [PMID: 33714951 PMCID: PMC8034948 DOI: 10.18632/aging.202689] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Accepted: 02/01/2021] [Indexed: 12/12/2022]
Abstract
BACKGROUND Early diagnosis of severe acute pancreatitis (SAP) is essential to minimize its mortality and improve prognosis. We aimed to develop an accurate and applicable machine learning predictive model based on routine clinical testing results for stratifying acute pancreatitis (AP) severity. RESULTS We identified 11 markers predictive of AP severity and trained an AP stratification model called APSAVE, which classified AP cases within 24 hours at an average area under the curve (AUC) of 0.74 +/- 0.04. It was further validated in 568 validation cases, achieving an AUC of 0.73, which is similar to that of Ranson's criteria (AUC = 0.74) and higher than APACHE II and BISAP (AUC = 0.69 and 0.66, respectively). CONCLUSIONS We developed and validated a venous blood marker-based AP severity stratification model with higher accuracy and broader applicability, which holds promises for reducing SAP mortality and improving its clinical outcomes. MATERIALS AND METHODS Nine hundred and forty-five AP patients were enrolled into this study. Clinical venous blood tests covering 65 biomarkers were performed on AP patients within 24 hours of admission. An SAP prediction model was built with statistical learning to select biomarkers that are most predictive for AP severity.
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13
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Yan P, Zhao HX, Chen X. Suboptimal management of hypertriglyceridemia in the outpatient setting is associated with the recurrent pancreatitis: A retrospective cohort study. Medicine (Baltimore) 2020; 99:e22887. [PMID: 33120833 PMCID: PMC7581036 DOI: 10.1097/md.0000000000022887] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Hyperlipemia is a well-established etiology of acute pancreatitis. However, few data are available in the medical literature about the management of triglyceride levels in the outpatient setting in patients with hypertriglyceridemic acute pancreatitis (HTG-AP). We evaluated the blood triglyceride levels and followed the triglyceride management of patients with HTG-AP.This retrospective study enrolled patients with HTG-AP from January 2013 to March 2019 in the Affiliated Hospital of Southwest Medical of University. By reviewing the hospitalization records and the follow-up data, the clinical features, blood triglyceride levels, use of lipid-lowering medications and rate of blood triglyceride levels monitoring after hospital discharge were analyzed.A total of 133 patients (46 women, 87 men; median age at presentation 37.4 years) diagnosed with HTG-AP were enrolled in the study. Thirty-two patients (24.1%) presented with recurrent acute pancreatitis (RAP). Patients who had RAP were younger and had higher blood triglyceride levels than those with a single attack (P < .05). No difference in serum amylase levels, hospitalization duration or mortality rate were observed between non-recurrent acute pancreatitis and RAP patients. Lipid monitoring was only observed in 12.8% of patients and 10 patients (7.5%) took medications to control their blood triglyceride levels after hospital discharge. The follow-up of triglyceride levels in the outpatient setting were higher in RAP patients than in patients with non-recurrent acute pancreatitis (P < .05). Among the patients who measured their triglyceride levels after discharge, 83.3% of patients with RAP had at least 1 follow-up triglyceride level that was higher than 500 mg/dL, while no patients had an HTG-AP attack with a triglyceride level higher than 500 mg/dL.Triglyceride levels after hospital discharge higher than 500 mg/dL may be associated with an increased risk of relapse of clinical acute pancreatitis events. Inappropriate management for triglyceride control in the outpatient setting may be associated with an increased risk of relapse of clinical HTG-AP events.
