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Wang Y, Dai GF, Xiao WB, Shi JS, Lin BW, Lin JD, Xiao XJ. Effects of continuous venous-venous hemofiltration with or without hemoperfusion on patients with hypertriglyceride acute pancreatitis. Clin Res Hepatol Gastroenterol 2025; 49:102572. [PMID: 40107658 DOI: 10.1016/j.clinre.2025.102572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2025] [Revised: 02/18/2025] [Accepted: 03/15/2025] [Indexed: 03/22/2025]
Abstract
BACKGROUND The role of continuous venous-venous hemofiltration (CVVH) and combined CVVH with hemoperfusion (HP) in patients with acute pancreatitis (AP) is diverse. We hypothesized HP+CVVH, rather than CVVH alone, could have significant benefits in hypertriglyceridemia (HTG)-AP patients. METHODS This single-center retrospective study included 347 patients with hypertriglyceride (HTH) -AP treated from January 2020 to December 2023. We assessed the association of short- and long-term outcomes (including incidence of systemic and local complications, length of ICU and hospital stays, and costs) between the HP+CVVH and CVVH groups. A subgroup analysis was performed to explore the effects of heterogeneity upon the incidence of severe AP (SAP). RESULTS Among 86 included patients, 40 received HP+CVVH therapy, and 46 received CVVH. Subgroup analysis revealed a lower incidence of severe AP after HP+CVVH therapy in patients with high procalcitonin, C-reactive protein, and interleukin-6 levels (46.4 % vs. 80.0 %, p = 0.019; 33.3 % vs. 72.7 %, p = 0.010; 37.5 % vs. 79.2 %, respectively). A significantly decreased hospital length of stay (LOS) in the HP+CVVH group was observed (10.40 [8.63-12.17] vs. 15.48 [13.02-17.94] days, p = 0.001). Furthermore, HP+CVVH showed a tendency towards lower hospital costs than CVVH ($5128 [4312-5943] vs. $8168 [6416-9920], p = 0.001). No significant differences were observed in the incidence of systemic or local complications, recurrence rates, or quality of life. CONCLUSIONS The use of HP+CVVH yielded superior outcomes in terms of the incidence of SAP compared to that of CVVH, for HTG-AP patients with a high inflammatory burden.
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Affiliation(s)
- Ying Wang
- Department of Intensive Care Units, the First Affiliated Hospital, Fujian Medical University, Fuzhou 350005, China; Department of Intensive Care Units, National Regional Medical Center, Binhai Campus of the First Affiliated Hospital, Fujian Medical University, Fuzhou 350212, China
| | - Gao-Fan Dai
- Department of Intensive Care Units, the First Affiliated Hospital, Fujian Medical University, Fuzhou 350005, China; Department of Intensive Care Units, National Regional Medical Center, Binhai Campus of the First Affiliated Hospital, Fujian Medical University, Fuzhou 350212, China
| | - Wen-Biao Xiao
- Department of Intensive Care Units, the First Affiliated Hospital, Fujian Medical University, Fuzhou 350005, China; Department of Intensive Care Units, National Regional Medical Center, Binhai Campus of the First Affiliated Hospital, Fujian Medical University, Fuzhou 350212, China
| | - Jing-Shi Shi
- Department of Intensive Care Units, the First Affiliated Hospital, Fujian Medical University, Fuzhou 350005, China; Department of Intensive Care Units, National Regional Medical Center, Binhai Campus of the First Affiliated Hospital, Fujian Medical University, Fuzhou 350212, China
| | - Bing-Wen Lin
- Department of Intensive Care Units, the First Affiliated Hospital, Fujian Medical University, Fuzhou 350005, China; Department of Intensive Care Units, National Regional Medical Center, Binhai Campus of the First Affiliated Hospital, Fujian Medical University, Fuzhou 350212, China
| | - Jian-Dong Lin
- Department of Intensive Care Units, the First Affiliated Hospital, Fujian Medical University, Fuzhou 350005, China; Department of Intensive Care Units, National Regional Medical Center, Binhai Campus of the First Affiliated Hospital, Fujian Medical University, Fuzhou 350212, China.
| | - Xiong-Jian Xiao
- Department of Intensive Care Units, the First Affiliated Hospital, Fujian Medical University, Fuzhou 350005, China; Department of Intensive Care Units, National Regional Medical Center, Binhai Campus of the First Affiliated Hospital, Fujian Medical University, Fuzhou 350212, China.
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Yu Z, Liang D, Zhang Z, Song K, Zhang Y, Xian Y, He M, Xie X, Xie S, Kong X, Ren Y. Efficacy of Metabolic and Bariatric Surgery for the Treatment of Recurrent Hypertriglyceridemia-Induced Acute Pancreatitis. Obes Surg 2025; 35:1297-1306. [PMID: 40082385 DOI: 10.1007/s11695-025-07742-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2024] [Revised: 10/03/2024] [Accepted: 02/07/2025] [Indexed: 03/16/2025]
Abstract
BACKGROUND Obesity is a predisposing factor for the onset of hypertriglyceridemia-induced acute pancreatitis (HTG-AP). Metabolic and bariatric surgery (MBS) has demonstrated significant short-term efficacy in the treatment of HTG-AP. The current evaluated the long-term efficacy of MBS for the management of recurrent HTG-AP. METHODS Between 01 January 2015 and 31 August 2019, a total of 51 patients diagnosed with obesity combined with HTG-AP at our hospital were enrolled in the study. 14 underwent laparoscopic sleeve gastrectomy (LSG), 9 underwent laparoscopic Roux-en-Y gastric bypass (LRYGB), and 28 underwent routine treatment including dietary therapy, pharmacotherapy, and plasma exchange. The aim of the study was to investigate the long-term therapeutic effects of LRYGB, LSG, and routine treatment on recurrent HTG-AP, and to assess patient prognoses under different treatment modalities. RESULTS The LSG and LRYGB groups achieved significant average weight loss, whereas the changes in the routine treatment group were not significant. The LRYGB group exhibited more weight loss than the LSG group. In both the LSG and LRYGB groups triglyceride levels decreased significantly within the first year after surgery. The routine treatment group exhibited a pancreatitis recurrence rate of 57.14%, compared to 15.38% in the LSG group and 11.11% in the LRYGB group. CONCLUSIONS Over a period of 5 years, LSG and LRYGB exhibited superior efficacy with respect to managing metabolic syndrome associated with recurrent HTG-AP, particularly by enhancing weight management and reducing the pancreatitis recurrence rate. These findings support the long-term efficacy of MBS for the treatment of recurrent HTG-AP.
