1
|
Tenner S, Vege SS, Sheth SG, Sauer B, Yang A, Conwell DL, Yadlapati RH, Gardner TB. American College of Gastroenterology Guidelines: Management of Acute Pancreatitis. Am J Gastroenterol 2024; 119:419-437. [PMID: 38857482 DOI: 10.14309/ajg.0000000000002645] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Accepted: 12/08/2023] [Indexed: 06/12/2024]
Abstract
Acute pancreatitis (AP), defined as acute inflammation of the pancreas, is one of the most common diseases of the gastrointestinal tract leading to hospital admission in the United States. It is important for clinicians to appreciate that AP is heterogenous, progressing differently among patients and is often unpredictable. While most patients experience symptoms lasting a few days, almost one-fifth of patients will go on to experience complications, including pancreatic necrosis and/or organ failure, at times requiring prolonged hospitalization, intensive care, and radiologic, surgical, and/or endoscopic intervention. Early management is essential to identify and treat patients with AP to prevent complications. Patients with biliary pancreatitis typically will require surgery to prevent recurrent disease and may need early endoscopic retrograde cholangiopancreatography if the disease is complicated by cholangitis. Nutrition plays an important role in treating patients with AP. The safety of early refeeding and importance in preventing complications from AP are addressed. This guideline will provide an evidence-based practical approach to the management of patients with AP.
Collapse
Affiliation(s)
- Scott Tenner
- State University of New York, Health Sciences Center, Brooklyn, New York, USA
| | | | - Sunil G Sheth
- Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Bryan Sauer
- University of Virginia, Charlottesville, Virginia, USA
| | | | | | | | | |
Collapse
|
2
|
O'Connor CE, Dang BQ, Miles B, Mackey J. Statin Therapy and Pancreatitis: A Multi-Institutional Retrospective Analysis. Cureus 2024; 16:e51723. [PMID: 38318563 PMCID: PMC10839132 DOI: 10.7759/cureus.51723] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/05/2024] [Indexed: 02/07/2024] Open
Abstract
INTRODUCTION Acute pancreatitis is a serious condition that has numerous etiologies and often requires hospital admission due to its high mortality rates. Statins are used worldwide to reduce the risk of cardiovascular disease. Some studies have shown an association between long-term statin use and acute pancreatitis. However, other studies have shown no effect or even postulated a mild protective effect. Due to conflicting information in the medical literature, the relationship between statins and acute pancreatitis remains unclear. The current study uses the TriNetX global research database to further investigate the impact of statin use on the development of acute pancreatitis over a five-year period. METHODS Two cohorts were created using the TriNetX global research database. One group consisted of patients not taking statins, while the other group included patients taking any statins. Patients in both groups were required to be between the ages of 40 and 75 and had normal low-density lipoprotein cholesterol (LDL) (≤200 mg/dl) and triglyceride (≤150 mg/dl) levels. Patients were matched for age, gender, race, and comorbidities. The statin group was then compared to the no-statin group and measured for the outcome of the incidence of acute pancreatitis and the frequency of episodes within the first five years of statin use. Patients who experienced any acute pancreatitis episode before starting statin therapy or before meeting inclusion criteria were excluded from the study. RESULTS Patients on statin therapy were significantly more likely to develop acute pancreatitis compared to patients not taking statin therapy (risk ratio 1.332, 95% CI: 1.242-1.429, P<0.0001). However, the statin group had a lower mean number of pancreatitis episodes than the no-statin group (4.6 vs. 5.3, P=0.043). CONCLUSION The results from this large global dataset support the previously established idea that prolonged use of statins is associated with an increased risk of pancreatitis. Clinicians should strongly consider statin-induced pancreatitis when other common etiologies have been ruled out.
Collapse
Affiliation(s)
| | - Brittany Q Dang
- Internal Medicine, University of Texas Medical Branch, Galveston, USA
| | - Brittany Miles
- Radiology, Baylor University Medical Center, Dallas, USA
| | - James Mackey
- Hematology and Oncology, Baylor University Medical Center, Dallas, USA
| |
Collapse
|
3
|
Chegini M, Sadeghi A, Zaeri F, Zamani M, Hekmatdoost A. Nano-curcumin supplementation in patients with mild and moderate acute pancreatitis: A randomized, placebo-controlled trial. Phytother Res 2023; 37:5279-5288. [PMID: 37490939 DOI: 10.1002/ptr.7958] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Revised: 05/16/2023] [Accepted: 06/30/2023] [Indexed: 07/27/2023]
Abstract
We aimed to investigate whether nano-curcumin as an anti-inflammatory agent is effective in patients with mild and moderate AP. This study was a double-blind, parallel-arm randomized controlled trial conducted at Taleghani hospital, Tehran, Iran. Eligible subjects with a diagnosis of mild and moderate AP were randomly assigned to receive either two doses of nano-curcumin (40 mg) or placebo (control) daily for 2 weeks. The primary endpoint was gastrointestinal (GI) ward length of stay (LOS). A total of 42 patients were randomly assigned to receive either nano-curcumin (n = 21) or placebo (n = 21). Compared with placebo, nano-curcumin supplementation decreased hospital LOS (RR = 0.67, 95% CI: 0.502-0.894; p = 0.006), reduced the need for analgesics over time (OR = 0.576, 95% CI: 0.421-0.790; p = 0.001), and increased overall appetite score over the study period (β = 0.104, SE: 0.053; p = 0.049). No adverse effects or mortality were reported and there was no withdrawal during the study period. The results indicate that nano-curcumin as an adjuvant therapy is safe and may reduce GI ward LOS, analgesics requirement, and improve the overall appetite in patients with mild and moderate AP. Future multi-center trials with larger sample sizes are required to verify these findings. Clinical trial registration: www.ClinicalTrials.gov NCT04989166.
Collapse
Affiliation(s)
- Maedeh Chegini
- Department of Clinical Nutrition, National Nutrition and Food Technology Research Institute, School of Nutrition and Food Technology, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Amir Sadeghi
- Gastroenterology and Liver Diseases Research Center, Research Institute for Gastroenterology and Liver Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Farid Zaeri
- Department of Biostatistics, Faculty of Paramedical Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Majid Zamani
- Faculty of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Azita Hekmatdoost
- Department of Clinical Nutrition, National Nutrition and Food Technology Research Institute, School of Nutrition and Food Technology, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| |
Collapse
|
4
|
Halaseh SA, Kostalas M, Kopec C, Toubasi AA, Salem R. Neutrophil-to-Lymphocyte Ratio as an Early Predictor of Complication and Mortality Outcomes in Individuals With Acute Pancreatitis at a UK District General Hospital: A Retrospective Analysis. Cureus 2022; 14:e29782. [PMID: 36340538 PMCID: PMC9621742 DOI: 10.7759/cureus.29782] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/29/2022] [Indexed: 11/16/2022] Open
Abstract
Aim The purpose of this study was to evaluate the predictive usefulness of the neutrophil-to-lymphocyte ratio (NLR) in patients with acute pancreatitis (AP) and establish a threshold for the prediction of poor outcomes. Methods For this investigation, we looked back at all cases of acute pancreatitis treated at Torbay Hospital in Torquay, UK, between January 1st, 2019, and December 31st, 2020. Those who were found to have chronic pancreatitis or whose baseline laboratory values could not be obtained were not included. Each patient’s entire hospital stay was analyzed, including up to 72 hours of medical and laboratory data. Results According to the Glasgow Coma Scale scoring system, 28 of the 314 included patients had severe acute pancreatitis, and 81 patients had pancreatitis with complications. Those with complications had a substantially higher NLR on day 1 (9.43 ± 7.57) than patients who recovered without complications (7.37 ± 5.88) (P-value = 0.028). The NLR on day 0 (>18.71) exhibited a sensitivity of 80%, a specificity of 90.2%, and an accuracy of 83.9% in forecasting the death of patients with pancreatitis. Conclusion Elevated baseline NLR corresponds with pancreatitis with complications and can predict mortality.
Collapse
|
5
|
Alagappan A, Sahoo B, Panigrahi MK, Sidhu S. Gastric perforation and renal vein thrombosis in acute pancreatitis: a case report. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2022. [DOI: 10.1186/s43055-022-00890-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Acute pancreatitis is one of the most common causes of acute abdomen. It is associated with multiple complications. Gastric perforation and isolated renal vein thrombosis are two infrequent complications. We present a case of acute pancreatitis with gastric perforation and isolated renal vein thrombosis in the same patient.
Case presentation
A 28-year-old gentleman with chronic alcohol intake presented with complaints of abdominal pain and not responding to analgesics. Biochemical investigations revealed elevated amylase and lipase level. Contrast-enhanced computed tomography (CECT) showed necrotizing pancreatitis with necrotic collection in the lesser sac. On oral contrast, active contrast extravasation from gastric perforation was picked up. Renal vein and splenic vein thrombosis was observed.
Conclusions
Gastric perforation and renal vein thrombosis are two infrequent complications of acute pancreatitis. High-end radiological suspicion is needed to reduce the associated morbidity and mortality.
Collapse
|
6
|
Yan F, Wang P, Xiong Z, Yang F, Cai W, Wang GX, Tan YH, Zhang J, Yang L. Pulmonary Artery Catheter in Patients with Severe Acute Pancreatitis: A Single-Center Retrospective Study. Dig Dis Sci 2022; 67:667-675. [PMID: 33570682 DOI: 10.1007/s10620-021-06881-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Accepted: 01/26/2021] [Indexed: 02/07/2023]
Abstract
OBJECTIVE It is still uncertain what effects pulmonary artery catheter (PAC)-guided resuscitation has on outcomes for patients with severe acute pancreatitis (SAP). Therefore, we aimed to investigate the effect of PAC on hospital mortality in patients with SAP. METHODS We collected the data of patients with a diagnosis of SAP from January 10, 2017, to July 30, 2019. Patients were divided into a PAC group and a control group. The primary outcome measured was the day-28 mortality. Secondary outcomes included day-90 mortality, duration of ICU and hospital stay, ventilation days, usage of renal support and vasoactive agents, incidences of acute abdominal compartment syndrome, infusion volumes, and fluid balance and hemodynamic characteristics measured by the PAC. Kaplan-Meier analysis was applied to estimate survival outcomes. Complications related to PAC were also analyzed. RESULTS There was no significant difference between the PAC group and the control group for day-28 mortality (22.7% vs. 30%, odds ratio, 0.69; 95% CI 0.31-1.52; P = 0.35). The duration of ICU stay in the PAC group was shorter (P = 0.00), and the rate of dependence on renal support treatment was lower in the PAC group than in the control group (P = 0.03). There was no difference in other secondary outcomes and no significant difference in the survival curve between the two groups (log-rank P = 0.72, X2 = 0.13). However, SAP patients inserted PAC within 24 h ICU admission showed that duration of renal support therapy in PAC patients within 24 h ICU admission (mean days, 1.60; standard deviation, 0.14) was shorter than those with 24-72 h ICU admission (mean days, 2.94; standard deviation, 0.73; P = 0.03). The organ failure rates (1 organ, 2 organs and 3 organs) were all lower in PAC patients within 24 h ICU admission than with 24-72 h ICU admission (P = 0.02, P = 0.02, P = 0.048, respectively). CONCLUSION In patients with severe acute pancreatitis, PAC-guided fluid resuscitation shortened the duration of ICU stay, and patients in the PAC group had a lower rate of dependence on renal support, while no benefit in terms of mortality was observed. However, SAP patients inserted PAC within 24 h ICU admission showed shorter duration of renal support therapy and lower organ failure rates than those with 24-72 h ICU admission, indicating that early use of PAC, especially within 24 h, might be better for SAP patients.
Collapse
Affiliation(s)
- Fang Yan
- Department of Gastroenterology and Hepatology, West China Hospital, Sichuan University, No.37 Guoxue Alley, Wuhou District, Chengdu, 610041, Sichuan, China.,Department of Intensive Care Medicine, Chengdu Fifth People's Hospital, Chengdu, 611130, Sichuan, China
| | - Ping Wang
- Department of Intensive Care Medicine, Chengdu Fifth People's Hospital, Chengdu, 611130, Sichuan, China
| | - Zhen Xiong
- Department of Intensive Care Medicine, Chengdu Fifth People's Hospital, Chengdu, 611130, Sichuan, China
| | - Fang Yang
- Department of Intensive Care Medicine, Chengdu Fifth People's Hospital, Chengdu, 611130, Sichuan, China
| | - Wei Cai
- Department of Intensive Care Medicine, Chengdu Fifth People's Hospital, Chengdu, 611130, Sichuan, China
| | - Guo-Xiang Wang
- Department of Intensive Care Medicine, Chengdu Fifth People's Hospital, Chengdu, 611130, Sichuan, China
| | - Yun-Hui Tan
- Department of Intensive Care Medicine, Chengdu Fifth People's Hospital, Chengdu, 611130, Sichuan, China
| | - Jing Zhang
- Department of Intensive Care Medicine, Chengdu Fifth People's Hospital, Chengdu, 611130, Sichuan, China
| | - Li Yang
- Department of Gastroenterology and Hepatology, West China Hospital, Sichuan University, No.37 Guoxue Alley, Wuhou District, Chengdu, 610041, Sichuan, China.
| |
Collapse
|
7
|
Wu M, Shi L, Zhang H, Liu H, Liu Y, Zhang W. Predictive value of arterial blood lactic acid concentration on the risk of all-cause death within 28 days of admission in patients with severe acute pancreatitis. Postgrad Med 2022; 134:210-216. [PMID: 35007467 DOI: 10.1080/00325481.2022.2027189] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
ObjectiveTo evaluate the ability of arterial blood lactic acid concentration to predict death within 28 days of admission of patients with severe acute pancreatitis (SAP) in the intensive care unit (ICU).MethodsClinical data of 523 SAP patients in the MIMIC-IV database were retrospectively analyzed. Patients were divided into those who survived (n=461) and those who died (n=62) within 28 days of admission. The association between lactic acid concentration and all-cause death in SAP patients was determined by Cox regression analysis, Kaplan-Meier survival analysis and subgroup analysis. The ability of lactic acid concentration to predict the risk of all-cause death in SAP patients was determined by time-dependent receiver operating curve (ROC) analysis.ResultsArterial blood lactic acid concentration was significantly higher in the 62 patients who died within 28 days than in the 461 patients who survived (P <0.05). Adjusted multivariate Cox regression analysis showed that lactic acid concentration was a significant independent predictor on all-cause mortality within 28 days of admission for SAP (hazard ratio=1.22, 95% confidence interval 1.09-1.36, P <0.001), as did time-dependent ROC analysis (area under the ROC curve=0.741). Kaplan-Meier analysis showed that the rate of all-cause mortality within 28 days of admission was significantly higher in patients with high than low lactic acid concentration (P <0.0001). Subgroup analysis showed that there was no significant interaction between lactic acid concentration and other factors with all-cause death within 28 days of admission (all P >0.05).ConclusionArterial blood lactic acid concentration is an important independent predictor of all-cause mortality within 28 days of admission of SAP patients in the ICU.