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Affiliation(s)
- Ping Yan
- Department of Gastroenterology, Affiliated Hospital of Southwest Medical University
| | - Hong-Xian Zhao
- Department of Histology and Embryology, Southwest Medical University, Luzhou City, P.R. China
| | - Xia Chen
- Department of Gastroenterology, Affiliated Hospital of Southwest Medical University
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14
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Bálint ER, Fűr G, Kiss L, Németh DI, Soós A, Hegyi P, Szakács Z, Tinusz B, Varjú P, Vincze Á, Erőss B, Czimmer J, Szepes Z, Varga G, Rakonczay Z. Assessment of the course of acute pancreatitis in the light of aetiology: a systematic review and meta-analysis. Sci Rep 2020; 10:17936. [PMID: 33087766 PMCID: PMC7578029 DOI: 10.1038/s41598-020-74943-8] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Accepted: 09/28/2020] [Indexed: 12/11/2022] Open
Abstract
The main causes of acute pancreatitis (AP) are biliary disease, alcohol consumption, hypertriglyceridaemia (HTG) and endoscopic retrograde cholangiopancreatography (ERCP). The aim of this meta-analysis was to evaluate the effects of these aetiological factors on the severity and outcome of AP. Pubmed and Embase were searched between 01/01/2012 and 31/05/2020. Included articles involved adult alcoholic, biliary, HTG- or post-ERCP AP (PAP) patients. Primary outcome was severity, secondary outcomes were organ failures, intensive care unit admission, recurrence rate, pancreatic necrosis, mortality, length of hospital stay, pseudocyst, fluid collection and systematic inflammatory response syndrome. Data were analysed from 127 eligible studies. The risk for non-mild (moderately severe and severe) condition was the highest in HTG-induced AP (HTG-AP) followed by alcoholic AP (AAP), biliary AP (BAP) and PAP. Recurrence rate was significantly lower among BAP vs. HTG-AP or AAP patients (OR = 2.69 and 2.98, 95% CI 1.55–4.65 and 2.22–4.01, respectively). Mortality rate was significantly greater in HTG-AP vs. AAP or BAP (OR = 1.72 and 1.50, 95% CI 1.04–2.84 and 0.96–2.35, respectively), pancreatic necrosis occurred more frequently in AAP than BAP patients (OR = 1.58, 95% CI 1.08–2.30). Overall, there is a potential association between aetiology and the development and course of AP. HTG-AP is associated with the highest number of complications. Furthermore, AAP is likely to be more severe than BAP or PAP. Greater emphasis should be placed on determining aetiology on admission.
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Affiliation(s)
- Emese Réka Bálint
- Department of Pathophysiology, University of Szeged, Szeged, Hungary
| | - Gabriella Fűr
- Department of Pathophysiology, University of Szeged, Szeged, Hungary
| | - Lóránd Kiss
- Department of Pathophysiology, University of Szeged, Szeged, Hungary
| | - Dávid István Németh
- Institute for Translational Medicine and Szentágothai Research Centre, University of Pécs, Pécs, Hungary
| | - Alexandra Soós
- Institute for Translational Medicine and Szentágothai Research Centre, University of Pécs, Pécs, Hungary.,Clinical Medicine Doctoral School, University of Szeged, Szeged, Hungary
| | - Péter Hegyi
- Institute for Translational Medicine and Szentágothai Research Centre, University of Pécs, Pécs, Hungary.,MTA-SZTE Momentum Translational Gastroenterology Research Group, Szeged, Hungary
| | - Zsolt Szakács
- Institute for Translational Medicine and Szentágothai Research Centre, University of Pécs, Pécs, Hungary
| | - Benedek Tinusz
- Institute for Translational Medicine and Szentágothai Research Centre, University of Pécs, Pécs, Hungary
| | - Péter Varjú
- First Department of Medicine, University of Pécs, Pécs, Hungary
| | - Áron Vincze
- First Department of Medicine, University of Pécs, Pécs, Hungary
| | - Bálint Erőss
- Institute for Translational Medicine and Szentágothai Research Centre, University of Pécs, Pécs, Hungary
| | - József Czimmer
- Institute for Translational Medicine and Szentágothai Research Centre, University of Pécs, Pécs, Hungary
| | - Zoltán Szepes
- First Department of Medicine, University of Szeged, Szeged, Hungary
| | - Gábor Varga
- Department of Oral Biology, Semmelweis University, Budapest, Hungary
| | - Zoltán Rakonczay
- Department of Pathophysiology, University of Szeged, Szeged, Hungary.
