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Zhu Q, Lu M, Ling B, Tan D, Wang H. Construction and validation of a nomogram for predicting survival in elderly patients with severe acute pancreatitis: a retrospective study from a tertiary center. BMC Gastroenterol 2024; 24:219. [PMID: 38977953 PMCID: PMC11229287 DOI: 10.1186/s12876-024-03308-6] [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: 04/15/2024] [Accepted: 06/28/2024] [Indexed: 07/10/2024] Open
Abstract
PURPOSE There is a lack of adequate models specifically designed for elderly patients with severe acute pancreatitis (SAP) to predict the risk of death. This study aimed to develop a nomogram for predicting the overall survival of SAP in elderly patients. METHODS Elderly patients diagnosed with SAP between January 1, 2017 and December 31, 2022 were included in the study. Risk factors were identified through least absolute shrinkage and selection operator regression analysis. Subsequently, a novel nomogram model was developed using multivariable logistic regression analysis. The predictive performance of the nomogram was evaluated using metrics such as the receiver operating characteristic curve, calibration curve, and decision curve analysis (DCA). RESULTS A total of 326 patients were included in the analysis, with 260 in the survival group and 66 in the deceased group. Multivariate logistic regression indicated that age, respiratory rate, arterial pH, total bilirubin, and calcium were independent prognostic factors for the survival of SAP patients. The nomogram demonstrated a performance comparable to sequential organ failure assessment (P = 0.065). Additionally, the calibration curve showed satisfactory predictive accuracy, and the DCA highlighted the clinical application value of the nomogram. CONCLUSION We have identified key demographic and laboratory parameters that are associated with the survival of elderly patients with SAP. These parameters have been utilized to create a precise and user-friendly nomogram, which could be an effective and valuable clinical tool for clinicians.
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Affiliation(s)
- Qingcheng Zhu
- Department of Emergency Medicine, Northern Jiangsu People's Hospital Affiliated to Yangzhou University, Yangzhou, 225001, China
| | - Mingfeng Lu
- Department of Emergency Medicine, Northern Jiangsu People's Hospital Affiliated to Yangzhou University, Yangzhou, 225001, China
| | - Bingyu Ling
- Department of Emergency Medicine, Northern Jiangsu People's Hospital Affiliated to Yangzhou University, Yangzhou, 225001, China
| | - Dingyu Tan
- Department of Emergency Medicine, Northern Jiangsu People's Hospital Affiliated to Yangzhou University, Yangzhou, 225001, China
| | - Huihui Wang
- Department of Emergency Medicine, Northern Jiangsu People's Hospital Affiliated to Yangzhou University, Yangzhou, 225001, China.
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Yu J, Liu C, Zhang J, Wang X, Song K, Wu P, Liu F. Global, regional, and national burden of pancreatitis in older adults, 1990-2019: A systematic analysis for the global burden of disease study 2019. Prev Med Rep 2024; 41:102722. [PMID: 38646072 PMCID: PMC11026839 DOI: 10.1016/j.pmedr.2024.102722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2023] [Revised: 04/07/2024] [Accepted: 04/09/2024] [Indexed: 04/23/2024] Open
Abstract
Background To describe the past, present and future burden of pancreatitis in older adults, and to explore cross-national inequalities across socio-demographic index (SDI). Methods Data on pancreatitis in older adults, including mortality and disability-adjusted life years (DALYs) rates, were collected from the Global Burden of Disease (GBD) 2019 study. Temporal trends were measured using joinpoint analyses and predicted using a Bayesian age-period-cohort model. Additionally, the unequal distribution of the burden of pancreatitis in older adults was quantified. Results From 1990 to 2019, the number of deaths and DALYs due to pancreatitis in older adults has been increasing annually. However, in most regions of the world, age-standardized death rates (ASDR) and age-standardized DALYs rates have been declining. The burden of pancreatitis in older adults was highest in low SDI region, primarily affecting the population aged 65-74, with a greater burden on males than females. Furthermore, from 1990 to 2019, absolute and relative cross-national inequalities in pancreatitis among older adults have remained largely unchanged. It is projected that in the next 11 years, the number of deaths in older adults due to pancreatitis will continue to increase, but the ASDR is expected to decline. Conclusion Over the past 30 years, the ASDR and age-standardized DALYs rate of pancreatitis in older adults have shown a decline globally, but the absolute burden continues to increase. Cross-national health inequalities persist. Therefore, it is necessary to develop targeted intervention measures and enhance awareness among this vulnerable population regarding the risk factors associated with pancreatitis.
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Affiliation(s)
- Jiangtao Yu
- Department of General Surgery, The First Affiliated Hospital of Anhui Medical University, Hefei 230000, China
- Department of Hepatobiliary and Pancreatic Surgery, Fuyang People's Hospital, Anhui Medical University, Fuyang 236000, China
| | - Chunlong Liu
- Department of Hepatobiliary and Pancreatic Surgery, Fuyang People's Hospital, Anhui Medical University, Fuyang 236000, China
| | - Jian Zhang
- Department of Neurosurgery, the Seventh Clinical College of China Medical University, Fushun 113001, China
| | - Xiangyu Wang
- Department of Hepatobiliary and Pancreatic Surgery, Fuyang People's Hospital, Bengbu Medical University, Fuyang 236000, China
| | - Kun Song
- Department of Hepatobiliary and Pancreatic Surgery, Fuyang People's Hospital, Bengbu Medical University, Fuyang 236000, China
| | - Panpan Wu
- Department of Hepatobiliary and Pancreatic Surgery, Fuyang People's Hospital, Anhui Medical University, Fuyang 236000, China
| | - Fubao Liu
- Department of General Surgery, The First Affiliated Hospital of Anhui Medical University, Hefei 230000, China
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Zou K, Huang S, Ren W, Xu H, Zhang W, Shi X, Shi L, Zhong X, Peng Y, Lü M, Tang X. Development and Validation of a Dynamic Nomogram for Predicting in-Hospital Mortality in Patients with Acute Pancreatitis: A Retrospective Cohort Study in the Intensive Care Unit. Int J Gen Med 2023; 16:2541-2553. [PMID: 37351008 PMCID: PMC10284301 DOI: 10.2147/ijgm.s409812] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Accepted: 06/04/2023] [Indexed: 06/24/2023] Open
Abstract
Purpose The aim of this study is to develop and validate a predictive model for the prediction of in-hospital mortality in patients with acute pancreatitis (AP) based on the intensive care database. Patients and Methods We analyzed the data of patients with AP in the Medical Information Mart for Intensive Care-IV (MIMIC-IV) database and Electronic Intensive Care Unit Collaborative Research Database (eICU-CRD). Then, patients from MIMIC-IV were divided into a development group and a validation group according to the ratio of 8:2, and eICU-CRD was assigned as an external validation group. Univariate logistic regression and least absolute shrinkage and selection operator regression were used for screening the best predictors, and multivariate logistic regression was used to establish a dynamic nomogram. We evaluated the discrimination, calibration, and clinical efficacy of the nomogram, and compared the performance of the nomogram with Acute Physiology and Chronic Health Evaluation II (APACHE-II) score and Bedside Index of Severity in AP (BISAP) score. Results A total of 1030 and 514 patients with AP in MIMIC-IV database and eICU-CRD were included in the study. After stepwise analysis, 8 out of a total of 37 variables were selected to construct the nomogram. The dynamic nomogram can be obtained by visiting https://model.sci-inn.com/KangZou/. The area under receiver operating characteristic curve (AUC) of the nomogram was 0.859, 0.871, and 0.847 in the development, internal, and external validation set respectively. The nomogram had a similar performance with APACHE-II (AUC = 0.841, p = 0.537) but performed better than BISAP (AUC = 0.690, p = 0.001) score in the validation group. Moreover, the calibration curve presented a satisfactory predictive accuracy, and the decision curve analysis suggested great clinical application value of the nomogram. Conclusion Based on the results of internal and external validation, the nomogram showed favorable discrimination, calibration, and clinical practicability in predicting the in-hospital mortality of patients with AP.