Collapse
Affiliation(s)
- Menghuan Wu
- Department of Gastroenterology, The Affiliated Hospital of Jiangsu University, Zhenjiang 212000, China
| | - Liang Shi
- Department of Nuclear Medicine, Nanjing First Hospital, Nanjing 210000, China
| | - Hao Zhang
- Department of Emergency, The Affiliated Hospital of Jiangsu University, Zhenjiang 212000, Jiangsu, China
| | - Hanqiong Liu
- Department of Emergency, The Affiliated Hospital of Jiangsu University, Zhenjiang 212000, Jiangsu, China
| | - Yanru Liu
- Department of Emergency, The Affiliated Hospital of Jiangsu University, Zhenjiang 212000, Jiangsu, China
| | - Wei Zhang
- Department of Gastroenterology, The Affiliated Hospital of Jiangsu University, Zhenjiang 212000, China
| |
Collapse
|
8
|
Higaki Y, Nishida T, Matsumoto K, Yamaoka S, Osugi N, Sugimoto A, Mukai K, Nakamatsu D, Hayashi S, Yamamoto M, Nakajima S, Fukui K, Inada M. Effect of abdominal visceral fat on mortality risk in patients with severe acute pancreatitis. JGH Open 2021; 5:1357-1362. [PMID: 34950779 PMCID: PMC8674542 DOI: 10.1002/jgh3.12681] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Revised: 10/22/2021] [Accepted: 11/09/2021] [Indexed: 11/23/2022]
Abstract
Background and Aim Obesity is a well‐known risk factor for the development and severity of acute pancreatitis (AP), but the relationship between the abdominal visceral fat area (VFA) and mortality is unclear. We evaluated the effect of the VFA on mortality in severe AP (SAP). Methods This retrospective, single‐center cohort study examined 119 consecutive patients with SAP from April 2009 to March 2019. The VFA at the umbilical level was assessed using computed tomography. The primary endpoint was to evaluate whether visceral obesity affects mortality in SAP. Results The median age was 63 years, and 66% of participants were male. Nine patients (7.5%) died during their hospital stay. The median body mass index (BMI) was 22.2 kg/m2, and six obese patients had a BMI of over 30 kg/m2 (5%). The median waist circumference and VFA were 85.5 cm and 112 cm2, respectively. Sixty‐eight (57.1%) patients had a VFA over 100 cm2. The prognostic factor score based on the Japanese guidelines for AP management (cutoff value [COV], 4; area under the curve [AUC] = 0.869) and age [COV, 72; AUC = 0.780]) showed moderate accuracy for predicting mortality, followed by the VFA (COV, 167 cm2; AUC = 0.679). Univariate logistic analysis, but not multivariate analysis, showed that an increased VFA was associated with a significantly higher odds ratio (OR) for predicting mortality (OR: 4.38, P = 0.0406). The survival times of SAP patients with and without an increased VFA of 167 cm2 were not significantly different. Conclusions Visceral obesity did not have a significant impact on predicting mortality in patients with SAP.
Collapse
Affiliation(s)
- Yu Higaki
- Department of Gastroenterology Toyonaka Municipal Hospital Toyonaka Osaka Japan
| | - Tsutomu Nishida
- Department of Gastroenterology Toyonaka Municipal Hospital Toyonaka Osaka Japan
| | - Kengo Matsumoto
- Department of Gastroenterology Toyonaka Municipal Hospital Toyonaka Osaka Japan
| | - Sho Yamaoka
- Department of Gastroenterology Toyonaka Municipal Hospital Toyonaka Osaka Japan
| | - Naoto Osugi
- Department of Gastroenterology Toyonaka Municipal Hospital Toyonaka Osaka Japan
| | - Aya Sugimoto
- Department of Gastroenterology Toyonaka Municipal Hospital Toyonaka Osaka Japan
| | - Kaori Mukai
- Department of Gastroenterology Toyonaka Municipal Hospital Toyonaka Osaka Japan
| | - Dai Nakamatsu
- Department of Gastroenterology Toyonaka Municipal Hospital Toyonaka Osaka Japan
| | - Shiro Hayashi
- Department of Gastroenterology Toyonaka Municipal Hospital Toyonaka Osaka Japan
- Department of Gastroenterology and Internal Medicine Hayashi Clinic Suita Osaka Japan
| | - Masashi Yamamoto
- Department of Gastroenterology Toyonaka Municipal Hospital Toyonaka Osaka Japan
| | - Sachiko Nakajima
- Department of Gastroenterology Toyonaka Municipal Hospital Toyonaka Osaka Japan
| | - Koji Fukui
- Department of Gastroenterology Toyonaka Municipal Hospital Toyonaka Osaka Japan
| | - Masami Inada
- Department of Gastroenterology Toyonaka Municipal Hospital Toyonaka Osaka Japan
| |
Collapse
|
9
|
Zhang D, Wang T, Dong X, Sun L, Wu Q, Liu J, Sun X. Systemic Immune-Inflammation Index for Predicting the Prognosis of Critically Ill Patients with Acute Pancreatitis. Int J Gen Med 2021; 14:4491-4498. [PMID: 34413676 PMCID: PMC8370754 DOI: 10.2147/ijgm.s314393] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Accepted: 06/28/2021] [Indexed: 12/25/2022] Open
Abstract
Background Systemic immune-inflammation index (SII) has been identified as a prognostic biomarker in various diseases. However, its significance in acute pancreatitis (AP) has not been reported. Therefore, the main aim of this study was to determine the association of SII with clinical outcomes of AP patients, after adjusting for several confounders. Methods This retrospective cohort study was conducted using data retrieved from the Medical Information Mart for Intensive Care III database (MIMIC-III). The study only included patients diagnosed with AP. SII was calculated as the platelet counts x neutrophil counts/lymphocyte counts. Cox regression models were employed to assess the impact of SII on the 30- and 90-day mortality of AP patients. Subgroup analysis was carried out to explore the stability of the relationship between SII and AP mortality. Results A total of 513 patients were found to be eligible based on the inclusion and exclusion criteria. For 30-day all-cause mortality, in the model adjusted for multiple confounders, the HR (95% CI) for mid-SII group (SII: 75.6−104.2) and high-SII groups (SII: >104.2) were 1.29 (0.65, 2.56) and 2.57 (1.35, 4.88), respectively, compared to the low-SII group (SII: <75.5). A similar trend was observed for 90-day mortality. Subgroup analyses presented a stable relationship between SII and 30-day all-cause mortality of AP patients. Conclusion SII is a potentially useful prognostic biomarker for AP. However, prospective studies are needed to confirm this finding.
Collapse
Affiliation(s)
- Daguan Zhang
- Department of Gastroenterology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, People's Republic of China
| | - Tingting Wang
- Department of Gastroenterology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, People's Republic of China
| | - Xiuli Dong
- Department of Gastroenterology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, People's Republic of China
| | - Liang Sun
- Department of Gastroenterology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, People's Republic of China
| | - Qiaolin Wu
- Department of Anesthesiology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, People's Republic of China
| | - Jianpeng Liu
- Department of Pathology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, People's Republic of China
| | - Xuecheng Sun
- Department of Gastroenterology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, People's Republic of China
| |
Collapse
|
10
|
Oxid Comparative Analysis of the Significance of Bisap and Mews Score for an Early Assessment of Illness Severity and Treatment Outcome of Acute Pancreatitis. SERBIAN JOURNAL OF EXPERIMENTAL AND CLINICAL RESEARCH 2021. [DOI: 10.2478/sjecr-2019-0013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Abstract
The aim of this study was to determine the significance of the use of the BISAP score, which is specific for patients with AP, in relation to the application of the MEWS score that is important for assessing the condition of critically ill patients in intensive care units, but is not specific for patients with AP. The research was conducted as a cohort prospective study and included patients of both sexes, older than 18 and diagnosed with AP. BISAP and MEWS score were monitored at least at four time points: on admission to the hospital (zero), 48 hours, 72 hours and 7 days after admission to the hospital.
High levels of discrimination between patients with fatal outcome and cured patients are determined in both cases, with discrimination at MEWS being somewhat higher than BISAP score. The BISAP0 had the best discrimination for BISAP score, AUROC (0.807) and also MEWS0 for MEWS score, AUROC (0.899). In our research, the highest sensitivity was shown by BISAP7d (92.1%) and MEWS48 (88.1%), and a high specificity of 87.5% had BISAP score, 48h, 72h and MEWS score at all four points of measurement.
BISAP score has a better prognostic value in relation to the form of pancreatitis, the development of complications and the outcome. However, the calculation of the MEWS score is based on monitoring the basic vital parameters so that its application is much simpler and does not require additional costs.
Collapse
|
11
|
Li C, Ren Q, Wang Z, Wang G. Early prediction of in-hospital mortality in acute pancreatitis: a retrospective observational cohort study based on a large multicentre critical care database. BMJ Open 2020; 10:e041893. [PMID: 33361165 PMCID: PMC7759962 DOI: 10.1136/bmjopen-2020-041893] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVE To develop and validate a prediction model for predicting in-hospital mortality in patients with acute pancreatitis (AP). DESIGN A retrospective observational cohort study based on a large multicentre critical care database. SETTING All subject data were collected from the eICU Collaborative Research Database (eICU-CRD), which covers 200 859 intensive care unit admissions of 139 367 patients in 208 US hospitals between 2014 and 2015. PARTICIPANTS A total of 746 patients with AP were drawn from eICU-CRD. Due to loss to follow-up (four patients) or incomplete data (364 patients), 378 patients were enrolled in the primary cohort to establish a nomogram model and to conduct internal validation. PRIMARY AND SECONDARY OUTCOME MEASURES The outcome of the prediction model was in-hospital mortality. All risk factors found significant in the univariate analysis were considered for multivariate analysis to adjust for confounding factors. Then a nomogram model was established. The performance of the nomogram model was evaluated by the concordance index (C-index) and the calibration plot. The nomogram model was internally validated using the bootstrap resampling method. The predictive accuracy of the nomogram model was compared with that of Acute Physiology, Age, and Chronic Health Evaluation (APACHE) IV. Decision curve analysis (DCA) was performed to evaluate and compare the potential net benefit using of different predictive models. RESULTS The overall in-hospital mortality rate is 4.447%. Age, BUN (blood urea nitrogen) and lactate (ABL) were the independent risk factors determined by multivariate analysis. The C-index of nomogram model ABL (0.896 (95% CI 0.825 to 0.967)) was similar to that of APACHE IV (p=0.086), showing a comparable discriminating power. Calibration plot demonstrated good agreement between the predicted and the actual in-hospital mortality. DCA showed that the nomogram model ABL was clinically useful. CONCLUSIONS Nomogram model ABL, which used readily available data, exhibited high predictive value for predicting in-hospital mortality in AP.