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15
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Zádori N, Gede N, Antal J, Szentesi A, Alizadeh H, Vincze Á, Izbéki F, Papp M, Czakó L, Varga M, de-Madaria E, Petersen OH, Singh VP, Mayerle J, Faluhelyi N, Miseta A, Reiber I, Hegyi P. EarLy Elimination of Fatty Acids iN hypertriglyceridemia-induced acuTe pancreatitis (ELEFANT trial): Protocol of an open-label, multicenter, adaptive randomized clinical trial. Pancreatology 2020; 20:369-376. [PMID: 31959416 DOI: 10.1016/j.pan.2019.12.018] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2019] [Revised: 12/03/2019] [Accepted: 12/20/2019] [Indexed: 12/11/2022]
Abstract
INTRODUCTION Acute pancreatitis (AP) is a life-threatening inflammatory disease, with no specific pharmacological treatment. However, concerning some etiologies, early specific intervention (such as ERCP in biliary AP) has proven to be remarkably beneficial. Hypertriglyceridemia (HTG) induces severe pancreatic damage by several direct (cellular damage) and indirect (deterioration of microcirculation) mechanisms. Published data suggest that early removal of triglycerides (TGs) and toxic free fatty acids (FFAs) may be advantageous; however, high-quality evidence is still missing in the literature. METHODS Design: ELEFANT is a randomized controlled, multicenter, international trial testing the concept that early elimination of TGs and FFAs from the blood is beneficial in HTG-AP. The study will be performed with the adaptive "drop-the-loser" design, which supports the possibility of dropping the inferior treatment arm, based on the results of the interim analysis. Patients with HTG-AP defined by TG level over 11.3 mmol/l (1000 mg/dL) are randomized into three groups: (A) patients who undergo plasmapheresis and receive aggressive fluid resuscitation; (B) patients who receive insulin and heparin treatment with aggressive fluid resuscitation; and (C) patients with aggressive fluid resuscitation. Please note that all intervention must be started within 48 h from the onset of abdominal pain. Exclusion criteria are designed logically to decrease the possibility of any distorting effects of other diseases. The composite primary endpoint will include both severity and mortality. RESULTS Our null hypothesis is that early elimination of HTG and FFAs reduces the risk of mortality and severity of AP. Sample size calculation suggests that 495 patients will need to be enrolled in order to confirm or reject the hypothesis with a 10% dropout, 80% power and 95% significance level. The general safety and quality checks required for high-quality evidence will be adhered to. The study will be organized between February 2020 and December 2025. CONCLUSION Our study would provide the first direct evidence for or against early intervention in HTG-induced AP.
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Affiliation(s)
- Noémi Zádori
- Institute for Translational Medicine, Szentágothai Research Centre, Medical School, University of Pécs, Pécs, Hungary. http://www.tm-centre.org
| | - Noémi Gede
- Institute for Translational Medicine, Szentágothai Research Centre, Medical School, University of Pécs, Pécs, Hungary.
| | - Judit Antal
- Institute for Translational Medicine, Szentágothai Research Centre, Medical School, University of Pécs, Pécs, Hungary.
| | - Andrea Szentesi
- Institute for Translational Medicine, Szentágothai Research Centre, Medical School, University of Pécs, Pécs, Hungary; Hungarian Academy of Sciences-University of Szeged, Translational Multidisciplinary Research Group, Szeged, Hungary.
| | - Hussain Alizadeh
- Division of Hematology, First Department of Internal Medicine, University of Pécs Medical School, Pécs, Hungary.
| | - Áron Vincze
- Institute for Translational Medicine, Szentágothai Research Centre, Medical School, University of Pécs, Pécs, Hungary; Division of Gastroenterology, First Department of Internal Medicine, University of Pécs Medical School, Pécs, Hungary.
| | - Ferenc Izbéki
- Division of Gastroenterology, Fejér County Saint George Teaching Hospital of the University of Pécs, Székesfehérvár, Hungary.
| | - Mária Papp
- Department of Internal Medicine, Division of Gastroenterology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary.
| | - László Czakó
- First Department of Internal Medicine, University of Szeged, Szeged, Hungary.
| | - Márta Varga
- Dr. Réthy Pál Hospital, Békéscsaba, Hungary.
