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Huang B, Cao F, Ding Y, Li A, Luo T, Wang X, Gao C, Wang Z, Zhang C, Li F. Development and validation of a nomogram based on Lasso-Logistic regression for predicting splenomegaly secondary to acute pancreatitis. BMC Gastroenterol 2024; 24:281. [PMID: 39174911 PMCID: PMC11340059 DOI: 10.1186/s12876-024-03331-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2024] [Accepted: 07/19/2024] [Indexed: 08/24/2024] Open
Abstract
PURPOSE Investigate the clinical characteristics of splenomegaly secondary to acute pancreatitis (SSAP) and construct a nomogram prediction model based on Lasso-Logistic regression. METHODS A retrospective case-control study was conducted to analyze the laboratory parameters and computed tomography (CT) imaging of acute pancreatitis (AP) patients recruited at Xuanwu Hospital from December 2014 to December 2021. Lasso regression was used to identify risk factors, and a novel nomogram was developed. The performance of the nomogram in discrimination, calibration, and clinical usefulness was evaluated through internal validation. RESULTS The prevalence of SSAP was 9.2% (88/950), with the first detection occurring 65(30, 125) days after AP onset. Compared with the control group, the SSAP group exhibited a higher frequency of persistent respiratory failure, persistent renal failure, infected pancreatic necrosis, and severe AP, along with an increased need for surgery and longer hospital stay (P < 0.05 for all). There were 185 and 79 patients in the training and internal validation cohorts, respectively. Variables screened by Lasso regression, including platelet count, white blood cell (WBC) count, local complications, and modified CT severity index (mCTSI), were incorporated into the Logistic model. Multivariate analysis showed that WBC count ≦9.71 × 109/L, platelet count ≦140 × 109/L, mCTSI ≧8, and the presence of local complications were independently associated with the occurrence of SSAP. The area under the receiver operating characteristic curve was 0.790. The Hosmer-Lemeshow test showed that the model had good fitness (P = 0.954). Additionally, the nomogram performed well in the internal validation cohorts. CONCLUSIONS SSAP is relatively common, and patients with this condition often have a worse clinical prognosis. Patients with low WBC and platelet counts, high mCTSI, and local complications in the early stages of the illness are at a higher risk for SSAP. A simple nomogram tool can be helpful for early prediction of SSAP.
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Affiliation(s)
- Bohan Huang
- Department of General Surgery, Xuanwu Hospital Capital Medical University, No.45, Changchun Street Xicheng District, Beijing, 100053, China
- Clinical Center for Acute Pancreatitis, Capital Medical University, Beijing, 100053, China
| | - Feng Cao
- Department of General Surgery, Xuanwu Hospital Capital Medical University, No.45, Changchun Street Xicheng District, Beijing, 100053, China
- Clinical Center for Acute Pancreatitis, Capital Medical University, Beijing, 100053, China
| | - Yixuan Ding
- Department of General Surgery, Xuanwu Hospital Capital Medical University, No.45, Changchun Street Xicheng District, Beijing, 100053, China
- Clinical Center for Acute Pancreatitis, Capital Medical University, Beijing, 100053, China
| | - Ang Li
- Department of General Surgery, Xuanwu Hospital Capital Medical University, No.45, Changchun Street Xicheng District, Beijing, 100053, China
- Clinical Center for Acute Pancreatitis, Capital Medical University, Beijing, 100053, China
| | - Tao Luo
- Department of General Surgery, Xuanwu Hospital Capital Medical University, No.45, Changchun Street Xicheng District, Beijing, 100053, China
- Clinical Center for Acute Pancreatitis, Capital Medical University, Beijing, 100053, China
| | - Xiaohui Wang
- Department of General Surgery, Xuanwu Hospital Capital Medical University, No.45, Changchun Street Xicheng District, Beijing, 100053, China
- Clinical Center for Acute Pancreatitis, Capital Medical University, Beijing, 100053, China
| | - Chongchong Gao
- Department of General Surgery, Xuanwu Hospital Capital Medical University, No.45, Changchun Street Xicheng District, Beijing, 100053, China
- Clinical Center for Acute Pancreatitis, Capital Medical University, Beijing, 100053, China
| | - Zhe Wang
- Department of General Surgery, Xuanwu Hospital Capital Medical University, No.45, Changchun Street Xicheng District, Beijing, 100053, China
- Clinical Center for Acute Pancreatitis, Capital Medical University, Beijing, 100053, China
| | - Chao Zhang
- Department of General Surgery, Xuanwu Hospital Capital Medical University, No.45, Changchun Street Xicheng District, Beijing, 100053, China
- Clinical Center for Acute Pancreatitis, Capital Medical University, Beijing, 100053, China
| | - Fei Li
- Department of General Surgery, Xuanwu Hospital Capital Medical University, No.45, Changchun Street Xicheng District, Beijing, 100053, China.