Collapse
Affiliation(s)
- Caifeng Li
- Department of Critical Care Medicine, Tianjin Medical University General Hospital, Tianjin, China
| | - Qian Ren
- Advertising Center, Tianjin Daily, Tianjin, China
| | - Zhiqiang Wang
- Department of Critical Care Medicine, Tianjin Medical University General Hospital, Tianjin, China
| | - Guolin Wang
- Department of Critical Care Medicine, Tianjin Medical University General Hospital, Tianjin, China
| |
Collapse
|
12
|
Raymond LJ, Ralston NV. Mercury: selenium interactions and health implications. Neurotoxicology 2020; 81:294-299. [DOI: 10.1016/j.neuro.2020.09.020] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
|
13
|
Akarsu C, Karabulut M, Aydin H, Sahbaz NA, Dural AC, Yegul D, Peker KD, Ferahman S, Bulut S, Dönmez T, Asar S, Yasar KK, Adas GT. Association between Acute Pancreatitis and COVID-19: Could Pancreatitis Be the Missing Piece of the Puzzle about Increased Mortality Rates? J INVEST SURG 2020; 35:119-125. [PMID: 33138658 DOI: 10.1080/08941939.2020.1833263] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
BACKGROUND The COVID-19 pandemic caused by SARS-CoV-2 commenced in Wuhan China in 2019 and soon spread worldwide. SARS-CoV-2 enters the cell by binding to the ACE II receptor and begins viral replication. The effects and clinical findings of SARS-CoV-2 on the liver, kidney, heart, gastrointestinal (GI) system and especially lungs have been widely discussed. However, the effects on the pancreas-another organ that also expresses ACE II-have not been studied. METHODS This work prospectively evaluated data from 316 patients who were admitted with a diagnosis of COVID-19 pneumonia. The patients were categorized into three according to the severity of pneumonia (mild, severe, critical). Demographic data, rate of pancreatitis, biochemical parameters, and radiological images from each group were analyzed. The patients were divided into two groups and outcomes were compared: COVID-19 patients with acute pancreatitis (Group P) and without acute pancreatitis (Group C). RESULTS The median age was 54 (18-87), and the median age for patients with acute pancreatitis was 55 (26-84). As an expected finding, we found a positive correlation between advanced age and mortality (p = 0.0003). 12.6% of the patients had acute pancreatitis. While pancreatitis was not seen in patients on mild status, the rate of pancreatitis was 32.5% in critical patients. Hospitalization and mortality rates were higher in patients with COVID-19 accompanied by acute pancreatitis (p = 0.0038 and p < 0.0001, respectively). C-Reactive Protein (CRP) and ferritin were significantly higher in those who had pancreatitis (p < 0.0001). D-Dimer and procalcitonin levels had only a small difference (p = 0.1127 and p = 0.3403, respectively). CONCLUSION Acute pancreatitis alone is a clinical condition that can lead to mortality and may be one of the reasons for the exaggerated immune response developing in the progression of COVID-19. Our results point out that the presence of pancreatic damage triggered by SARS-CoV-2 can deteriorate the clinical condition of patients and the mortality rate may increase in these patients.
Collapse
Affiliation(s)
- Cevher Akarsu
- Faculty of Medicine, Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Department of Surgery, University of Health Sciences, Istanbul, Turkey
| | - Mehmet Karabulut
- Faculty of Medicine, Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Department of Surgery, University of Health Sciences, Istanbul, Turkey
| | - Husnu Aydin
- Faculty of Medicine, Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Department of Surgery, University of Health Sciences, Istanbul, Turkey
| | - Nuri Alper Sahbaz
- Faculty of Medicine, Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Department of Surgery, University of Health Sciences, Istanbul, Turkey
| | - Ahmet Cem Dural
- Faculty of Medicine, Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Department of Surgery, University of Health Sciences, Istanbul, Turkey
| | - Duygu Yegul
- Faculty of Medicine, Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Department of Radiology, University of Health Sciences, Istanbul, Turkey
| | - Kivanc Derya Peker
- Basaksehir Cam and Sakura Training and Research Hospital, Department of Surgery, Turkish Ministry of Health, University of Health Sciences (UHS), Istanbul, Turkey
| | - Sina Ferahman
- Faculty of Medicine, Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Department of Surgery, University of Health Sciences, Istanbul, Turkey
| | - Sezer Bulut
- Faculty of Medicine, Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Department of Surgery, University of Health Sciences, Istanbul, Turkey
| | - Turgut Dönmez
- Faculty of Medicine, Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Department of Surgery, University of Health Sciences, Istanbul, Turkey
| | - Sinan Asar
- Faculty of Medicine, Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Department of Anesthesiology and Reanimation, University of Health Sciences, Istanbul, Turkey
| | - Kadriye Kart Yasar
- Faculty of Medicine, Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Department of Infectious Diseases and Microbiology, University of Health Sciences, Istanbul, Turkey
| | - Gokhan Tolga Adas
- Faculty of Medicine, Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Department of Surgery, University of Health Sciences, Istanbul, Turkey
| |
Collapse
|
14
|
|
15
|
Karim T, Jain A, Kumar V, Kumar RB, Kumar L, Patel M. Clinical and Severity Profile of Acute Pancreatitis in a Hospital for Low Socioeconomic Strata. Indian J Endocrinol Metab 2020; 24:416-421. [PMID: 33489847 PMCID: PMC7810056 DOI: 10.4103/ijem.ijem_447_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Accepted: 07/15/2020] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION There is an upsurge in the incidence of acute pancreatitis over the last few decades; although the case fatality rate has remained unchanged. This may either be due to increased incidence of gallstone disease or improvement in diagnostic modalities. It is a potentially life threatening disease with varying severity of presentation. METHODS This observational analytical study was conducted in the Department of General Surgery in our hospital for a period of one year. All patients of acute pancreatitis were included in the study as per inclusion & exclusion criteria. OBSERVATIONS AND RESULTS Total 62 Patients were included in the study. Gall stones disease is the most common cause of acute pancreatitis. The mean age of the patients in the study was 39 years. 28 females and 34 male patients were present. 22 patients of the patients had severe disease as per Atlanta classification. Four out of these 22 severe pancreatitis patients expired. All patients in the severe pancreatitis group had mild to life threatening complications and pleural effusion was the most common followed by necrosis. There was notable difference in terms of hospital stay between mild group and severe group of AP. CONCLUSION The clinician should be aware that acute pancreatitis can occur in any age group and gender due to different etiology. The severity of AP does not depend on etiology, age or gender and it is associated with significant morbidity and mortality. SAP can be diagnosed on clinicoradiological basis and appropriate management can be done in those patients.
Collapse
Affiliation(s)
- Tanweer Karim
- Department of Surgery, ESI PGIMSR, Basaidarapur, New Delhi, India
| | - Atul Jain
- Department of Surgery, ESI PGIMSR, Basaidarapur, New Delhi, India
| | - Vinod Kumar
- Department of Surgery, ESI PGIMSR, Basaidarapur, New Delhi, India
| | - Ram B. Kumar
- Department of Surgery, ESI PGIMSR, Basaidarapur, New Delhi, India
| | - Lalit Kumar
- Department of Surgery, ESI PGIMSR, Basaidarapur, New Delhi, India
| | | |
Collapse
|
16
|
Park HS, In SG, Yoon HJ, Lee WJ, Woo SH, Kim D. Predictive values of neutrophil-lymphocyte ratio as an early indicator for severe acute pancreatitis in the emergency department patients. J Lab Physicians 2020; 11:259-264. [PMID: 31579249 PMCID: PMC6771314 DOI: 10.4103/jlp.jlp_82_19] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
CONTEXT: Acute pancreatitis is an acute inflammatory disease presenting with a wide range of severity. AIMS: We investigated the predictive values of the neutrophil-lymphocyte ratio (NLR) as an indicator for severe acute pancreatitis in the emergency department patients. SETTINGS AND DESIGN: This retrospective study was conducted on patients with acute pancreatitis who were diagnosed in the emergency department, from January 2008 to December 2017. SUBJECTS AND METHODS: Patients were classified into either mild-to-moderate severe group or severe group according to the Revised Atlanta Classification for Acute Pancreatitis. Clinical features and laboratory blood test parameters were considered as independent variables. STATISTICAL ANALYSIS USED: Independent variables were analyzed using the Chi-square test and Mann–Whitney U-test to determine statistically significant differences between the two groups. Logistic regression analysis and receiver operating characteristic analysis were performed to evaluate the predictive values of significantly different variables. RESULTS: Of the 672 patients, 52 (7.7%) were classified into the severe group. Tachycardia, fever, prevalence of liver cirrhosis and chronic alcoholism, white blood cell count, NLR, C-reactive protein (CRP), blood urea nitrogen (BUN), creatinine, aspartate transaminase, and total bilirubin were significantly higher in the severe group. Among them, NLR (adjusted odds ratio [aOR]: 1.13; 95% confidence interval [CI]: 1.081–1.181), CRP (aOR: 1.011; 95% CI: 1.004–1.017), BUN (aOR: 1.036; 95% CI: 1.004–1.069), and creatinine (aOR: 1.703; 95% CI: 1.008–2.877) were significant in the logistic regression analysis. NLR showed relatively high sensitivity (82.7%) and specificity (70%) and showed the highest area under the curve (0.821). CONCLUSIONS: The increase in NLR was associated with severe acute pancreatitis. NLR is expected to be useful as a prognostic factor in patients with acute pancreatitis who are visiting the emergency department.
Collapse
Affiliation(s)
- Hyun Sok Park
- Department of Emergency Medicine, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Sang Guk In
- Department of Emergency Medicine, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Hai-Jeon Yoon
- Department of Nuclear Medicine, College of Medicine, Ewha Womans University, Seoul, Korea
| | - Woon Jeong Lee
- Department of Emergency Medicine, College of Medicine, The Catholic University of Korea, Incheon, Korea
| | - Seon Hee Woo
- Department of Emergency Medicine, College of Medicine, The Catholic University of Korea, Incheon, Korea
| | - Daehee Kim
- Department of Emergency Medicine, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| |
Collapse
|
17
|
Zhou H, Mei X, He X, Lan T, Guo S. Severity stratification and prognostic prediction of patients with acute pancreatitis at early phase: A retrospective study. Medicine (Baltimore) 2019; 98:e15275. [PMID: 31008971 PMCID: PMC6494233 DOI: 10.1097/md.0000000000015275] [Citation(s) in RCA: 71] [Impact Index Per Article: 14.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Severity stratification and prognostic prediction at early stage is crucial for reducing the rates of mortality of patients with acute pancreatitis (AP). We aim to investigate the predicting performance of neutrophil-lymphocyte ratio (NLR), platelet-lymphocyte ratio (PLR), and red-cell distribution width (RDW) combined with severity scores (sequential organ failure assessment [SOFA], bed-side index for severity of AP [BISAP], Ranson criteria, and acute physiology and chronic health evaluation II [APACHE II]) for severe AP (SAP) and mortality.A total of 406 patients diagnosed with AP admitted in a tertiary teaching hospital were enrolled. Demographic information and clinical parameters were retrospectively collected and analyzed. NLR, PLR, RDW, blood urea nitrogen (BUN), and AP severity scores (SOFA, BISAP, Ranson, and APACHE II) were compared between different severity groups and the survival and death group. Receiver-operating characteristic (ROC) curves for SAP and 28-day mortality were calculated for each predictor using cut-off values. Area under the curve (AUC) analysis and logistic regression models were performed to compare the performance of laboratory biomarkers and severity scores.Our results showed that NLR, PLR, RDW, glucose, and BUN level of the SAP group were significantly increased compared to the mild acute pancreatitis (MAP) group on admission (P < .001). The severity of AP increased as the NLR, SOFA, BISAP, and Ranson increased (P < .01). The AUC values of NLR, PLR, RDW, BUN, SOFA, BISAP, Ranson, and APACHE II to predict SAP were 0.722, 0.621, 0.787, 0.677, 0.806, 0.841, 0.806, and 0.752, respectively, while their AUC values to predict 28-day mortality were 0.851, 0.693, 0.885, 0.765, 0.968, 0.929, 0.812, and 0.867, respectively. BISAP achieved the highest AUC, sensitivity and NPV in predicting SAP, while SOFA is the most superior in predicting mortality. The combination of BISAP + RDW achieved the highest AUC (0.872) in predicting SAP and the combination of SOFA + RDW achieved the highest AUC (0.976) in predicting mortality. RDW (OR = 1.739), SOFA (OR = 1.554), BISAP (OR = 2.145), and Ranson (OR = 1.434) were all independent risk factors for predicting SAP, while RDW (OR = 7.361) and hematocrit (OR = 0.329) were independent risk factors for predicting mortality by logistic regression model.NLR, PLR, RDW, and BUN indicated good predictive value for SAP and mortality, while RDW had the highest discriminatory capacity. RDW is a convenient and reliable indicator for prediction not only SAP, but also mortality.
Collapse
Affiliation(s)
- Haijiang Zhou
- Department of Emergency Medicine, Beijing Chao-yang Hospital
| | - Xue Mei
- Department of Emergency Medicine, Beijing Chao-yang Hospital
| | - Xinhua He
- Department of Emergency Medicine, Beijing Chao-yang Hospital
| | - Tianfei Lan
- Department of Allergy, Beijing Shijitan Hospital, Capital Medical University, Beijing, China
| | - Shubin Guo
- Department of Emergency Medicine, Beijing Chao-yang Hospital
| |
Collapse
|
18
|
Quero G, Covino M, Fiorillo C, Rosa F, Menghi R, Simeoni B, Potenza A, Ojetti V, Alfieri S, Franceschi F. Acute pancreatitis in elderly patients: a single-center retrospective evaluation of clinical outcomes. Scand J Gastroenterol 2019; 54:492-498. [PMID: 30905212 DOI: 10.1080/00365521.2019.1588369] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Introduction: Acute pancreatitis (AP) incidence in the elderly population has increased in the last years. However, the role of age as influencing factor on the AP clinical course is still debated. Methods: We reviewed clinical records of consecutive patients admitted with diagnosis of AP. Patients were divided in elderly (≥65 years) and non-elderly (<65 years). Primary endpoint was comparison of overall mortality. Secondary endpoint included ICU admission, in-hospital length of stay (LOS) and surgical procedures. Results: We enrolled 352 elderly and 532 non-elderly patients. A higher mortality rate (7.4% vs 1.9%; p < .001), ICU admission rate (18.9% vs 6.3%; p < .001) and prolonged length of hospital stay (9 (6-14) vs 7 (5-11.7) days; p = .01) were registered in the ≥65 years group. Multivariate analysis identified age (OR: 3.5; 95% CI:1.645-7.555; p = .001), a higher Ranson score at admission (OR: 5.52; 95% CI:1.11-27.41; p<.001) and necrotic pancreatitis (OR: 8.6; 95% CI:2.46-30.27; p = .001) as independent predictors of mortality. Conversely age and necrotic pancreatitis were independent risk factors for higher LOS and ICU admission. Conclusions: Patients with AP and age ≥65 years have a higher mortality, ICU admission and prolonged LOS. Early recognition and prompt treatment are key elements to improve outcomes in this population.