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Affiliation(s)
- Kang Zou
- Department of Gastroenterology, the Affiliated Hospital of Southwest Medical University, Luzhou, People’s Republic of China
- Nuclear Medicine and Molecular Imaging Key Laboratory of Sichuan Province, Luzhou, People’s Republic of China
| | - Shu Huang
- Department of Gastroenterology, Lianshui County People’ Hospital, Huaian, People’s Republic of China
- Department of Gastroenterology, Lianshui People’ Hospital of Kangda College Affiliated to Nanjing Medical University, Huaian, People’s Republic of China
| | - Wensen Ren
- Department of Gastroenterology, the Affiliated Hospital of Southwest Medical University, Luzhou, People’s Republic of China
- Nuclear Medicine and Molecular Imaging Key Laboratory of Sichuan Province, Luzhou, People’s Republic of China
| | - Huan Xu
- Department of Gastroenterology, the Affiliated Hospital of Southwest Medical University, Luzhou, People’s Republic of China
- Nuclear Medicine and Molecular Imaging Key Laboratory of Sichuan Province, Luzhou, People’s Republic of China
| | - Wei Zhang
- Department of Gastroenterology, the Affiliated Hospital of Southwest Medical University, Luzhou, People’s Republic of China
- Nuclear Medicine and Molecular Imaging Key Laboratory of Sichuan Province, Luzhou, People’s Republic of China
| | - Xiaomin Shi
- Department of Gastroenterology, the Affiliated Hospital of Southwest Medical University, Luzhou, People’s Republic of China
- Nuclear Medicine and Molecular Imaging Key Laboratory of Sichuan Province, Luzhou, People’s Republic of China
| | - Lei Shi
- Department of Gastroenterology, the Affiliated Hospital of Southwest Medical University, Luzhou, People’s Republic of China
- Nuclear Medicine and Molecular Imaging Key Laboratory of Sichuan Province, Luzhou, People’s Republic of China
| | - Xiaolin Zhong
- Department of Gastroenterology, the Affiliated Hospital of Southwest Medical University, Luzhou, People’s Republic of China
- Nuclear Medicine and Molecular Imaging Key Laboratory of Sichuan Province, Luzhou, People’s Republic of China
| | - Yan Peng
- Department of Gastroenterology, the Affiliated Hospital of Southwest Medical University, Luzhou, People’s Republic of China
- Nuclear Medicine and Molecular Imaging Key Laboratory of Sichuan Province, Luzhou, People’s Republic of China
| | - Muhan Lü
- Department of Gastroenterology, the Affiliated Hospital of Southwest Medical University, Luzhou, People’s Republic of China
- Nuclear Medicine and Molecular Imaging Key Laboratory of Sichuan Province, Luzhou, People’s Republic of China
| | - Xiaowei Tang
- Department of Gastroenterology, the Affiliated Hospital of Southwest Medical University, Luzhou, People’s Republic of China
- Nuclear Medicine and Molecular Imaging Key Laboratory of Sichuan Province, Luzhou, People’s Republic of China
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Jiang W, Du Y, Xiang C, Li X, Zhou W. Age-period-cohort analysis of pancreatitis epidemiological trends from 1990 to 2019 and forecasts for 2044: a systematic analysis from the Global Burden of Disease Study 2019. Front Public Health 2023; 11:1118888. [PMID: 37361161 PMCID: PMC10288197 DOI: 10.3389/fpubh.2023.1118888] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Accepted: 05/18/2023] [Indexed: 06/28/2023] Open
Abstract
Objective Pancreatitis poses a serious medical problem worldwide. This study aims to explore the epidemiological trends of pancreatitis from 1990 to 2019, analyze the association between disease burden and age, period and birth cohort, and subsequently present a forecast of pancreatitis incidence and deaths. Methods Epidemiologic data were gathered from the Global Health Data Exchange query tool. Joinpoint regression model was used to calculate the average annual percentage changes (AAPCs). Age-period-cohort analysis was utilized to estimate the independent effects of age, period and birth cohort. We also predicted the global epidemiological trends to 2044. Results Globally, the incident cases and deaths of pancreatitis increased 1.63-and 1.65-fold from 1990 to 2019, respectively. Joinpoint regression analysis showed that the age-standardized incidence rate (ASIR) and age-standardized death rate (ASDR) decreased over the past three decades. The age effect indicates that older people have higher age-specific incidence and death rates. The period effect on incidence and deaths showed downward trends from 1990 to 2019. The cohort effect demonstrated that incidence and death risk peaked in the earlier birth cohort and were lower in the latest birth cohort. Incident cases and deaths of pancreatitis may significantly increase in the next 25 years. The ASIRs were predicted to slightly increase, while the ASDRs were predicted to decrease. Conclusion Epidemiologic patterns and trends of pancreatitis across age, period and birth cohort may provide novel insight into public health. Limitations of alcohol use and prevention strategies for pancreatitis are necessary to reduce future burden.
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Affiliation(s)
- Wenkai Jiang
- The Second Clinical Medical College, Lanzhou University, Lanzhou, China
| | - Yan Du
- The Second Clinical Medical College, Lanzhou University, Lanzhou, China
| | - Caifei Xiang
- The Second Clinical Medical College, Lanzhou University, Lanzhou, China
| | - Xin Li
- The First Clinical Medical College, Lanzhou University, Lanzhou, China
| | - Wence Zhou
- The Second Clinical Medical College, Lanzhou University, Lanzhou, China
- Department of General Surgery, Lanzhou University Second Hospital, Lanzhou, China
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Hidalgo NJ, Pando E, Mata R, Fernandes N, Villasante S, Barros M, Herms D, Blanco L, Balsells J, Charco R. Impact of comorbidities on hospital mortality in patients with acute pancreatitis: a population-based study of 110,021 patients. BMC Gastroenterol 2023; 23:81. [PMID: 36949385 PMCID: PMC10035222 DOI: 10.1186/s12876-023-02730-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Accepted: 03/16/2023] [Indexed: 03/24/2023] Open
Abstract
BACKGROUND The impact of pre-existing comorbidities on acute pancreatitis (AP) mortality is not clearly defined. Our study aims to determine the trend in AP hospital mortality and the role of comorbidities as a predictor of hospital mortality. METHODS We analyzed patients aged ≥ 18 years hospitalized with AP diagnosis between 2016 and 2019. The data have been extracted from the Spanish National Hospital Discharge Database of the Spanish Ministry of Health. We performed a univariate and multivariable analysis of the association of age, sex, and comorbidities with hospital mortality in patients with AP. The role of the Charlson and Elixhauser comorbidity indices as predictors of mortality was evaluated. RESULTS A total of 110,021 patients diagnosed with AP were hospitalized during the analyzed period. Hospital mortality was 3.8%, with a progressive decrease observed in the years evaluated. In multivariable analysis, age ≥ 65 years (OR: 4.11, p < 0.001), heart disease (OR: 1.73, p < 0.001), renal disease (OR: 1.99, p < 0.001), moderate-severe liver disease (OR: 2.86, p < 0.001), peripheral vascular disease (OR: 1.43, p < 0.001), and cerebrovascular disease (OR: 1.63, p < 0.001) were independent risk factors for mortality. The Charlson > 1.5 (OR: 2.03, p < 0.001) and Elixhauser > 1.5 (OR: 2.71, p < 0.001) comorbidity indices were also independently associated with mortality, and ROC curve analysis showed that they are useful for predicting hospital mortality. CONCLUSIONS Advanced age, heart disease, renal disease, moderate-severe liver disease, peripheral vascular disease, and cerebrovascular disease before admission were independently associated with hospital mortality. The Charlson and Elixhauser comorbidity indices are useful for predicting hospital mortality in AP patients.