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Affiliation(s)
- Zhenghang Yu
- Institute of Hepatobiliary Pancreatic Intestinal Diseases, North Sichuan Medical College, Nanchong, 637000, China
- Department of Gastroenterology, Affiliated Hospital of North Sichuan Medical College, Nanchong, 637000, China
| | - Dianyuan Liang
- Institute of Hepatobiliary Pancreatic Intestinal Diseases, North Sichuan Medical College, Nanchong, 637000, China
- Department of Gastroenterology, Affiliated Hospital of North Sichuan Medical College, Nanchong, 637000, China
| | - Zhongyang Zhang
- Institute of Hepatobiliary Pancreatic Intestinal Diseases, North Sichuan Medical College, Nanchong, 637000, China
- Department of Gastroenterology, Affiliated Hospital of North Sichuan Medical College, Nanchong, 637000, China
| | - Ke Song
- Institute of Hepatobiliary Pancreatic Intestinal Diseases, North Sichuan Medical College, Nanchong, 637000, China
- Department of Gastroenterology, Affiliated Hospital of North Sichuan Medical College, Nanchong, 637000, China
| | - Yuan Zhang
- Department of Gastroenterology, Affiliated Hospital of North Sichuan Medical College, Nanchong, 637000, China
| | - Yin Xian
- Nanchong Psychosomatic Hospital, Nanchong, 637770, China
| | - Ming He
- Department of Gastroenterology, Affiliated Hospital of North Sichuan Medical College, Nanchong, 637000, China
| | - Xing Xie
- Department of Gastroenterology, Affiliated Hospital of North Sichuan Medical College, Nanchong, 637000, China
| | - Sijun Xie
- Department of Gastroenterology, Affiliated Hospital of North Sichuan Medical College, Nanchong, 637000, China
| | - Xiangxin Kong
- Engineering and Translational Medicine, Medical College, Tianjin University, Tianjin, 300072, China.
| | - Yixing Ren
- Department of Gastroenterology, Affiliated Hospital of North Sichuan Medical College, Nanchong, 637000, China.
- General Surgery, Chengdu XinHua Hospital Affiliated to North Sichuan Medical College, Chengdu, 610000, China.
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Edu AV, Pahomeanu MR, Olăreanu A, Corbu DG, Treteanu AR, Constantinescu A, Șandru V, Zărnescu NO, Negreanu L. Epidemiology of Biliary Acute Pancreatitis-A Seven-Year Experience of a Large Tertiary Center. Life (Basel) 2025; 15:139. [PMID: 40003548 PMCID: PMC11856301 DOI: 10.3390/life15020139] [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: 12/19/2024] [Revised: 01/17/2025] [Accepted: 01/18/2025] [Indexed: 02/27/2025] Open
Abstract
(1) Introduction: One of the most common causes of acute pancreatitis is cholelithiasis, which is considered to be associated with female sex, older age, and recurrence. Our aim was to define a group of patients with B-AP to facilitate their diagnosis and management, while more judiciously using medical resources. (2) Materials and Methods: This retrospective, large cohort study, which was conducted by extracting data from the BUC-API registry, consisted of 1855 cases between 1 June 2015 and 1 April 2022. Each admission of the same patient was considered a separate case if it did not have signs of chronic pancreatitis. Severity and morphology were stratified according to the Revised Atlanta Classification. (3) Results: A total of 732 cases of B-AP were analyzed, with 92.5% occurring at the first attack. The median age was 65 years, with 61.9% of the patients being female. The majority (82.2%) were surgical cases, and the length of stay (LoS) was 7 days. There were 10.2% severe cases, with a mortality rate of 4%. (4) Discussion: We found positive associations between sex, age, recurrence, and morphology and biliary etiology. Compared with the general population, female sex and age over 65 years correlate better with a biliary etiology. In most scenarios, patients suffer from first attacks, with a lower probability of developing local complications. There was a tendency for biliary pancreatitis patients to be admitted to surgical wards.
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Affiliation(s)
- Andrei Vicențiu Edu
- Faculty of Medicine, Carol Davila University of Medicine and Pharmacy Bucharest, 050474 Bucharest, Romania (D.G.C.); (A.R.T.)
- Internal Medicine & Gastroenterology Department, University Emergency Hospital of Bucharest, 050098 Bucharest, Romania
| | - Mihai Radu Pahomeanu
- Faculty of Medicine, Carol Davila University of Medicine and Pharmacy Bucharest, 050474 Bucharest, Romania (D.G.C.); (A.R.T.)