| | - Enrique de-Madaria
- Department of Gastroenterology, Alicante University General Hospital, Alicante Institute for Health and Biomedical Research (ISABIAL), Alicante, Spain.
| | | | - Vijay P Singh
- Department of Medicine, Mayo Clinic, Scottsdale, AZ, USA.
| | - Julia Mayerle
- Medizinische Klinik und Poliklinik II, Klinikum der Universität München, München, Germany.
| | | | - Attila Miseta
- Department of Laboratory Medicine, University of Pécs, Pécs, Hungary.
| | - István Reiber
- Division of Gastroenterology, Fejér County Saint George Teaching Hospital of the University of Pécs, Székesfehérvár, Hungary.
| | - Péter Hegyi
- Institute for Translational Medicine, Szentágothai Research Centre, Medical School, University of Pécs, Pécs, Hungary; Hungarian Academy of Sciences-University of Szeged, Translational Multidisciplinary Research Group, Szeged, Hungary. http://www.tm-centre.org
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16
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Yan K, Yang J, Qian Q, Xu D, Liu H, Wei L, Li M, Xu W. Pathogenic Role of an IL-23/γδT17/Neutrophil Axis in Coxsackievirus B3-Induced Pancreatitis. THE JOURNAL OF IMMUNOLOGY 2019; 203:3301-3312. [PMID: 31748346 DOI: 10.4049/jimmunol.1900787] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Accepted: 10/12/2019] [Indexed: 12/16/2022]
Abstract
Coxsackievirus B is a common cause of viral myocarditis and pancreatitis. IL-17A is intensively involved in the pathogenesis of viral myocarditis. Whether IL-17A plays a role in Coxsackievirus B-induced pancreatitis, characterized by acinar cell destruction and immune infiltration, remains largely unknown. We found a significant, but transient, increase of IL-17A expression and γδT influx in the pancreas of C57BL/6J mice within 3 d following CVB3 infection. The pancreatic IL-17A was mainly produced by Vγ4 γδ T cells, to a lesser extent by CD4+ Th17 cells. IL-17A-/- and TCRδ-/- mice both reduced their susceptibility to CVB3 infection and pancreatitis severity when compared with the wild-type mice, without altering viral load. mAb depletion of Vγ4γδ T cells significantly improved mice survival and pancreatic pathology via decreasing Th17 expansion and neutrophil influx into the pancreas compared with isotype-treated mice. Transfer of Vγ4γδ T cells from wild-type, but not IL-17-/-, mice reconstituted TCRδ-/- mice to produce IL-17 and develop pancreatitis to the level of wild-type mice during CVB3 infection, indicating γδ T IL-17A is required for the onset of viral pancreatitis. IL-23 was robustly induced in the pancreas within the first day of infection. Administration of exogenous rIL-23 to mice increased CVB3 pancreatitis through in vivo expansion of IL-17+γδT17 cells at 12 h postinfection. Our findings reveal a key pathogenic role for early-activated γδT17 cells in viral pancreatitis via promoting neutrophil infiltration and Th17 induction. This IL-23/γδT17/neutrophil axis is critically involved in the onset of CVB3 pancreatitis and represents a potential treating target for the disease.
