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Hussen MS, Ibrahim AF, Tekle Y, Gebremariam S, Feto AD, Nida T, Mohammed H. Aetiology, clinical profile, management and outcome of acute pancreatitis at public hospitals in Addis Ababa, Ethiopia: a prospective observational study. Ann Med Surg (Lond) 2024; 86:2494-2502. [PMID: 38694301 PMCID: PMC11060299 DOI: 10.1097/ms9.0000000000001967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2023] [Accepted: 02/19/2024] [Indexed: 05/04/2024] Open
Abstract
Background Acute pancreatitis (AP) is a rare gastrointestinal pathology that has recently become increasingly common owing to lifestyle changes. Its clinical presentation ranges from mild discomfort to organ failure and death. Previous studies in Ethiopia reported that AP is rare. However, lifestyle changes have recently increased. Therefore, this study aimed to assess the aetiology, clinical profile, management, and outcomes of AP. Methods This prospective observational study included 59 adults diagnosed with AP using the Revised Atlanta Classification between November 2021 and August 2022 at five public hospitals in Addis Ababa. The data were analyzed using SPSS 25. The mean ± standard deviation and adjusted odds ratio (AOR) at 95% CI were used. Results The mean age was 38.2 (SD±11.5 years), mostly aged 30-44, with 67% males and 89.8% patients presenting with new-onset AP. Abdominal pain and nausea were the most common presentations in 93.2% of patients. More than 52.5% of AP cases were caused by alcohol, followed by gallstones (28.8%), and gallstones (47.1%) underwent cholecystectomy during the index admission. One patient (1.7%) died. The length of hospital stay ranges from 1-47 days and increases with the severity of AP. Patients with recurrent AP had a 2.4 folds increase in complications compared to new-onset AP (AOR=2.4, 95% CI=1.38, 15.71). Conclusion Most AP cases were caused by alcohol consumption, followed by gallstones, smoking, and hypertriglyceridemia. One death in a 60-year-old male with an alcohol and smoking history was diagnosed and triaged as severe AP with persistent multiple organ failure; BISAP score 4, his Creatinine=2.55 mg/dl, haematocrit 72.6%; and left shift of WBC, was associated.
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Affiliation(s)
| | | | | | | | | | - Tamrat Nida
- Department of Medical Biochemistry, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Hussen Mohammed
- School of Public Health, College of Medicine and Health Science, Dire Dawa University, Dire Dawa
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Parveen S, Singh Sodhi J, Dhar N, Nazir S, Sharma A, Mir TA, Acharya K, Khan MA, Gulzar GM, Shah AH, Yattoo GN, Raina KS. Increase in acute pancreatitis, especially gallstone related, as the cause for emergency admissions: Temporal trend from Kashmir, India. Indian J Gastroenterol 2024:10.1007/s12664-023-01509-7. [PMID: 38446349 DOI: 10.1007/s12664-023-01509-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Accepted: 12/19/2023] [Indexed: 03/07/2024]
Abstract
BACKGROUND The incidence of acute pancreatitis is increasing globally. Gallstones (GS) and ascariasis are the major causes for acute pancreatitis in the Kashmiri population. In recent years, we have observed an increase in the admission rate of acute pancreatitis. Many patients who present first time as gallstone pancreatitis have asymptomatic gallstones. We aimed at studying the etiology and yearly admission rate of acute pancreatitis with main focus on gallstone pancreatitis and the contribution of asymptomatic gallstones. METHODS This was a hospital-based, prospective, observational study from January 2015 to December 2019 for a period of five years. Patients of acute pancreatitis were evaluated for etiology and yearly admission rate. Patients of gallstone pancreatitis were evaluated in terms of clinical profile, risk factors, nature (symptomatic/asymptomatic, known/unknown gallstones), size of stones, treatment and outcome in terms of severity and mortality. The data was analyzed by Statistical Package for the Social Sciences (SPSS) version 20.0, as mean (SD), frequencies and percentages. RESULTS As many as 702 (8.5%) patients of acute pancreatitis were admitted among 8245 gastrointestinal emergencies in five years. The yearly admission rate of acute pancreatitis was 5.6%, 7.3%, 8.7%, 9.5% and 10.3%, respectively (p = 0.013). Gallstones, Ascariasis, alcohol and idiopathic acute pancreatitis were 47.7%, 6.9%, 1.2% and 33.7%, respectively. Gallstone pancreatitis increased from 31% in 2015 to 52.4% in 2019 (p = 0.045) and ascariasis-related acute pancreatitis declined from 14.4% to 1.6% (p = 0.034). Asymptomatic gallstones constituted 87.7% of cases. Known/unknown asymptomatic gallstones and symptomatic gallstones were 24.4%, 63.2% and 12.2%, respectively. Gallstones < 5 mm and > 5 mm were76.1% and 23.8% respectively (p = 0.027). Cholecystectomy rate in index admission was 4.7%. Mild, moderate and severe gallstone pancreatitis was 60.2%, 18.8% and 20.8%, respectively. Mortality in gallstone pancreatitis was 10.4%. CONCLUSION The incidence of acute pancreatitis is increasing due to gallstone pancreatitis. Ascariasis-related acute pancreatitis has declined. There is significant contribution of asymptomatic gallstones in patients who present for the first time as acute pancreatitis. Small gallstones < 5 mm are likely to be the risk factors for gallstone pancreatitis.