- Internal Medicine & Gastroenterology Department, University Emergency Hospital of Bucharest, 050098 Bucharest, Romania
| | - Alexandru Olăreanu
- Faculty of Medicine, Carol Davila University of Medicine and Pharmacy Bucharest, 050474 Bucharest, Romania (D.G.C.); (A.R.T.)
| | - Dana Gabriela Corbu
- Faculty of Medicine, Carol Davila University of Medicine and Pharmacy Bucharest, 050474 Bucharest, Romania (D.G.C.); (A.R.T.)
| | - Andreea Ramona Treteanu
- Faculty of Medicine, Carol Davila University of Medicine and Pharmacy Bucharest, 050474 Bucharest, Romania (D.G.C.); (A.R.T.)
| | - Alexandru Constantinescu
- Faculty of Medicine, Carol Davila University of Medicine and Pharmacy Bucharest, 050474 Bucharest, Romania (D.G.C.); (A.R.T.)
- Internal Medicine & Gastroenterology Department, University Emergency Hospital of Bucharest, 050098 Bucharest, Romania
| | - Vasile Șandru
- Faculty of Medicine, Carol Davila University of Medicine and Pharmacy Bucharest, 050474 Bucharest, Romania (D.G.C.); (A.R.T.)
- Gastroenterology Department, Emergency Clinical Hospital of Bucharest, 014461 Bucharest, Romania
| | - Narcis Octavian Zărnescu
- Faculty of Medicine, Carol Davila University of Medicine and Pharmacy Bucharest, 050474 Bucharest, Romania (D.G.C.); (A.R.T.)
- Abdominal Surgery Department, University Emergency Hospital of Bucharest, 050098 Bucharest, Romania
| | - Lucian Negreanu
- Faculty of Medicine, Carol Davila University of Medicine and Pharmacy Bucharest, 050474 Bucharest, Romania (D.G.C.); (A.R.T.)
- Internal Medicine & Gastroenterology Department, University Emergency Hospital of Bucharest, 050098 Bucharest, Romania
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Cho SH, Lee Y, Huh G, Jeong H, Yoo C, Tae Jun S, Seo DW, Oh D. Acute pancreatitis as an early sign of pancreatic cancer; a retrospective, matched cohort study. Scand J Gastroenterol 2024; 59:1330-1335. [PMID: 39387458 DOI: 10.1080/00365521.2024.2414804] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2024] [Revised: 09/30/2024] [Accepted: 10/06/2024] [Indexed: 10/15/2024]
Abstract
BACKGROUND AND AIMS Pancreatic ductal adenocarcinoma (PDAC) often presents as acute pancreatitis (AP). However, data on the clinical outcomes of PDAC initially presenting as AP are limited. We aimed to assess the clinical features of PDAC that manifest as AP. METHODS We reviewed the PDAC database at the Asan Medical Center between 2010-2016. Our study included 77 patients with PDAC who presented with AP (PDAC-AP group) and 154 age-gender-matched PDAC patients as controls (PDAC-other group). Patients' demographics, disease characteristics, and outcomes were compared between both groups. RESULTS Acute pancreatitis was an initial symptom in 1.12% of the patients with PDAC (77 of 6,821). Approximately 81.8% of the patients had clinically mild pancreatitis, and 91% were diagnosed with PDAC within two months of presentation with AP. Main tumor size was significantly smaller in the PDAC-AP group than in the PDAC-other group (PDAC-AP: 2.59 ± 1.21 cm vs. PDAC-other: 3.73 ± 1.78 cm, p < 0.01). The PDAC-AP group patients were diagnosed earlier than those in the PDAC-other group (PDAC-AP: stage 1-2, 80.6% vs. PDAC-other: 46.7%, p < 0.01). The proportion of resectable PDAC was significantly higher in the PDAC-AP group (PDAC-AP: 64.9% vs. PDAC-other: 50%, p < 0.01). Overall survival was significantly longer in the PDAC-AP group than in the PDAC-other group (30.2 months vs. 19.9 months, p = 0.03). CONCLUSIONS In patients who presented with clinical AP, PDAC was identified at an earlier stage, and these patients showed better survival rates. These results suggest that AP may be an early sign of PDAC.
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Affiliation(s)
- Sung Hyun Cho
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Yoonchan Lee
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Gunn Huh
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Hyehyun Jeong
- Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Changhoon Yoo
- Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Song Tae Jun
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Dong-Wan Seo
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Dongwook Oh
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
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Kim EJ, Lee SH, Jung MK, Jang DK, Jo JH, Lee JM, Choe JW, Han SY, Choi YH, Kim SH, Park JM, Paik KH. Current Diagnosis and Treatment of Acute Pancreatitis in Korea: A Nationwide Survey. Gut Liver 2024; 18:897-905. [PMID: 38712394 PMCID: PMC11391141 DOI: 10.5009/gnl230350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Revised: 01/20/2024] [Accepted: 01/22/2024] [Indexed: 05/08/2024] Open
Abstract
Background/Aims Acute pancreatitis (AP) is a leading cause of emergency hospitalization. We present the current diagnostic and therapeutic status of AP as revealed by analysis of a large multicenter dataset. Methods The medical records of patients diagnosed with AP between 2018 and 2019 in 12 tertiary medical centers in Korea were retrospectively reviewed. Results In total, 676 patients were included, of whom 388 (57.4%) were male, and the mean age of all patients was 58.6 years. There were 355 (52.5%), 301 (44.5%), and 20 (3.0%) patients with mild, moderate, and severe AP, respectively, as assessed by the revised Atlanta classification. The most common etiologies of AP were biliary issues (41.6%) and alcohol consumption (24.6%), followed by hypertriglyceridemia (6.8%). The etiology was not identified in 111 (16.4%) patients at the time of initial admission. The overall mortality rate was 3.3%, increasing up to 45.0% among patients with severe AP. Notably, 70.0% (14/20) of patients with severe AP and 81.5% (154/189) of patients with systemic inflammatory response syndrome had received <4 L per day during the initial 24 hours of admission. Only 23.8% (67/281) of acute biliary pancreatitis patients underwent cholecystectomy during their initial admission. In total, 17.8% of patients experienced recurrent attacks during follow-up. However, none of the patients with acute biliary pancreatitis experienced recurrent attacks if they had undergone cholecystectomy during their initial admission. Conclusions This study provides insights into the current status of AP in Korea, including its etiology, severity, and management. Results reveal disparities between clinical guidelines and their practical implementation for AP treatment.