Collapse
Affiliation(s)
- Giuseppe Quero
- a Dipartimento di Chirurgia, CRMPG (Gemelli Pancreatic Advanced Research Center) , Fondazione Policlinico Universitario A. Gemelli IRCCS , Roma, Italia
| | - Marcello Covino
- b Medicina D'Urgenza , Fondazione Policlinico Universitario A. Gemelli IRCCS , Roma, Italia
| | - Claudio Fiorillo
- a Dipartimento di Chirurgia, CRMPG (Gemelli Pancreatic Advanced Research Center) , Fondazione Policlinico Universitario A. Gemelli IRCCS , Roma, Italia
| | - Fausto Rosa
- a Dipartimento di Chirurgia, CRMPG (Gemelli Pancreatic Advanced Research Center) , Fondazione Policlinico Universitario A. Gemelli IRCCS , Roma, Italia
| | - Roberta Menghi
- a Dipartimento di Chirurgia, CRMPG (Gemelli Pancreatic Advanced Research Center) , Fondazione Policlinico Universitario A. Gemelli IRCCS , Roma, Italia
| | - Benedetta Simeoni
- b Medicina D'Urgenza , Fondazione Policlinico Universitario A. Gemelli IRCCS , Roma, Italia
| | - Annalisa Potenza
- b Medicina D'Urgenza , Fondazione Policlinico Universitario A. Gemelli IRCCS , Roma, Italia
| | - Veronica Ojetti
- b Medicina D'Urgenza , Fondazione Policlinico Universitario A. Gemelli IRCCS , Roma, Italia.,c Università Cattolica del Sacro Cuore , Roma , Italia
| | - Sergio Alfieri
- a Dipartimento di Chirurgia, CRMPG (Gemelli Pancreatic Advanced Research Center) , Fondazione Policlinico Universitario A. Gemelli IRCCS , Roma, Italia.,c Università Cattolica del Sacro Cuore , Roma , Italia
| | - Francesco Franceschi
- b Medicina D'Urgenza , Fondazione Policlinico Universitario A. Gemelli IRCCS , Roma, Italia.,c Università Cattolica del Sacro Cuore , Roma , Italia
| |
Collapse
|
19
|
Yamashita T, Horibe M, Sanui M, Sasaki M, Sawano H, Goto T, Ikeura T, Hamada T, Oda T, Yasuda H, Ogura Y, Miyazaki D, Hirose K, Kitamura K, Chiba N, Ozaki T, Koinuma T, Oshima T, Yamamoto T, Hirota M, Masuda Y, Tokuhira N, Kobayashi M, Saito S, Izai J, Lefor AK, Iwasaki E, Kanai T, Mayumi T. Large Volume Fluid Resuscitation for Severe Acute Pancreatitis is Associated With Reduced Mortality: A Multicenter Retrospective Study. J Clin Gastroenterol 2019; 53:385-391. [PMID: 29688917 DOI: 10.1097/mcg.0000000000001046] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND AND AIMS Although fluid resuscitation is critical in acute pancreatitis, the optimal fluid volume is unknown. The aim of this study is to evaluate the association between the volume of fluid administered and clinical outcomes in patients with severe acute pancreatitis (SAP). METHODS We conducted a multicenter retrospective study at 44 institutions in Japan. Inclusion criteria were age 18 years or older, and diagnosed with SAP from 2009 to 2013. Patients were stratified into 2 groups: administered fluid volume <6000 and ≥6000 mL in the first 24 hours. We evaluated the association between the 2 groups and clinical outcomes using multivariable logistic regression analysis. The primary outcome was in-hospital mortality. Secondary outcomes included the incidence of pancreatic infection and the need for surgical intervention. RESULTS We analyzed 1097 patients, and the mean fluid volume administered was 5618±3018 mL (mean±SD), with 708 and 389 patients stratified into the fluid <6000 mL and fluid ≥6000 mL groups, respectively. Overall in-hospital mortality was 12.3%. The fluid ≥6000 mL group had significantly higher mortality than the fluid <6000 mL group (univariable analysis, 15.9% vs. 10.3%; P<0.05). In multivariable logistic regression analysis, administration of ≥6000 mL of fluid within the first 24 hours was significantly associated with reduced mortality (odds ratio, 0.58; P<0.05). No significant association was found between the administered fluid volume and pancreatic infection, or between the volume administered and the need for surgical intervention. CONCLUSIONS In patients with SAP, administration of a large fluid volume within the first 24 hours is associated with decreased mortality.
Collapse
Affiliation(s)
- Takahiro Yamashita
- Emergency Medical Center, Fukuyama City Hospital, Zao-cho, Fukuyama City
- Acute Care Medical Center, Hyogo Prefectural Kakogawa Medical Center, Kanno-cho, Kakogawa City, Hyogo
| | - Masayasu Horibe
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Keio University School of Medicine, Shinanomachi, Shinjuku-ku
- Department of Gastroenterology and Hepatology, Tokyo Metropolitan Tama Medical Center, Musashidai, Fuchu City
| | - Masamitsu Sanui
- Department of Anesthesiology and Critical Care Medicine, Jichi Medical University Saitama Medical Center, Amanumacho, Omiya-ku, Saitama
| | - Mitsuhito Sasaki
- Department of Hepatobiliary and Pancreatic Oncology, National Cancer Center Hospital, Tsukiji, Chuo-ku
| | - Hirotaka Sawano
- Senri Critical Care Medical Center, Osaka Saiseikai Senri Hospital, Tsukumodai, Suita
| | - Takashi Goto
- Department of Anesthesiology and Intensive Care, Hiroshima City Hiroshima Citizens Hospital, Motomachi, Naka-ku, Hiroshima City, Hiroshima
| | - Tsukasa Ikeura
- The Third Department of Internal Medicine, Kansai Medical University, Shinmachi, Hirakata
| | - Tsuyoshi Hamada
- Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Hongo, Bunkyo-ku
| | - Takuya Oda
- Department of General Internal Medicine, Iizuka Hospital, Yoshiomachi, Iizuka-shi
| | - Hideto Yasuda
- Department of Emergency and Critical Care Medicine, Japanese Red Cross Musashino Hospital, Kyounancho, Musashino City
| | - Yuki Ogura
- Department of Gastroenterology and Hepatology, Tokyo Metropolitan Tama Medical Center, Musashidai, Fuchu City
| | - Dai Miyazaki
- Advanced Emergency Medical and Critical Care Center, Japanese Red Cross Maebashi Hospital, Asahi-cho, Maebashi City, Gunma
| | - Kaoru Hirose
- Department of Emergency Medicine, Shonan Kamakura General Hospital, Okamoto, Kamakura City, Kanagawa
| | - Katsuya Kitamura
- Division of Gastroentelology, Department of Medicine, Showa University School of Medicine, Hatanodai, Shinagawa-ku
| | - Nobutaka Chiba
- Department of Emergency and Critical Care Medicine, Nihon University Hospital, Kanda-Surugadai, Chiyoda-ku
| | - Tetsu Ozaki
- Department of Acute care and General Medicine, Saiseikai Kumamoto Hospital, Chikami, minami-ku, Kumamoto city, Kumamoto
| | - Toshitaka Koinuma
- Division of Intensive Care, Department of Anesthesiology and Intensive Care Medicine, Jichi Medical University School of Medicine
| | - Taku Oshima
- Department of Emergency and Critical Care Medicine, Chiba University Graduate School of Medicine, Inohana, Chuo-ku, Chiba City, Chiba
| | - Tomonori Yamamoto
- Department of Traumatology and Critical Care Medicine, Osaka City University, Asahimachi, Abenoku, Osaka City, Osaka
| | - Morihisa Hirota
- Division of Gastroenterology, Tohoku University Hospital, Seiryo-cho, Aoba-ku
| | - Yukiko Masuda
- Emergency and Critical Care Center, National Hospital Organization Nagasaki Medical Center, Kubara, Omura, Nagasaki
| | - Natsuko Tokuhira
- Division of Intensive Care Medicine, University Hospital, Kyoto Prefectural University of Medicine, Kamigyo-ku, Kyoto, Japan
| | - Mioko Kobayashi
- Tertiary Emergency Medical Center, Tokyo Metropolitan Bokutoh Hospital, Kotobashi, Sumida-ku
| | - Shinjiro Saito
- Intensive Care Unit, Department of Anesthesiology, Jikei University School of Medicine, Nishi-Shinbashi, Minato-ku, Tokyo
| | - Junko Izai
- Department of Surgery, Saka General Hospital, Nishiki-cho, Shiogama City, Miyagi
| | - Alan K Lefor
- Department of Surgery, Jichi Medical University, Yakushiji, Shimotsuke, Tochigi
| | - Eisuke Iwasaki
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Keio University School of Medicine, Shinanomachi, Shinjuku-ku
| | - Takanori Kanai
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Keio University School of Medicine, Shinanomachi, Shinjuku-ku
| | - Toshihiko Mayumi
- Department of Emergency Medicine, School of Medicine, University of Occupational and Environmental Health, Iseigaoka, Yahata Nishi, KitaKyushu, Fukuoka
| |
Collapse
|
20
|
Samanta J, Singh S, Arora S, Muktesh G, Aggarwal A, Dhaka N, Kant Sinha S, Gupta V, Sharma V, Kochhar R. Cytokine profile in prediction of acute lung injury in patients with acute pancreatitis. Pancreatology 2018; 18:878-884. [PMID: 30361069 DOI: 10.1016/j.pan.2018.10.006] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2018] [Revised: 10/13/2018] [Accepted: 10/16/2018] [Indexed: 12/11/2022]
Abstract
OBJECTIVES To study the role of cytokines in prediction of acute lung injury (ALI) in acute pancreatitis. METHODS Levels of TNFα, IL-6, IL-10, IL-8 and IL-1β were measured in 107 patients at presentation and at 72 h in patients who developed acute lung injury. A model was devised to predict development of ALI using cytokine levels and SIRS score. RESULTS The levels of TNF α (p < 0.0001), IL-6 (p < 0.0001), IL-8 (p < 0.0001) and IL-1β (p < 0.0001) were significantly higher in the ALI group. IL-10 levels were significantly lower in persistent ALI (p-ALI) than in transient ALI (t-ALI) patients (p < 0.038). p-ALI group had significant rise of TNFα (p = 0.019) and IL-1β (p = 0.001) while t-ALI group had significant rise of only IL-1β (p = 0.044) on day 3 vs day 1. Combined values of IL-6 and IL-8 above 251 pg/ml had sensitivity of 90.9% and a specificity of 100% to predict future development of ALI. Composite marker-I (IL6 ≥ 80 pg/ml + SIRS) yielded sensitivity and specificity of 73% and 98% whereas composite marker-II (IL8 ≥ 100 pg/ml + SIRS) yielded sensitivity and specificity of 73% and 95% to predict future ALI. CONCLUSIONS IL-6 and IL-8 can predict future development of ALI. When they are combined with SIRS, they can be used as comprehensive composite markers.
Collapse
Affiliation(s)
- Jayanta Samanta
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Sukhwinder Singh
- Department of Immunology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Sunil Arora
- Department of Immunology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Gaurav Muktesh
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Ashutosh Aggarwal
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Narendra Dhaka
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Saroj Kant Sinha
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Vikas Gupta
- Department of Surgery, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Vishal Sharma
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Rakesh Kochhar
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
| |
Collapse
|
21
|
Elzouki AN, Alsaed O, Saeed A, Ayash A, Khan FY. Incidence and epidemiological features of acute pancreatitis among adult inhabitants in Qatar. TURKISH JOURNAL OF GASTROENTEROLOGY 2018; 30:95-100. [PMID: 30301711 DOI: 10.5152/tjg.2018.17806] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
BACKGROUND/AIMS Acute pancreatitis (AP) is one of the most common gastrointestinal causes of hospital admission in Qatar. The aim of the present study was to investigate the epidemiological features and demographic characteristics of patients with AP and to estimate the annual incidence rates of this disease among adult inhabitants in Qatar. MATERIALS AND METHODS This retrospective study was conducted using the data collected by reviewing records of patients with AP admitted to the medical and surgical wards of Hamad GeneralHospital and Alkhor Hospital, Qatar from January 2007 to December 2012. Diagnosis of AP was based on abdominal pain suggestive of AP, serum lipase and/or amylase at least three times the upper limit of normal, and/or characteristic findings of AP on abdominal ultrasound or computed tomography. RESULTS A total of 382 AP events were reported in 334 patients. There were 250 (75%) males and 84 (25%) females. The mean age (±SD) of the patients was 56.8±18.7 years. Gallstone disease (40.6%) was the highest cause of AP, followed by alcohol consumption (28.5%) and idiopathic AP (20.7%). The mean annual incidence rate of AP was 5 per 100,000 adult inhabitants in Qatar from January 2007 to December 2012. The incidence rate among men was higher than that among women. Mortality rate was low (0.3%), and there were complications in 112 (29.3%) patients. CONCLUSION The annual incidence rate of AP is relatively low in Qatar and tends to behave similar to many European countries in etiology, which can be explained by population structure. Gallstone and alcohol consumption are the main causes, and idiopathic AP is responsible for more cases than expected.
