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Zhang C, Lin F, Guo DF, Wang QL, Xiao DX, Lin JY, Chen S. Assessing the causal link between liver function and acute pancreatitis: A Mendelian randomisation study. PLoS One 2024; 19:e0300890. [PMID: 38578756 PMCID: PMC10997074 DOI: 10.1371/journal.pone.0300890] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2023] [Accepted: 03/06/2024] [Indexed: 04/07/2024] Open
Abstract
A correlation has been reported to exist between exposure factors (e.g. liver function) and acute pancreatitis. However, the specific causal relationship remains unclear. This study aimed to infer the causal relationship between liver function and acute pancreatitis using the Mendelian randomisation method. We employed summary data from a genome-wide association study involving individuals of European ancestry from the UK Biobank and FinnGen. Single-nucleotide polymorphisms (SCNPs), closely associated with liver function, served as instrumental variables. We used five regression models for causality assessment: MR-Egger regression, the random-effect inverse variance weighting method (IVW), the weighted median method (WME), the weighted model, and the simple model. We assessed the heterogeneity of the SNPs using Cochran's Q test. Multi-effect analysis was performed using the intercept term of the MR-Egger method and leave-one-out detection. Odds ratios (ORs) were used to evaluate the causal relationship between liver function and acute pancreatitis risk. A total of 641 SNPs were incorporated as instrumental variables. The MR-IVW method indicated a causal effect of gamma-glutamyltransferase (GGT) on acute pancreatitis (OR = 1.180, 95%CI [confidence interval]: 1.021-1.365, P = 0.025), suggesting that GGT may influence the incidence of acute pancreatitis. Conversely, the results for alkaline phosphatase (ALP) (OR = 0.997, 95%CI: 0.992-1.002, P = 0.197) and aspartate aminotransferase (AST) (OR = 0.939, 95%CI: 0.794-1.111, P = 0.464) did not show a causal effect on acute pancreatitis. Additionally, neither the intercept term nor the zero difference in the MR-Egger regression attained statistical significance (P = 0.257), and there were no observable gene effects. This study suggests that GGT levels are a potential risk factor for acute pancreatitis and may increase the associated risk. In contrast, ALP and AST levels did not affect the risk of acute pancreatitis.
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Affiliation(s)
- Chun Zhang
- Department of General Surgery, Mindong Hospital Affiliated to Fujian Medical University, Ningde, Fujian, China
- Shengli Clinical Medical College of Fujian Medical University, Fuzhou, China
| | - Feng Lin
- Department of General Surgery, Mindong Hospital Affiliated to Fujian Medical University, Ningde, Fujian, China
| | - Deng-fang Guo
- Department of General Surgery, Mindong Hospital Affiliated to Fujian Medical University, Ningde, Fujian, China
| | - Qing-lin Wang
- Department of General Surgery, Mindong Hospital Affiliated to Fujian Medical University, Ningde, Fujian, China
| | - De-xian Xiao
- Department of General Surgery, Mindong Hospital Affiliated to Fujian Medical University, Ningde, Fujian, China
| | - Jian-yuan Lin
- Department of General Surgery, Mindong Hospital Affiliated to Fujian Medical University, Ningde, Fujian, China
| | - Shi Chen
- Shengli Clinical Medical College of Fujian Medical University, Fuzhou, China
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Wu S, Zhou Q, Cai Y, Duan X. Development and validation of a prediction model for the early occurrence of acute kidney injury in patients with acute pancreatitis. Ren Fail 2023; 45:2194436. [PMID: 36999227 PMCID: PMC10071964 DOI: 10.1080/0886022x.2023.2194436] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Revised: 03/09/2023] [Accepted: 03/10/2023] [Indexed: 04/01/2023] Open
Abstract
BACKGROUND Acute pancreatitis (AP) is associated with a high incidence of acute kidney injury (AKI). This study aimed to develop a nomogram for predicting the early onset of AKI in AP patients admitted to the intensive care unit. METHOD Clinical data for 799 patients diagnosed with AP were extracted from the Medical Information Mart for Intensive Care IV database. Eligible AP patients were randomly divided into training and validation cohorts. The independent prognostic factors for the early development of AKI in AP patients were determined using the all-subsets regression method and multivariate logistic regression. A nomogram was constructed for predicting the early occurrence of AKI in AP patients. The performance of the nomogram was evaluated based on the area under the receiver operating characteristic curve (AUC), calibration curves and decision curve analysis (DCA). RESULTS Seven independent prognostic factors were identified as predictive factors for early onset AKI in AP patients. The AUC of the nomogram in the training and validation cohorts were 0.795 (95% CI, 0.758-0.832) and 0.772 (95% CI, 0.711-0.832), respectively. The AUC of the nomogram was higher compared with that of the BISAP, Ranson, APACHE II scores. Further, the calibration curve revealed that the predicted outcome was in agreement with the actual observations. Finally, the DCA curves showed that the nomogram had a good clinical applicability value. CONCLUSION The constructed nomogram showed a good predictive ability for the early occurrence of AKI in AP patients.