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Affiliation(s)
- Nils Jimmy Hidalgo
- Universitat Autonoma de Barcelona, Barcelona, Spain
- Department of Hepato-Pancreato-Biliary and Transplant Surgery, Hospital Universitari Vall d'Hebron, Passeig de La Vall d'Hebron, 119-129. 08035, Barcelona, Spain
| | - Elizabeth Pando
- Universitat Autonoma de Barcelona, Barcelona, Spain.
- Department of Hepato-Pancreato-Biliary and Transplant Surgery, Hospital Universitari Vall d'Hebron, Passeig de La Vall d'Hebron, 119-129. 08035, Barcelona, Spain.
| | - Rodrigo Mata
- Department of Hepato-Pancreato-Biliary and Transplant Surgery, Hospital Universitari Vall d'Hebron, Passeig de La Vall d'Hebron, 119-129. 08035, Barcelona, Spain
| | - Nair Fernandes
- Department of Hepato-Pancreato-Biliary and Transplant Surgery, Hospital Universitari Vall d'Hebron, Passeig de La Vall d'Hebron, 119-129. 08035, Barcelona, Spain
| | - Sara Villasante
- Department of Hepato-Pancreato-Biliary and Transplant Surgery, Hospital Universitari Vall d'Hebron, Passeig de La Vall d'Hebron, 119-129. 08035, Barcelona, Spain
| | - Marta Barros
- Department of Hepato-Pancreato-Biliary and Transplant Surgery, Hospital Universitari Vall d'Hebron, Passeig de La Vall d'Hebron, 119-129. 08035, Barcelona, Spain
| | - Daniel Herms
- Department of Hepato-Pancreato-Biliary and Transplant Surgery, Hospital Universitari Vall d'Hebron, Passeig de La Vall d'Hebron, 119-129. 08035, Barcelona, Spain
| | - Laia Blanco
- Department of Hepato-Pancreato-Biliary and Transplant Surgery, Hospital Universitari Vall d'Hebron, Passeig de La Vall d'Hebron, 119-129. 08035, Barcelona, Spain
| | - Joaquim Balsells
- Department of Hepato-Pancreato-Biliary and Transplant Surgery, Hospital Universitari Vall d'Hebron, Passeig de La Vall d'Hebron, 119-129. 08035, Barcelona, Spain
| | - Ramon Charco
- Department of Hepato-Pancreato-Biliary and Transplant Surgery, Hospital Universitari Vall d'Hebron, Passeig de La Vall d'Hebron, 119-129. 08035, Barcelona, Spain
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Wang F, Zhu M, Meng Y, Lin M. Serum soluble T cell immunoglobulin mucin domain-3 as an early predictive marker for severity of acute pancreatitis; a retrospective analysis. BMC Gastroenterol 2022; 22:522. [PMID: 36526975 PMCID: PMC9756921 DOI: 10.1186/s12876-022-02537-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Accepted: 09/08/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Early prediction of severe acute pancreatitis (SAP) plays an important role in timely treatment decisions. Soluble T cell immunoglobulin and mucin domain-3 (sTIM-3) has been applied as a potential biomarker for the prediction of many diseases, while its predictive ability for AP severity remains largely unexplored. In this study, we aimed to identify whether serum sTIM-3 could be used as an indicator of AP severity in the early stage of the disease. METHODS A retrospective study was conducted. The enrolled AP patients should meet the 2012 Atlanta guideline and have an onset to admission ≤ 48 h. RESULTS A total of 94 AP patients were enrolled in the current analysis, including 42 (45%), 35 (37%), and 17 (18%) patients were diagnosed as mild AP (MAP), moderately SAP (MSAP), and SAP, respectively. SAP patients had significantly higher the white blood cells (WBCs) count, red blood cells (RBCs) count, C-reactive protein (CRP) level, direct bilirubin level, creatinine and procalcitonin levels compared with MAP and MSAP patients. Among SAP and MSAP patients, significantly higher APACHE II, BISAP, and MCTSI scores were observed compared with MAP patients, and there was significant difference in APACHE II and BISAP scores between SAP and MSAP patients. Stepwise multivariate linear regression analysis showed that the concentrations of serum sTIM-3, as well as the BISAP and MCTSI scores, were significantly associated with the severity of AP. The areas under the ROC curve were 0.914 (95% CI, 0.865-0.963), 0.855 (95%CI, 0.742-0.968) 0.853 (95%CI, 0.768-0.938), and 0.746 (95%CI, 0.633-0.860) for BISAP score, APACHE II score, sTIM-3 level, and MCTSI score, respectively. CONCLUSIONS Serum sTIM-3 might be ultimately incorporated into a predictive system for assessing the severity of AP.
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Affiliation(s)
- Fushuang Wang
- grid.89957.3a0000 0000 9255 8984Department of Gastroenterology, The Affiliated Changzhou No.2 People’s Hospital of Nanjing Medical University, No.188 Gehu Road, Wujin District, Changzhou, Jiangsu Province, China ,grid.411971.b0000 0000 9558 1426Dalian Medical University, No.9 of Lushun South Road, Dalian, Liaoning Province China
| | - Minghui Zhu
- grid.452253.70000 0004 1804 524XDepartment of Gastroenterology, The Third Affiliated Hospital of Soochow University, No.185 Juqian Road, Tianning District, Changzhou, Jiangsu Province China
| | - Yao Meng
- grid.89957.3a0000 0000 9255 8984Department of Gastroenterology, The Affiliated Changzhou No.2 People’s Hospital of Nanjing Medical University, No.188 Gehu Road, Wujin District, Changzhou, Jiangsu Province, China ,grid.411971.b0000 0000 9558 1426Dalian Medical University, No.9 of Lushun South Road, Dalian, Liaoning Province China
| | - Min Lin
- grid.89957.3a0000 0000 9255 8984Department of Gastroenterology, The Affiliated Changzhou No.2 People’s Hospital of Nanjing Medical University, No.188 Gehu Road, Wujin District, Changzhou, Jiangsu Province, China
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Timing, approach, and treatment strategies for infected pancreatic necrosis: a narrative review. JOURNAL OF PANCREATOLOGY 2022. [DOI: 10.1097/jp9.0000000000000105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
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İnce AT, Seven G, Koçhan K, Kiremitçi S, Yıldız K, Şentürk H. The course of acute pancreatitis in patients with different BMI groups. Pancreatology 2022; 22:348-355. [PMID: 35322789 DOI: 10.1016/j.pan.2022.03.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2021] [Revised: 01/06/2022] [Accepted: 03/08/2022] [Indexed: 02/07/2023]
Abstract
OBJECTIVES To evaluate the risk factors, Atlanta severity score, Balthazar-CTSI score, and disease course in patients of varying weight with acute pancreatitis (AP). METHODS A retrospective evaluation was made of normal weight (NW), overweight (OW), and obese (OB) patients (n:1134) with respect to demographic findings, diabetes (DM)/hypertension, smoking/alcohol use, etiologies, laboratory findings, Balthazar/Atlanta severity scores, and disease outcomes. After consistency and associations among the BMI, Balthazar, and Atlanta groups were evaluated, combined effects of risk factors on mortality, hospital and ICU stays were re-examined statistically. RESULTS In the OB group, mean age (p < 0.001), female gender (p < 0.001), increased BUN(p < 0.027) and Hct (p = 0.039), DM(p < 0.024), and mortality (p < 0.011) were statistically significant. In the non-NW groups, the rates of complications (40.6%/38.6%), mortality (3.7%/4.9%), interventional procedures (36%/39%), and length of hospital stay (11.6%/9.8%) were increased. Obesity constituted 23.7% of severe AP(SAP) and 50% of mortality. There was no significant relationship between Atlanta and Balthazar groups and BMI, nor between Balthazar and moderate AP (MSAP) to SAP. Old age (p = 0.000), male sex (p = 0.05), obesity (p = 0.046), alcohol (p = 0.014), low Hct (p = 0.044), high CRP (p = 0.024), MSAP/SAP (p = 0.02/(p < 0.001), and any complications (p < 0.001) increased the mortality risk. Female gender (p = 0.024), smoking (p = 0.021), hypertriglyceridemia (p = 0.047), idiopathic etiology (p = 0.023), and MSAP/SAP (p < 0.001) associations increased ICU admission. Co-occurrences of higher Balthazar score (p < 0.001), MSAP/SAP (p < 0.001), all kinds of complications (p < 0.001), and recurrence (p = 0.040) increased the hospital stay (≥11 days). CONCLUSIONS Although complications, mortality, longer hospitalization, and interventional procedures were observed more in the overweight and obese, successful prediction of Atlanta severity and Balthazar-CTSI scores based on BMI does not appear to be accurate. OB carries an increased risk for morbidity and mortality. The combined effects of risk factors increased mortality, longer hospital stays, and ICU admission.
