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Yu NJ, Li XH, Liu C, Chen C, Xu WH, Chen C, Chen Y, Liu TT, Chen TW, Zhang XM. Radiomics models of contrast-enhanced computed tomography for predicting the activity and prognosis of acute pancreatitis. Insights Imaging 2024; 15:158. [PMID: 38902394 PMCID: PMC11190132 DOI: 10.1186/s13244-024-01738-0] [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: 01/14/2024] [Accepted: 06/02/2024] [Indexed: 06/22/2024] Open
Abstract
BACKGROUND The modified pancreatitis activity scoring system (mPASS) was proposed to assess the activity of acute pancreatitis (AP) while it doesn't include indicators that directly reflect pathophysiology processes and imaging characteristics. OBJECTIVES To determine the threshold of admission mPASS and investigate radiomics and laboratory parameters to construct a model to predict the activity of AP. METHODS AP inpatients at institution 1 were randomly divided into training and validation groups based on a 5:5 ratio. AP inpatients at Institution 2 were served as test group. The cutoff value of admission mPASS scores in predicting severe AP was selected to divide patients into high and low level of disease activity group. LASSO was used in screening features. Multivariable logistic regression was used to develop radiomics model. Meaningful laboratory parameters were used to construct combined model. RESULTS There were 234 (48 years ± 10, 155 men) and 101 (48 years ± 11, 69 men) patients in two institutions. The threshold of admission mPASS score was 112.5 in severe AP prediction. The AUC of the radiomics model was 0.79, 0.72, and 0.76 and that of the combined model incorporating rad-score and white blood cell were 0.84, 0.77, and 0.80 in three groups for activity prediction. The AUC of the combined model in predicting disease without remission was 0.74. CONCLUSIONS The threshold of admission mPASS was 112.5 in predicting severe AP. The model based on CECT radiomics has the ability to predict AP activity. Its ability to predict disease without remission is comparable to mPASS. CRITICAL RELEVANCE STATEMENT This work is the first attempt to assess the activity of acute pancreatitis using contrast-enhanced CT radiomics and laboratory parameters. The model provides a new method to predict the activity and prognosis of AP, which could contribute to further management. KEY POINTS Radiomics features and laboratory parameters are associated with the activity of acute pancreatitis. The combined model provides a new method to predict the activity and prognosis of AP. The ability of the combined model is comparable to the modified Pancreatitis Activity Scoring System.
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Affiliation(s)
- Ning Jun Yu
- Medical Imaging Key Laboratory of Sichuan Province, Department of Radiology, Affiliated Hospital of North Sichuan Medical College, No.1 South Maoyuan Road, Nanchong, 637001, Sichuan, China
| | - Xing Hui Li
- Medical Imaging Key Laboratory of Sichuan Province, Department of Radiology, Affiliated Hospital of North Sichuan Medical College, No.1 South Maoyuan Road, Nanchong, 637001, Sichuan, China
| | - Chao Liu
- Medical Imaging Key Laboratory of Sichuan Province, Department of Radiology, Affiliated Hospital of North Sichuan Medical College, No.1 South Maoyuan Road, Nanchong, 637001, Sichuan, China
| | - Chao Chen
- Department of Radiology, The Second Clinical Medical College of North Sichuan Medical College Nanchong Central Hospital, Nanchong, Sichuan, China
| | - Wen Han Xu
- Medical Imaging Key Laboratory of Sichuan Province, Department of Radiology, Affiliated Hospital of North Sichuan Medical College, No.1 South Maoyuan Road, Nanchong, 637001, Sichuan, China
| | - Chao Chen
- Medical Imaging Key Laboratory of Sichuan Province, Department of Radiology, Affiliated Hospital of North Sichuan Medical College, No.1 South Maoyuan Road, Nanchong, 637001, Sichuan, China
| | - Yong Chen
- Department of Radiology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Ting Ting Liu
- Medical Imaging Key Laboratory of Sichuan Province, Department of Radiology, Affiliated Hospital of North Sichuan Medical College, No.1 South Maoyuan Road, Nanchong, 637001, Sichuan, China
| | - Tian Wu Chen
- Medical Imaging Key Laboratory of Sichuan Province, Department of Radiology, Affiliated Hospital of North Sichuan Medical College, No.1 South Maoyuan Road, Nanchong, 637001, Sichuan, China
| | - Xiao Ming Zhang
- Medical Imaging Key Laboratory of Sichuan Province, Department of Radiology, Affiliated Hospital of North Sichuan Medical College, No.1 South Maoyuan Road, Nanchong, 637001, Sichuan, China.