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Affiliation(s)
- Simin Wu
- Department of Respiratory Medicine, The First Affiliated Hospital of Yangtze University, Jingzhou, P.R. China
| | - Qin Zhou
- Department of Intensive care Medicine, The First People’s Hospital of Changde, Changde, P.R. China
| | - Yang Cai
- Department of Infectious Diseases, The First People’s Hospital of Changde, Changde, P.R. China
| | - Xiangjie Duan
- Department of Infectious Diseases, The First People’s Hospital of Changde, Changde, P.R. China
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Computed tomography imaging-based predictors of the need for a step-up approach after initial endoscopic ultrasound-guided transmural drainage for pancreatic fluid collections. Surg Endosc 2023; 37:1096-1106. [PMID: 36123547 DOI: 10.1007/s00464-022-09610-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Accepted: 09/03/2022] [Indexed: 12/03/2022]
Abstract
BACKGROUND A step-up approach is recommended as a new treatment algorithm for pancreatic fluid collections (PFCs). However, determining which patients with PFCs require a step-up approach after endoscopic ultrasound-guided transmural drainage (EUS-TD) is unclear. If the need for a step-up approach could be predicted, it could be performed early for relevant patients. We aimed to identify PFC-related predictive factors for a step-up approach after EUS-TD. METHODS This retrospective cohort study included consecutive patients who had undergone EUS-TD for PFCs from January 2008 to May 2020. Multivariable logistic regression analyses were performed to investigate PFC factors related to requiring a step-up approach. A step-up approach was performed for patients who did not respond clinically to EUS-TD. RESULTS We enrolled 81 patients, of whom 25 (30.9%) required a step-up approach. In multivariate logistic regression analysis, the pre-EUS-TD number of PFC-occupied regions ≥ 3 (multivariate odds ratio [OR] 16.2, 95% confidence interval [CI] 2.68-97.6, P = 0.002), the post-EUS-TD PFC-remaining percentage ≥ 35% (multivariate OR 19.9, 95% CI 2.91-136.1, P = 0.002), and a positive sponge sign, which is a distinctive computed tomography finding in the early stage after EUS-TD (multivariate OR 6.26, 95% CI 1.33-29.3, P = 0.020), were independent predictive factors associated with requiring a step-up approach for PFCs. CONCLUSION Pre-EUS-TD PFC-occupied regions, post-EUS-TD PFC-remaining percentage, and a positive sponge sign were predictors of the need for a step-up approach. Patients with PFC with these findings should be offered a step-up approach whereas conservative treatment is recommended for patients without these findings. CLINICAL REGISTRATION NUMBER UMIN 000030898.
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Lai Q, Wei W, He Y, Cheng T, Han T, Cao Y. A Rapid Prognostic Score Based on Bedside Arterial Blood Gas Analysis (ABG) Established for Predicting 60-Day Adverse Outcomes in Patients with Acute Pancreatitis in the Emergency Department. J Inflamm Res 2022; 15:5337-5346. [PMID: 36131781 PMCID: PMC9484575 DOI: 10.2147/jir.s381438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Accepted: 08/29/2022] [Indexed: 12/02/2022] Open
Abstract
Objective To establish a rapid and concise prognosis scoring system for pancreatitis in the emergency department based on bedside arterial blood gas analysis (ABG). Methods A single-center, retrospective cohort study was used to establish the new scoring system, and a validation group was used to verify it. The primary endpoint was 60-day death, and secondary endpoints were 28-day death, admission to the intensive care unit (AICU), requirement for mechanical ventilation (MV) and persistent organ failure (POF). Receiver operating characteristic (ROC) curves was drawn to validate the predictive value of the new scoring system. The performance of the new scoring system was compared with that of conventional predictive scoring. Results 443 patients were in the derivation group and 217 patients in the validation group, of which 27 and 25 died during follow-up. A total of 443 patients in the derivation group, 27 of whom died during the follow-up period. Multivariate regression analysis showed that mental status, hematocrit (HCT), base excess (BE) and Serum ionic calcium (Ca2+) were independent risk factors for 60-day mortality of pancreatitis, and they were used to create a new scoring system (MHBC). In the derivation and validation, the ability of MHBC (AUC= 0.922, 0.773, respectively) to predict 60-day mortality from pancreatitis was no less than that of APACHE II (AUC= 0.838, 0.748, respectively) and BISAP (AUC= 0.791, 0.750, respectively), while, MHBC is more quickly and concisely than APACHE II and BISAP. Compared with MHBC less than or equal to 2, when MHBC is greater than 2, the 28-day mortality, 60-day mortality and the incidence of AICU, MV and POF increased significantly (P <0.001). Conclusion The MHBC can quickly and concisely evaluate the 60-day mortality, 28-day mortality, and the incidence of AICU, MV and POF of patients with acute pancreatitis in the emergency department.