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Affiliation(s)
- Ali Tüzün İnce
- Gastroenterology Clinic, Adnan Menderes Bulvarı, Vatan Cad, 34093, Fatih, İstanbul, Turkey.
| | - Gülseren Seven
- Gastroenterology Clinic, Adnan Menderes Bulvarı, Vatan Cad, 34093, Fatih, İstanbul, Turkey
| | - Koray Koçhan
- Gastroenterology Clinic, Adnan Menderes Bulvarı, Vatan Cad, 34093, Fatih, İstanbul, Turkey
| | - Sercan Kiremitçi
- Gastroenterology Clinic, Adnan Menderes Bulvarı, Vatan Cad, 34093, Fatih, İstanbul, Turkey
| | - Kemal Yıldız
- Internal Medicine Clinic, Medicana International Hospital, Beylikdüzü Cd. No:3, 34520, Beylikdüzü, İstanbul, Turkey
| | - Hakan Şentürk
- Gastroenterology Clinic, Adnan Menderes Bulvarı, Vatan Cad, 34093, Fatih, İstanbul, Turkey
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Pancreatitis aguda. Med Clin (Barc) 2022; 158:556-563. [DOI: 10.1016/j.medcli.2021.12.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Revised: 12/26/2021] [Accepted: 12/29/2021] [Indexed: 12/15/2022]
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10
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Spagnolo DM, Greer PJ, Ohlsen CS, Mance S, Ellison M, Breze C, Busby B, Whitcomb DC, Haupt M. Acute and Chronic Pancreatitis Disease Prevalence, Classification, and Comorbidities: A Cohort Study of the UK BioBank. Clin Transl Gastroenterol 2022; 13:e00455. [PMID: 35060944 PMCID: PMC8806365 DOI: 10.14309/ctg.0000000000000455] [Citation(s) in RCA: 24] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2021] [Accepted: 12/08/2021] [Indexed: 12/26/2022] Open
Abstract
INTRODUCTION Pancreatitis is a complex syndrome that results from many etiologies. Large well-characterized cohorts are needed to further understand disease risk and prognosis. METHODS A pancreatitis cohort of more than 4,200 patients and 24,000 controls were identified in the UK BioBank (UKBB) consortium. A descriptive analysis was completed, comparing patients with acute (AP) and chronic pancreatitis (CP). The Toxic-metabolic, Idiopathic, Genetic, Autoimmune, Recurrent, and severe pancreatitis and Obstructive checklist Version 2 classification was applied to patients with AP and CP and compared with the control population. RESULTS CP prevalence in the UKBB is 163 per 100,000. AP incidence increased from 21.4/100,000 per year from 2001 to 2005 to 48.2/100,000 per year between 2016 and 2020. Gallstones and smoking were confirmed as key risk factors for AP and CP, respectively. Both populations carry multiple risk factors and a high burden of comorbidities, including benign and malignant neoplastic disorders. DISCUSSION The UKBB serves as a rich cohort to evaluate pancreatitis. Disease burden of AP and CP was high in this population. The association of common risk factors identified in other cohort studies was confirmed in this study. Further analysis is needed to link genomic risks and biomarkers with disease features in this population.
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Affiliation(s)
- Daniel M. Spagnolo
- Ariel Precision Medicine, Inc., Pittsburgh, Pennsylvania, USA
- University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Phil J. Greer
- Ariel Precision Medicine, Inc., Pittsburgh, Pennsylvania, USA
| | | | | | | | - Cameron Breze
- Ariel Precision Medicine, Inc., Pittsburgh, Pennsylvania, USA
| | - Ben Busby
- DNAnexus, Mountain View, California, USA
| | - David C. Whitcomb
- Ariel Precision Medicine, Inc., Pittsburgh, Pennsylvania, USA
- University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
- University of Pittsburgh, Pennsylvania, USA
| | - Mark Haupt
- Ariel Precision Medicine, Inc., Pittsburgh, Pennsylvania, USA
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Early infection is an independent risk factor for increased mortality in patients with culture-confirmed infected pancreatic necrosis. Pancreatology 2022; 22:67-73. [PMID: 34774414 DOI: 10.1016/j.pan.2021.11.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Revised: 11/01/2021] [Accepted: 11/03/2021] [Indexed: 02/08/2023]
Abstract
BACKGROUND Mortality in infected pancreatic necrosis (IPN) is dynamic over the course of the disease, with type and timing of interventions as well as persistent organ failure being key determinants. The timing of infection onset and how it pertains to mortality is not well defined. OBJECTIVES To determine the association between mortality and the development of early IPN. METHODS International multicenter retrospective cohort study of patients with IPN, confirmed by a positive microbial culture from (peri) pancreatic collections. The association between timing of infection onset, timing of interventions and mortality were assessed using Cox regression analyses. RESULTS A total of 743 patients from 19 centers across 3 continents with culture-confirmed IPN from 2000 to 2016 were evaluated, mortality rate was 20.9% (155/734). Early infection was associated with a higher mortality, when early infection occurred within the first 4 weeks from presentation with acute pancreatitis. After adjusting for comorbidity, advanced age, organ failure, enteral nutrition and parenteral nutrition, early infection (≤4 weeks) and early open surgery (≤4 weeks) were associated with increased mortality [HR: 2.45 (95% CI: 1.63-3.67), p < 0.001 and HR: 4.88 (95% CI: 1.70-13.98), p = 0.003, respectively]. There was no association between late open surgery, early or late minimally invasive surgery, early or late percutaneous drainage with mortality (p > 0.05). CONCLUSION Early infection was associated with increased mortality, independent of interventions. Early surgery remains a strong predictor of excess mortality.
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Thapa R, Iqbal Z, Garikipati A, Siefkas A, Hoffman J, Mao Q, Das R. Early prediction of severe acute pancreatitis using machine learning. Pancreatology 2022; 22:43-50. [PMID: 34690046 DOI: 10.1016/j.pan.2021.10.003] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Revised: 09/27/2021] [Accepted: 10/12/2021] [Indexed: 12/11/2022]
Abstract
BACKGROUND Acute pancreatitis (AP) is one of the most common causes of gastrointestinal-related hospitalizations in the United States. Severe AP (SAP) is associated with a mortality rate of nearly 30% and is distinguished from milder forms of AP. Risk stratification to identify SAP cases needing inpatient treatment is an important aspect of AP diagnosis. METHODS We developed machine learning algorithms to predict which patients presenting with AP would require treatment for SAP. Three models were developed using logistic regression, neural networks, and XGBoost. Models were assessed in terms of area under the receiver operating characteristic (AUROC) and compared to the Harmless Acute Pancreatitis Score (HAPS) and Bedside Index for Severity in Acute Pancreatitis (BISAP) scores for AP risk stratification. RESULTS 61,894 patients were used to train and test the machine learning models. With an AUROC value of 0.921, the model developed using XGBoost outperformed the logistic regression and neural network-based models. The XGBoost model also achieved a higher AUROC than both HAPS and BISAP for identifying patients who would be diagnosed with SAP. CONCLUSIONS Machine learning may be able to improve the accuracy of AP risk stratification methods and allow for more timely treatment and initiation of interventions.