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Lv C, Zhang ZX, Ke L. Early prediction and prevention of infected pancreatic necrosis. World J Gastroenterol 2024; 30:1005-1010. [PMID: 38577189 PMCID: PMC10989483 DOI: 10.3748/wjg.v30.i9.1005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Revised: 01/02/2024] [Accepted: 02/06/2024] [Indexed: 03/06/2024] Open
Abstract
Approximately 20%-30% of patients with acute necrotizing pancreatitis develop infected pancreatic necrosis (IPN), a highly morbid and potentially lethal complication. Early identification of patients at high risk of IPN may facilitate appropriate preventive measures to improve clinical outcomes. In the past two decades, several markers and predictive tools have been proposed and evaluated for this purpose. Conventional biomarkers like C-reactive protein, procalcitonin, lymphocyte count, interleukin-6, and interleukin-8, and newly developed biomarkers like angiopoietin-2 all showed significant association with IPN. On the other hand, scoring systems like the Acute Physiology and Chronic Health Evaluation II and Pancreatitis Activity Scoring System have also been tested, and the results showed that they may provide better accuracy. For early prevention of IPN, several new therapies were tested, including early enteral nutrition, antibiotics, probiotics, immune enhancement, etc., but the results varied. Taken together, several evidence-supported predictive markers and scoring systems are readily available for predicting IPN. However, effective treatments to reduce the incidence of IPN are still lacking apart from early enteral nutrition. In this editorial, we summarize evidence concerning early prediction and prevention of IPN, providing insights into future practice and study design. A more homogeneous patient population with reliable risk-stratification tools may help find effective treatments to reduce the risk of IPN, thereby achieving individualized treatment.
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Affiliation(s)
- Cheng Lv
- Department of Critical Care Medicine, Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing 210000, Jiangsu Province, China
| | - Zi-Xiong Zhang
- Department of Critical Care Medicine, Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing 210000, Jiangsu Province, China
| | - Lu Ke
- Department of Critical Care Medicine, Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing 210000, Jiangsu Province, China
- Research Institute of Critical Care Medicine and Emergency Rescue, Nanjing University, Nanjing 210000, Jiangsu Province, China
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Yu Z, Ni Q, Zhang P, Jia H, Yang F, Gao H, Zhu H, Liu F, Zhou X, Chang H, Lu J. Clinical utility of the pancreatitis activity scoring system in severe acute pancreatitis. Front Physiol 2022; 13:935329. [PMID: 36072851 PMCID: PMC9441599 DOI: 10.3389/fphys.2022.935329] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Accepted: 07/11/2022] [Indexed: 11/13/2022] Open
Abstract
Objective: To analyze clinical utility of pancreatitis activity scoring system (PASS) in prediction of persistent organ failure, poor prognosis, and in-hospital mortality in patients with moderately severe acute pancreatitis (MSAP) or severe acute pancreatitis (SAP) admitted to the intensive care unit (ICU).Methods: The study included a total of 140 patients with MSAP and SAP admitted to the ICU of Shandong Provincial Hospital from 2015 to 2021. The general information, biochemical indexes and PASS scores of patients at ICU admission time were collected. Independent risk factors of persistent organ failure, poor prognosis and in-hospital mortality were analyzed by binary logistic regression. Through receiver operating characteristic curve (ROC), the predictive ability of lactic acid, procalcitonin, urea nitrogen, PASS, and PASS in combination with urea nitrogen for the three outcomes was compared. The best cut-off value was determined.Results: Binary logistic regression showed that PASS might be an independent risk factor for patients with persistent organ failure (odds ratio [OR]: 1.027, 95% confidence interval [CI]: 1.014–1.039), poor prognosis (OR: 1.008, 95% CI: 1.001–1.014), and in-hospital mortality (OR: 1.009, 95% CI: 1.000–1.019). PASS also had a good predictive ability for persistent organ failure (area under the curve (AUC) = 0.839, 95% CI: 0.769–0.910) and in-hospital mortality (AUC = 0.780, 95% CI: 0.669–0.891), which was significantly superior to lactic acid, procalcitonin, urea nitrogen and Ranson score. PASS (AUC = 0.756, 95% CI: 0.675–0.837) was second only to urea nitrogen (AUC = 0.768, 95% CI: 0.686–0.850) in the prediction of poor prognosis. Furthermore, the predictive power of urea nitrogen in combination with PASS was better than that of each factor for persistent organ failure (AUC = 0.849, 95% CI: 0.779–0.920), poor prognosis (AUC = 0.801, 95% CI: 0.726–0.876), and in-hospital mortality (AUC = 0.796, 95% CI: 0.697–0.894).Conclusion: PASS was closely correlated with the prognosis of patients with MSAP and SAP. This scoring system may be used as a common clinical index to measure the activity of acute pancreatitis and evaluate disease prognosis.