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Affiliation(s)
- Qiang Lai
- Emergency Department, West China Hospital, Sichuan University, Chengdu, Sichuan, People's Republic of China.,Laboratory of Emergency Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan, People's Republic of China.,Disaster Medical Center, Sichuan University, Chengdu, Sichuan, People's Republic of China
| | - Wei Wei
- Emergency Department, West China Hospital, Sichuan University, Chengdu, Sichuan, People's Republic of China.,Laboratory of Emergency Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan, People's Republic of China.,Disaster Medical Center, Sichuan University, Chengdu, Sichuan, People's Republic of China
| | - Yarong He
- Emergency Department, West China Hospital, Sichuan University, Chengdu, Sichuan, People's Republic of China.,Laboratory of Emergency Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan, People's Republic of China.,Disaster Medical Center, Sichuan University, Chengdu, Sichuan, People's Republic of China
| | - Tao Cheng
- Emergency Department, West China Hospital, Sichuan University, Chengdu, Sichuan, People's Republic of China.,Laboratory of Emergency Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan, People's Republic of China.,Disaster Medical Center, Sichuan University, Chengdu, Sichuan, People's Republic of China
| | - Tianyong Han
- Emergency Department, West China Hospital, Sichuan University, Chengdu, Sichuan, People's Republic of China.,Laboratory of Emergency Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan, People's Republic of China.,Disaster Medical Center, Sichuan University, Chengdu, Sichuan, People's Republic of China
| | - Yu Cao
- Emergency Department, West China Hospital, Sichuan University, Chengdu, Sichuan, People's Republic of China.,Laboratory of Emergency Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan, People's Republic of China.,Disaster Medical Center, Sichuan University, Chengdu, Sichuan, People's Republic of China
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Iannuzzi JP, King JA, Leong JH, Quan J, Windsor JW, Tanyingoh D, Coward S, Forbes N, Heitman SJ, Shaheen AA, Swain M, Buie M, Underwood FE, Kaplan GG. Global Incidence of Acute Pancreatitis Is Increasing Over Time: A Systematic Review and Meta-Analysis. Gastroenterology 2022; 162:122-134. [PMID: 34571026 DOI: 10.1053/j.gastro.2021.09.043] [Citation(s) in RCA: 210] [Impact Index Per Article: 105.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Revised: 09/09/2021] [Accepted: 09/18/2021] [Indexed: 02/06/2023]
Abstract
BACKGROUND & AIMS Acute pancreatitis is a common disease with significant associated morbidity and mortality. We performed a systematic review and meta-analysis of population-based studies to explore the changing temporal trends of acute pancreatitis incidence globally. METHODS We performed a systematic literature search to identify population-based studies reporting the annual incidence of acute pancreatitis. Abstracts were assessed independently to identify applicable articles for full-text review and data extraction. Joinpoint temporal trend analyses were performed to calculate the average annual percent change (AAPC) with 95% confidence intervals (CIs). The AAPCs were pooled in a meta-analysis to capture the overall and regional trends in acute pancreatitis incidence over time. Temporal data were summarized in a static map and an interactive, web-based map. RESULTS Forty-four studies reported the temporal incidence of acute pancreatitis (online interactive map: https://kaplan-acute-pancreatitis-ucalgary.hub.arcgis.com/). The incidence of acute pancreatitis has increased from 1961 to 2016 (AAPC, 3.07%; 95% CI, 2.30% to 3.84%; n = 34). Increasing incidence was observed in North America (AAPC, 3.67%; 95% CI, 2.76% to 4.57%; n = 4) and Europe (AAPC, 2.77%; 95% CI, 1.91% to 3.63%; n = 23). The incidence of acute pancreatitis was stable in Asia (AAPC, -0.28%; 95% CI, -5.03% to 4.47%; n = 4). CONCLUSIONS This meta-analysis provides a comprehensive overview of the global incidence of acute pancreatitis over the last 56 years and demonstrates a steadily rising incidence over time in most countries of the Western world. More studies are needed to better define the changing incidence of acute pancreatitis in Asia, Africa, and Latin America.
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Affiliation(s)
- Jordan P Iannuzzi
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - James A King
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Jessica Hope Leong
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Joshua Quan
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Joseph W Windsor
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Divine Tanyingoh
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada; Department of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Stephanie Coward
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada; Department of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Nauzer Forbes
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Steven J Heitman
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada; Department of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Abdel-Aziz Shaheen
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada; Department of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Mark Swain
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Michael Buie
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Fox E Underwood
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada; Department of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Gilaad G Kaplan
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada; Department of Medicine, University of Calgary, Calgary, Alberta, Canada.
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Chang RJ, Wang HL, Qin MB, Liang ZH, He JP, Wei YL, Fu HZ, Tang GD. Ghrelin inhibits IKKβ/NF-κB activation and reduces pro-inflammatory cytokine production in pancreatic acinar AR42J cells treated with cerulein. Hepatobiliary Pancreat Dis Int 2021; 20:366-375. [PMID: 32553660 DOI: 10.1016/j.hbpd.2020.05.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2019] [Accepted: 05/23/2020] [Indexed: 02/05/2023]
Abstract
BACKGROUND Previous studies have provided conflicting results regarding whether the serum ghrelin concentration can reflect the severity of acute pancreatitis (AP). The present study examined the correlation between the serum ghrelin concentration and AP severity in animal models and investigated whether altered ghrelin expression in pancreatic acinar cells influences IKKβ/NF-κB signaling and pro-inflammatory cytokine production. METHODS Mild or severe AP was induced in rats by intraperitoneal injection of cerulein or retrograde cholangiopancreatic duct injection of sodium taurocholate, respectively. After successful model induction, serum ghrelin, tumor necrosis factor-α (TNF-α), and interleukin-6 (IL-6) concentrations were determined by enzyme-linked immunosorbent assay, and IKKβ/NF-κB activation was assessed by immunohistochemistry. Subsequently, stable overexpression or knockdown of ghrelin in AR42J cells was achieved by lentiviral transfection. After transfected cells and control cells were treated with cerulein for 24 h, the TNF-α and IL-1β levels in the supernatants were determined by enzyme-linked immunosorbent assay, and the expression levels of p-p65, IKKβ, and p-IKKβ were detected by Western blotting. RESULTS In rat AP models, AP severity was correlated with increased IKKβ/NF-κB activation, pro-inflammatory cytokine production, and ghrelin secretion. The levels of pro-inflammatory cytokines TNF-α and IL-1β as well as IKKβ/NF-κB signaling activity were increased upon knockdown of ghrelin in the AP acinar cell model and decreased with ghrelin overexpression. CONCLUSIONS Serum ghrelin is related to the severity of AP. Ghrelin may play a protective role in the pathogenesis of AP by inhibiting the pro-inflammatory cytokines and the activation of the IKKβ/NF-κB signaling pathway.