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Shao MJ, Luo JY, Shi J, Liu F, Shan CF, Luo F, Yu XL, Zhao Q, Tian T, Li XM, Yang YN. Association of Visceral Obesity-Related Indices With Coronary Collateralization in Patients With Chronic Total Occlusion. Front Cardiovasc Med 2021; 8:742855. [PMID: 34746259 PMCID: PMC8566720 DOI: 10.3389/fcvm.2021.742855] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Accepted: 09/24/2021] [Indexed: 01/20/2023] Open
Abstract
Background: Obesity is an independent risk factor for cardiovascular disease. We investigated whether and to what extent visceral obesity-related indices were associated with coronary collateralization (CC) in chronic total occlusion (CTO) patients. Methods: This retrospective cohort study involved 1,008 consecutive patients with CTO who underwent CTO-percutaneous coronary artery intervention (PCI). CC was graded according to the Rentrop scoring system. Data on demographic and clinical characteristics were collected by cardiovascular doctors. Logistic regression, receiver operating characteristic (ROC) curve and Kaplan-Meier analyses were performed to assess the predictive value of visceral obesity-related indices for CC. Results: Overall, 1,008 inpatients were assigned to the poor CC group (n = 592) and good CC group (n = 416). In multivariate-adjusted logistic regression analyses, all visceral obesity-related indices (P-value < 0.001) were significantly associated with CC. After ROC analysis and the Delong test, the Chinese visceral adiposity index (CVAI) had the largest area under the curve (AUC) of 0.741 (0.711–0.771). Further analysis revealed that CVAI quartile remained a risk factor for poor CC in all groups, CVAI was associated with a 1.018-fold higher risk of poor CC (OR = 1.018, 95% CI: 1.014–1.021, P < 0.001). Individuals in the top CVAI quartile group had the highest risk of poor CC (OR = 10.657, 95% CI: 6.492–17.493, P < 0.001). Subgroup analyses showed similar results, and CVAI quartile remained a risk factor for poor CC. Moreover, increased CVAI predicted poor prognosis in CTO patients. Conclusion: In summary, this study indicated that all the increased visceral obesity-related indices were significantly associated with increased poor CC risk. After adjusting for potential risks, CVAI had the best performance for estimating CC and predicting prognosis in CTO patients.
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Affiliation(s)
- Meng-Jiao Shao
- Department of Cardiology, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | - Jun-Yi Luo
- Department of Cardiology, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | - Jia Shi
- Department of Cardiology, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | - Fen Liu
- Xinjiang Key Laboratory of Cardiovascular Disease Research, Clinical Medical Research Institute of First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | - Chun-Fang Shan
- Department of Cardiology, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | - Fan Luo
- Department of Cardiology, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | - Xiao-Lin Yu
- Department of Cardiology, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China.,Department of Cardiology, People's Hospital of Xinjiang Uygur Autonomous Region, Urumqi, China
| | - Qian Zhao
- Department of Cardiology, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | - Ting Tian
- Department of Cardiology, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | - Xiao-Mei Li
- Department of Cardiology, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China.,Xinjiang Key Laboratory of Cardiovascular Disease Research, Clinical Medical Research Institute of First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | - Yi-Ning Yang
- Department of Cardiology, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China.,Xinjiang Key Laboratory of Cardiovascular Disease Research, Clinical Medical Research Institute of First Affiliated Hospital of Xinjiang Medical University, Urumqi, China.,Department of Cardiology, People's Hospital of Xinjiang Uygur Autonomous Region, Urumqi, China
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Commentary on "Fatty liver disease is associated with the severity of acute pancreatitis:A systematic review and meta-analysis" [Int. J. Surg. 65 (2019) 147-153]. Int J Surg 2021; 95:106059. [PMID: 34390844 DOI: 10.1016/j.ijsu.2021.106059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Accepted: 08/09/2021] [Indexed: 11/23/2022]
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15
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Spangler R, Manning S. Disaster Diagnoses in Geriatric Patients with Abdominal Pain. Emerg Med Clin North Am 2021; 39:347-360. [PMID: 33863464 DOI: 10.1016/j.emc.2021.01.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Care of geriatric patients with abdominal pain can pose significant diagnostic and therapeutic challenges to emergency physicians. Older adults rarely present with classic signs, symptoms, and laboratory abnormalities. The incidence of life-threatening emergencies, including abdominal aortic aneurysm, mesenteric ischemia, perforated viscus, and other surgical emergencies, is high. This article explores the evaluation and management of several important causes of abdominal pain in geriatric patients with an emphasis on high-risk presentations.
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Affiliation(s)
- Ryan Spangler
- Department of Emergency Medicine, University of Maryland School of Medicine, 110 South Paca Street, 6th Floor, Suite 200, Baltimore, MD 21201, USA.
| | - Sara Manning
- Department of Emergency Medicine, University of Maryland School of Medicine, 110 South Paca Street, 6th Floor, Suite 200, Baltimore, MD 21201, USA
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IL-10-1082G>A polymorphism, use of opioids and age affect the course of acute pancreatitis. Eur J Gastroenterol Hepatol 2021; 32:178-185. [PMID: 32804849 DOI: 10.1097/meg.0000000000001875] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
PURPOSE We aimed to determine the association of two of the most important functional polymorphisms of IL-8 and IL-10 with the clinical course and outcome of acute pancreatitis. METHOD Ninety-three patients with acute pancreatitis were genotyped for IL-8-251T>A and IL-10-1082G>A using PCR-RFLP. The severity of the disease was determined based on the Atlanta Classification system. RESULTS In patients treated with opioids, the odds for severe form of acute pancreatitis, its complications, and death were increased. Advanced age was associated with higher odds of organ/multiple organ failure and other systemic complications. Multivariate logistic regression analyses confirmed the observed effect of age and use of opioids, and revealed higher odds for the development of severe form of acute pancreatitis [P = 0.017, odds ratio (OR): 4.324, 95% confidence interval (CI): 1.305-14.323], its complications in general (P = 0.011, OR: 4.936, 95% CI: 1.442-16.897), pancreatic necrosis (P = 0.032, OR: 3.922, 95% CI: 1.122-13.707) and systemic inflammatory response syndrome (P = 0.037, OR: 3.838, 95% CI: 1.085-13.583) in the absence of IL-10-1082G>A variant allele. The effect of IL-8 -251T>A on acute pancreatitis severity or mortality was not detected. CONCLUSION Our study suggests the IL-10 -1082A allele as a protective factor in acute pancreatitis. Opioid analgesics treatment in acute pancreatitis is associated with severity, complications and mortality, while advanced age increases the risk of systemic complications.