- Clinical Center for Acute Pancreatitis, Capital Medical University, Beijing, 100053, China.
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Borbély RZ, Szalai EÁ, Philip BM, Dobszai D, Teutsch B, Zolcsák Á, Veres DS, Erőss B, Gellért B, Hegyi PJ, Hegyi P, Faluhelyi N. The risk of developing splanchnic vein thrombosis in acute pancreatitis increases 3 days after symptom onset: A systematic review and meta-analysis. United European Gastroenterol J 2024; 12:678-690. [PMID: 38400822 PMCID: PMC11250419 DOI: 10.1002/ueg2.12550] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Accepted: 01/12/2024] [Indexed: 02/26/2024] Open
Abstract
BACKGROUND Splanchnic vein thrombosis is a complication of acute pancreatitis (AP) and is likely often underdiagnosed. OBJECTIVES We aimed to understand the time course and risk factors of splanchnic vein thrombosis in the early phase of AP. METHODS A systematic search was conducted using the PRISMA guidelines (PROSPERO registration CRD42022367578). Inclusion criteria were appropriate imaging techniques in adult AP patients, studies that reported splanchnic vein thrombosis data from the early phase, and reliable information on the timing of imaging in relation to the onset of pancreatitis symptoms or hospital admission. The proportion of patients with thrombosis with 95% confidence intervals (CI) was calculated using random-effects meta-analyses, and multiple subgroup analyses were performed. RESULTS Data from 1951 patients from 14 studies were analyzed. The proportion of patients with splanchnic vein thrombosis within 12 days after symptom onset was 0.13 (CI 0.07-0.23). The occurrence was lowest at 0.06 (CI 0.03-0.1) between 0 and 3 days after symptom onset, and increased fourfold to 0.23 (CI 0.16-0.31) between 3 and 11 days. On hospital admission, the proportion of patients affected was 0.12 (CI 0.02-0.49); it was 0.17 (CI 0.03-0.58) 1-5 days after admission. The prevalence in mild, moderate, and severe AP was 0.15 (CI 0.05-0.36), 0.26 (CI 0.15-0.43), and 0.27 (CI 0.17-0.4), respectively. Alcoholic etiology (0.31, CI 0.13-0.58) and pancreatic necrosis (0.55, CI 0.29-0.78, necrosis above 30%) correlated with increased SVT prevalence. CONCLUSION The risk of developing splanchnic vein thrombosis is significant in the early stages of AP and may affect up to a quarter of patients. Alcoholic etiology, pancreatic necrosis, and severity may increase the prevalence of splanchnic vein thrombosis.