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Affiliation(s)
- Ren-Jie Chang
- Department of Gastroenterology, The First Affiliated Hospital of Guangxi Medical University, Nanning 530021, China; Department of Gastroenterology, The First People's Hospital of Nanning City, The Fifth Affiliated Hospital of Guangxi Medical University, Nanning 530022, China
| | - Hui-Lin Wang
- Department of Chemotherapy, Affiliated Tumor Hospital of Guangxi Medical University, Nanning 530021, China
| | - Meng-Bin Qin
- Department of Gastroenterology, Second Affiliated Hospital of Guangxi Medical University, Nanning 530007, China
| | - Zhi-Hai Liang
- Department of Gastroenterology, The First Affiliated Hospital of Guangxi Medical University, Nanning 530021, China
| | - Jia-Ping He
- Department of Gastroenterology, Liuzhou General Hospital, Liuzhou 545006, China
| | - Yu-Le Wei
- Department of Gastroenterology, The First Affiliated Hospital of Guangxi Medical University, Nanning 530021, China
| | - Hong-Zong Fu
- Department of Gastroenterology, Guangxi International Zhuang Medical Hospital, Nanning 530001, China
| | - Guo-Du Tang
- Department of Gastroenterology, The First Affiliated Hospital of Guangxi Medical University, Nanning 530021, China.
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7
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Factors predicting the severity of acute pancreatitis in elderly patients. Aging Clin Exp Res 2021; 33:183-192. [PMID: 32185694 DOI: 10.1007/s40520-020-01523-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2019] [Accepted: 02/26/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND Moderately severe acute pancreatitis (MSAP) and severe acute pancreatitis (SAP) are associated with organ failure (OF), which can be lethal. AIMS This study determined the factors that predict the severity of AP at admission in elderly patients. METHODS In this retrospective study, the data from elderly patients (> 60 years of age) admitted within 72 h of onset of symptoms without OF were collected. These data at admission were analyzed and correlated with the severity of AP. To identify the factors associated with more serious AP (i.e. MSAP and SAP), patients were divided into mild acute pancreatitis (MAP) and MSAP + SAP groups. RESULTS A total of 198 patients [MAP group (n = 135) and MSAP + SAP group (n = 63)] were included. Biliary disease was the most common etiology. Respiratory failure was the most common OF. Logistic regression analyses indicated that idiopathic etiology (odds ratio [OR]: 3.029, 95% confidence interval [CI]: 1.017-9.022, p = 0.047), pre-existing pulmonary disease (OR: 7.104, CI 1.750-28.84, p = 0.006), increased hematocrit level (OR: 3.717, 95%CI 1.372-10.070, p = 0.010), serum calcium (OR: 0.023, 95%CI 0.001-0.371, p = 0.008), serum glucose (OR: 1.157, 95%CI 1.031-1.299, p = 0.013), arterial partial pressure of oxygen (PaO2) (OR: 0.914, 95%CI 0.874-0.956, p < 0.001), and pleural effusion (OR: 4.979, 95%CI 1.863-13.303, p = 0.001) were independent predictors of more serious AP. CONCLUSION This study found that idiopathic etiology, pre-existing pulmonary diseases, increased hematocrit level or pleural effusion, higher serum glucose, and lower serum calcium or PaO2 at the time of admission independently correlated with more serious AP in the elderly patients.
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Risk Factors for Acute Kidney Injury in Acute Pancreatitis: A 7-Year Retrospective Analysis of Patients in a Large Tertiary Hospital. Pancreas 2020; 49:1057-1062. [PMID: 32769851 DOI: 10.1097/mpa.0000000000001613] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVE The aim of our study was to investigate the risk factors for acute kidney injury (AKI) in patients with acute pancreatitis (AP). METHODS Acute pancreatitis patients were retrospectively divided into 2 groups: AKI and non-AKI. We used logistic regression analysis to investigate the risk factors for AP patients with AKI. We also compared the incidence of complications and mortality between the non-AKI and AKI groups. RESULTS A total of 1255 AP patients without AKI and 430 AP patients with AKI were included. The risk factors for AKI in AP were hypertriglyceridemia (P = 0.001), severity (P = 0.001), etiology (P = 0.001), and Acute Physiology and Chronic Health Evaluation II scores (P = 0.001). The incidences of organ failure (P = 0.001), pancreatic necrosis (P = 0.001), and mortality (P = 0.001) were greater in the AKI group than in the non-AKI group. CONCLUSIONS Hypertriglyceridemia, severity, etiology, and Acute Physiology and Chronic Health Evaluation II scores are independent risk factors for AKI in AP patients. Those patients have serious outcomes such as high rate of organ failure, pancreatic necrosis, and debridement of necrosis.