Collapse
Affiliation(s)
- Abdel-Naser Elzouki
- Department of Medicine, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar.; Weill Cornell Medical College, Doha, Qatar
| | - Omar Alsaed
- Department of Medicine, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar.; Weill Cornell Medical College, Doha, Qatar
| | - Abazar Saeed
- Department of Medicine, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar.; Weill Cornell Medical College, Doha, Qatar
| | - Ahmed Ayash
- Department of Medicine, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar.; Weill Cornell Medical College, Doha, Qatar
| | - Fahmi Yousef Khan
- Department of Medicine, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar.; Weill Cornell Medical College, Doha, Qatar
| |
Collapse
|
22
|
Disease Course Differences in Acute Pancreatitis Based on Etiology Using the Pancreatitis Activity Scoring System. Pancreas 2018; 47:e40-e41. [PMID: 29985848 PMCID: PMC6044454 DOI: 10.1097/mpa.0000000000001091] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
|
23
|
Tee YS, Fang HY, Kuo IM, Lin YS, Huang SF, Yu MC. Serial evaluation of the SOFA score is reliable for predicting mortality in acute severe pancreatitis. Medicine (Baltimore) 2018; 97:e9654. [PMID: 29443733 PMCID: PMC5839831 DOI: 10.1097/md.0000000000009654] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Acute severe pancreatitis caused high mortality, and several scoring systems for predicting mortality are available. We evaluated the effectiveness of serial measurement of several scoring systems in patients with acute severe pancreatitis.We retrospectively obtained serial measurements of Ranson, Acute Physiology and Chronic Health Assessment (APACHE) II, and Sequential Organ Failure Assessment (SOFA) scores of 159 patients with acute severe pancreatitis.The overall mortality rate was 20%, and early mortality (in the first 2 weeks) occurred in 10 (7.4%) patients, while late mortality occurred in 17 (12.6%).All scoring systems were reliable for predicting overall and intensive care unit mortality, while the SOFA score on day 7 presented the largest area under the receiver operator characteristic (ROC) curve (0.858, SE 0.055). Changes in scores over time were evaluated for predicting the progression of organ failure, and the change in SOFA score on hospital day 7 or no interval change in SOFA score was associated with higher mortality rates.APACHE II and SOFA scores are both sensitive for predicting mortality in acute pancreatitis. The serial SOFA scores showed reliable for predicting mortality. Hospital day 7 is a reasonable time for SOFA score reassessment to predict late mortality in acute severe pancreatitis.
Collapse
Affiliation(s)
- Yu-San Tee
- Division of General Surgery, Department of Surgery, Chang Gung Memorial Hospital, Kweishan, Taoyuan city, Taiwan
| | - Hsin-Yueh Fang
- Division of General Surgery, Department of Surgery, Chang Gung Memorial Hospital, Kweishan, Taoyuan city, Taiwan
| | - I.-Ming Kuo
- Division of General Surgery, Department of Surgery, Chang Gung Memorial Hospital, Kweishan, Taoyuan city, Taiwan
| | - Yann-Sheng Lin
- Division of General Surgery, Department of Surgery, Chang Gung Memorial Hospital, Kweishan, Taoyuan city, Taiwan
| | - Song-Fong Huang
- Division of General Surgery, Department of Surgery, Chang Gung Memorial Hospital, Kweishan, Taoyuan city, Taiwan
| | - Ming-Chin Yu
- Division of General Surgery, Department of Surgery, Chang Gung Memorial Hospital, Kweishan, Taoyuan city, Taiwan
- Department of Surgery, Xiamen Chang Gung Hospital, Xiamen, Fujian, China
| |
Collapse
|
24
|
Abstract
PURPOSE OF REVIEW The obesity pandemic poses a unique set of problems for acute pancreatitis - both by increasing acute pancreatitis incidence, and worsening acute pancreatitis severity. This review explores these associations, underlying mechanisms, and potential therapies. RECENT FINDINGS We review how the obesity associated increase in gallstones, surgical, and endoscopic interventions for obesity management, diabetes, and related medications such as incretin-based therapies and hypertriglyceridemia may increase the incidence of acute pancreatitis. The mechanism of how obesity may increase acute pancreatitis severity are discussed with a focus on cytokines, adipokines, damage-associated molecular patterns and unsaturated fatty acid-mediated lipotoxicity. The role of obesity in exacerbating pancreatic necrosis is discussed; focusing on obesity-associated pancreatic steatosis. We also discuss how peripancreatic fat necrosis worsens organ failure independent of pancreatic necrosis. Last, we discuss emerging therapies including choice of intravenous fluids and the use of lipase inhibitors which have shown promise during severe acute pancreatitis. SUMMARY We discuss how obesity may contribute to increasing acute pancreatitis incidence, the role of lipolytic unsaturated fatty acid release in worsening acute pancreatitis, and potential approaches, including appropriate fluid management and lipase inhibition in improving acute pancreatitis outcomes.
Collapse
|
25
|
Bierma MJ, Coffey MJ, Nightingale S, van Rheenen PF, Ooi CY. Predicting severe acute pancreatitis in children based on serum lipase and calcium: A multicentre retrospective cohort study. Pancreatology 2016; 16:529-34. [PMID: 27161174 DOI: 10.1016/j.pan.2016.04.005] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2016] [Revised: 03/26/2016] [Accepted: 04/10/2016] [Indexed: 12/11/2022]
Abstract
OBJECTIVE This study aims to identify predictors of severe paediatric AP based on laboratory trends and peak/trough values on day 2 (D2) after presentation. The performance of identified predictors was first assessed and then combined with the previously validated sensitive predictor serum lipase ≥7 times the upper limit of normal (× ULN) on day 1 (D1). METHODS A retrospective review of children with AP (January 2000-July 2011) was performed at three tertiary referral hospitals (two in Australia, one in the Netherlands). Trends of candidate predictors were analysed using the percentage change from D1 to D2 or peak/trough values within 48 h after presentation. RESULTS 175 AP episodes (including 50 severe episodes [29%]) were identified. Serum lipase ≥50% decrease on D2 (sensitivity 73%, specificity 54%) and calcium trough ≤2.15 mmol/L within 48 h (sensitivity 59%, specificity 81%) were identified as statistically significant predictors for severe AP. By combining the newly identified predictors with the previously validated predictor serum lipase ≥7× ULN on D1 (sensitivity 82%, specificity 53%), specificity improved to predict severe AP on D2 with the addition of: (i) serum lipase ≥50% decrease (sensitivity 67%, specificity 79%), or (ii) trough calcium ≤2.15 mmol/L (sensitivity 46%, specificity 89%). CONCLUSIONS Serum lipase and calcium, may be helpful in predicting severity of paediatric AP. There may be a clinical role on D1 for using serum lipase ≥7× ULN (high sensitivity), and on D2 for combining D1 serum lipase ≥7× ULN with calcium trough ≤2.15 mmol/L within 48 h (high specificity) to help predict severe paediatric AP.
Collapse
Affiliation(s)
- Marrit J Bierma
- Department of Paediatric Gastroenterology, Beatrix Children's Hospital, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands; Discipline of Paediatrics, School of Women's and Children's Health, Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - Michael J Coffey
- Discipline of Paediatrics, School of Women's and Children's Health, Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - Scott Nightingale
- Department of Gastroenterology, John Hunter Children's Hospital, Newcastle, New South Wales, Australia; Discipline of Paediatrics and Child Health, School of Medicine and Public Health, University of Newcastle, Newcastle, New South Wales, Australia
| | - Patrick F van Rheenen
- Department of Paediatric Gastroenterology, Beatrix Children's Hospital, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Chee Y Ooi
- Discipline of Paediatrics, School of Women's and Children's Health, Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia; Department of Gastroenterology, Sydney Children's Hospital Randwick, Randwick, New South Wales, Australia.
| |
Collapse
|
26
|
Noel P, Patel K, Durgampudi C, Trivedi RN, de Oliveira C, Crowell MD, Pannala R, Lee K, Brand R, Chennat J, Slivka A, Papachristou GI, Khalid A, Whitcomb DC, DeLany JP, Cline RA, Acharya C, Jaligama D, Murad FM, Yadav D, Navina S, Singh VP. Peripancreatic fat necrosis worsens acute pancreatitis independent of pancreatic necrosis via unsaturated fatty acids increased in human pancreatic necrosis collections. Gut 2016; 65:100-11. [PMID: 25500204 PMCID: PMC4869971 DOI: 10.1136/gutjnl-2014-308043] [Citation(s) in RCA: 103] [Impact Index Per Article: 12.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2014] [Accepted: 11/17/2014] [Indexed: 02/06/2023]
Abstract
BACKGROUND AND AIMS Peripancreatic fat necrosis occurs frequently in necrotising pancreatitis. Distinguishing markers from mediators of severe acute pancreatitis (SAP) is important since targeting mediators may improve outcomes. We evaluated potential agents in human pancreatic necrotic collections (NCs), pseudocysts (PCs) and pancreatic cystic neoplasms and used pancreatic acini, peripheral blood mononuclear cells (PBMC) and an acute pancreatitis (AP) model to determine SAP mediators. METHODS We measured acinar and PBMC injury induced by agents increased in NCs and PCs. Outcomes of caerulein pancreatitis were studied in lean rats coadministered interleukin (IL)-1β and keratinocyte chemoattractant/growth-regulated oncogene, triolein alone or with the lipase inhibitor orlistat. RESULTS NCs had higher fatty acids, IL-8 and IL-1β versus other fluids. Lipolysis of unsaturated triglyceride and resulting unsaturated fatty acids (UFA) oleic and linoleic acids induced necro-apoptosis at less than half the concentration in NCs but other agents did not do so at more than two times these concentrations. Cytokine coadministration resulted in higher pancreatic and lung inflammation than caerulein alone, but only triolein coadministration caused peripancreatic fat stranding, higher cytokines, UFAs, multisystem organ failure (MSOF) and mortality in 97% animals, which were prevented by orlistat. CONCLUSIONS UFAs, IL-1β and IL-8 are elevated in NCs. However, UFAs generated via peripancreatic fat lipolysis causes worse inflammation and MSOF, converting mild AP to SAP.
Collapse
Affiliation(s)
- Pawan Noel
- Departments of Medicine, Mayo Clinic, Scottsdale, Arizona, USA
| | - Krutika Patel
- Departments of Medicine, Mayo Clinic, Scottsdale, Arizona, USA
| | - Chandra Durgampudi
- Departments of Medicine, University of Pittsburgh Medical Center, Pasavant, Pennsylvania, USA
| | - Ram N Trivedi
- Departments of Medicine, Mayo Clinic, Scottsdale, Arizona, USA
| | | | | | - Rahul Pannala
- Departments of Medicine, Mayo Clinic, Scottsdale, Arizona, USA
| | - Kenneth Lee
- Departments of Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Randall Brand
- Departments of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Jennifer Chennat
- Departments of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Adam Slivka
- Departments of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | | | - Asif Khalid
- Departments of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - David C Whitcomb
- Departments of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - James P DeLany
- Departments of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Rachel A Cline
- Departments of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Chathur Acharya
- Departments of Medicine, University of Pittsburgh Medical Center, Pasavant, Pennsylvania, USA
| | - Deepthi Jaligama
- Departments of Medicine, University of Pittsburgh Medical Center, Pasavant, Pennsylvania, USA
| | - Faris M Murad
- Departments of Medicine, Washington University, Saint Louis, Missouri, USA
| | - Dhiraj Yadav
- Departments of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Sarah Navina
- Departments of Pathology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Vijay P Singh
- Departments of Medicine, Mayo Clinic, Scottsdale, Arizona, USA
| |
Collapse
|
27
|
Shyu JY, Sainani NI, Sahni VA, Chick JF, Chauhan NR, Conwell DL, Clancy TE, Banks PA, Silverman SG. Necrotizing pancreatitis: diagnosis, imaging, and intervention. Radiographics 2015; 34:1218-39. [PMID: 25208277 DOI: 10.1148/rg.345130012] [Citation(s) in RCA: 73] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Acute necrotizing pancreatitis is a severe form of acute pancreatitis characterized by necrosis in and around the pancreas and is associated with high rates of morbidity and mortality. Although acute interstitial edematous pancreatitis is diagnosed primarily on the basis of signs, symptoms, and laboratory test findings, the diagnosis and severity assessment of acute necrotizing pancreatitis are based in large part on imaging findings. On the basis of the revised Atlanta classification system of 2012, necrotizing pancreatitis is subdivided anatomically into parenchymal, peripancreatic, and combined subtypes, and temporally into clinical early (within 1 week of onset) and late (>1 week after onset) phases. Associated collections are categorized as "acute necrotic" or "walled off" and can be sterile or infected. Imaging, primarily computed tomography and magnetic resonance imaging, plays an essential role in the diagnosis of necrotizing pancreatitis and the identification of complications, including infection, bowel and biliary obstruction, hemorrhage, pseudoaneurysm formation, and venous thrombosis. Imaging is also used to help triage patients and guide both temporizing and definitive management. A "step-up" method for the management of necrotizing pancreatitis that makes use of imaging-guided percutaneous catheter drainage of fluid collections prior to endoscopic or surgical necrosectomy has been shown to improve clinical outcomes. The authors present an algorithmic approach to the care of patients with necrotizing pancreatitis and review the use of imaging and interventional techniques in the diagnosis and management of this pathologic condition.