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Affiliation(s)
- Eui Joo Kim
- Department of Internal Medicine, Gil Medical Center, Gachon University College of Medicine, Incheon, Korea
- Department of Medicine, Inha University Graduate School, Incheon, Korea
| | - Sang Hyub Lee
- Department of Internal Medicine and Liver Research Institute, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Min Kyu Jung
- Department of Internal Medicine, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Dong Kee Jang
- Department of Internal Medicine, Seoul Metropolitan Government Seoul National University Boramae Medical Center, Seoul National University College of Medicine, Seoul, Korea
| | - Jung Hyun Jo
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Jae Min Lee
- Department of Internal Medicine, Gyeongsang National University Changwon Hospital, Gyeongsang National University College of Medicine, Changwon, Korea
| | - Jung Wan Choe
- Department of Internal Medicine, Korea University Ansan Hospital, Korea University College of Medicine, Ansan, Korea
| | - Sung Yong Han
- Department of Internal Medicine, Biomedical Research Institute, Pusan National University Hospital and Pusan National University School of Medicine Busan, Korea
| | - Young Hoon Choi
- Department of Internal Medicine, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Seong-Hun Kim
- Department of Internal Medicine, Research Institute of Clinical Medicine of Jeonbuk National University-Biomedical Research Institute of Jeonbuk National University Hospital, Jeonju, Korea
| | - Jin Myung Park
- Department of Internal Medicine, Kangwon National University Hospital, Kangwon National University School of Medicine, Chuncheon, Korea
| | - Kyu-Hyun Paik
- Department of Internal Medicine, Daejeon St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Daejeon, Korea
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Li L, Wu H, Yin H, Cao H. Serum uric acid concentration in acute pancreatitis is significantly higher than healthy population. Sci Rep 2024; 14:18279. [PMID: 39112553 PMCID: PMC11306582 DOI: 10.1038/s41598-024-69425-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2024] [Accepted: 08/05/2024] [Indexed: 08/10/2024] Open
Abstract
Acute pancreatitis (AP) is a common disease caused by a variety of causes. Is uric acid associated with the onset of AP? The objective of this study was to assess whether uric acid concentration in AP patients was higher than that in healthy population, and whether there were associations between uric acid concentration and serological indicators related to AP. A total of 205 AP patients were included in this study. Two hundred and five people who underwent physical examination in our hospital were randomly selected as controls. We analyzed whether there was difference in uric acid concentrations between the two groups. If the difference was statistically significant, the correlations between uric acid concentration and serological indicators in AP patients was further analyzed. There was significant difference in uric acid concentration (P < 0.001) between AP patients and healthy population. Serum uric acid concentration in AP group was significantly higher than that in control group. Two hundred and five AP patients were divided into mild AP group and non-mild AP group. There was no statistically significant difference in uric acid concentration between the two groups (P = 0.176). There was a low linear correlation between serum uric acid concentration and triglyceride level (r = 0.316, P < 0.001). But there was no linear correlation between serum uric acid concentration and hypersensitive C-reactive protein (r = 0.126, P = 0.072), white blood cell (r = 0.192, P = 0.006), albumin (r = 0.183, P = 0.009), total cholesterol concentration (r = 0.133, P = 0.058), fasting blood-glucose (r = 0.133, P = 0.058) and blood calcium (r = 0.155, P = 0.026). Uric acid concentration in patients with AP was significantly higher than healthy population. There was correlation between uric acid concentration and triglyceride in AP patients.
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Affiliation(s)
- Linzhen Li
- Departments of Gastroenterology, First Affiliated Hospital of Wannan Medical College, Wuhu, 241001, Anhui, People's Republic of China
| | - Han Wu
- Departments of Endocrinology Department, First Affiliated Hospital of Wannan Medical College, Wuhu, 241001, Anhui, People's Republic of China
| | - Hui Yin
- Departments of Infection Management, First Affiliated Hospital of Wannan Medical College, Wuhu, 241001, Anhui, People's Republic of China
| | - Huiru Cao
- Departments of Gastroenterology, First Affiliated Hospital of Wannan Medical College, Wuhu, 241001, Anhui, People's Republic of China.
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Kolck J, Hosse C, Leimbach A, Beetz NL, Auer TA, Collettini F, Fehrenbach U, Pille C, Geisel D. Opportunistic screening for long-term muscle wasting in critically ill patients: insights from an acute pancreatitis cohort. Eur J Med Res 2024; 29:294. [PMID: 38778361 PMCID: PMC11110383 DOI: 10.1186/s40001-024-01884-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2024] [Accepted: 05/13/2024] [Indexed: 05/25/2024] Open
Abstract
OBJECTIVES To assess the feasibility of long-term muscle monitoring, we implemented an AI-guided segmentation approach on clinically indicated Computed Tomography (CT) examinations conducted throughout the hospitalization period of patients admitted to the intensive care unit (ICU) with acute pancreatitis (AP). In addition, we aimed to investigate the potential of muscle monitoring for early detection of patients at nutritional risk and those experiencing adverse outcomes. This cohort served as a model for potential integration into clinical practice. MATERIALS Retrospective cohort study including 100 patients suffering from AP that underwent a minimum of three CT scans during hospitalization, totaling 749 assessments. Sequential segmentation of psoas muscle area (PMA) was performed and was relative muscle loss per day for the entire monitoring period, as well as for the interval between each consecutive scan was calculated. Subgroup and outcome analyses were performed including ANOVA. Discriminatory power of muscle decay rates was evaluated using ROC analysis. RESULTS Monitoring PMA decay revealed significant long-term losses of 48.20% throughout the hospitalization period, with an average daily decline of 0.98%. Loss rates diverged significantly between survival groups, with 1.34% PMA decay per day among non-survivors vs. 0.74% in survivors. Overweight patients exhibited significantly higher total PMA losses (52.53 vs. 42.91%; p = 0.02) and average PMA loss per day (of 1.13 vs. 0.80%; p = 0.039). The first and the maximum decay rate, in average available after 6.16 and 17.03 days after ICU admission, showed convincing discriminatory power for survival in ROC analysis (AUC 0.607 and 0.718). Both thresholds for maximum loss (at 3.23% decay per day) and for the initial loss rate (at 1.98% per day) proved to be significant predictors of mortality. CONCLUSIONS The innovative AI-based PMA segmentation method proved robust and effortless, enabling the first comprehensive assessment of muscle wasting in a large cohort of intensive care pancreatitis patients. Findings revealed significant muscle wasting (48.20% on average), particularly notable in overweight individuals. Higher rates of initial and maximum muscle loss, detectable early, correlated strongly with survival. Integrating this tool into routine clinical practice will enable continuous muscle status tracking and early identification of those at risk for unfavorable outcomes.