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Masamune A, Kikuta K, Hamada S, Tsuji I, Takeyama Y, Shimosegawa T, Okazaki K. Clinical practice of acute pancreatitis in Japan: An analysis of nationwide epidemiological survey in 2016. Pancreatology 2020; 20:629-636. [PMID: 32409278 DOI: 10.1016/j.pan.2020.04.013] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Revised: 04/15/2020] [Accepted: 04/17/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND To provide updates on clinical practice of acute pancreatitis (AP) in Japan, we conducted a nationwide epidemiological survey. METHODS This study consisted of a two-staged survey; the number of AP patients was estimated by the first-stage survey and their clinical features were examined by the second-stage survey. We surveyed AP patients who had visited hospitals in 2016. RESULTS The estimated number of AP patients in 2016 was 78,450, with an overall incidence of 61.8 per 100,000 persons. We obtained detailed clinical information of 2994 AP patients, including 706 (23.6%) severe cases classified according to the Japanese severity criteria. The male-to-female sex ratio was 2.0, and the mean age at onset was 59.9 years in males and 66.5 years in females. Alcohol was the most common etiology (42.8%) in males and gallstones in females (37.7%). The AP-associated mortality was 6.1% in severe AP cases, which was decreased by 40% compared to the 2011 survey. Antibiotics were administered to most cases, with carbapenem being frequently used. Enteral nutrition was given in 31.8% of severe cases, but majority cases received after 48 h. Among the 107 patients who received intervention for walled-off necrosis, five patients received surgery-first approach, 66 received endoscopic ultrasound-guided transluminal drainage, and 19 underwent step-up approach. CONCLUSIONS We clarified the current status of AP in Japan including the significant reduction of mortality in severe cases, shift to endoscopic approaches for walled-off necrosis, and poor compliance of the recommendations in the guidelines including management of enteral nutrition and antibiotic administration.
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Affiliation(s)
- Atsushi Masamune
- Division of Gastroenterology, Department of Public Health and Forensic Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan.
| | - Kazuhiro Kikuta
- Division of Gastroenterology, Department of Public Health and Forensic Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Shin Hamada
- Division of Gastroenterology, Department of Public Health and Forensic Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Ichiro Tsuji
- Division of Epidemiology, Department of Public Health and Forensic Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Yoshifumi Takeyama
- Department of Surgery, Kindai University Faculty of Medicine, Osaka, Japan
| | - Tooru Shimosegawa
- Division of Gastroenterology, Department of Public Health and Forensic Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Kazuichi Okazaki
- Department of Gastroenterology and Hepatology, Kansai Medical University, Hirakata, Japan
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Berger Z, Mancilla C, Tobar E, Morales MP, Baró M, Carrasco M, Cordero J, Cruz R, Cruz R, Lara C, Ledesma S, Ramírez G, Sierralta A, Godoy L, Valdés E. Acute pancreatitis in Chile: A multicenter study on epidemiology, etiology and clinical outcome. Retrospective analysis of clinical files. Pancreatology 2020; 20:637-643. [PMID: 32386970 DOI: 10.1016/j.pan.2020.04.016] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2020] [Revised: 04/19/2020] [Accepted: 04/21/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND Epidemiology of acute pancreatitis (AP) is variable in different geographical regions. OBJECTIVES To compare etiology and severity of AP to published data from South America and the rest of world, study impact of demographical factors and treatment on its outcome in Chilean hospitals. METHODS Multicenter observational study. Data of consecutive patients with AP were collected at the moment of discharge from 11 centers and retrospectively analyzed. RESULTS Data of 962 patients were included in the analysis, 447 men and 515 women. Mean age was 48,2 years. Biliary etiology was significantly more frequent in women (70%) than in men (52%). Conversely, alcohol was responsible for about 17% of AP in men but exceptional in women. Mild AP was seen in 73.4%, moderately severe in 14.1% and severe in 13%. The overall mortality was 2.5% (24 of 962): 0.3%, 3.1% and 15.1% in mild, moderately severe and severe cases, respectively. No difference was found in the mortality and severity of biliary versus alcoholic AP, while hypertriglyceridemia induced AP was more severe, without increased mortality. Severity and mortality increased with age. ERCP was performed in 16% of biliary pancreatitis. Adherence to main guidelines was heterogeneous: more than half of mild AP patients were admitted to critical care units and antibiotics were used in about 25% them. CONCLUSION This is the first multicenter study in Chile on AP. When compared to literature, we found similar severity distribution and an acceptably low mortality. Biliary etiology was dominant, but alcohol was also important in men.
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Affiliation(s)
- Zoltán Berger
- Hospital Clínico Universidad de Chile, Department of Medicine, Section of Gastroenterology, Santos Dumont 999, Independencia, Santiago, Chile; Clínica Dávila, Section of Gastroenterology, Recoleta 464, Recoleta, Santiago, Chile.
| | - Carla Mancilla
- Hospital Clínico Universidad de Chile, Department of Medicine, Critical Care Unit, Santos Dumont 999, Independencia, Santiago, Chile
| | - Eduardo Tobar
- Hospital Clínico Universidad de Chile, Department of Medicine, Critical Care Unit, Santos Dumont 999, Independencia, Santiago, Chile
| | - María Paz Morales
- Hospital Clínico Universidad de Chile, Department of Medicine, Section of Gastroenterology, Santos Dumont 999, Independencia, Santiago, Chile
| | - Michel Baró
- Hospital Puerto Montt Dr. Eduardo Schütz Schroeder, Department of Medicine, Los Aromos 65, Puerto Montt, Los Lagos, Chile
| | - Mauricio Carrasco
- Hospital Regional Copiapó San José del Carmen Los Carrera, 1320, Copiapó, Atacama, Chile
| | - Julián Cordero
- Hospital Mauricio Heyermann, Angol Ilabaca 752, Angol, Araucanía, Chile
| | - Rodrigo Cruz
- Hospital Clínico UC Christus, Pontificia Universidad Católica, Department of Medicine, Gastroenterology, Marcoleta 367, Santiago, Chile
| | - Ricardo Cruz
- Hospital Clínico UC Christus, Pontificia Universidad Católica, Department of Medicine, Gastroenterology, Marcoleta 367, Santiago, Chile
| | - Christián Lara
- Hospital Dr Hernán Henriquez Aravena, Manuel Montt 115, Temuco, Araucanía, Chile
| | - Sergio Ledesma
- Hospital Regional Dr. Leonardo Guzmán, Azapa 5935, Antofagasta, Chile
| | - Gustavo Ramírez
- Hospital San José, Department of Medicine, San José 1196, Independencia, Santiago, Chile
| | - Armando Sierralta
- Hospital Dr Hernán Henriquez Aravena, Manuel Montt 115, Temuco, Araucanía, Chile
| | - Luis Godoy
- Hospital Clínico Magallanes, Department of Gastroenterology, Av. Los Flamencos, 01364, Punta Arenas, Chile
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11
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Abstract
Acute pancreatitis is an inflammatory process of the pancreas, which can range from a localized inflammatory process to a systemic response, resulting in sepsis and multisystem failure. Pancreatic fluid collections are a complication of pancreatitis. Treatment of these fluid collections is dependent on correct classification. The 2012 Atlanta Criteria divides fluid collections into four categories: acute peripancreatic fluid collections, pancreatic pseudocysts, acute necrotic collections, and walled-off necrosis. Endoscopic ultrasound-guided management of chronic fluid collections is currently the preferred treatment modality. Endoscopy nurses need to be aware of their role in this treatment approach. Continued research in this area will lead to both advancements in equipment and treatment options.