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Affiliation(s)
- Kepeng Yan
- Jiangsu Provincial Key Laboratory of Infection and Immunity, Institutes of Biology and Medical Sciences, Soochow University, Suzhou 215123, China
| | - Jie Yang
- Jiangsu Provincial Key Laboratory of Infection and Immunity, Institutes of Biology and Medical Sciences, Soochow University, Suzhou 215123, China
| | - Qian Qian
- Jiangsu Provincial Key Laboratory of Infection and Immunity, Institutes of Biology and Medical Sciences, Soochow University, Suzhou 215123, China
| | - Dan Xu
- Jiangsu Provincial Key Laboratory of Infection and Immunity, Institutes of Biology and Medical Sciences, Soochow University, Suzhou 215123, China
| | - Hui Liu
- Jiangsu Provincial Key Laboratory of Infection and Immunity, Institutes of Biology and Medical Sciences, Soochow University, Suzhou 215123, China
| | - Lin Wei
- Jiangsu Provincial Key Laboratory of Infection and Immunity, Institutes of Biology and Medical Sciences, Soochow University, Suzhou 215123, China
| | - Min Li
- Jiangsu Provincial Key Laboratory of Infection and Immunity, Institutes of Biology and Medical Sciences, Soochow University, Suzhou 215123, China
| | - Wei Xu
- Jiangsu Provincial Key Laboratory of Infection and Immunity, Institutes of Biology and Medical Sciences, Soochow University, Suzhou 215123, China
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17
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Siregar GA, Siregar GP. Management of Severe Acute Pancreatitis. Open Access Maced J Med Sci 2019; 7:3319-3323. [PMID: 31949538 PMCID: PMC6953950 DOI: 10.3889/oamjms.2019.720] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2019] [Revised: 08/17/2019] [Accepted: 08/18/2019] [Indexed: 12/16/2022] Open
Abstract
Acute pancreatitis is one of the most common causes of hospitalisation from gastrointestinal diseases. The causes of pancreatitis vary between countries. Acute pancreatitis is classified based on Revised Atlanta classification 2013 as mild, moderately severe and severe acute pancreatitis. Acute pancreatic severity can be stratified by scoring systems such as Ranson's score, BISAP score, APACHE-II score, SOFA score. In severe acute pancreatitis, to diagnose, abdominal pain raised amylase or lipase, supported imaging finding and organ failure. Organ failure can be diagnosed by using Modified Marshall Scoring System. Management is started conservatively, which are fluid resuscitation, enteral nutrition, analgesics, and antibiotics. Surgical management is indicated when infected pancreas necrosis is detected. In this review, we will discuss the current management based on recent research.
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Affiliation(s)
- Gontar Alamsyah Siregar
- Division of Gastroenterohepatology, Department of Internal Medicine, Faculty of Medicine, Universitas Sumatera Utara, Medan, Indonesia
| | - Ginanda Putra Siregar
- Department of Surgery, Faculty of Medicine, Universitas Sumatera Utara, Medan, Indonesia
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18
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Wei HF, Tang GD, Liang ZH, Qin MB, Yang HY, Wu Q, Tang YF, Zhang QY, Xu MT. Clinical features of acute pancreatitis in people of different age groups: A retrospective analysis. Shijie Huaren Xiaohua Zazhi 2019; 27:624-631. [DOI: 10.11569/wcjd.v27.i10.624] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Acute pancreatitis (AP) is one of the common causes of acute abdomen in clinical practice. In the past, patients with AP were mostly young adults. However, in recent years, with the growth and aging of our country's population, the incidence of AP in the elderly and children is also on the rise. The clinical manifestations of AP at different age groups are slightly different due to their physiological characteristics. The clinical manifestations of elderly and children are atypical, which can easily lead to misdiagnosis and missed diagnosis.
AIM To analyze the clinical features of AP in people of different age groups.
METHODS In this retrospective clinical trial, 1758 cases of AP were enrolled from January 2003 to June 2016, and they were divided into three groups according to age: <18, 18-60, and ≥ 60 years old. The general clinical data, etiology, severity of AP, complications, clinical course, prognosis, and biochemical criteria for AP were summarized in different age groups.