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Affiliation(s)
- Ruben Zsolt Borbély
- Centre for Translational MedicineSemmelweis UniversityBudapestHungary
- Department of Medical ImagingBajcsy‐Zsilinszky Hospital and ClinicBudapestHungary
| | - Eszter Ágnes Szalai
- Centre for Translational MedicineSemmelweis UniversityBudapestHungary
- Department of Restorative Dentistry and EndodonticsSemmelweis UniversityBudapestHungary
| | | | - Dalma Dobszai
- Institute for Translational MedicineMedical SchoolUniversity of PécsPécsHungary
| | - Brigitta Teutsch
- Centre for Translational MedicineSemmelweis UniversityBudapestHungary
- Institute for Translational MedicineMedical SchoolUniversity of PécsPécsHungary
| | - Ádám Zolcsák
- Centre for Translational MedicineSemmelweis UniversityBudapestHungary
- Department of Biophysics and Radiation BiologySemmelweis UniversityBudapestHungary
| | - Dániel Sándor Veres
- Centre for Translational MedicineSemmelweis UniversityBudapestHungary
- Department of Biophysics and Radiation BiologySemmelweis UniversityBudapestHungary
| | - Bálint Erőss
- Centre for Translational MedicineSemmelweis UniversityBudapestHungary
- Institute for Translational MedicineMedical SchoolUniversity of PécsPécsHungary
- Institute of Pancreatic DiseasesSemmelweis UniversityBudapestHungary
| | - Bálint Gellért
- Centre for Translational MedicineSemmelweis UniversityBudapestHungary
- Department of SurgeryTransplantation and GastroenterologySemmelweis UniversityBudapestHungary
| | - Péter Jenő Hegyi
- Centre for Translational MedicineSemmelweis UniversityBudapestHungary
- Institute of Pancreatic DiseasesSemmelweis UniversityBudapestHungary
| | - Péter Hegyi
- Centre for Translational MedicineSemmelweis UniversityBudapestHungary
- Institute for Translational MedicineMedical SchoolUniversity of PécsPécsHungary
- Institute of Pancreatic DiseasesSemmelweis UniversityBudapestHungary
- Translational Pancreatology Research GroupInterdisciplinary Centre of Excellence for Research Development and InnovationUniversity of SzegedSzegedHungary
| | - Nándor Faluhelyi
- Centre for Translational MedicineSemmelweis UniversityBudapestHungary
- Department of Medical ImagingMedical SchoolUniversity of PécsPécsHungary
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Zeng T, An J, Wu Y, Hu X, An N, Gao L, Wan C, Liu L, Shen Y. Incidence and prognostic role of pleural effusion in patients with acute pancreatitis: a meta-analysis. Ann Med 2023; 55:2285909. [PMID: 38010411 PMCID: PMC10880572 DOI: 10.1080/07853890.2023.2285909] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Accepted: 11/15/2023] [Indexed: 11/29/2023] Open
Abstract
BACKGROUND Pleural effusion (PE) is reported as a common complication in acute pancreatitis (AP), while the incidence of PE in AP varies widely among studies, and the association between PE and mortality is not clear. This study aimed to comprehensively analyze the pooled incidence of PE in patients with AP and to evaluate the influence of PE on mortality through a meta-analysis. METHOD Six databases (PubMed, Web of Science, EMBASE, Cochrane, Scopus, and OVID) were searched thoroughly for relevant studies. Data were extracted, and Stata SE 16.0 software was applied to compute the pooled incidence of PE and assess the association between PE and mortality, taking the risk ratio (RR) as the effect size. RESULTS Thirty-five articles involving 7,675 patients with AP were eventually included in this meta-analysis. The pooled incidence of PE was 34% (95% CI: 28%-39%), with significant heterogeneity among studies (I2=96.7%). Further analysis revealed that the pooled incidence of unilateral and small PE occupied 49% (95% CI: 21%-77%) and 59% (95% CI: 38%-81%) of AP patients complicated by PE, respectively. The subgroup analysis revealed that "region" and "examination method" may contribute to heterogeneity. PE may be associated with increased mortality in AP patients (RR 3.99, 95% CI: 1.73-9.2). CONCLUSION This study suggested that PE is a common complication with high pooled incidence and that PE may be associated with increased mortality in AP patients. More studies should be performed to validate our findings.