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Affiliation(s)
- Johannes Kolck
- Department of Radiology, Charité - Universitätsmedizin Berlin, Corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Augustenburger Platz 1, 13353, Berlin, Germany.
| | - Clarissa Hosse
- Department of Radiology, Charité - Universitätsmedizin Berlin, Corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Alexandra Leimbach
- Department of Anesthesiology and Intensive Care Medicine | CCM | CVK, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Nick L Beetz
- Department of Radiology, Charité - Universitätsmedizin Berlin, Corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Augustenburger Platz 1, 13353, Berlin, Germany
- Berlin Institute of Health at Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Timo A Auer
- Department of Radiology, Charité - Universitätsmedizin Berlin, Corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Augustenburger Platz 1, 13353, Berlin, Germany
- Berlin Institute of Health at Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Federico Collettini
- Department of Radiology, Charité - Universitätsmedizin Berlin, Corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Augustenburger Platz 1, 13353, Berlin, Germany
- Berlin Institute of Health at Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Uli Fehrenbach
- Department of Radiology, Charité - Universitätsmedizin Berlin, Corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Christian Pille
- Department of Anesthesiology and Intensive Care Medicine | CCM | CVK, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Dominik Geisel
- Department of Radiology, Charité - Universitätsmedizin Berlin, Corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Augustenburger Platz 1, 13353, Berlin, Germany
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Tenner S, Vege SS, Sheth SG, Sauer B, Yang A, Conwell DL, Yadlapati RH, Gardner TB. American College of Gastroenterology Guidelines: Management of Acute Pancreatitis. Am J Gastroenterol 2024; 119:419-437. [PMID: 38857482 DOI: 10.14309/ajg.0000000000002645] [Citation(s) in RCA: 60] [Impact Index Per Article: 60.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Accepted: 12/08/2023] [Indexed: 06/12/2024]
Abstract
Acute pancreatitis (AP), defined as acute inflammation of the pancreas, is one of the most common diseases of the gastrointestinal tract leading to hospital admission in the United States. It is important for clinicians to appreciate that AP is heterogenous, progressing differently among patients and is often unpredictable. While most patients experience symptoms lasting a few days, almost one-fifth of patients will go on to experience complications, including pancreatic necrosis and/or organ failure, at times requiring prolonged hospitalization, intensive care, and radiologic, surgical, and/or endoscopic intervention. Early management is essential to identify and treat patients with AP to prevent complications. Patients with biliary pancreatitis typically will require surgery to prevent recurrent disease and may need early endoscopic retrograde cholangiopancreatography if the disease is complicated by cholangitis. Nutrition plays an important role in treating patients with AP. The safety of early refeeding and importance in preventing complications from AP are addressed. This guideline will provide an evidence-based practical approach to the management of patients with AP.
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Affiliation(s)
- Scott Tenner
- State University of New York, Health Sciences Center, Brooklyn, New York, USA
| | | | - Sunil G Sheth
- Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Bryan Sauer
- University of Virginia, Charlottesville, Virginia, USA
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Nawacki Ł, Głuszek S. Hospital mortality rate and predictors in acute pancreatitis in Poland: A single-center experience. Asian J Surg 2024; 47:208-215. [PMID: 37541899 DOI: 10.1016/j.asjsur.2023.07.063] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Revised: 06/04/2023] [Accepted: 07/09/2023] [Indexed: 08/06/2023] Open
Abstract
BACKGROUND Despite advances in medicine, acute pancreatitis remains a disorder that is associated with a high mortality rate. The objective of this study was to analyze in-hospital mortality in patients hospitalized with acute pancreatitis. METHODS A prospective analysis of patients hospitalized with acute pancreatitis in a single surgical center was performed. Etiological factors, concomitant diseases, age, and intensive care unit treatment status were assessed to determine their impact on the cause and time of patient death. In addition, conventional laboratory tests performed in the emergency ward were evaluated for their potential as predictors of mortality. RESULTS The study included 476 (n) patients hospitalized with acute pancreatitis in a single surgical center. The presentations included mild disease in 261 (54.8%) patients, moderate disease in 132 (27.7%) patients, and severe disease in 83 (17.5%) patients. The overall mortality rate was 7.14% (n = 34), including 41% in the severe disease group. The mean and median hospitalization times for these patients were 13.9 and 7 days, respectively. Respiratory failure is the main cause of patient death. CONCLUSIONS Acute pancreatitis remains one of the most common gastroenterological diseases that may lead to death. Acute pancreatitis-related respiratory failure is the most common cause of death among patients with alcohol etiology of the disease. Moreover, the mortality rate was higher among older patients. Therefore, actions should be taken to discover prognostic factors of the severe form and initiate appropriate treatment.