RESULTS In the < 18 age group, the incidence of AP in male patients (53.8%) was slightly higher than that of females (46.2%); the proportion of mild AP (MAP) (78.5%) was higher than those the other two groups; and the rates of complications and mortality were significantly lower than those of the other two groups (P < 0.05). In the 18-60 age group, the incidence of AP in male patients (71.0%) was higher than that of the other two groups (P < 0.05); the incidence of alcoholic and hyperlipidemic pancreatitis (13.4%, 21.5%) was higher than that of the other two groups (P < 0.05); the incidence of pancreatic necrosis in this group of patients was the highest (23.4%); and the rates of peripancreatic exudation, pleural effusion, acute respiratory distress syndrome, and acute renal insufficiency (54.3%, 36.9%, 5.6%, and 6.5%, respectively) were significantly higher than those of the < 18 age group (P < 0.05). In the ≥ 60 age group, the incidence of AP in male patients (57.7%) was slightly higher than that in females (42.3%); the rate of nausea (58.2%) was significantly higher than those of the other two groups (P < 0.05); the incidence of biliary pancreatitis (61.2%) was the highest (P < 0.05); and the proportion of patients with moderately severe AP (43.5%) was higher than those of the other two groups (P < 0.05). The patients in the < 18 age group had the longest hospital stay (17.97 ± 12.14 d; P < 0.05). The proportion of patients staying in the intensive care unit and the mortality rate in the ≥ 60 age group were the highest (4.1% and 13.1%, respectively; P < 0.05). There was no difference in hospitalization cost among patients of different age groups (P > 0.05). There was no significant difference in peripheral blood leukocyte count among the three groups (P > 0.05). Mean C-reactive protein level in the < 18 age group was higher than those of the other two groups. Serum amylase was higher in the ≥ 60 age group than in the < 18 age group. Lipase (LPS) in the ≥ 60 age group was higher than those of the other two groups (P < 0.05), and mean LPS did not differ significantly between the18-60 and < 18 age groups (P > 0.05).
CONCLUSION The incidence of alcoholic and hyperlipidemic pancreatitis is higher in middle-aged people. Elderly patients with AP are most prone to nausea, and the mortality rate is the highest. When young people have unexplained vomiting and bloating, AP should be suspected.
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Affiliation(s)
- Hui-Fen Wei
- Department of Gastroenterology, the First Affiliated Hospital of Guangxi Medical University, Nanning 530021, Guangxi Zhuang Autonomous Region, China
| | - Guo-Du Tang
- Department of Gastroenterology, the First Affiliated Hospital of Guangxi Medical University, Nanning 530021, Guangxi Zhuang Autonomous Region, China
| | - Zhi-Hai Liang
- Department of Gastroenterology, the First Affiliated Hospital of Guangxi Medical University, Nanning 530021, Guangxi Zhuang Autonomous Region, China
| | - Meng-Bin Qin
- Department of Gastroenterology, the Second Affiliated Hospital of Guangxi Medical University, Nanning 530001, Guangxi Zhuang Autonomous Region, China
| | - Hui-Ying Yang
- Department of Gastroenterology, the First Affiliated Hospital of Guangxi Medical University, Nanning 530021, Guangxi Zhuang Autonomous Region, China
| | - Qing Wu
- Department of Gastroenterology, the Second Affiliated Hospital of Guangxi Medical University, Nanning 530001, Guangxi Zhuang Autonomous Region, China
| | - Yong-Feng Tang
- Department of Gastroenterology, the First Affiliated Hospital of Guangxi Medical University, Nanning 530021, Guangxi Zhuang Autonomous Region, China
| | - Qi-Yue Zhang
- Department of Gastroenterology, the First Affiliated Hospital of Guangxi Medical University, Nanning 530021, Guangxi Zhuang Autonomous Region, China
| | - Meng-Tao Xu
- Department of Gastroenterology, the First Affiliated Hospital of Guangxi Medical University, Nanning 530021, Guangxi Zhuang Autonomous Region, China
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19
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Gong QQ, Chen TJ. MiR-181a-5p down-regulates LIF expression to inhibit apoptosis of pancreatic acinar cells. Shijie Huaren Xiaohua Zazhi 2019; 27:494-502. [DOI: 10.11569/wcjd.v27.i8.494] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Acute pancreatitis (AP) develops rapidly and is often complicated by systemic infections, so early and effective treatment plays a key role in controlling the disease. The mechanism of action and clinical application of microRNAs (miRNAs) in AP have become a hot topic in recent years. Understanding the roles of miRNAs in the development and outcome of AP can help provide new ideas for the diagnosis and treatment of AP.
AIM To investigate the effect and mechanism of miR-181a-5p on cerulean-induced apoptosis of rat pancreatic acinar cells.