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Affiliation(s)
- Tingting Zeng
- Department of Respiratory and Critical Care Medicine, West China Hospital of Sichuan University and Division of Pulmonary Diseases, State Key Laboratory of Biotherapy of China, Chengdu, China
| | - Jing An
- Department of Respiratory and Critical Care Medicine, West China Hospital of Sichuan University and Division of Pulmonary Diseases, State Key Laboratory of Biotherapy of China, Chengdu, China
| | - Yanqiu Wu
- Department of Respiratory and Critical Care Medicine, West China Hospital of Sichuan University and Division of Pulmonary Diseases, State Key Laboratory of Biotherapy of China, Chengdu, China
| | - Xueru Hu
- Department of Respiratory and Critical Care Medicine, West China Hospital of Sichuan University and Division of Pulmonary Diseases, State Key Laboratory of Biotherapy of China, Chengdu, China
| | - Naer An
- Department of Respiratory and Critical Care Medicine, West China Hospital of Sichuan University and Division of Pulmonary Diseases, State Key Laboratory of Biotherapy of China, Chengdu, China
| | - Lijuan Gao
- Department of Respiratory and Critical Care Medicine, West China Hospital of Sichuan University and Division of Pulmonary Diseases, State Key Laboratory of Biotherapy of China, Chengdu, China
| | - Chun Wan
- Department of Respiratory and Critical Care Medicine, West China Hospital of Sichuan University and Division of Pulmonary Diseases, State Key Laboratory of Biotherapy of China, Chengdu, China
| | - Lian Liu
- Department of Respiratory and Critical Care Medicine, West China Hospital of Sichuan University and Division of Pulmonary Diseases, State Key Laboratory of Biotherapy of China, Chengdu, China
| | - Yongchun Shen
- Department of Respiratory and Critical Care Medicine, West China Hospital of Sichuan University and Division of Pulmonary Diseases, State Key Laboratory of Biotherapy of China, Chengdu, China
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Xie CL, Zhang M, Chen Y, Hu R, Tang MY, Chen TW, Xue HD, Jin ZY, Zhang XM. Spleen and splenic vascular involvement in acute pancreatitis: an MRI study. Quant Imaging Med Surg 2018; 8:291-300. [PMID: 29774182 DOI: 10.21037/qims.2018.03.04] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Background To investigate the spleen and splenic vascular involvement in acute pancreatitis (AP) and their correlations with the severity of AP using magnetic resonance imaging (MRI). Methods MRI of 239 patients with AP was retrospectively reviewed to assess splenic and splenic vascular complications, and the severity of AP. The severity of AP was graded by the MRI severity index (MRSI) and the New Revised Classification of AP 2012. The intravoxel incoherent motion (IVIM) parameters (D, D*, and f) of spleen were measured. Thirty-five subjects without pancreatic and splenic disorders were enrolled as controls for IVIM parameters. Results Among the 239 patients with AP, splenomegaly (16.7%), splenic infarction (0.4%), splenic vein thrombosis (4.2%), phlebitis (7.5%) and arteritis (4.2%) were observed. Splenic vascular involvement was positively correlated with the severity of AP based on both the MRSI and the New Revised Classification of AP 2012 (P<0.05). In the control and AP groups, the splenic f values were (0.164±0.074) vs. (0.210±0.095) (P=0.023) respectively. In AP patients with and without splenomegaly, f = (0.240±0.091) vs. (0.203±0.095) (P<0.001). Conclusions Splenic vascular involvement and splenomegaly were common in AP. The vascular involvement was associated with the severity of AP. This complication should be considered when severity and prognosis of AP are assessed. Quantitative analysis of the spleen with IVIM might be a useful imaging biomarker for splenic perfusion changes in AP, especially in those with splenomegaly.
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Affiliation(s)
- Chao-Lian Xie
- Sichuan Key Laboratory of Medical Imaging and Department of Radiology, Affiliated Hospital of North Sichuan Medical College, Nanchong 637000, China
| | - Mao Zhang
- Department of General Surgery, the Fourth People's Hospital of Sichuan Province, Chengdu 610021, China
| | - Yong Chen
- Sichuan Key Laboratory of Medical Imaging and Department of Radiology, Affiliated Hospital of North Sichuan Medical College, Nanchong 637000, China
| | - Ran Hu
- Sichuan Key Laboratory of Medical Imaging and Department of Radiology, Affiliated Hospital of North Sichuan Medical College, Nanchong 637000, China
| | - Meng-Yue Tang
- Sichuan Key Laboratory of Medical Imaging and Department of Radiology, Affiliated Hospital of North Sichuan Medical College, Nanchong 637000, China
| | - Tian-Wu Chen