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Affiliation(s)
- Łukasz Nawacki
- Collegium Medicum, The Jan Kochanowski University in Kielce, Poland.
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Nagy R, Ocskay K, Sipos Z, Szentesi A, Vincze Á, Czakó L, Izbéki F, Shirinskaya NV, Poluektov VL, Zolotov AN, Zhu Y, Xia L, He W, Sutton R, Szatmary P, Mukherjee R, Burridge IS, Wauchope E, Francisco E, Aparicio D, Pinto B, Gomes A, Nunes V, Tantau VM, Sagau ED, Tantau AI, Suceveanu AI, Tocia C, Dumitru A, Pando E, Alberti P, Cirera A, Molero X, Lee HS, Jung MK, Kim EJ, Lee S, Rebollo MLR, Nistal RB, Santervas SI, Lesko D, Soltes M, Radonak J, Zatorski H, Małecka-Panas E, Fabisiak A, Yaroslav MS, Mykhailo VM, Olekcandr AT, Barauskas G, Simanaitis V, Ignatavicius P, Jinga M, Balaban VD, Patoni C, Gong L, Song K, Li Y, Gonçalves TC, Freitas M, Macedo V, Vornhuelz M, Klauss S, Beyer G, Koksal AS, Tozlu M, Eminler AT, Monclús NT, Comas EP, Oballe JAR, Nawacki Ł, Głuszek S, Rama-Fernández A, Galego M, de la Iglesia D, Aykut UE, Duman DG, Aslan R, Gherbon A, Deng L, Huang W, Xia Q, Poropat G, Radovan A, Vranić L, Ricci C, Ingaldi C, Casadei R, Negoi I, Ciubotaru C, Iordache FM, Constantinescu G, Sandru V, Altintas E, Balci HR, Constantino J, Aveiro D, Pereira J, Gunay S, Misirlioglu Sucan S, et alNagy R, Ocskay K, Sipos Z, Szentesi A, Vincze Á, Czakó L, Izbéki F, Shirinskaya NV, Poluektov VL, Zolotov AN, Zhu Y, Xia L, He W, Sutton R, Szatmary P, Mukherjee R, Burridge IS, Wauchope E, Francisco E, Aparicio D, Pinto B, Gomes A, Nunes V, Tantau VM, Sagau ED, Tantau AI, Suceveanu AI, Tocia C, Dumitru A, Pando E, Alberti P, Cirera A, Molero X, Lee HS, Jung MK, Kim EJ, Lee S, Rebollo MLR, Nistal RB, Santervas SI, Lesko D, Soltes M, Radonak J, Zatorski H, Małecka-Panas E, Fabisiak A, Yaroslav MS, Mykhailo VM, Olekcandr AT, Barauskas G, Simanaitis V, Ignatavicius P, Jinga M, Balaban VD, Patoni C, Gong L, Song K, Li Y, Gonçalves TC, Freitas M, Macedo V, Vornhuelz M, Klauss S, Beyer G, Koksal AS, Tozlu M, Eminler AT, Monclús NT, Comas EP, Oballe JAR, Nawacki Ł, Głuszek S, Rama-Fernández A, Galego M, de la Iglesia D, Aykut UE, Duman DG, Aslan R, Gherbon A, Deng L, Huang W, Xia Q, Poropat G, Radovan A, Vranić L, Ricci C, Ingaldi C, Casadei R, Negoi I, Ciubotaru C, Iordache FM, Constantinescu G, Sandru V, Altintas E, Balci HR, Constantino J, Aveiro D, Pereira J, Gunay S, Misirlioglu Sucan S, Dronov O, Kovalska I, Bush N, Rana SS, Chooklin S, Chuklin S, Saizu IA, Gheorghe C, Göltl P, Hirth M, Mateescu RB, Papuc G, Minkov GA, Enchev ET, Mastrangelo L, Jovine E, Chen W, Zhu Q, Gąsiorowska A, Fabisiak N, Bezmarevic M, Litvin A, Mottes MC, Choi EK, Bánovčin P, Nosáková L, Kovacheva-Slavova MD, Kchaou A, Tlili A, Marino MV, Kusnierz K, Mickevicius A, Hollenbach M, Molcan P, Ioannidis O, Tokarev MV, Ince AT, Semenenko IA, Galeev S, Ramírez-Maldonado E, Sallinen V, Pencik P, Bajor J, Sarlós P, Hágendorn R, Gódi S, Szabó I, Czimmer J, Pár G, Illés A, Faluhelyi N, Kanizsai P, Nagy T, Mikó A, Németh B, Hamvas J, Bod B, Varga M, Török I, Novák J, Patai Á, Sümegi J, Góg C, Papp M, Erőss B, Váncsa S, Teutsch B, Márta K, Hegyi PJ, Tornai T, Lázár B, Hussein T, Tarján D, Lipp M, Kovács B, Urbán O, Fürst E, Tari E, Kocsis I, Maurovich-Horvát P, Tihanyi B, Eperjesi O, Kormos Z, Deák PÁ, Párniczky A, Hegyi P. Discharge protocol in acute pancreatitis: an international survey and cohort analysis. Sci Rep 2023; 13:22109. [PMID: 38092809 PMCID: PMC10719286 DOI: 10.1038/s41598-023-48480-z] [Show More Authors] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Accepted: 11/27/2023] [Indexed: 12/17/2023] Open
Abstract
There are several overlapping clinical practice guidelines in acute pancreatitis (AP), however, none of them contains suggestions on patient discharge. The Hungarian Pancreatic Study Group (HPSG) has recently developed a laboratory data and symptom-based discharge protocol which needs to be validated. (1) A survey was conducted involving all members of the International Association of Pancreatology (IAP) to understand the characteristics of international discharge protocols. (2) We investigated the safety and effectiveness of the HPSG-discharge protocol. According to our international survey, 87.5% (49/56) of the centres had no discharge protocol. Patients discharged based on protocols have a significantly shorter median length of hospitalization (LOH) (7 (5;10) days vs. 8 (5;12) days) p < 0.001), and a lower rate of readmission due to recurrent AP episodes (p = 0.005). There was no difference in median discharge CRP level among the international cohorts (p = 0.586). HPSG-protocol resulted in the shortest LOH (6 (5;9) days) and highest median CRP (35.40 (13.78; 68.40) mg/l). Safety was confirmed by the low rate of readmittance (n = 35; 5%). Discharge protocol is necessary in AP. The discharge protocol used in this study is the first clinically proven protocol. Developing and testifying further protocols are needed to better standardize patients' care.