Collapse
Affiliation(s)
- Jeffrey Y Shyu
- From the Department of Radiology, Division of Abdominal Imaging and Intervention (J.Y.S., N.I.S., V.A.S., J.F.C., N.R.C., S.G.S.), Department of Medicine, Division of Gastroenterology, Hepatology and Endoscopy (D.L.C., P.A.B.), and Department of Surgery, Division of Surgical Oncology (T.E.C.), Brigham and Women's Hospital, Harvard Medical School, 75 Francis St, Boston, MA 02115
| | | | | | | | | | | | | | | | | |
Collapse
|
28
|
Patel K, Trivedi RN, Durgampudi C, Noel P, Cline RA, DeLany JP, Navina S, Singh VP. Lipolysis of visceral adipocyte triglyceride by pancreatic lipases converts mild acute pancreatitis to severe pancreatitis independent of necrosis and inflammation. THE AMERICAN JOURNAL OF PATHOLOGY 2015; 185:808-19. [PMID: 25579844 DOI: 10.1016/j.ajpath.2014.11.019] [Citation(s) in RCA: 82] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/13/2014] [Revised: 11/13/2014] [Accepted: 11/20/2014] [Indexed: 02/06/2023]
Abstract
Visceral fat necrosis has been associated with severe acute pancreatitis (SAP) for over 100 years; however, its pathogenesis and role in SAP outcomes are poorly understood. Based on recent work suggesting that pancreatic fat lipolysis plays an important role in SAP, we evaluated the role of pancreatic lipases in SAP-associated visceral fat necrosis, the inflammatory response, local injury, and outcomes of acute pancreatitis (AP). For this, cerulein pancreatitis was induced in lean and obese mice, alone or with the lipase inhibitor orlistat and parameters of AP induction (serum amylase and lipase), fat necrosis, pancreatic necrosis, and multisystem organ failure, and inflammatory response were assessed. Pancreatic lipases were measured in fat necrosis and were overexpressed in 3T3-L1 cells. We noted obesity to convert mild cerulein AP to SAP with greater cytokines, unsaturated fatty acids (UFAs), and multisystem organ failure, and 100% mortality without affecting AP induction or pancreatic necrosis. Increased pancreatic lipase amounts and activity were noted in the extensive visceral fat necrosis of dying obese mice. Lipase inhibition reduced fat necrosis, UFAs, organ failure, and mortality but not the parameters of AP induction. Pancreatic lipase expression increased lipolysis in 3T3-L1 cells. We conclude that UFAs generated via lipolysis of visceral fat by pancreatic lipases convert mild AP to SAP independent of pancreatic necrosis and the inflammatory response.
Collapse
Affiliation(s)
- Krutika Patel
- Department of Medicine, University of Pittsburgh Medical Center and the University of Pittsburgh, Pittsburgh, Pennsylvania; Mayo Clinic, Scottsdale, Arizona
| | - Ram N Trivedi
- Department of Medicine, University of Pittsburgh Medical Center and the University of Pittsburgh, Pittsburgh, Pennsylvania; Mayo Clinic, Scottsdale, Arizona
| | - Chandra Durgampudi
- Department of Medicine, University of Pittsburgh Medical Center and the University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Pawan Noel
- Department of Medicine, University of Pittsburgh Medical Center and the University of Pittsburgh, Pittsburgh, Pennsylvania; Mayo Clinic, Scottsdale, Arizona
| | - Rachel A Cline
- Department of Medicine, University of Pittsburgh Medical Center and the University of Pittsburgh, Pittsburgh, Pennsylvania
| | - James P DeLany
- Department of Medicine, University of Pittsburgh Medical Center and the University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Sarah Navina
- Department of Pathology, University of Pittsburgh Medical Center and the University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Vijay P Singh
- Department of Medicine, University of Pittsburgh Medical Center and the University of Pittsburgh, Pittsburgh, Pennsylvania; Mayo Clinic, Scottsdale, Arizona.
| |
Collapse
|
29
|
Zhou XH, He JD, Qiu X, Chen O, Liu L, Zhu YJ. Enteral nutrition vs total parenteral nutrition in patients with severe acute pancreatitis: A systematic review of randomized controlled trials. Shijie Huaren Xiaohua Zazhi 2014; 22:3153-3160. [DOI: 10.11569/wcjd.v22.i21.3153] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM: To assess the safety and efficacy of enteral nutrition and total parenteral nutrition in patients with severe acute pancreatitis.
METHODS: We searched Cochrane Central Register of Controlled Trails (CENTRAL), MEDLINE or PubMed, Embase, OVID database, Chinese Biological Medicine database (CBMDisc), CNKI, Chinese VIP database and Wanfang database to retrieve relevant articles. The bibliographies of the retrieved articles and conference proceedings were searched manually. Systematic review was conducted using the method recommended by The Cochrane Collaboration.
RESULTS: Sixteen trials involving 791 patients were included in the systematic review. Meta-analysis showed that compared with total parenteral nutrition, enteral nutrition was associated with a significantly lower mortality (OR = 0.26, 95%CI: 0.16-0.45, P < 0.00001), 1ower incidence of infectious complications and organ failure (OR = 0.19, 95%CI: 0.13-0.27, P < 0.00001; OR = 0.25, 95%CI: 0.09-0.66, P = 0.005), fewer surgical interventions (P = 0.006), shorter hospitalization and fewer hospital fees (WMD = -12.37, 95%CI: -17.22--7.52, P < 0.00001; WMD = -1.90, 95%CI: -2.40--1.39, P < 0.00001).
CONCLUSION: The current evidence shows that enteral nutrition is safe and effective and is the preferred nutrition feeding method in patients with severe acute pancreatitis.
Collapse
|
30
|
Cui ML, Kim KH, Kim HG, Han J, Kim H, Cho KB, Jung MK, Cho CM, Kim TN. Incidence, risk factors and clinical course of pancreatic fluid collections in acute pancreatitis. Dig Dis Sci 2014; 59:1055-62. [PMID: 24326631 DOI: 10.1007/s10620-013-2967-4] [Citation(s) in RCA: 65] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2013] [Accepted: 11/15/2013] [Indexed: 12/12/2022]
Abstract
BACKGROUND Acute pancreatitis is an acute inflammatory process of the pancreas with variable involvement of other regional tissues or remote organ systems. Acute fluid collections and pseudocyst formation are the most frequent complications of acute pancreatitis. AIMS The aims of this study were to evaluate the incidence, risk factors, and clinical course of pancreatic fluid collections and pseudocyst formation following acute pancreatitis. METHODS A prospective multicenter study was conducted in five participating centers with 302 patients diagnosed with acute pancreatitis from January 2011 to July 2012. RESULTS The incidence of pancreatic fluid collections and pseudocyst was 42.7 and 6.3 %, respectively. Patients with fluid collections were significantly younger, compared to those without fluid collections (51.5 ± 15.9 vs. 60.4 ± 16.5 years, P = 0.000). The proportion of alcoholic etiology (54.3 %) in patients with fluid collections was significantly higher compared to other etiologies (P = 0.000). C-reactive protein (CRP) (48 h) was significantly higher in patients with fluid collections, compared to patients without fluid collections (39.2 ± 77.4 vs. 15.1 ± 36.2 mg/dL, P = 0.016). LDH (48 h) was significantly higher in patients with pseudocyst formation, compared to patients with complete resolution (1,317.6 ± 706.4 vs. 478.7 ± 190.5 IU/L, P = 0.000). Pancreatic fluid collections showed spontaneous resolution in 69.8 % (90/129) and 84.2 % of the pseudocysts disappeared or decreased in size during follow up. CONCLUSIONS Age, CRP (48 h), and alcohol etiology are risk factors for pancreatic fluid collections. LDH (48 h) appears to be a risk factor for pseudocyst formation. Most pseudocysts showed a decrease in size or spontaneous resolution with conservative management.
Collapse
Affiliation(s)
- Mei Lan Cui
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Yeungnam University College of Medicine, 317-1 Daemyung 5-dong Nam-gu, Taegu, 705-717, Korea,
| | | | | | | | | | | | | | | | | |
Collapse
|
31
|
Ince AT, Senturk H, Singh VK, Yildiz K, Danalioğlu A, Cinar A, Uysal O, Kocaman O, Baysal B, Gürakar A. A randomized controlled trial of home monitoring versus hospitalization for mild non-alcoholic acute interstitial pancreatitis: a pilot study. Pancreatology 2014; 14:174-8. [PMID: 24854612 DOI: 10.1016/j.pan.2014.02.007] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2013] [Revised: 01/31/2014] [Accepted: 02/25/2014] [Indexed: 12/11/2022]
Abstract
BACKGROUND/OBJECTIVES Acute pancreatitis (AP) is a disease typically requiring in-hospital treatment. We conducted a trial to assess the feasibility of early discharge from the hospital for patients with mild non-alcoholic acute pancreatitis (NAAP). METHODS Eighty-four patients with mild NAAP were randomized to home or hospital groups after a short hospital stay (≤24 h). AP was defined by the revised Atlanta criteria. Mild AP was defined as an Imrie score≤5 and a harmless acute pancreatitis score (HAPS)≤2 in the first 24-h of presentation. A nurse visited all patients in the home group on the 2nd, 3rd and 5th days. All patients presented for follow-up in clinic on the 7th, 14th, and 30th days. The primary outcome was the time to resolution of pain. Secondary outcomes evaluated included time to resumption of an oral diet, 30 day hospital readmission rate as well as the total costs associated with either approach to care. RESULTS There was no difference between the groups with regards to demographics, prognostic severity scores, symptoms, and biliary findings. No patients developed organ failure, pancreatic necrosis, or died in either group. Time to the resolution of pain and resumption of solid food intake were similar. Three (3.6%) patients required readmission within 30 days, 1 from home and 2 from the hospital groups. The total cost was significantly less in home group ($139 ± 73 vs. $951 ± 715,p < 0.001). CONCLUSIONS Mild NAAP can be safely treated at home with regular visits by a nurse under the supervision of a physician. Widespread adoption of this practice may result in large cost savings.
Collapse
Affiliation(s)
- Ali Tüzün Ince
- Gastroenterology Clinic, Bezmialem Vakıf University School of Medicine, İstanbul, Turkey
| | - Hakan Senturk
- Gastroenterology Clinic, Bezmialem Vakıf University School of Medicine, İstanbul, Turkey.
| | - Vikesh K Singh
- Division of Gastroenterology & Hepatology, Department of Medicine, Johns Hopkins Medical Institutions, Baltimore, MD, USA
| | - Kemal Yildiz
- Gastroenterology Clinic, Bezmialem Vakıf University School of Medicine, İstanbul, Turkey
| | - Ahmet Danalioğlu
- Gastroenterology Clinic, Bezmialem Vakıf University School of Medicine, İstanbul, Turkey
| | - Ahmet Cinar
- Gastroenterology Clinic, Bezmialem Vakıf University School of Medicine, İstanbul, Turkey
| | - Omer Uysal
- Gastroenterology Clinic, Bezmialem Vakıf University School of Medicine, İstanbul, Turkey
| | - Orhan Kocaman
- Gastroenterology Clinic, Bezmialem Vakıf University School of Medicine, İstanbul, Turkey
| | - Birol Baysal
- Gastroenterology Clinic, Bezmialem Vakıf University School of Medicine, İstanbul, Turkey
| | - Ahmet Gürakar
- Division of Gastroenterology & Hepatology, Department of Medicine, Johns Hopkins Medical Institutions, Baltimore, MD, USA
| |
Collapse
|
32
|
Acharya C, Navina S, Singh VP. Role of pancreatic fat in the outcomes of pancreatitis. Pancreatology 2014; 14:403-8. [PMID: 25278311 PMCID: PMC4185152 DOI: 10.1016/j.pan.2014.06.004] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2014] [Revised: 06/19/2014] [Accepted: 06/19/2014] [Indexed: 12/11/2022]
Abstract
The role of obesity in relation to various disease processes is being increasingly studied, with reports over the last several years increasingly mentioning its association with worse outcomes in acute disease. Obesity has also gained recognition as a risk factor for severe acute pancreatitis (SAP).The mortality in SAP may be as high as 30% and is usually attributable to multi system organ failure (MSOF) earlier in the disease, and complications of necrotizing pancreatitis later [9-11]. To date there is no specific treatment for acute pancreatitis (AP) and the management is largely expectant and supportive. Obesity in general has also been associated with poor outcomes in sepsis and other pathological states including trauma and burns. With the role of unsaturated fatty acids (UFA) as propagators in SAP having recently come to light and with the recognition of acute lipotoxicity, there is now an opportunity to explore different strategies to reduce the mortality and morbidity in SAP and potentially other disease states associated with such a pathophysiology. In this review we will discuss the role of fat and implications of the consequent acute lipotoxicity on the outcomes of acute pancreatitis in lean and obese states and during acute on chronic pancreatitis.