- Sichuan Key Laboratory of Medical Imaging and Department of Radiology, Affiliated Hospital of North Sichuan Medical College, Nanchong 637000, China
| | - Hua-Dan Xue
- Radiology Department, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing 100000, China
| | - Zheng-Yu Jin
- Radiology Department, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing 100000, China
| | - Xiao-Ming Zhang
- Sichuan Key Laboratory of Medical Imaging and Department of Radiology, Affiliated Hospital of North Sichuan Medical College, Nanchong 637000, China
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Nakamura K, Fukatsu K, Sasayama A, Yamaji T. An immune-modulating formula comprising whey peptides and fermented milk improves inflammation-related remote organ injuries in diet-induced acute pancreatitis in mice. BIOSCIENCE OF MICROBIOTA FOOD AND HEALTH 2018; 37:1-8. [PMID: 29387516 PMCID: PMC5787410 DOI: 10.12938/bmfh.17-011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/31/2017] [Accepted: 07/30/2017] [Indexed: 02/06/2023]
Abstract
It has been demonstrated that an immune-modulating enteral formula enriched with whey peptides and fermented milk (IMF) had anti-inflammatory effects in some experimental models when it was administered before the
induction of inflammation. Here, we investigated the anti-inflammatory effects of the IMF administration after the onset of systemic inflammation and investigated whether the IMF could improve the remote organ injuries
in an acute pancreatitis (AP) model. Mice were fasted for 12 hours and then fed a choline-deficient and ethionine-supplemented diet (CDE diet) for 24 hours to induce pancreatitis. In experiment 1, the diet was replaced
with a control enteral formula, and mice were sacrificed at 24-hour intervals for 96 hours. In experiment 2, mice were randomized into control and IMF groups and received the control formula or the IMF respectively for
72 hr or 96 hr. In experiment 1, pancreatitis was induced by the CDE diet, and inflammatory mediators were elevated for several days. Remote organ injuries such as splenomegaly, hepatomegaly, and elevation of the hepatic
enzymes developed. A significant strong positive correlation was observed between plasma MCP-1 and hepatic enzymes. In experiment 2, the IMF significantly improved splenomegaly, hepatomegaly, and the elevation of hepatic
enzymes. Plasma MCP-1 levels were significantly lower in the IMF group than in the control group. Nutrition management with the IMF may be useful for alleviating remote organ injuries after AP.
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Affiliation(s)
- Kentaro Nakamura
- Nutrition Research Department, Food Science & Technology Research Laboratories, Meiji Co., Ltd., 1-29-1 Nanakuni, Hachiouji, Tokyo 192-0919, Japan
| | | | - Akina Sasayama
- Nutrition Research Department, Food Science & Technology Research Laboratories, Meiji Co., Ltd., 1-29-1 Nanakuni, Hachiouji, Tokyo 192-0919, Japan
| | - Taketo Yamaji
- Nutrition Research Department, Food Science & Technology Research Laboratories, Meiji Co., Ltd., 1-29-1 Nanakuni, Hachiouji, Tokyo 192-0919, Japan
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Xu W, Qi X, Chen J, Su C, Guo X. Prevalence of Splanchnic Vein Thrombosis in Pancreatitis: A Systematic Review and Meta-Analysis of Observational Studies. Gastroenterol Res Pract 2015; 2015:245460. [PMID: 26451142 PMCID: PMC4584234 DOI: 10.1155/2015/245460] [Citation(s) in RCA: 56] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2014] [Accepted: 11/24/2014] [Indexed: 02/07/2023] Open
Abstract
Splanchnic vein thrombosis (SVT) may be negatively associated with the prognosis of pancreatitis. We performed a systematic review and meta-analysis of literatures to explore the prevalence of SVT in pancreatitis. All observational studies regarding the prevalence of SVT in pancreatitis were identified via PubMed and EMBASE databases. The prevalence of SVT was pooled in the total of patients with pancreatitis. And it was also pooled in the subgroup analyses according to the stage and causes of pancreatitis, location of SVT, and regions where the studies were performed. After the review of 714 studies, 44 studies fulfilled the inclusion criteria. Meta-analyses showed a pooled prevalence of SVT of 13.6% in pancreatitis. According to the stage of pancreatitis, the pooled prevalence of SVT was 16.6% and 11.6% in patients with acute and chronic pancreatitis, respectively. According to the causes of pancreatitis, the pooled prevalence of SVT was 12.2% and 14.6% in patients with hereditary and autoimmune pancreatitis. According to the location of SVT, the pooled prevalence of portal vein, splenic vein, and mesenteric vein thrombosis was 6.2%, 11.2%, and 2.7% in pancreatitis. The prevalence of SVT in pancreatitis was 16.9%, 11.5%, and 8.5% in Europe, America, and Asia, respectively.