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12
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Robin-Lersundi A, Abella Alvarez A, San Miguel Mendez C, Moreno Elalo-Olaso A, Cruz Cidoncha A, Aguilera Velardo A, Gordo Vidal F, García-Ureña MA. Multidisciplinary Approach to Treating Severe Acute Pancreatitis in a Low-Volume Hospital. World J Surg 2019; 43:2994-3002. [PMID: 31440777 DOI: 10.1007/s00268-019-05114-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Up to 25% of patients with acute pancreatitis develop severe complications and are classified as severe pancreatitis with a high death rate. To improve outcomes, patients may require interventional measures including surgical procedures. Multidisciplinary approach and best practice guidelines are important to decrease mortality. METHODS We have conducted a retrospective analysis from a prospectively maintained database in a low-volume hospital. A total of 1075 patients were attended for acute pancreatitis over a ten-year period. We have analysed 44 patients meeting the criteria for severe acute pancreatitis and for intensive care unit (ICU) admittance. Demographics and clinical data were analysed. Patients were treated according to international guidelines and a multidisciplinary flowchart for acute pancreatitis and a step-up approach for pancreatic necrosis. RESULTS Forty-four patients were admitted to the ICU due to severe acute pancreatitis. Twenty-five patients needed percutaneous drainage of peri-pancreatic or abdominal fluid collections or cholecystitis. Eight patients underwent endoscopic retrograde cholangiopancreatography for choledocholithiasis and biliary sepsis or pancreatic leakage, and one patient received endoscopic trans-gastric endoscopic prosthesis for pancreatic necrosis. Sixteen patients underwent surgery: six patients for septic abdomen, four patients for pancreatic necrosis and two patients due to abdominal compartment syndrome. Four patients had a combination of surgical procedures for pancreatic necrosis and for abdominal compartment syndrome. Overall mortality was 9.1%. CONCLUSION Severe acute pancreatitis represents a complex pathology that requires a multidisciplinary approach. Establishing best practice treatments and evidence-based guidelines for severe acute pancreatitis may improve outcomes in low-volume hospitals.
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Affiliation(s)
- Alvaro Robin-Lersundi
- Department of Surgery, Hospital Universitario del Henares, Avda. Marie Curie, s/n, 28822, Coslada, Madrid, Spain.
| | - Ana Abella Alvarez
- Department of Intensive Care Medicine, Hospital Universitario del Henares, Avda. Marie Curie, s/n, 28822, Coslada, Madrid, Spain
| | - Carlos San Miguel Mendez
- Department of Surgery, Hospital Universitario del Henares, Avda. Marie Curie, s/n, 28822, Coslada, Madrid, Spain
| | - Almudena Moreno Elalo-Olaso
- Department of Surgery, Hospital Universitario del Henares, Avda. Marie Curie, s/n, 28822, Coslada, Madrid, Spain
| | - Arturo Cruz Cidoncha
- Department of Surgery, Hospital Universitario del Henares, Avda. Marie Curie, s/n, 28822, Coslada, Madrid, Spain
| | - Asunción Aguilera Velardo
- Department of Surgery, Hospital Universitario del Henares, Avda. Marie Curie, s/n, 28822, Coslada, Madrid, Spain
| | - Federico Gordo Vidal
- Department of Intensive Care Medicine, Hospital Universitario del Henares, Avda. Marie Curie, s/n, 28822, Coslada, Madrid, Spain
- Grupo de Investigación en Patología Crítica, Universidad Francisco de Vitoria, Pozuelo de Alarcón, Madrid, Spain
| | - Miguel-Angel García-Ureña
- Department of Surgery, Hospital Universitario del Henares, Avda. Marie Curie, s/n, 28822, Coslada, Madrid, Spain
- Grupo de Investigación en Pared Abdominal, Universidad Francisco de Vitoria, Pozuelo de Alarcón, Madrid, Spain
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13
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Abstract
Acute and chronic pancreatitises are gastrointestinal inflammatory diseases, the incidence of which is increasing worldwide. Most (~ 80%) acute pancreatitis (AP) patients have mild disease, and about 20% have severe disease, which causes multiple organ failure and has a high mortality rate. Chronic pancreatitis (CP) is characterized by chronic inflammation and destruction of normal pancreatic parenchyma, which leads to loss of exocrine and endocrine tissues. Patients with CP also have a higher incidence of pancreatic ductal adenocarcinoma. Although a number of factors are associated with the development and progression of AP and CP, the underlying mechanism is unclear. Adhesion molecules play important roles in cell migration, proliferation, and signal transduction, as well as in development and tissue repair. Loosening of cell-cell adhesion between pancreatic acinar cells and/or endothelial cells increases solute permeability, resulting in interstitial edema, which promotes inflammatory cell migration and disrupts tissue structure. Oxidative stress, which is one of the important pathogenesis of pancreatitis, leads to upregulation of adhesion molecules. Soluble adhesion molecules are reportedly involved in AP. In this review, we focus on the roles of tight junctions (occludin, tricellulin, claudin, junctional adhesion molecule, and zonula occludin), adherens junctions (E-cadherin and p120-, α-, and β-catenin), and other adhesion molecules (selectin and intercellular adhesion molecules) in the progression of AP and CP. Maintaining the normal function of adhesion molecules and preventing their abnormal activation maintain the structure of the pancreas and prevent the development of pancreatitis.