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Zhang X, Ding Y, Shao Y, He J, Ma J, Guo H, Keerman M, Liu J, Si H, Guo S, Ma R. Visceral Obesity-Related Indices in the Identification of Individuals with Metabolic Syndrome Among Different Ethnicities in Xinjiang, China. Diabetes Metab Syndr Obes 2021; 14:1609-1620. [PMID: 33889002 PMCID: PMC8055644 DOI: 10.2147/dmso.s306908] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Accepted: 03/20/2021] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Few studies have focused on the predictive ability of visceral obesity-related indices for metabolic syndrome (MetS), especially in different ethnic groups. This study aimed to evaluate the applicability of visceral obesity-related indices for MetS screening among three major ethnic groups living in remote rural areas of Xinjiang. METHODS Based on multistage stratified cluster random sampling method, 3,192 Uyghurs, 3,054 Kazakhs, and 3,658 Hans were recruited from Xinjiang, China. The Joint Interim Statement (JIS) criteria were used to define MetS. The receiver operating characteristic curve (ROC), area under the ROC curve (AUC), and predictive value of each visceral obesity-related index were used to evaluate the predictive ability of MetS. RESULTS After adjusting for potential confounding factors, the lipid accumulation product (LAP), Chinese visceral adiposity index (CVAI), waist-to-height ratio (WHtR), and atherogenic index of plasma (AIP) were significantly correlated with MetS for each ethnic group, and the odds ratios (ORs) for MetS increased across quartiles. LAP was best able to identify MetS status in Kazakhs (AUC=0.853) and Uyghurs (AUC=0.851), with optimal cut-offs being 36.3 and 28.2, respectively. Both LAP (AUC=0.798) and CVAI (AUC=0.791) most accurately identified MetS status in Hans, with the optimal cut-offs being 27.3 and 85.0, respectively. Moreover, the AUC of the combination of these visceral obesity-related indices is higher for each ethnic group. However, compared with LAP, the improved value of combined screening was not significant. CONCLUSION LAP had the best discriminative capability for the screening of MetS among Kazakhs, Uyghurs, and Hans. The screening ability of CVAI for MetS was similar to that of LAP in Hans. Thus, LAP may be a complementary indicator for assessing MetS in various ethnic groups.
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Affiliation(s)
- Xianghui Zhang
- Department of Public Health, Shihezi University School of Medicine, Shihezi, Xinjiang, People’s Republic of China
| | - Yusong Ding
- Department of Public Health, Shihezi University School of Medicine, Shihezi, Xinjiang, People’s Republic of China
| | - Yinbao Shao
- Department of Public Health, Shihezi University School of Medicine, Shihezi, Xinjiang, People’s Republic of China
| | - Jia He
- Department of Public Health, Shihezi University School of Medicine, Shihezi, Xinjiang, People’s Republic of China
| | - Jiaolong Ma
- Department of Public Health, Shihezi University School of Medicine, Shihezi, Xinjiang, People’s Republic of China
| | - Heng Guo
- Department of Public Health, Shihezi University School of Medicine, Shihezi, Xinjiang, People’s Republic of China
| | - Mulatibieke Keerman
- Department of Public Health, Shihezi University School of Medicine, Shihezi, Xinjiang, People’s Republic of China
| | - Jiaming Liu
- Department of Public Health, Shihezi University School of Medicine, Shihezi, Xinjiang, People’s Republic of China
| | - Huili Si
- Department of Neurology, Shihezi People’s Hospital, Shihezi, Xinjiang, People’s Republic of China
| | - Shuxia Guo
- Department of Public Health, Shihezi University School of Medicine, Shihezi, Xinjiang, People’s Republic of China
- Department of Pathology and Key Laboratory of Xinjiang Endemic and Ethnic Diseases (Ministry of Education), Shihezi University School of Medicine, Shihezi, Xinjiang, People’s Republic of China
- Correspondence: Shuxia Guo Department of Public Health, Shihezi University School of Medicine, Suite 721, Building No. 1, Beier Road, Shihezi, 832000, Xinjiang, People’s Republic of ChinaTel +86 1800-9932-625Fax +86 993-2057-153 Email
| | - Rulin Ma
- Department of Public Health, Shihezi University School of Medicine, Shihezi, Xinjiang, People’s Republic of China
- Rulin Ma Department of Public Health, Shihezi University School of Medicine, Suite 816, Building No. 1, Beier Road, Shihezi, 832000, Xinjiang, People’s Republic of ChinaTel +86 1330-9930-561Fax +86 993-2057-153Email
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Factors predicting the severity of acute pancreatitis in elderly patients. Aging Clin Exp Res 2021; 33:183-192. [PMID: 32185694 DOI: 10.1007/s40520-020-01523-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2019] [Accepted: 02/26/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND Moderately severe acute pancreatitis (MSAP) and severe acute pancreatitis (SAP) are associated with organ failure (OF), which can be lethal. AIMS This study determined the factors that predict the severity of AP at admission in elderly patients. METHODS In this retrospective study, the data from elderly patients (> 60 years of age) admitted within 72 h of onset of symptoms without OF were collected. These data at admission were analyzed and correlated with the severity of AP. To identify the factors associated with more serious AP (i.e. MSAP and SAP), patients were divided into mild acute pancreatitis (MAP) and MSAP + SAP groups. RESULTS A total of 198 patients [MAP group (n = 135) and MSAP + SAP group (n = 63)] were included. Biliary disease was the most common etiology. Respiratory failure was the most common OF. Logistic regression analyses indicated that idiopathic etiology (odds ratio [OR]: 3.029, 95% confidence interval [CI]: 1.017-9.022, p = 0.047), pre-existing pulmonary disease (OR: 7.104, CI 1.750-28.84, p = 0.006), increased hematocrit level (OR: 3.717, 95%CI 1.372-10.070, p = 0.010), serum calcium (OR: 0.023, 95%CI 0.001-0.371, p = 0.008), serum glucose (OR: 1.157, 95%CI 1.031-1.299, p = 0.013), arterial partial pressure of oxygen (PaO2) (OR: 0.914, 95%CI 0.874-0.956, p < 0.001), and pleural effusion (OR: 4.979, 95%CI 1.863-13.303, p = 0.001) were independent predictors of more serious AP. CONCLUSION This study found that idiopathic etiology, pre-existing pulmonary diseases, increased hematocrit level or pleural effusion, higher serum glucose, and lower serum calcium or PaO2 at the time of admission independently correlated with more serious AP in the elderly patients.
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Associations between body composition and prognosis of patients admitted because of acute pancreatitis: a retrospective study. Eur J Clin Nutr 2020; 75:817-822. [PMID: 33116236 DOI: 10.1038/s41430-020-00789-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Revised: 07/31/2020] [Accepted: 10/13/2020] [Indexed: 11/09/2022]
Abstract
OBJECTIVES To investigate the possible associations of muscle and visceral fat mass with the prognosis of patients hospitalized with acute pancreatitis. METHODS Body composition analysis (Sliceomatic, TomoVision, Montreal, Canada) was performed on CT images at the L3 level in patients admitted with acute pancreatitis during 2008-2014. Regression analysis was used to examine associations of body composition with 1-year mortality and 1-year readmission rates. RESULTS A total of 158 patients were included (mean age 63.7 ± 17.4 years, 91 (57.6%) were male). Fat was the most abundant tissue (408 ± 180 cm2 surface area). None of the prognostic factors examined were associated with 1-year mortality. Values below compared to above the medians for muscle mass and visceral fat were associated with higher mean 1-year readmissions: 1.7 versus 1.0, p = 0.02 and 1.6 versus 1.1, p = 0.09, respectively. Logistic regression analysis showed an association of high visceral fat with reduced 1-year readmission (OR 0.995, 95% CI 0.991-1.000, p = 0.03). Linear regression analysis showed an inverse correlation of visceral fat mass with the number of 1-year readmissions (HR -0.004, 95% CI -0.008-000, p = 0.070). CONCLUSIONS Higher amounts of visceral fat and muscle mass were positively associated with lower recurrent hospitalizations in patients admitted with acute pancreatitis. These results support the importance of nutritional rehabilitation in patients after admission due to acute pancreatitis.