Collapse
Affiliation(s)
- Chathur Acharya
- Department of Medicine, Virginia Commonwealth University, Richmond, VA, USA
| | | | | |
Collapse
|
33
|
American College of Gastroenterology guideline: management of acute pancreatitis. Am J Gastroenterol 2013; 108:1400-15; 1416. [PMID: 23896955 DOI: 10.1038/ajg.2013.218] [Citation(s) in RCA: 1273] [Impact Index Per Article: 115.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2012] [Accepted: 06/18/2013] [Indexed: 02/06/2023]
Abstract
This guideline presents recommendations for the management of patients with acute pancreatitis (AP). During the past decade, there have been new understandings and developments in the diagnosis, etiology, and early and late management of the disease. As the diagnosis of AP is most often established by clinical symptoms and laboratory testing, contrast-enhanced computed tomography (CECT) and/or magnetic resonance imaging (MRI) of the pancreas should be reserved for patients in whom the diagnosis is unclear or who fail to improve clinically. Hemodynamic status should be assessed immediately upon presentation and resuscitative measures begun as needed. Patients with organ failure and/or the systemic inflammatory response syndrome (SIRS) should be admitted to an intensive care unit or intermediary care setting whenever possible. Aggressive hydration should be provided to all patients, unless cardiovascular and/or renal comorbidites preclude it. Early aggressive intravenous hydration is most beneficial within the first 12-24 h, and may have little benefit beyond. Patients with AP and concurrent acute cholangitis should undergo endoscopic retrograde cholangiopancreatography (ERCP) within 24 h of admission. Pancreatic duct stents and/or postprocedure rectal nonsteroidal anti-inflammatory drug (NSAID) suppositories should be utilized to lower the risk of severe post-ERCP pancreatitis in high-risk patients. Routine use of prophylactic antibiotics in patients with severe AP and/or sterile necrosis is not recommended. In patients with infected necrosis, antibiotics known to penetrate pancreatic necrosis may be useful in delaying intervention, thus decreasing morbidity and mortality. In mild AP, oral feedings can be started immediately if there is no nausea and vomiting. In severe AP, enteral nutrition is recommended to prevent infectious complications, whereas parenteral nutrition should be avoided. Asymptomatic pancreatic and/or extrapancreatic necrosis and/or pseudocysts do not warrant intervention regardless of size, location, and/or extension. In stable patients with infected necrosis, surgical, radiologic, and/or endoscopic drainage should be delayed, preferably for 4 weeks, to allow the development of a wall around the necrosis.
Collapse
|
34
|
Thandassery RB, Yadav TD, Dutta U, Appasani S, Singh K, Kochhar R. Dynamic nature of organ failure in severe acute pancreatitis: the impact of persistent and deteriorating organ failure. HPB (Oxford) 2013; 15:523-8. [PMID: 23750495 PMCID: PMC3692022 DOI: 10.1111/j.1477-2574.2012.00613.x] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2012] [Accepted: 09/19/2012] [Indexed: 12/12/2022]
Abstract
BACKGROUND AND AIMS In acute pancreatitis (AP), patients with persistent organ failure [POF, duration of organ failure (OF) ≥48 h] and transient organ failure (TOF, duration of OF <48 h) have different outcomes. We have compared the clinical course and outcome of patients with severe AP (SAP) with TOF and POF in the first week of hospitalization as well as the impact of change in the OF score in the first week on patient outcome. METHODS Consecutive patients with SAP were evaluated for OF and its dynamics during the first week of hospitalization. The modified multiple organ failure score (MOFS) was used to identify OF, grade its severity and monitor its progression. The clinical course and outcome of patients were studied. RESULTS Of 114 patients, mean age 39.2 ± 13.7 years, 37 (32.5%) patients had no OF, 34 (29.8%) had TOF and 43(37.7%) had POF. Patients with POF had the higher infected necrosis, increased requirement for percutaneous drain placement, surgery and higher mortality as compared with those with TOF. The odds ratio for mortality with persistent and deteriorating OF was 26.2 [confidence interval (CI) 5.1-134.9] compared with only persistent OF. CONCLUSION The dynamics of OF in the first week of SAP predicts the clinical course and outcome. Persistent and deteriorating OF indicates a poor outcome.
Collapse
Affiliation(s)
- Ragesh Babu Thandassery
- Department of Gastroenterology, Postgraduate Institute of Medical Education and ResearchChandigarh, India
| | - Thakur Deen Yadav
- Department of General Surgery, Postgraduate Institute of Medical Education and ResearchChandigarh, India
| | - Usha Dutta
- Department of Gastroenterology, Postgraduate Institute of Medical Education and ResearchChandigarh, India
| | - Sreekanth Appasani
- Department of Gastroenterology, Postgraduate Institute of Medical Education and ResearchChandigarh, India
| | - Kartar Singh
- Department of Gastroenterology, Postgraduate Institute of Medical Education and ResearchChandigarh, India
| | - Rakesh Kochhar
- Department of Gastroenterology, Postgraduate Institute of Medical Education and ResearchChandigarh, India
| |
Collapse
|
35
|
Early hemodynamic variables and outcome in severe acute pancreatitis: a retrospective single-center cohort study. Pancreas 2013; 42:272-8. [PMID: 22982820 DOI: 10.1097/mpa.0b013e318264c9f7] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
OBJECTIVES The aim of this study was to assess the association of hemodynamic factors with 90-day mortality in critically ill patients with severe acute pancreatitis (SAP). METHODS One hundred fifty-nine consecutive patients with SAP admitted to the intensive care units between January 2005 and December 2008 were included in study. We assessed the association of hemodynamic variables during the first 24 hours in the intensive care unit with 90-day mortality using multivariate analysis for all patients with SAP and for a subgroup with circulatory shock. RESULTS Advanced age (odds ratio [OR], 1.09; 95% confidence interval, 1.04-1.15 per year), higher serum creatinine (OR, 1.01; 95% confidence interval, 1.00-1.02 per unit), and lower mean arterial pressure (OR, 0.92; 95% confidence interval, 0.86-0.99 per mm Hg) were independently associated with 90-day mortality. In the subgroup of SAP with shock, higher Acute Physiology and Chronic Health Evaluation II score (OR, 1.15; 95% confidence interval, 1.00-1.32 per point), higher central venous pressure (OR, 1.25; 95% confidence interval, 1.03-1.52 per mm Hg), and lower cardiac index (OR, 0.33; 95% confidence interval, 0.11-0.98 per L/min per m²) were independent risk factors for 90-day mortality. CONCLUSIONS Advanced age, higher serum creatinine, and lower mean arterial pressure are associated with 90-day mortality in patients with SAP. In the subgroup of patients with SAP and shock, higher Acute Physiology and Chronic Health Evaluation II score, higher central venous pressure, and lower cardiac index predicted 90-day mortality.
Collapse
|
36
|
Lee WS, Huang JF, Chuang WL. Outcome assessment in acute pancreatitis patients. Kaohsiung J Med Sci 2013; 29:469-77. [PMID: 24018149 DOI: 10.1016/j.kjms.2012.10.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2012] [Accepted: 07/13/2012] [Indexed: 12/11/2022] Open
Abstract
Early diagnosis and severity evaluation in patients with acute pancreatitis (AP) are very important due to its potential morbidity and mortality. Several clinical, laboratory, and radiologic factors, and many scoring systems have been proposed for outcome prediction. Although the Ranson and Acute Physiology and Chronic Health Evaluation II scoring systems have been widely used for decades, the cumbersome components partly limit their predictability. Recently, the Bedside Index for Severity in AP scoring system and series blood urea nitrogen changes, which are simple and convenient to evaluate within 24 hours after admission, have been validated for accuracy by several large-cohort studies. The presence of organ failure and systemic inflammatory response syndrome are also helpful to evaluate the severity of AP. Herein we review recent advances of the predictive methods for AP to provide an up-to-date perspective on outcome assessment of AP.
Collapse
Affiliation(s)
- Wei-Sin Lee
- Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | | | | |
Collapse
|
37
|
Golay V, Roychowdhary A. Acute Pancreatitis in Chronic Kidney Disease—A Common but Often Misunderstood Combination. Ren Fail 2012; 34:1338-40. [DOI: 10.3109/0886022x.2012.718951] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
|
38
|
Tse F, Yuan Y. Early routine endoscopic retrograde cholangiopancreatography strategy versus early conservative management strategy in acute gallstone pancreatitis. Cochrane Database Syst Rev 2012:CD009779. [PMID: 22592743 DOI: 10.1002/14651858.cd009779.pub2] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
BACKGROUND The role and timing of endoscopic retrograde cholangiopancreatography (ERCP) in acute gallstone pancreatitis remains controversial. A number of clinical trials and meta-analyses have provided conflicting evidence. OBJECTIVES To systematically review evidence from randomized controlled trials (RCTs) assessing the clinical effectiveness and safety of the early routine ERCP strategy compared to the early conservative management with or without selective use of ERCP strategy, based on all important, clinically relevant and standardized outcomes including mortality, local and systemic complications as defined by the Atlanta Classification (Bradley 1993) and by authors of the primary study, and ERCP-related complications in unselected patients with acute gallstone pancreatitis. SEARCH METHODS We searched the CENTRAL (The Cochrane Library), MEDLINE, EMBASE, and LILACS databases and major conference proceedings up to January 2012, using the Cochrane Upper Gastrointestinal and Pancreatic Diseases model with no language restrictions. SELECTION CRITERIA RCTs comparing the early routine ERCP strategy versus the early conservative management with or without selective use of ERCP strategy in patients with suspected acute gallstone pancreatitis. We included studies in which the population with acute gallstone pancreatitis was a subgroup within a larger group of patients. We only included studies involving only a selected subgroup of patients with acute gallstone pancreatitis (actual severe pancreatitis) in subgroup analyses. DATA COLLECTION AND ANALYSIS Two review authors conducted study selection, data extraction, and methodological quality assessment independently. Using intention-to-treat analysis with random-effects models, we combined dichotomous data to obtain risk ratios (RR) with 95% confidence intervals (CI). We assessed heterogeneity using the Chi² test and I² statistic. To explore sources of heterogeneity, we conducted a priori subgroup analyses according to predicted severity of pancreatitis, cholangitis, biliary obstruction, time to ERCP in routine ERCP strategy, use of selective ERCP in conservative management strategy, and risk of bias. To assess the robustness of our results, we carried out sensitivity analyses using different summary statistics (RR versus odds ratio (OR)) and meta-analytic models (fixed versus random-effects), and per-protocol analysis. We performed influence analysis by exclusion of each study. MAIN RESULTS Five RCTs comprising 644 participants were included in the main analyses. Two additional RCTs, comprising only patients with actual severe acute gallstone pancreatitis, were included only in subgroup analyses. There was statistical heterogeneity among trials for mortality, but not for other outcomes. In unselected patients with acute gallstone pancreatitis, there were no statistically significant differences between the two strategies in mortality (RR 0.74, 95% CI 0.18 to 3.03), local and systemic complications as defined by the Atlanta Classification (RR 0.86, 95% CI 0.52 to 1.43; and RR 0.59, 95% CI 0.31 to 1.11 respectively) and by authors of the primary study (RR 0.80, 95% CI 0.51 to 1.26; and RR 0.76, 95% CI 0.53 to 1.09 respectively). The results were robust to sensitivity and influence analyses except for systemic complications as defined by the Atlanta Classification. There was no evidence to suggest that the results were dependent on predicted severity of pancreatitis. Among trials that included patients with cholangitis, the early routine ERCP strategy significantly reduced mortality (RR 0.20, 95% CI 0.06 to 0.68), local and systemic complications as defined by the Atlanta Classification (RR 0.45, 95% CI 0.20 to 0.99; and RR 0.37, 95% CI 0.18 to 0.78 respectively) and by authors of the primary study (RR 0.50, 95% CI 0.29 to 0.87; and RR 0.41, 95% CI 0.21 to 0.82 respectively). Among trials that included patients with biliary obstruction, the early routine ERCP strategy was associated with a significant reduction in local complications as defined by authors of the primary study (RR 0.54, 95% CI 0.32 to 0.91), and a non-significant trend towards reduction of local and systemic complications as defined by the Atlanta Classification (RR 0.53, 95% CI 0.26 to 1.07; and RR 0.56, 95% CI 0.30 to 1.02 respectively) and systemic complications as defined by authors of the primary study (RR 0.59, 95% CI 0.35 to 1.01). ERCP complications were infrequent. AUTHORS' CONCLUSIONS In patients with acute gallstone pancreatitis, there is no evidence that early routine ERCP significantly affects mortality, and local or systemic complications of pancreatitis, regardless of predicted severity. Our results, however, provide support for current recommendations that early ERCP should be considered in patients with co-existing cholangitis or biliary obstruction.
Collapse
Affiliation(s)
- Frances Tse
- Department of Medicine, Division of Gastroenterology, McMaster University, Hamilton, Canada.
| | | |
Collapse
|
39
|
Tse F, Yuan Y. Early routine endoscopic retrograde cholangiopancreatography strategy versus early conservative management strategy in acute gallstone pancreatitis. THE COCHRANE DATABASE OF SYSTEMATIC REVIEWS 2012. [DOI: 10.1002/14651858.cd009779] [Citation(s) in RCA: 60] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
|
40
|
Ma Q, Zhang M, Wang Z, Ma Z, Sha H. The beneficial effect of resveratrol on severe acute pancreatitis. Ann N Y Acad Sci 2011; 1215:96-102. [PMID: 21261646 DOI: 10.1111/j.1749-6632.2010.05847.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Acute pancreatitis is a common kind of acute abdominal disease. The management of severe acute pancreatitis (SAP) is a challenge because of its high morbidity, which is due to systemic inflammatory response syndrome and multiorgan dysfunction syndrome. Therefore, it is important to explore therapies to control the disease's progression. A series of in vivo and in vitro experiments has demonstrated that resveratrol-an extract from Chinese herbs, grapes, and many plants-exhibits a wide range of biological and pharmacological activities, including anti-inflammatory, antioxidation, and chemopreventive effects, as well as the inhibition of platelet aggregation, which could benefit the treatment of SAP. Here, we examine the possible mechanism of resveratrol in treating the progression of SAP. Resveratrol could inhibit the production and progression of SAP through down-regulating pro-inflammatory cytokines, improving microcirculation, modulating cell apoptosis, and blocking calcium overload. We propose that resveratrol has a potentially therapeutic effect on the progression of SAP.