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Affiliation(s)
- Wenda Xu
- The 251st Hospital of PLA, Zhangjiakou 075000, China
| | - Xingshun Qi
- Department of Gastroenterology, Shenyang General Hospital of PLA, Shenyang 110840, China
| | - Jiang Chen
- Department of Gastroenterology, Shenyang General Hospital of PLA, Shenyang 110840, China
| | - Chunping Su
- Library of Fourth Military Medical University, Xi'an 710032, China
| | - Xiaozhong Guo
- Department of Gastroenterology, Shenyang General Hospital of PLA, Shenyang 110840, China
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Butler JR, Eckert GJ, Zyromski NJ, Leonardi MJ, Lillemoe KD, Howard TJ. Natural history of pancreatitis-induced splenic vein thrombosis: a systematic review and meta-analysis of its incidence and rate of gastrointestinal bleeding. HPB (Oxford) 2011; 13:839-45. [PMID: 22081918 PMCID: PMC3244622 DOI: 10.1111/j.1477-2574.2011.00375.x] [Citation(s) in RCA: 139] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Pancreatitis-induced splenic vein thrombosis (PISVT) is an acquired anatomic abnormality that impacts decision making in pancreatic surgery. Despite this influence, its incidence and the rate of associated gastrointestinal (GI) bleeding are imprecisely known. METHODS The MEDLINE, EMBASE, Cochrane Central Register of Clinical Trials and Cochrane Database of Systematic Reviews databases were searched from their inception to June 2010 for abstracts documenting PISVT in acute (AP) or chronic pancreatitis (CP). Two reviewers independently graded abstracts for inclusion in this review. Heterogeneity in combining data was assumed prior to pooling. Random-effects meta-analyses were performed to estimate percentages and 95% confidence intervals. RESULTS After review of 241 abstracts, 47 studies and 52 case reports were graded as relevant. These represent a cohort of 805 patients with PISVT reported in the literature. A meta-analysis of studies meeting inclusion criteria shows mean incidences of PISVT of 14.1% in all patients, 22.6% in patients with AP and 12.4% in patients with CP. The incidence of associated splenomegaly was only 51.9% in these patients. Varices were identified in 53.0% of patients and were gastric in 77.3% of cases. The overall rate of GI bleeding was 12.3%. CONCLUSIONS Although reported incidences of PISVT vary widely across studies, an overall incidence of 14.1% is reported. Splenomegaly is an unreliable sign of PISVT. Although the true natural history of PISVT remains unknown, the collective reported rate of associated GI bleeding is 12.3%.
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Affiliation(s)
- James R Butler
- Department of Surgery, Indiana University School of MedicineIndianapolis, IN, USA
| | - George J Eckert
- Department of Biostatistics, Indiana University School of MedicineIndianapolis, IN, USA
| | - Nicholas J Zyromski
- Department of Surgery, Indiana University School of MedicineIndianapolis, IN, USA
| | - Michael J Leonardi
- Department of Surgery, Indiana University School of MedicineIndianapolis, IN, USA
| | - Keith D Lillemoe
- Department of Surgery, Indiana University School of MedicineIndianapolis, IN, USA
| | - Thomas J Howard
- Department of Surgery, Indiana University School of MedicineIndianapolis, IN, USA
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Abstract
INTRODUCTION In severe acute pancreatitis, immunologic impairment is supposed to be linked to the development of subsequent infectious complications. AIM To examine alterations of spleen in rat experimental severe acute pancreatitis. METHODOLOGY Severe necrotizing pancreatitis was induced by retrograde injection of 3% sodium deoxycholate into the biliopancreatic ducts of male Wistar rats. RESULTS In the rats with pancreatitis 12 and 24 hours after the induction, splenic weights were significantly lower than those of sham-operated rats. Numbers of splenocytes were also significantly reduced simultaneously. By in situ nick-end labeling, DNA fragmentation enzyme linked immunosorbent assay (ELISA), and DNA electrophoresis, no apoptosis was detected on the splenocytes from the rats with pancreatitis 6, 12, and 24 hours after the onset. Peripheral lymphocytes in the rats with pancreatitis were significantly decreased 6, 12, and 24 hours after the onset compared with those in sham-operated rats. With antecedent splenectomy, peripheral lymphocyte counts 12 hours after the onset were significantly lower than those in rats who had not undergone splenectomy. Moreover, nuclear fragmentation was noted, and DNA fragments were significantly increased in peripheral lymphocytes at 6 hours in sodium deoxycholate pancreatitis. CONCLUSION These results indicate that splenic atrophy resulting from splenocyte reduction occurs in rat experimental severe acute pancreatitis. It is suggested that splenocytes are recruited into systemic circulation in response to peripheral lymphocyte reduction as a result of apoptosis.
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Affiliation(s)
- Takeo Yasuda
- First Department of Surgery, Kobe University School of Medicine, Kobe, Japan
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