METHODS The expression of AMY, tumor necrosis factor alpha (TNF-α), and interleukin-6, (IL-6) in rat pancreatic acinar cells induced with cerulein was detected by ELISA. AR42J cells were divided into the following groups: cerulean + anti-miR-con group (transfected with anti-miR-con), cerulean + anti-miR-181a-5p group (transfected with anti-miR-181a-5p), cerulean + si-con group (transfected with si-con), and cerulean + si-leukemia inhibitory factor (LIF) group (transfected with si-LIF). All cells were transfected using liposomes and treated with 15 nmol/L of cerulein for 8 h. Cell apoptosis in each group was detected by flow cytometry. The expression of miR-181a-5p mRNA was detected by qRT-PCR. The protein expression of LIF and caspase-3 was detected by Western blot. The fluorescence activity in each group was detected by double luciferase reporter gene assay.
RESULTS Compared with the control group, the levels of AMY, TNF-α, and IL-6 increased at 8 h after treatment with cerulein, and the apoptosis rate were significantly decreased (P < 0.05). Compared with the control group, the expression of miR-181a-5p mRNA was down-regulated, and the expression of LIF mRNA and protein was significantly up-regulated in the cerulein group (P < 0.05). Overexpression of miR-181a-5p or knockdown of LIF could inhibit the apoptosis of AR42J cells induced by cerulein. miR-181a-5p can inhibit the fluorescent activity of wild-type LIF cells and negatively regulate the protein expression of LIF.
CONCLUSION MiR-181a-5p inhibits cerulein-induced apoptosis of AR42J cells via mechanism possibly related to targeting of LIF, which will provide a new direction for the treatment of AP.
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Affiliation(s)
- Qian-Qian Gong
- Department of Emergency Medicine, Yiwu Central Hospital, Yiwu 322000, Zhejiang Province, China
| | - Tie-Jiang Chen
- Department of Emergency Medicine, Yiwu Central Hospital, Yiwu 322000, Zhejiang Province, China
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20
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Ding Y, Zhang M, Wang L, Yin T, Wang N, Wu J, Zhi J, Chen W, Wu K, Gong W, Xiao W, Xu Z, Lu G. Association of the hypertriglyceridemic waist phenotype and severity of acute pancreatitis. Lipids Health Dis 2019; 18:93. [PMID: 30961653 PMCID: PMC6454768 DOI: 10.1186/s12944-019-1019-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2018] [Accepted: 03/14/2019] [Indexed: 01/16/2023] Open
Abstract
Background The aim of this study was to evaluate the effect of a simple visceral obesity phenotype, known as the hypertriglyceridemic waist phenotype and its quantitative indicator waist circumference index on the severity of acute pancreatitis. Materials and methods Diagnosis and severity analysis of acute pancreatitis were determined according to the Atlanta classification guidelines, revised in 2012. We considered the hypertriglyceridemic waist phenotype as characterized by increased waist circumference and elevated triglyceride concentrations. We investigated the association between the acute pancreatitis severity and hypertriglyceridemic waist phenotype, including waist circumference index. Results The hypertriglyceridemic waist phenotype was significantly associated with systemic inflammatory response syndrome, organ failure, and severe acute pancreatitis. The median waist circumference index and demonstration of hypertriglyceridemic waist phenotype were positively correlated with acute pancreatitis severity. In addition, multivariate logistic analysis showed that patients with the hypertriglyceridemic waist phenotype had 1.664 times the risk of organ failure and 1.891 times the risk of systemic inflammatory response syndrome, compared with the other groups. Conclusion Upon admission, the hypertriglyceridemic waist phenotype was strongly associated with acute pancreatitis in patients. This phenotype, including waist circumference index, might be a simple method for evaluating individuals at high risk of severe acute pancreatitis. Electronic supplementary material The online version of this article (10.1186/s12944-019-1019-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Yanbing Ding