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Affiliation(s)
- Takeshi Sato
- 0000 0001 1033 6139grid.268441.dDepartment of Gastroenterology, Yokohama City University Graduate School of Medicine, Fukuura 3-9, Kanazawa-ku, Yokohama, Kanagawa 236-0004 Japan
| | - Wataru Shibata
- 0000 0001 1033 6139grid.268441.dDepartment of Gastroenterology, Yokohama City University Graduate School of Medicine, Fukuura 3-9, Kanazawa-ku, Yokohama, Kanagawa 236-0004 Japan ,0000 0001 1033 6139grid.268441.dDivision of Translational Research, Advanced Medical Research Center, Yokohama City University, Fukuura 3-9, Kanazawa-ku, Yokohama, Kanagawa 236-0004 Japan
| | - Shin Maeda
- 0000 0001 1033 6139grid.268441.dDepartment of Gastroenterology, Yokohama City University Graduate School of Medicine, Fukuura 3-9, Kanazawa-ku, Yokohama, Kanagawa 236-0004 Japan
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14
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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.
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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
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15
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Hamada S, Masamune A, Kikuta K, Shimosegawa T. Severity assessment of acute pancreatitis using four prognostic factors - a nationwide multicenter study of 3682 cases in Japan. United European Gastroenterol J 2017; 5:1136-1137. [PMID: 29238593 DOI: 10.1177/2050640617725961] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- Shin Hamada
- Division of Gastroenterology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Atsushi Masamune
- Division of Gastroenterology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Kazuhiro Kikuta
- Division of Gastroenterology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Tooru Shimosegawa
- Division of Gastroenterology, Tohoku University Graduate School of Medicine, Sendai, Japan
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16
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Wang H, Qin M, Liang Z, Chang R, Fu H, Wei Y, Tang G. Serum ghrelin, but not obestatin, is a potential predictor of acute pancreatitis severity. Medicine (Baltimore) 2017; 96:e7963. [PMID: 28858127 PMCID: PMC5585521 DOI: 10.1097/md.0000000000007963] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
The roles of ghrelin and obestatin in AP remain controversial.This study investigates the effects and the predictive value of serum ghrelin and obestatin levels in the early stage of AP.A total of 193 consecutive patients with AP and 24 healthy controls were included. Patients were divided into mild acute pancreatitis (MAP), moderately severe acute pancreatitis (MSAP), and severe acute pancreatitis (SAP) groups. Serum levels of ghrelin and obestatin were measured on the first, third, and fifth days of hospitalization. The predictive value of serum ghrelin and obestatin levels on the first day in AP was examined using receiver-operating characteristic (ROC) curves.On the first day of hospitalization, the mean serum ghrelin level was significantly lower in patients with AP than in controls (P < .01). The serum ghrelin concentration decreased with increasing AP severity and was lower in patients with SAP than in those with MAP and MSAP (P < .05). It increased gradually from the first to the fifth day after treatment. ROC curves demonstrated that the serum ghrelin level on the first day had some predictive value for AP severity (area under the ROC curve = 0.646), with an optimal cut-off value of 87.83 pg/mL. Logistic regression showed that the serum ghrelin level had independent predictive value for non-MAP (odds ratio = 10.94; 95% confidence interval, 5.08-23.55; P < .01). The serum obestatin level did not differ significantly between patients with AP and controls and had the limited predictive value for non-MAP (area under the ROC curve = 0.564). However, the serum obestatin concentration showed a "warning" effect regarding AP etiology; on the first day of treatment, it was significantly lower in patients with AP of hypertriglyceridemic etiology than in those with AP of biliary, alcohol-related, and other etiologies (P = .05, P = .031, and P = .029, respectively).Serum ghrelin and obestatin levels may be related to the progression of AP in the early stage. Only the serum ghrelin level is a potential predictor of AP severity in the early stage. Obestatin may be involved in the pathogenesis of AP caused by hypertriglyceridemia.