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Affiliation(s)
- Shaheena Parveen
- Department of Gastroenterology, Sheri-I-Kashmir Institute of Medical Sciences, Srinagar, 190 011, India
| | - Jaswinder Singh Sodhi
- Department of Gastroenterology, Sheri-I-Kashmir Institute of Medical Sciences, Srinagar, 190 011, India.
| | - Neeraj Dhar
- Department of Gastroenterology and Hepatology, Sarvodya Hospital, Faridabad, 121 006, India
| | - Shaheen Nazir
- Department of Gastroenterology, Sheri-I-Kashmir Institute of Medical Sciences, Srinagar, 190 011, India
| | - Ankush Sharma
- Department of Gastroenterology, Sheri-I-Kashmir Institute of Medical Sciences, Srinagar, 190 011, India
| | - Tariq Abdullah Mir
- Department of Gastroenterology, Sheri-I-Kashmir Institute of Medical Sciences, Srinagar, 190 011, India
| | - Kalpana Acharya
- Department of Gastroenterology, Sheri-I-Kashmir Institute of Medical Sciences, Srinagar, 190 011, India
| | - Mushtaq Ahmed Khan
- Department of Gastroenterology, Sheri-I-Kashmir Institute of Medical Sciences, Srinagar, 190 011, India
| | - Ghulam Mohd Gulzar
- Department of Gastroenterology, Sheri-I-Kashmir Institute of Medical Sciences, Srinagar, 190 011, India
| | - Altaf Hussain Shah
- Department of Gastroenterology, Sheri-I-Kashmir Institute of Medical Sciences, Srinagar, 190 011, India
| | | | - Kuldeep S Raina
- Department of Radiation Oncology, Sheri-I-Kashmir Institute of Medical Sciences, Srinagar, 190 011, India
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Formanchuk TV. Etiological differences in demographics, clinical course and consequences of acute pancreatitis: a retrospective study. WIADOMOSCI LEKARSKIE (WARSAW, POLAND : 1960) 2024; 77:909-918. [PMID: 39008576 DOI: 10.36740/wlek202405105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/17/2024]
Abstract
OBJECTIVE Aim: The study is intended to consider acute pancreatitis from the point of view of its etiological structure, as well as demographic description, features of the clinical course, distribution of morphological forms, severity and consequences of the disease in different etiological variants. PATIENTS AND METHODS Materials and Methods: The work was based on a retrospective analysis of the medical records of 677 patients with acute pancreatitis who underwent inpatient treatment from 2017 to 2022 in an emergency hospital and a tertiary regional hospital in Vinnytsia, Ukraine. RESULTS Results: The etiological structure of the general sample was as follows: the alimentary factors - 37,5% of cases, biliary - 18,6%, alcohol - 14,0% and postoperative - 7,8%, respectively. The oldest patients were observed in the group with biliary AP (age [median, interquartile range] 61 [46-72] years), the youngest - in the group with alcoholic AP (age [median, interquartile range] 40 [35-47] years). Men significantly predominated in the groups with alimentary and alcoholic AP. A significant predominance of women was observed in the group with biliary AP (62,7% vs. 37,3%, p=0,0003). The highest mortality was in the alcoholic AP group (22,1%), also here was a significantly lower rate of inpatient bed days (6,0). Edematous AP was dominant in all etiological variants. While infected necrotic pancreatitis was significantly more often found in patients with alcoholic genesis (7,4%). CONCLUSION Conclusions: The etiologic variations of acute pancreatitis differ by demographic and clinical indicators and require more detailed study to understand its prognosis, management, and development of effective prevention and treatment strategies.