Collapse
Affiliation(s)
- Qingyong Ma
- Department of Hepatobiliary and Pancreas Surgery, First Affiliated Hospital of Xi'an Jiaotong University, China.
| | | | | | | | | |
Collapse
|
41
|
Doctor N, Philip S, Gandhi V, Hussain M, Barreto SG. Analysis of the delayed approach to the management of infected pancreatic necrosis. World J Gastroenterol 2011; 17:366-71. [PMID: 21253397 PMCID: PMC3022298 DOI: 10.3748/wjg.v17.i3.366] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2010] [Revised: 09/02/2010] [Accepted: 09/09/2010] [Indexed: 02/06/2023] Open
Abstract
AIM: To analyze outcomes of delayed single-stage necrosectomy after early conservative management of patients with infected pancreatic necrosis (IPN) associated with severe acute pancreatitis (SAP).
METHODS: Between January 1998 and December 2009, data from patients with SAP who developed IPN and were managed by pancreatic necrosectomy were analyzed.
RESULTS: Fifty-nine of 61 pancreatic necrosectomies were performed by open surgery and 2 laparoscopically. In 55 patients, single-stage necrosectomy could be performed (90.2%). Patients underwent surgery at a median of 29 d (range 13-46 d) after diagnosis of acute pancreatitis. Sepsis and multiple organ failure accounted for the 9.8% mortality rate. Pancreatic fistulae (50.8%) predominantly accounted for the morbidity. The median hospital stay was 23 d, and the median interval for return to regular activities was 110 d.
CONCLUSION: This series supports the concept of delayed single-stage open pancreatic necrosectomy for IPN. Advances in critical care, antibiotics and interventional radiology have played complementary role in improving the outcomes.
Collapse
|
42
|
Bacterial translocation and infected pancreatic necrosis in acute necrotizing pancreatitis derives from small bowel rather than from colon. Am J Surg 2010; 200:111-7. [PMID: 20637344 DOI: 10.1016/j.amjsurg.2009.08.019] [Citation(s) in RCA: 116] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2009] [Revised: 08/02/2009] [Accepted: 08/04/2009] [Indexed: 12/13/2022]
Abstract
BACKGROUND The clinical course of acute necrotizing pancreatitis (ANP) is determined by the superinfection of pancreatic necrosis. To date, the pathophysiology of the underlying bacterial translocation is poorly understood. The present study investigated the bacterial source of translocation. METHODS A terminal loop ileostomy was applied in rats. Selective digestive decontamination (SDD) of either the small bowel or the colon was performed. After 3 days of SDD, severe ANP was induced. At 24 hours, bacterial translocation was assessed by cultures of bowel mucosa, mesenteric lymph nodes, and pancreas using a scoring system (0-4). RESULTS Without SDD, pancreatic infection was present in all cases with an average score of 2.67. Colon SDD reduced pancreatic superinfection to 1.67 (not significant). SDD of the small bowel significantly reduced superinfection to 1.0 (P < .005). CONCLUSIONS Bacterial translocation from the colon is less frequent than translocation from the small bowel. Thus, the small bowel seems to be the major source of enteral bacteria in infected pancreatic necrosis.
Collapse
|
43
|
|
44
|
Treatment strategy for acute pancreatitis. JOURNAL OF HEPATO-BILIARY-PANCREATIC SCIENCES 2009; 17:79-86. [PMID: 20012325 DOI: 10.1007/s00534-009-0218-z] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/01/2009] [Accepted: 09/01/2009] [Indexed: 12/16/2022]
Abstract
When a diagnosis of acute pancreatitis (AP) is made, fundamental medical treatment consisting of fasting, intravenous (IV) fluid replacement, and analgesics with a close monitoring of vital signs should be immediately started. In parallel with fundamental medical treatment, assessment of severity based on clinical signs, blood test, urinalysis and imaging tests should be performed to determine the way of treatment for each patient. A repeat evaluation of severity is important since the condition is unstable especially in the early stage of AP. At the time of initial diagnosis, the etiology should be investigated by means of blood test, urinalysis and diagnostic imaging. If a biliary pancreatitis accompanied with acute cholangitis or biliary stasis is diagnosed or suspected, an early endoscopic retrograde cholangiopancreatography with or without endoscopic sphincterotomy (ERCP/ES) is recommended in addition to the fundamental medical treatment. In mild cases, the fundamental medical treatment should be continued until clinical symptom is subsided with normal laboratory data. In cases with severe acute pancreatitis (SAP) referral should be considered to medical centers experienced in the treatment of SAP, and intensive care is recommended for preventing both organ failures and infectious complications. Hemodynamic stabilization with vigorous fluid resuscitation, respiratory support and antibiotics are the major parts of intensive care in the early period of SAP. Continuous hemodiafiltration (CHDF) and continuous regional arterial infusion (CRAI) of protease inhibitor and/or antibiotics may be effective to improve pathophysiology of AP especially in the early stage of the disease. In the late stage of AP, infectious complications are critical. If an infectious complication is suspected based on clinical signs, blood test and imaging, a fine needle aspiration (FNA) is recommended to establish a diagnosis. The accuracy of FNA is reported to be 89 ~ 100%. For patients with sterile pancreatitis, non-surgical treatment should be indicated. For patients with infected pancreatic necrosis, therapeutic intervention either by percutaneous, endoscopic, laparoscopic or surgical approach are indicated. The most preferred surgical intervention is necrosectomy, however, non-surgical treatment with antibiotics is still the treatment of choice if the general condition is stable. Necrosectomy should be performed as late as possible. For patients with pancreatic abscess, drainage is recommended.
Collapse
|
45
|
Zhao H, Zhao X, Bai C, Wang X. Potential factors of interorgan signals in the development of pancreatitis-associated acute lung injury and acute respiratory distress syndrome. ACTA ACUST UNITED AC 2009. [DOI: 10.1080/17471060500223365] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
|
46
|
Abstract
OBJECTIVES To determine overall mortality and timing of death in patients with severe acute pancreatitis and factors affecting mortality. METHODS This was a retrospective, observational study of 110 patients admitted to a general intensive care unit (ICU) from January 2003 to January 2006. RESULTS The overall mortality rate was 53.6% (59/110); 25.4% (n = 15) of deaths were early (<or=14 days after ICU admission). There were no significant differences in age, sex, or surgical/medical treatment between survivors and nonsurvivors. Median Acute Physiology and Chronic Health Evaluation (APACHE) II score was higher among nonsurvivors than survivors (score = 26 vs 19, respectively; P < 0.001), and the duration of hospitalization before ICU admission was significantly longer (4 vs 1 day; P < 0.001). Among the 59 patients who died, those in the early-mortality group were admitted to the ICU significantly earlier than those in the late-mortality group (3 vs 6.5 days; P < 0.05). CONCLUSIONS Overall mortality and median APACHE II score were high. Death predominantly occurred late and was unaffected by patient age, length of stay in the ICU, or surgical/medical treatment. An APACHE II cutoff of 24.5 and pre-ICU admission time of 2.5 days were sensitive predictors of fatal outcome.
Collapse
|
47
|
Sha H, Ma Q, Jha RK. Trypsin is the culprit of multiple organ injury with severe acute pancreatitis. Med Hypotheses 2008; 72:180-2. [PMID: 18938042 DOI: 10.1016/j.mehy.2008.09.007] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2008] [Revised: 08/10/2008] [Accepted: 09/10/2008] [Indexed: 11/24/2022]
Abstract
The consistently high proportion of early deaths in patients with severe acute pancreatitis (SAP) has been associated mainly with the development of multiple organ dysfunction syndromes (MODS). So far, scholars believed that the main reasons of MODS with SAP are systemic microcirculation dysfunction and inflammatory mediator induced cascading effect on the basis of pancreas digesting itself. However, there is some special pathological phenomenon in the process of SAP which could not be explained by current theories. First, it has been evident that the pancreatic tissue bleeding and necrosis is special pathological change in pancreas autodigestive effect from digestive enzymes such as trypsin in SAP. However, we found that the liver, the lung, the intestine, the brain and the kidney have the same pathological changes in experimental animal models of SAP. Secondly, unlike the general inflammatory response, a significantly amount of bloody ascites and pleural effusion was often in patients with SAP and in experimental SAP animal models. It indicates that the vascular permeability significantly increased leading to the red blood cells extravasation. Thirdly, apart from dual blood supply, liver bears a strong compensatory function. However, liver has the highest incidence of injury in SAP when compared with other organs. In addition, we found a very interesting phenomenon after reading texts and clinical records. From the pancreatic venous drainage from the point of view, the farther the organ from the pancreas, the lower injury incidence rate observed. How to explain these mysteries? We postulate that the trypsin is the culprit of multiple organs dysfunction in SAP. The activated trypsin destroy the pancreas itself, causing pancreatic tissue bleeding and necrosis, at the same time, through venous flow it flow into the blood circulation and destroy the vascular endothelial barrier, leading to highly increased vascular permeability. So, a large number of bloody exudates leakages from the vessels, resulting in patients early circulatory disorders, multiple organ bleeding, bloody pleural effusion and ascites. This pathological change is the most apparent in the liver because the liver is the first organ to receive the pancreatic venous flow having the highest concentration of trypsin. Thus, if the quantity of trypsin decreases in blood, its ability to damage other organs also shows a trend of gradually reducing. These mysteries can be explained by this hypothesis and might help us to understand more clearly about the mechanism of SAP-associated MODS.
Collapse
Affiliation(s)
- Huanchen Sha
- Department of Surgery, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an 710061, China
| | | | | |
Collapse
|
48
|
Sha H, Ma Q, Jha RK, Xu F, Wang L, Wang Z, Zhao Y, Fan F. Resveratrol ameliorates hepatic injury via the mitochondrial pathway in rats with severe acute pancreatitis. Eur J Pharmacol 2008; 601:136-42. [PMID: 18977215 DOI: 10.1016/j.ejphar.2008.10.017] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2008] [Revised: 09/16/2008] [Accepted: 10/09/2008] [Indexed: 01/30/2023]
Abstract
To gain insight into the processes by which severe acute pancreatitis induced apoptosis takes place in the liver, and to observe the protective effect of resveratrol on hepatic injury, a rat model of severe acute pancreatitis was induced by administering 4% sodium taurocholate through the common biliopancreatic duct. Pancreatic and hepatic injury was assessed by histology. Serum ALT (alanine aminotransferase), AST (aspartate aminotransferase) and total bilirubin were determined by reaction rate assay, and the serum levels of TNF-alpha (tumor necrosis factor-alpha) and IL-6 (interleukin-6) were detected by ELISA (enzyme linked immunosorbent assay). We investigated cytochrome c released from mitochondria and used the RT-PCR (reverse transcription PCR), Western blot technique to evaluate Bax, Bcl-2, and caspase-3 expression levels in hepatic tissue over the time course of apoptosis. Changes in hepatic cell mitochondrial membrane potential were observed by confocal laser scanning microscopy. The majority of cytochrome c release occurred early in apoptosis from mitochondria, which undergo gradual hepatic impairment. The released cytochrome c can be reduced by resveratrol through both up-regulation of Bcl-2 and down-regulation of Bax and caspase-3. These data provide substantial evidence that apoptosis is involved in hepatic injury during the severe acute pancreatitis process and that resveratrol can ameliorate the situation, thus protecting liver function in rats with severe acute pancreatitis.
Collapse
Affiliation(s)
- Huanchen Sha
- Department of Surgery, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710061, China
| | | | | | | | | | | | | | | |
Collapse
|
49
|
Navarro S, Amador J, Argüello L, Ayuso C, Boadas J, de Las Heras G, Farré A, Fernández-Cruz L, Ginés A, Guarner L, López Serrano A, Llach J, Lluis F, de Madaria E, Martínez J, Mato R, Molero X, Oms L, Pérez-Mateo M, Vaquero E. [Recommendations of the Spanish Biliopancreatic Club for the Treatment of Acute Pancreatitis. Consensus development conference]. GASTROENTEROLOGIA Y HEPATOLOGIA 2008; 31:366-87. [PMID: 18570814 DOI: 10.1157/13123605] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- Salvador Navarro
- Servicio de Gastroenterología, Institut de Malalties Digestives i Metabóliques, Hospital Clínic, Barcelona, Spain.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
50
|
Xia Q, Huang W, Yang XN. Prophylactic use of antibiotics in treatment of severe acute pancreatitis. Shijie Huaren Xiaohua Zazhi 2008; 16:1446-1451. [DOI: 10.11569/wcjd.v16.i13.1446] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Necrotic pancreatic infection is the most serious complication of severe acute pancreatitis (SAP). Although prophylactic antibiotics are widely used to reduce its death rate, its practical efficiency still remains controversial. Therefore, the clinical experiences with prophylactic use of antibiotics are summarized in this paper, hoping to offer certain guides to its treatment. However, results from recent studies do not support prophylactic use of antibiotics in all cases of necrotic pancreatic infection and suggest that only imipenem or meropenem can be used for no more than three weeks in patients with their pancreatic necrosis area >30% or in patients with biliogenic pancreatitis to decrease the risk of necrotic infection and its mortality rate.
Collapse
|