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Affiliation(s)
- Huilin Wang
- Department of Gastroenterology, The First Affiliated Hospital of Guangxi Medical University
- Department of Chemotherapy, Affiliated Tumor Hospital of Guangxi Medical University, Nanning, China
| | - Mengbin Qin
- Department of Gastroenterology, The First Affiliated Hospital of Guangxi Medical University
| | - Zhihai Liang
- Department of Gastroenterology, The First Affiliated Hospital of Guangxi Medical University
| | - Renjie Chang
- Department of Gastroenterology, The First Affiliated Hospital of Guangxi Medical University
| | - Hongzong Fu
- Department of Gastroenterology, The First Affiliated Hospital of Guangxi Medical University
| | - Yule Wei
- Department of Gastroenterology, The First Affiliated Hospital of Guangxi Medical University
| | - Guodu Tang
- Department of Gastroenterology, The First Affiliated Hospital of Guangxi Medical University
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17
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Wu C, Zou L, Shi S, Tong Z, Shen X, Yang D, Ke L, Li W, Li J. The role of hypertriglyceridemia for acute kidney injury in the course of acute pancreatitis and an animal model. Pancreatology 2017. [PMID: 28647101 DOI: 10.1016/j.pan.2017.06.006] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE The aim of this study was to investigate the role of hypertriglyceridemia for acute kidney injury (AKI) in the course of acute pancreatitis. METHODS Patients with acute pancreatitis were retrospectively divided into four groups according to admission triglyceride: normal group, mild HTG group, moderate HTG group and severe HTG group. Clinical characteristics were compared among these groups. Wild type (WT) mice and Human ApoC III transgenic (ApoCIIItg) mice were used in the next animal experiments. Severe acute pancreatitis (SAP) model was established by retrograde injection of 0.5% sodium taurocholate (0.1 ml/100 g) from duodenum to pancreatic duct. Histological scores, serum amylase, creatinine, usea nitrogen were compared between WT mice and ApoCIIItg mice. RESULTS Two hundred and sixty-two patients were classified into 4 groups: normal TG (104, 39.7%), mild HTG (72, 27.5%), moderate HTG (47, 17.9%), and severe HTG (39, 14.9%) groups. The proportions of AKI were 13.5% (14/104, normal), 13.9% (10/72, mild), 21.3% (10/47, moderate), and 38.5% (15/39, severe), respectively. After establishing SAP model, the levels of serum amylase (P < 0.05) and pancreatic histological score (P < 0.05) of ApoCIII-SAP-9h group were significantly higher than that of WT-SAP-9h group, respectively. ApoCIII-SAP-9h group had significantly higher levels of serum creatinine (P < 0.001), usea nitrogen (P < 0.001), and kidney histological score (P < 0.05) than that of WT-SAP-9h group, respectively. CONCLUSIONS Mild HTG has little adverse impact on disease severity of acute pancreatitis; severe HTG can aggravate kidney injury in the course of acute pancreatitis. ApoCIII-SAP mice have more serious pancreatic damage and kidney injury than WT-SAP mice.
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Affiliation(s)
- Congye Wu
- Department of SICU, Research Institute of General Surgery, Jinling Hospital, Nanjing University School of Medicine, Nanjing, Jiangsu, China; Department of Oncology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Lei Zou
- Department of SICU, Research Institute of General Surgery, Jinling Hospital, Nanjing University School of Medicine, Nanjing, Jiangsu, China
| | - Shujing Shi
- Department of Oncology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Zhihui Tong
- Department of SICU, Research Institute of General Surgery, Jinling Hospital, Nanjing University School of Medicine, Nanjing, Jiangsu, China
| | - Xiao Shen
- Department of SICU, Research Institute of General Surgery, Jinling Hospital, Nanjing University School of Medicine, Nanjing, Jiangsu, China
| | - Dongliang Yang
- Department of SICU, Research Institute of General Surgery, Jinling Hospital, Nanjing University School of Medicine, Nanjing, Jiangsu, China
| | - Lu Ke
- Department of SICU, Research Institute of General Surgery, Jinling Hospital, Nanjing University School of Medicine, Nanjing, Jiangsu, China
| | - Weiqin Li
- Department of SICU, Research Institute of General Surgery, Jinling Hospital, Nanjing University School of Medicine, Nanjing, Jiangsu, China.
| | - Jieshou Li
- Department of SICU, Research Institute of General Surgery, Jinling Hospital, Nanjing University School of Medicine, Nanjing, Jiangsu, China
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18
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Hamada S, Masamune A, Shimosegawa T. Transition of early-phase treatment for acute pancreatitis: An analysis of nationwide epidemiological survey. World J Gastroenterol 2017; 23:2826-2831. [PMID: 28522901 PMCID: PMC5413778 DOI: 10.3748/wjg.v23.i16.2826] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2017] [Revised: 02/28/2017] [Accepted: 03/21/2017] [Indexed: 02/06/2023] Open
Abstract
Treatment of acute pancreatitis (AP) is one of the critical challenges to the field of gastroenterology because of its high mortality rate and high medical costs associated with the treatment of severe cases. Early-phase treatments for AP have been optimized in Japan, and clinical guidelines have been provided. However, changes in early-phase treatments and the relationship between treatment strategy and clinical outcome remain unclear. Retrospective analysis of nationwide epidemiological data shows that time for AP diagnosis has shortened, and the amount of initial fluid resuscitation has increased over time, indicating the compliance with guidelines. In contrast, prophylactic use of broad-spectrum antibiotics has emerged. Despite the potential benefits of early enteral nutrition, its use is still limited. The roles of continuous regional arterial infusion in the improvement of prognosis and the prevention of late complications are uncertain. Furthermore, early-phase treatments have had little impact on late-phase complications, such as walled-off necrosis, surgery requirements and late (> 4 w) AP-related death. Based on these observations, early-phase treatments for AP in Japan have approached the optimal level, but late-phase complications have become concerning issues. Early-phase treatments and the therapeutic strategy for late-phase complications both need to be optimized based on firm clinical evidence and cost-effectiveness.
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19
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Disseminated Intravascular Coagulation on Admission Predicts Complications and Poor Prognosis of Acute Pancreatitis: Analysis of the Nationwide Epidemiological Survey in Japan. Pancreas 2017; 46:e15-e16. [PMID: 28085757 DOI: 10.1097/mpa.0000000000000739] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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