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Affiliation(s)
- Zetao Yu
- Department of Hepatobiliary Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Department of Hepatobiliary Surgery, Shandong Provincial Hospital, Shandong University, Shandong, China
| | - Qingqiang Ni
- Department of Hepatobiliary Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Department of Hepatobiliary Surgery, Shandong Provincial Hospital, Shandong University, Shandong, China
- *Correspondence: Qingqiang Ni,
| | - Peng Zhang
- ICU, Shandong Provincial Hospital Affiliated to Shandong First Medical University, ICU, Shandong Provincial Hospital, Shandong University, Shandong, China
| | - Hongtao Jia
- Department of Hepatobiliary Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Department of Hepatobiliary Surgery, Shandong Provincial Hospital, Shandong University, Shandong, China
| | - Faji Yang
- Department of Hepatobiliary Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Department of Hepatobiliary Surgery, Shandong Provincial Hospital, Shandong University, Shandong, China
| | - Hengjun Gao
- Department of Hepatobiliary Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Department of Hepatobiliary Surgery, Shandong Provincial Hospital, Shandong University, Shandong, China
| | - Huaqiang Zhu
- Department of Hepatobiliary Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Department of Hepatobiliary Surgery, Shandong Provincial Hospital, Shandong University, Shandong, China
| | - Fangfeng Liu
- Department of Hepatobiliary Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Department of Hepatobiliary Surgery, Shandong Provincial Hospital, Shandong University, Shandong, China
| | - Xu Zhou
- Department of Hepatobiliary Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Department of Hepatobiliary Surgery, Shandong Provincial Hospital, Shandong University, Shandong, China
| | - Hong Chang
- Department of Hepatobiliary Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Department of Hepatobiliary Surgery, Shandong Provincial Hospital, Shandong University, Shandong, China
| | - Jun Lu
- Department of Hepatobiliary Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Department of Hepatobiliary Surgery, Shandong Provincial Hospital, Shandong University, Shandong, China
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Zhou L, Chen J, Mu G, Lu Z, Li W, Deng Y. Heparin-binding protein (HBP) worsens the severity of pancreatic necrosis via up-regulated M1 macrophages activation in acute pancreatitis mouse models. Bioengineered 2021; 12:11978-11986. [PMID: 34895060 PMCID: PMC8810113 DOI: 10.1080/21655979.2021.2011018] [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] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Revised: 11/22/2021] [Accepted: 11/22/2021] [Indexed: 11/24/2022] Open
Abstract
Acute pancreatitis (AP) is one of the most widespread clinical emergencies. Macrophages are the most common immune cells in AP pancreatic tissue and are closely associated with pancreatic necrosis and recovery. The level of heparin-binding protein (HBP) is closely linked to inflammation. In this study, we assessed the effect of HBP on AP tissue necrosis severity and whether HBP is associated with M1 macrophages in pancreatic necrosis. We observed the dynamic changes of HBP levels in the pancreas during acute inflammation in the caerulein-induced AP mice model. We used hematoxylin-eosin staining to evaluate pancreatic edema and necrosis, and to detect infiltration of macrophages by immunohistochemistry. Moreover, expressions of the maker and cytokines of macrophages, including inducible nitric oxide synthase (iNOS), and arginase 1 (Arg-1), interleukin-1β (IL-1β), tumor necrosis factor-α (TNF-α), and interleukin-6 (IL-6) mRNA, were detected by real-time polymerase-chain reaction (RT-PCR). High levels of HBP in the pancreas were detected at 48 h, and heparin inhibited HBP expression in AP pancreatic tissue. Inhibiting HBP expression by injecting heparin before AP can alleviate pancreatic necrosis and inhibit F4/80 labeled M1 macrophage infiltration and IL-6, TNF-α, and iNOS mRNA expression. Clodronate liposome (CLDL) intraperitoneally treated mice showed no change in pancreatic HBP levels, but pancreatic macrophage-specific antigen F4/80 and TNF-α, IL-1β, and IL-6 mRNA levels decreased after CLDL treatment. HBP is critical for pancreatic necrosis response in acute pancreatitis by increasing the infiltration of M1 macrophages and promoting the secretion of inflammatory factors, such as TNF-α, IL-6, IL-1β, which can be reduced by heparin.