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Affiliation(s)
- Rita Nagy
- Centre for Translational Medicine, Semmelweis University, Budapest, Hungary
- Institute for Translational Medicine, Medical School, University of Pécs, Pécs, Hungary
- Heim Pál National Pediatric Institute, Budapest, Hungary
| | | | - Zoltán Sipos
- Institute for Translational Medicine, Medical School, University of Pécs, Pécs, Hungary
| | - Andrea Szentesi
- Institute for Translational Medicine, Medical School, University of Pécs, Pécs, Hungary
| | - Áron Vincze
- Division of Gastroenterology, First Department of Medicine, Medical School, University of Pécs, Pécs, Hungary
| | - László Czakó
- Department of Medicine, University of Szeged, Szeged, Hungary
| | - Ferenc Izbéki
- Szent György University Teaching Hospital of Fejér County, Székesfehérvár, Hungary
| | - Natalia V Shirinskaya
- Omsk State Medical Information-Analytical Centre, Omsk State Medical University, Omsk, Russia
| | | | - Alexandr N Zolotov
- Department of Pathophysiology, Clinical Pathophysiology, Omsk State Medical University, Omsk, Russia
| | - Yin Zhu
- Department of Gastroenterology, First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Liang Xia
- Department of Gastroenterology, First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Wenhua He
- Department of Gastroenterology, First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Robert Sutton
- University of Liverpool, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
| | - Peter Szatmary
- University of Liverpool, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
| | - Rajarshi Mukherjee
- University of Liverpool, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
| | | | - Emma Wauchope
- Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
| | - Elsa Francisco
- Surgery Department, Hospital Prof. Ferndo Fonseca, Amadora, Portugal
| | - David Aparicio
- Surgery Department, Hospital Prof. Ferndo Fonseca, Amadora, Portugal
| | - Bruno Pinto
- Surgery Department, Hospital Prof. Ferndo Fonseca, Amadora, Portugal
| | - António Gomes
- Surgery Department, Hospital Prof. Ferndo Fonseca, Amadora, Portugal
| | - Vitor Nunes
- Surgery Department, Hospital Prof. Ferndo Fonseca, Amadora, Portugal
| | - Vasile Marcel Tantau
- "Octavin Fodor" Institute of Gastroenterology and Hepartology, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj Napoca, Romania
| | - Emanuela Denisa Sagau
- "Octavin Fodor" Institute of Gastroenterology and Hepartology, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj Napoca, Romania
| | - Alina Ioana Tantau
- Gastroenterology Department, 4th Medical Clinic, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj Napoca, Romania
| | | | - Cristina Tocia
- Faculty of Medicine, Ovidius University of Constanta, Constanta, Romania
| | - Andrei Dumitru
- Faculty of Medicine, Ovidius University of Constanta, Constanta, Romania
| | - Elizabeth Pando
- Department of Hepato-Pancreato-Biliary and Transplant Surgery, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Piero Alberti
- Department of Hepato-Pancreato-Biliary and Transplant Surgery, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Arturo Cirera
- Department of Hepato-Pancreato-Biliary and Transplant Surgery, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Xavier Molero
- Exocrine Pancreas Research Unit, Hospital Universitari Vall d'Hebron, Institut de Recerca, Universitat Autònoma de Barcelona, CIBEREHD, Barcelona, Spain
| | - Hong Sik Lee
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Korea University Anam Hospital, Seoul, Republic of Korea
| | - Min Kyu Jung
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Korea University Anam Hospital, Seoul, Republic of Korea
| | - Eui Joo Kim
- Division of Gastroenterology, Department of Internal Medicine, Gachon University Gil Medical Center, Gachon University College of Medicine, Incheon, Republic of Korea
| | - Sanghyub Lee
- Department of Internal Medicine and Liver Research Institute, Seoul National University Hospital, Seoul, Republic of Korea
| | | | - Reyes Busta Nistal
- Servicio de Aparato Digestivo Hospital Clínico Universitario Valladolid, Valladolid, Spain
| | | | - Dusan Lesko
- 1st Department of Surgery, University Hospital of L. Pasteur, Kosice, Slovak Republic
| | - Marek Soltes
- 1st Department of Surgery, University Hospital of L. Pasteur, Kosice, Slovak Republic
| | - Jozef Radonak
- 1st Department of Surgery, University Hospital of L. Pasteur, Kosice, Slovak Republic
| | - Hubert Zatorski
- Department of Digestive Tract Diseases, Medical University of Lodz, Lodz, Poland
| | - Ewa Małecka-Panas
- Department of Digestive Tract Diseases, Medical University of Lodz, Lodz, Poland
| | - Adam Fabisiak
- Department of Digestive Tract Diseases, Medical University of Lodz, Lodz, Poland
| | - M Susak Yaroslav
- Department of Surgery With a Course of Emergency and Vascular Surgery, Bogomolet National Medical University, Kiev, Ukraine
| | - V Maksymenko Mykhailo
- Department of Surgery With a Course of Emergency and Vascular Surgery, Bogomolet National Medical University, Kiev, Ukraine
| | | | - Giedrius Barauskas