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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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The impact of obesity on acute pancreatitis outcomes in older patients. Eur Geriatr Med 2020; 11:427-432. [PMID: 32297267 DOI: 10.1007/s41999-020-00305-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2019] [Accepted: 02/28/2020] [Indexed: 10/24/2022]
Abstract
PURPOSE Although obesity is an established risk factor for a number of diseases, several epidemiological studies have demonstrated that older obese patients have better survival rates than non-obese old patients in various disease states. In this context, the relationship between obesity and acute pancreatitis outcome in older patients is controversial. Therefore, the authors aimed to investigate the impact of obesity on acute pancreatitis outcomes in older patients. METHODS Patients aged > 65 years who had been hospitalized for acute pancreatitis were retrospectively analyzed. Among them, 190 patients were included. The median age was 73 (68-79) years, and 118 (62.1%) were women. Obesity was assessed according to body mass index, and patients were classified as either obese or non-obese. The primary endpoint of the study was in-hospital major adverse events (major in-hospital complications and death). The secondary endpoints were acute pancreatitis recurrence, 30-day all-cause mortality, and long-term all-cause mortality. RESULTS A total of 77 (40.5%) patients were obese. In-hospital major adverse events were observed in 40 (21.1%) patients. There was no statistical difference in major in-hospital adverse events between the two groups (27 [23.9%] in non-obese patients vs. 13 [16.9%] in obese patients, p = 0.24). Further, the 30-day mortality, long-term survival, and acute pancreatitis recurrence rates were similar (all p > 0.05). The median follow-up time was 18 (0-80) months. CONCLUSION Obesity does not result in higher mortality or complications in older patients with acute pancreatitis. Although the underlying mechanism needs to be elucidated, the deleterious effect of obesity seems to be diminished in older patients.
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García-Rayado G, Varela-Moreiras G, Lanas Á, Ferrández Á, Balza-Lareu N, Cervera JI, Bodenlle-Bello MP, Argüelles-Arias AM, Latorre P, Udaondo-Cascante MA, Soria-de-la-Cruz MJ, Lariño-Noia J, García-Figueiras R, Gil-García-Ollauri C, Ituarte-Uriarte R, Rosales-Alexander CL, Soriano J, Rodríguez-Peláez M, Mesa-Álvarez A, Oblitas E, Menso MM, Bertoletti F, Rodríguez-Prada JI, Guzmán-Suárez S, Closa D, de-Madaria E. Dietary Fat Patterns and Outcomes in Acute Pancreatitis in Spain. Front Med (Lausanne) 2020; 7:126. [PMID: 32328495 PMCID: PMC7160296 DOI: 10.3389/fmed.2020.00126] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2019] [Accepted: 03/20/2020] [Indexed: 12/25/2022] Open
Abstract
Background/Objective: Evidence from basic and clinical studies suggests that unsaturated fatty acids (UFAs) might be relevant mediators of the development of complications in acute pancreatitis (AP). Objective: The aim of this study was to analyze outcomes in patients with AP from regions in Spain with different patterns of dietary fat intake. Materials and Methods: A retrospective analysis was performed with data from 1,655 patients with AP from a Spanish prospective cohort study and regional nutritional data from a Spanish cross-sectional study. Nutritional data considered in the study concern the total lipid consumption, detailing total saturated fatty acids, UFAs and monounsaturated fatty acids (MUFAs) consumption derived from regional data and not from the patient prospective cohort. Two multivariable analysis models were used: (1) a model with the Charlson comorbidity index, sex, alcoholic etiology, and recurrent AP; (2) a model that included these variables plus obesity. Results: In multivariable analysis, patients from regions with high UFA intake had a significantly increased frequency of local complications, persistent organ failure (POF), mortality, and moderate-to-severe disease in the model without obesity and a higher frequency of POF in the model with obesity. Patients from regions with high MUFA intake had significantly more local complications and moderate-to-severe disease; this significance remained for moderate-to-severe disease when obesity was added to the model. Conclusions: Differences in dietary fat patterns could be associated with different outcomes in AP, and dietary fat patterns may be a pre-morbid factor that determines the severity of AP. UFAs, and particulary MUFAs, may influence the pathogenesis of the severity of AP.
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Affiliation(s)
- Guillermo García-Rayado
- Service of Digestive Diseases, University Clinic Hospital Lozano Blesa, Aragón Health Research Institute (IIS Aragón), CIBERehd, Zaragoza, Spain
| | | | - Ángel Lanas
- Service of Digestive Diseases, University Clinic Hospital Lozano Blesa, Aragón Health Research Institute (IIS Aragón), CIBERehd, Zaragoza, Spain
| | - Ángel Ferrández
- Service of Digestive Diseases, University Clinic Hospital Lozano Blesa, Aragón Health Research Institute (IIS Aragón), CIBERehd, Zaragoza, Spain
| | | | - Juan I Cervera
- Department of Radiology, Hospital Clínico Universitario, Valencia, Spain
| | | | | | - Patricia Latorre
- Department of Gastroenterology, Hospital Universitario Doctor Peset, Valencia, Spain
| | | | | | - José Lariño-Noia
- Department of Gastroenterology and Hepatology, University Hospital of Santiago de Compostela, Santiago de Compostela, Spain
| | - Roberto García-Figueiras
- Department of Radiology, University Hospital of Santiago de Compostela, Santiago de Compostela, Spain
| | | | | | | | - Jordi Soriano
- Department of Gastroenterology, Hospital Universitari Doctor Josep Trueta, Girona, Spain
| | - María Rodríguez-Peláez
- Department of Gastroenterology, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - Alicia Mesa-Álvarez
- Department of Radiology, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - Elida Oblitas
- Department of Gastroenterology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - María M Menso
- Department of Radiology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Federico Bertoletti
- Department of Gastroenterology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | | | | | - Daniel Closa
- Department of Experimental Pathology, Institut d'Investigacions Biomèdiques de Barcelona (IIBB-CSIC-IDIBAPS), Barcelona, Spain
| | - Enrique de-Madaria
- Department of Gastroenterology, Alicante University General Hospital, Alicante Institute for Health and Biomedical Research (ISABIAL-FISABIO Foundation), Alicante, Spain
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23
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García-Rayado G, Cárdenas-Jaén K, de-Madaria E. Towards evidence-based and personalised care of acute pancreatitis. United European Gastroenterol J 2020; 8:403-409. [PMID: 32213025 DOI: 10.1177/2050640620903225] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Acute pancreatitis is a heterogeneous illness. Most patients experience a mild course of disease, but one third will develop local complications and/or organ failure associated with increased morbidity and risk of mortality. Diagnosis of acute pancreatitis is based on typical epigastric pain, elevation of serum lipase or amylase levels, and/or characteristic findings on imaging. Personalised management is needed in patients with acute pancreatitis. Currently, analgesia, Ringer's lactate solution-based goal-directed fluid resuscitation and early oral refeeding providing enteral nutrition if not tolerated are the cornerstones for early management. Prophylactic antibiotics or endoscopic retrograde cholangiopancreatography in the absence of cholangitis are considered to be futile. Future clinical trials should address optimal fluid resuscitation, the early administration of anti-inflammatory drugs and the exact role of nutritional support in severe acute pancreatitis. Here, we present a patient case and review the diagnosis, treatment and prognosis of acute pancreatitis.