- Department of Gastroenterology, Affiliated Hospital of Yangzhou University, Yangzhou University, No. 386 Hanjiang Media Road, Yangzhou, 225000, Jiangsu, China.,Laboratory of Gastroenterology, Affiliated Hospital of Yangzhou University, Yangzhou University, No. 386 Hanjiang Media Road, Yangzhou, 225000, Jiangsu, China
| | - Min Zhang
- Department of Gastroenterology, Affiliated Hospital of Yangzhou University, Yangzhou University, No. 386 Hanjiang Media Road, Yangzhou, 225000, Jiangsu, China.,Laboratory of Gastroenterology, Affiliated Hospital of Yangzhou University, Yangzhou University, No. 386 Hanjiang Media Road, Yangzhou, 225000, Jiangsu, China
| | - Lisheng Wang
- Department of Gastroenterology, The second Clinical Medical College (Shenzhen People's Hospital), Jinan University, Shenzhen, 518000, Guangdong, China
| | - Tao Yin
- Laboratory of Gastroenterology, Affiliated Hospital of Yangzhou University, Yangzhou University, No. 386 Hanjiang Media Road, Yangzhou, 225000, Jiangsu, China
| | - Ningzhi Wang
- Department of Gastroenterology, Affiliated Hospital of Yangzhou University, Yangzhou University, No. 386 Hanjiang Media Road, Yangzhou, 225000, Jiangsu, China.,Laboratory of Gastroenterology, Affiliated Hospital of Yangzhou University, Yangzhou University, No. 386 Hanjiang Media Road, Yangzhou, 225000, Jiangsu, China
| | - Jian Wu
- Department of Gastroenterology, Affiliated Hospital of Yangzhou University, Yangzhou University, No. 386 Hanjiang Media Road, Yangzhou, 225000, Jiangsu, China.,Laboratory of Gastroenterology, Affiliated Hospital of Yangzhou University, Yangzhou University, No. 386 Hanjiang Media Road, Yangzhou, 225000, Jiangsu, China
| | - Jiehua Zhi
- Department of Gastroenterology, Affiliated Hospital of Yangzhou University, Yangzhou University, No. 386 Hanjiang Media Road, Yangzhou, 225000, Jiangsu, China.,Laboratory of Gastroenterology, Affiliated Hospital of Yangzhou University, Yangzhou University, No. 386 Hanjiang Media Road, Yangzhou, 225000, Jiangsu, China
| | - Weiwei Chen
- Department of Gastroenterology, Clinical Medical College, Yangzhou University, Yangzhou, China
| | - Keyan Wu
- Department of Gastroenterology, Affiliated Hospital of Yangzhou University, Yangzhou University, No. 386 Hanjiang Media Road, Yangzhou, 225000, Jiangsu, China.,Laboratory of Gastroenterology, Affiliated Hospital of Yangzhou University, Yangzhou University, No. 386 Hanjiang Media Road, Yangzhou, 225000, Jiangsu, China
| | - Weijuan Gong
- Department of Gastroenterology, Affiliated Hospital of Yangzhou University, Yangzhou University, No. 386 Hanjiang Media Road, Yangzhou, 225000, Jiangsu, China.,Laboratory of Gastroenterology, Affiliated Hospital of Yangzhou University, Yangzhou University, No. 386 Hanjiang Media Road, Yangzhou, 225000, Jiangsu, China.,Department of Immunology, School of Medicine, Yangzhou University, Yangzhou, China
| | - Weiming Xiao
- Department of Gastroenterology, Affiliated Hospital of Yangzhou University, Yangzhou University, No. 386 Hanjiang Media Road, Yangzhou, 225000, Jiangsu, China.,Laboratory of Gastroenterology, Affiliated Hospital of Yangzhou University, Yangzhou University, No. 386 Hanjiang Media Road, Yangzhou, 225000, Jiangsu, China
| | - Zhenglei Xu
- Department of Gastroenterology, The second Clinical Medical College (Shenzhen People's Hospital), Jinan University, Shenzhen, 518000, Guangdong, China.
| | - Guotao Lu
- Department of Gastroenterology, Affiliated Hospital of Yangzhou University, Yangzhou University, No. 386 Hanjiang Media Road, Yangzhou, 225000, Jiangsu, China. .,Laboratory of Gastroenterology, Affiliated Hospital of Yangzhou University, Yangzhou University, No. 386 Hanjiang Media Road, Yangzhou, 225000, Jiangsu, China.
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