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Affiliation(s)
- Liangliang Zhou
- Department of Intensive Care Medicine, Yancheng First Hospital, Affiliated Hospital of Nanjing University Medical School/The First People’s Hospital of Yancheng, Yancheng, Jiangsu Province, China
| | - Jianjun Chen
- Department of Intensive Care Medicine, Yancheng First Hospital, Affiliated Hospital of Nanjing University Medical School/The First People’s Hospital of Yancheng, Yancheng, Jiangsu Province, China
| | - Genhua Mu
- Department of Intensive Care Medicine, Yancheng First Hospital, Affiliated Hospital of Nanjing University Medical School/The First People’s Hospital of Yancheng, Yancheng, Jiangsu Province, China
| | - Zhongqian Lu
- Department of Intensive Care Medicine, Yancheng First Hospital, Affiliated Hospital of Nanjing University Medical School/The First People’s Hospital of Yancheng, Yancheng, Jiangsu Province, China
| | - Weiqin Li
- Department of Intensive Care Medicine, Yancheng First Hospital, Affiliated Hospital of Nanjing University Medical School/The First People’s Hospital of Yancheng, Yancheng, Jiangsu Province, China
| | - Yijun Deng
- Department of Intensive Care Medicine, Yancheng First Hospital, Affiliated Hospital of Nanjing University Medical School/The First People’s Hospital of Yancheng, Yancheng, Jiangsu Province, China
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Ma X, Li L, Jin T, Xia Q. [Harmless acute pancreatitis score on admission can accurately predict mild acute pancreatitis]. NAN FANG YI KE DA XUE XUE BAO = JOURNAL OF SOUTHERN MEDICAL UNIVERSITY 2020; 40:190-195. [PMID: 32376542 DOI: 10.12122/j.issn.1673-4254.2020.02.09] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
OBJECTIVE To evaluate the efficacy of harmless acute pancreatitis score (HAPS) on admission for predicting mild acute pancreatitis (MAP). METHODS We prospectively collected the data from consecutive AP patients admitted to West China Hospital between January, 2016 and August, 2017, and HAPS scores were calculated on admission. The clinical outcomes of the patients with harmless AP (HAPS>2) and those with non-harmless AP (HAPS≤2) were compared. MAP was defined based on the severity classification of 2012 Revised Atlanta guidelines. The area under the curve (AUC) of the receiver- operator characteristic curve (ROC), specificity, sensitivity, positive predictive value (PPV) and negative predictive value (NPV) of HAPS on admission for predicting MAP were analyzed. RESULTS Of the 703 patients with AP analyzed, 182 were predicted to have harmless AP and 521 to have non- harmless AP, and the patients in the latter group had significantly worse clinical outcomes (P < 0.001). The total number of patients with MAP was 359 in the study. The specificity, the sensitivity, the PPV and NPV of HAPS on admission for predicting MAP was 97.7% (95% CI: 95.4-99.0), 48.2% (95% CI: 42.9-53.3), 95.6% (95% CI: 91.5- 98.1) and 64.1% (95% CI: 59.8- 68.2), respectively, and the AUC was 0.749 (95% CI: 0.72- 0.78). CONCLUSIONS HAPS score on admission can accurately predict MAP.