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Affiliation(s)
- Guillermo García-Rayado
- Service of Digestive Diseases, University Clinic Hospital Lozano Blesa, Aragón Health Research Institute (IIS Aragón), Zaragoza, Spain
| | - Karina Cárdenas-Jaén
- Gastroenterology Department, Alicante University General Hospital, Alicante Institute for Health and Biomedical Research (ISABIAL), Alicante, Spain
| | - Enrique de-Madaria
- Gastroenterology Department, Alicante University General Hospital, Alicante Institute for Health and Biomedical Research (ISABIAL), Alicante, Spain
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24
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Szentesi A, Párniczky A, Vincze Á, Bajor J, Gódi S, Sarlós P, Gede N, Izbéki F, Halász A, Márta K, Dobszai D, Török I, Farkas H, Papp M, Varga M, Hamvas J, Novák J, Mickevicius A, Maldonado ER, Sallinen V, Illés D, Kui B, Erőss B, Czakó L, Takács T, Hegyi P. Multiple Hits in Acute Pancreatitis: Components of Metabolic Syndrome Synergize Each Other's Deteriorating Effects. Front Physiol 2019; 10:1202. [PMID: 31620021 PMCID: PMC6763590 DOI: 10.3389/fphys.2019.01202] [Citation(s) in RCA: 44] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2019] [Accepted: 09/03/2019] [Indexed: 12/16/2022] Open
Abstract
Introduction The incidence of acute pancreatitis (AP) and the prevalence of metabolic syndrome (MetS) are growing worldwide. Several studies have confirmed that obesity (OB), hyperlipidemia (HL), or diabetes mellitus (DM) can increase severity, mortality, and complications in AP. However, there is no comprehensive information on the independent or joint effect of MetS components on the outcome of AP. Our aims were (1) to understand whether the components of MetS have an independent effect on the outcome of AP and (2) to examine the joint effect of their combinations. Methods From 2012 to 2017, 1435 AP cases from 28 centers were included in the prospective AP Registry. Patient groups were formed retrospectively based on the presence of OB, HL, DM, and hypertension (HT). The primary endpoints were mortality, severity, complications of AP, and length of hospital stay. Odds ratio (OR) with 95% confidence intervals (CIs) were calculated. Results 1257 patients (55.7 ± 17.0 years) were included in the analysis. The presence of OB was an independent predictive factor for renal failure [OR: 2.98 (CI: 1.33–6.66)] and obese patients spent a longer time in hospital compared to non-obese patients (12.1 vs. 10.4 days, p = 0.008). HT increased the risk of severe AP [OR: 3.41 (CI: 1.39–8.37)], renal failure [OR: 7.46 (CI: 1.61–34.49)], and the length of hospitalization (11.8 vs. 10.5 days, p = 0.020). HL increased the risk of local complications [OR: 1.51 (CI: 1.10–2.07)], renal failure [OR: 6.4 (CI: 1.93–21.17)], and the incidence of newly diagnosed DM [OR: 2.55 (CI: 1.26–5.19)]. No relation was found between the presence of DM and the outcome of AP. 906 cases (mean age ± SD: 56.9 ± 16.7 years) had data on all four components of MetS available. The presence of two, three, or four MetS factors increased the incidence of an unfavorable outcome compared to patients with no MetS factors. Conclusion OB, HT, and HL are independent risk factors for a number of complications. HT is an independent risk factor for severity as well. Components of MetS strongly synergize each other’s detrimental effect. It is important to search for and follow up on the components of MetS in AP.
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Affiliation(s)
- Andrea Szentesi
- Institute for Translational Medicine, Szentágothai Research Centre, Medical School, University of Pécs, Pécs, Hungary.,First Department of Medicine, University of Szeged, Szeged, Hungary.,Doctoral School of Clinical Medicine, University of Szeged, Szeged, Hungary
| | - Andrea Párniczky
- Institute for Translational Medicine, Szentágothai Research Centre, Medical School, University of Pécs, Pécs, Hungary.,Heim Pál National Institute of Pediatrics, Budapest, Hungary
| | - Áron Vincze
- Division of Gastroenterology, First Department of Medicine, Medical School, University of Pécs, Pécs, Hungary
| | - Judit Bajor
- Division of Gastroenterology, First Department of Medicine, Medical School, University of Pécs, Pécs, Hungary
| | - Szilárd Gódi
- Division of Translational Medicine, First Department of Medicine, Medical School, University of Pécs, Pécs, Hungary
| | - Patricia Sarlós
- Division of Gastroenterology, First Department of Medicine, Medical School, University of Pécs, Pécs, Hungary
| | - Noémi Gede
- Institute for Translational Medicine, Szentágothai Research Centre, Medical School, University of Pécs, Pécs, Hungary
| | - Ferenc Izbéki
- Szent György Teaching Hospital of Fejér County, Székesfehérvár, Hungary
| | - Adrienn Halász
- Szent György Teaching Hospital of Fejér County, Székesfehérvár, Hungary
| | - Katalin Márta
- Institute for Translational Medicine, Szentágothai Research Centre, Medical School, University of Pécs, Pécs, Hungary
| | - Dalma Dobszai
- Institute for Translational Medicine, Szentágothai Research Centre, Medical School, University of Pécs, Pécs, Hungary.,Doctoral School of Clinical Medicine, University of Szeged, Szeged, Hungary
| | - Imola Török
- County Emergency Clinical Hospital - Gastroenterology and University of Medicine, Pharmacy, Sciences and Technology, Târgu Mureş, Romania
| | - Hunor Farkas
- County Emergency Clinical Hospital - Gastroenterology and University of Medicine, Pharmacy, Sciences and Technology, Târgu Mureş, Romania
| | - Mária Papp
- Division of Gastroenterology, Department of Internal Medicine, University of Debrecen, Debrecen, Hungary
| | - Márta Varga
- Dr. Réthy Pál Hospital of Békés County, Békéscsaba, Hungary
| | | | - János Novák
- Department of Gastroenterology, Pándy Kálmán Hospital of Békés County, Gyula, Hungary
| | - Artautas Mickevicius
- Vilnius University Hospital Santaros Clinics, Vilnius, Lithuania.,Clinics of Abdominal Surgery, Nephrourology and Gastroenterology, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | | | - Ville Sallinen
- Department of Transplantation and Liver Surgery, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Dóra Illés
- First Department of Medicine, University of Szeged, Szeged, Hungary
| | - Balázs Kui
- First Department of Medicine, University of Szeged, Szeged, Hungary
| | - Bálint Erőss
- Institute for Translational Medicine, Szentágothai Research Centre, Medical School, University of Pécs, Pécs, Hungary
| | - László Czakó
- First Department of Medicine, University of Szeged, Szeged, Hungary
| | - Tamás Takács
- First Department of Medicine, University of Szeged, Szeged, Hungary
| | - Péter Hegyi
- Institute for Translational Medicine, Szentágothai Research Centre, Medical School, University of Pécs, Pécs, Hungary.,First Department of Medicine, University of Szeged, Szeged, Hungary.,Division of Translational Medicine, First Department of Medicine, Medical School, University of Pécs, Pécs, Hungary.,Hungarian Academy of Sciences - University of Szeged, Momentum Gastroenterology Multidisciplinary Research Group, Szeged, Hungary
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25
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Żorniak M, Beyer G, Mayerle J. Risk Stratification and Early Conservative Treatment of Acute Pancreatitis. Visc Med 2019; 35:82-89. [PMID: 31192241 PMCID: PMC6514505 DOI: 10.1159/000497290] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2019] [Accepted: 01/28/2019] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Acute pancreatitis (AP) is a potentially life-threatening common gastrointestinal disorder with increasing incidence around the globe. Although the majority of cases will take an uneventful, mild course, a fraction of patients is at risk of moderately severe or severe pancreatitis which is burdened with substantial morbidity and mortality. Early identification of patients at risk of a severe disease course and an adopted treatment strategy are crucial to avoid adverse outcomes. SUMMARY In this review we summarize the most recent concepts of severity grading in patients diagnosed with AP by adopting recommendations of current guidelines and discussing them in the context of the available literature. The severity of AP depends on the presence of local and/or systemic complications and organ failure. To predict the severity early in the disease course, host-specific factors (age, comorbidities, body mass index), clinical risk factors (biochemical and physiological parameters and scoring systems), as well as the response to initial therapy need to be considered and revisited in the short term. Depending on the individual risk and comorbidity the initial treatment can be guided, which will be discussed in the second part of this review. KEY MESSAGE Predicting the severity of AP and adapting the individual treatment strategy requires multidimensional risk assessment and close observation during the early phase of AP development.
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Affiliation(s)
- Michał Żorniak
- Department of Gastroenterology, Medical University of Silesia, Katowice, Poland
| | - Georg Beyer
- Department of Medicine II, University Hospital, LMU Munich, Munich, Germany
| | - Julia Mayerle
- Department of Medicine II, University Hospital, LMU Munich, Munich, Germany
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