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M Y, Nagda J, Gandhi R, Patel RH, Babaria D. Exploring the Prognostic Significance of the C-reactive Protein/Albumin Ratio in Assessing the Severity of Acute Pancreatitis: A Prospective Observational Study in the Indian Population. Cureus 2023; 15:e51170. [PMID: 38283464 PMCID: PMC10814687 DOI: 10.7759/cureus.51170] [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: 12/27/2023] [Indexed: 01/30/2024] Open
Abstract
Background The present study aimed to evaluate the predictive utility of the C-reactive protein (CRP)/albumin (CRP/Alb) ratio in predicting outcomes of acute pancreatitis in Indian patients. Methods This prospective observational study included 150 patients admitted within 24 hours of symptom onset. Serum CRP and albumin levels were measured to calculate the CRP/Alb ratio. Atlanta criteria classified severity as mild, moderate, or severe. The primary outcome was persistent organ failure. Results The mean age was 45±15 years, and 63% were males. The median C-reactive protein was 120 mg/L, Alb 3.2 g/dL, and CRP/Alb ratio 0.28. Severe acute pancreatitis patients (n = 50) had higher CRP/Alb ratios than mild cases (0.45 vs. 0.20, p<0.001). At a cut-off of 0.25, the CRP/Alb ratio demonstrated 85% sensitivity, 80% specificity, and an AUROC of 0.82 for predicting organ failure. This was significantly higher than the CRP (area under the receiver operating characteristic (AUROC) curve 0.72, p = 0.03) and Ranson score (AUROC 0.76, p = 0.04). On multivariate regression, CRP/Alb ratio >0.25 independently predicted severe acute pancreatitis after adjusting for age, gender, and CT severity index (adjusted OR 5.2, 95% CI 2.8-9.6). Conclusion The CRP/Alb ratio calculated within 24 hours reliably predicts persistent organ dysfunction in Indian acute pancreatitis patients. Incorporating this inexpensive biomarker into clinical prediction tools could significantly improve early risk stratification and streamline healthcare delivery in resource-limited settings.
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Affiliation(s)
- Yogesh M
- Community Medicine, Shri M P Shah Medical College, Jamnagar, IND
| | - Jay Nagda
- Internal Medicine, Ahmedabad Municipal Corporation Medical Education Trust Medical College, Ahmedabad, IND
- Community Medicine, Shri M P Shah Medical College, Jamnagar, IND
| | - Rohankumar Gandhi
- Community and Family Medicine, Shri M P Shah Medical College, Jamnagar, IND
| | - Rushi H Patel
- Internal Medicine, Narendra Modi Medical College, Ahmedabad, IND
| | - Dhruvam Babaria
- Internal Medicine, Shri M P Shah Medical College, Jamnagar, IND
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Saxena R, Kumar S, Nafe Z, Chattoraj A, Chauhan S. Clinical, Biochemical, and Radiological Correlation in the Severity of Acute Pancreatitis: A Retrospective Study. Cureus 2023; 15:e34996. [PMID: 36938172 PMCID: PMC10020066 DOI: 10.7759/cureus.34996] [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: 02/14/2023] [Indexed: 02/16/2023] Open
Abstract
OBJECTIVES To analyze the etiologies and the varying clinical presentations and to validate the clinical, biochemical, and radiological signs with severity and prognosis of acute pancreatitis. METHODS A retrospective study of 1316 patients diagnosed with acute pancreatitis in an industrial hospital in Jamshedpur, Jharkhand, was conducted, and their clinicoradiological profiles, etiological factors, and outcomes were studied. RESULT A total of 1316 cases were enrolled, out of which maximum cases (411 [31.23%]) were from the age group of 30-44 years, and the mean and median age were 44.54 and 47 years, respectively. A total of 731 (55.45%) patients had social habits (i.e., alcohol and smoking), and 585 (44.45%) patients did not have any social habits. Based on the etiology of acute pancreatitis (AP), the majority of cases were due to alcoholism (710 [53.95%]) followed by gallstone (343 [26.06%]) and idiopathic pancreatitis (217 [16.48%]). As per the severity of AP, most patients showed mild pancreatitis (937 [71.20%]) followed by moderate (312 [23.71%]) and severe pancreatitis (67 [05.09%]). Mild and moderate pancreatitis patients were shown in 85 and 28 cases, respectively, suggestive of chronic pancreatitis after repeated episodes of AP. But severe pancreatitis shown in 19 cases had hypocalcemia + shock + multi-organ dysfunction syndrome (MODS). In mild, moderate, and severe AP, the mortality rates were 19 (02.03%), 44 (14.10%), and 21 (31.34%), respectively. Overall, 1232 (93.62%) of AP cases recovered and were discharged in stable condition, but 84 (06.38%) cases expired. CONCLUSION AP is a common cause of acute abdomen in patients presenting to the surgical emergency department. The management is mainly conservative with surgery limited to only a few selected cases, depending upon the severity of the disease.
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Affiliation(s)
- Rahul Saxena
- Department of General Surgery, Tata Main Hospital, Jamshedpur, IND
| | - Shishir Kumar
- Department of General Surgery, Tata Main Hospital, Jamshedpur, IND
| | - Zaid Nafe
- Department of Gastroenterology, Tata Main Hospital, Jamshedpur, IND
- Community Medicine, Dr. Vaishampayan Memorial Government Medical College (VMGMC), Jamshedpur, IND
| | - Ashok Chattoraj
- Department of General Surgery, Tata Main Hospital, Jamshedpur, IND
| | - Shivraj Chauhan
- Department of General Surgery, Tata Main Hospital, Jamshedpur, IND
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