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Affiliation(s)
- Xiaohua Ma
- Department of Integrated Traditional Chinese and Western Medicine, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Lan Li
- Department of Integrated Traditional Chinese and Western Medicine, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Tao Jin
- Department of Integrated Traditional Chinese and Western Medicine, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Qing Xia
- Department of Integrated Traditional Chinese and Western Medicine, West China Hospital, Sichuan University, Chengdu 610041, China
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Silva-Vaz P, Abrantes AM, Castelo-Branco M, Gouveia A, Botelho MF, Tralhão JG. Multifactorial Scores and Biomarkers of Prognosis of Acute Pancreatitis: Applications to Research and Practice. Int J Mol Sci 2020; 21:E338. [PMID: 31947993 PMCID: PMC6982212 DOI: 10.3390/ijms21010338] [Citation(s) in RCA: 81] [Impact Index Per Article: 16.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Revised: 12/30/2019] [Accepted: 01/02/2020] [Indexed: 02/07/2023] Open
Abstract
Acute pancreatitis (AP) is a severe inflammation of the pancreas presented with sudden onset and severe abdominal pain with a high morbidity and mortality rate, if accompanied by severe local and systemic complications. Numerous studies have been published about the pathogenesis of AP; however, the precise mechanism behind this pathology remains unclear. Extensive research conducted over the last decades has demonstrated that the first 24 h after symptom onset are critical for the identification of patients who are at risk of developing complications or death. The identification of these subgroups of patients is crucial in order to start an aggressive approach to prevent mortality. In this sense and to avoid unnecessary overtreatment, thereby reducing the financial implications, the proper identification of mild disease is also important and necessary. A large number of multifactorial scoring systems and biochemical markers are described to predict the severity. Despite recent progress in understanding the pathophysiology of AP, more research is needed to enable a faster and more accurate prediction of severe AP. This review provides an overview of the available multifactorial scoring systems and biochemical markers for predicting severe AP with a special focus on their advantages and limitations.
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Affiliation(s)
- Pedro Silva-Vaz
- Health Sciences Research Centre, University of Beira Interior (CICS-UBI), 6200-506 Covilhã, Portugal;
- General Surgery Department, Hospital Local de Saúde de Castelo Branco, 6000-085 Castelo Branco, Portugal;
- Faculty of Health Sciences, University of Beira Interior, 6200-506 Covilhã, Portugal
| | - Ana Margarida Abrantes
- Coimbra Institute for Clinical and Biomedical Research (iCBR) area of Environment Genetics and Oncobiology (CIMAGO), Faculty of Medicine, University of Coimbra, 3000-548 Coimbra, Portugal; (A.M.A.); (M.F.B.); (J.G.T.)
- Faculty of Medicine, University of Coimbra, 3000-548 Coimbra, Portugal
- Biophysics and Biomathematics Institute, IBILI-Faculty of Medicine of University of Coimbra, 3000-348 Coimbra, Portugal
| | - Miguel Castelo-Branco
- Health Sciences Research Centre, University of Beira Interior (CICS-UBI), 6200-506 Covilhã, Portugal;
- Faculty of Health Sciences, University of Beira Interior, 6200-506 Covilhã, Portugal
| | - António Gouveia
- General Surgery Department, Hospital Local de Saúde de Castelo Branco, 6000-085 Castelo Branco, Portugal;
- Faculty of Health Sciences, University of Beira Interior, 6200-506 Covilhã, Portugal
| | - Maria Filomena Botelho
- Coimbra Institute for Clinical and Biomedical Research (iCBR) area of Environment Genetics and Oncobiology (CIMAGO), Faculty of Medicine, University of Coimbra, 3000-548 Coimbra, Portugal; (A.M.A.); (M.F.B.); (J.G.T.)
- Faculty of Medicine, University of Coimbra, 3000-548 Coimbra, Portugal
- Biophysics and Biomathematics Institute, IBILI-Faculty of Medicine of University of Coimbra, 3000-348 Coimbra, Portugal
| | - José Guilherme Tralhão
- Coimbra Institute for Clinical and Biomedical Research (iCBR) area of Environment Genetics and Oncobiology (CIMAGO), Faculty of Medicine, University of Coimbra, 3000-548 Coimbra, Portugal; (A.M.A.); (M.F.B.); (J.G.T.)
- Faculty of Medicine, University of Coimbra, 3000-548 Coimbra, Portugal
- Biophysics and Biomathematics Institute, IBILI-Faculty of Medicine of University of Coimbra, 3000-348 Coimbra, Portugal
- Surgery Department, Centro Hospitalar e Universitário de Coimbra (CHUC), University Hospital, Faculty of Medicine, 3000-075 Coimbra, Portugal
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