- Department of Surgery, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Vytautas Simanaitis
- Department of Surgery, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | | | - Mariana Jinga
- Department of Surgery, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | | | - Cristina Patoni
- "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania
| | - Liang Gong
- "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania
| | - Kai Song
- "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania
| | - Yunlong Li
- "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania
| | - T Cúrdia Gonçalves
- Gastroenterology Department, Hospital da Senhora da Oliveira, Guimarães, Portugal
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga/Guimarães, Portugal
- ICVS/3B's-PT Government Associate Laboratory, Braga/Guimarães, Portugal
| | - Marta Freitas
- Department of Gastroenterology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Vítor Macedo
- Department of Gastroenterology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
- Gastroenterology Department, Hospital da Senhora da Oliveira, Guimarães, Portugal
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga/Guimarães, Portugal
| | | | - Sarah Klauss
- LMU University Hospital, LMU Munich, Munich, Germany
| | - Georg Beyer
- LMU University Hospital, LMU Munich, Munich, Germany
| | - Aydin Seref Koksal
- Department of Gastroenterology, Faculty of Medicine, Sakarya University, Sakarya, Turkey
| | - Mukaddes Tozlu
- Department of Gastroenterology, Faculty of Medicine, Sakarya University, Sakarya, Turkey
| | - Ahmet Tarik Eminler
- Department of Gastroenterology, Faculty of Medicine, Sakarya University, Sakarya, Turkey
| | - Nuria Torres Monclús
- University Hospital Arnau de Vilanova, Hospital University Santa Maria, Lleida, Spain
| | - Eva Pijoan Comas
- University Hospital Arnau de Vilanova, Hospital University Santa Maria, Lleida, Spain
| | | | - Łukasz Nawacki
- Collegium Medicum, The Jan Kochanowski University in Kielce, Kielce, Poland
| | - Stanisław Głuszek
- Collegium Medicum, The Jan Kochanowski University in Kielce, Kielce, Poland
| | - Alberto Rama-Fernández
- Gastroenterology Department, University Hospital of Santiago de Compostela, Santiago de Compostela, Spain
| | - Marco Galego
- Gastroenterology Department, University Hospital of Santiago de Compostela, Santiago de Compostela, Spain
| | - Daniel de la Iglesia
- Gastroenterology Department, University Hospital of Santiago de Compostela, Santiago de Compostela, Spain
| | - Umut Emre Aykut
- Marmara University Education and Training Hospital, Istanbul, Turkey
| | - Deniz Güney Duman
- Marmara University Education and Training Hospital, Istanbul, Turkey
| | - Rahmi Aslan
- Marmara University Education and Training Hospital, Istanbul, Turkey
| | - Adriana Gherbon
- Discipline of Internal Medicine: Diabetes, Nutrition, Metabolic Diseases and Systemic Rheumatology, Victor Babeş University of Medicine and Pharmacy Timisoara, Timisoara, Romania
| | - Lihui Deng
- Department of Integrated Traditional Chinese and Western Medicine, Sichuan Provincial Pancreatitis Center and West China-Liverpool Biomedical Research Center, West China Hospital, Sichuan University, Chengdu, China
| | - Wei Huang
- Department of Integrated Traditional Chinese and Western Medicine, Sichuan Provincial Pancreatitis Center and West China-Liverpool Biomedical Research Center, West China Hospital, Sichuan University, Chengdu, China
| | - Qing Xia
- Department of Integrated Traditional Chinese and Western Medicine, Sichuan Provincial Pancreatitis Center and West China-Liverpool Biomedical Research Center, West China Hospital, Sichuan University, Chengdu, China
| | - Goran Poropat
- Department of Gastroenterology, Clinical Hospital Center Rijeka, University of Rijeka, Rijeka, Croatia
| | - Anja Radovan
- Department of Gastroenterology, Clinical Hospital Center Rijeka, University of Rijeka, Rijeka, Croatia
| | - Luka Vranić
- Department of Gastroenterology, Clinical Hospital Center Rijeka, University of Rijeka, Rijeka, Croatia
| | - Claudio Ricci
- Division of Pancreatic Surgery, IRCCS, Azienda Ospedaliero Universitaria di Bologna, Bologna, Italy
- Department of Internal Medicine and Surgery (DIMEC), Alma Mater Studiorum, University of Bologna, S. Orsola-Malpighi Hospital, Bologna, Italy
| | - Carlo Ingaldi
- Division of Pancreatic Surgery, IRCCS, Azienda Ospedaliero Universitaria di Bologna, Bologna, Italy
- Department of Internal Medicine and Surgery (DIMEC), Alma Mater Studiorum, University of Bologna, S. Orsola-Malpighi Hospital, Bologna, Italy
| | - Riccardo Casadei
- Division of Pancreatic Surgery, IRCCS, Azienda Ospedaliero Universitaria di Bologna, Bologna, Italy
- Department of Internal Medicine and Surgery (DIMEC), Alma Mater Studiorum, University of Bologna, S. Orsola-Malpighi Hospital, Bologna, Italy
| | - Ionut Negoi
- Emergency Hospital of Bucharest, Carol Davila University of Medicine and Pharmacy Bucharest, Bucharest, Romania
| | - Cezar Ciubotaru
- Emergency Hospital of Bucharest, Carol Davila University of Medicine and Pharmacy Bucharest, Bucharest, Romania
| | - Florin Mihail Iordache
- Emergency Hospital of Bucharest, Carol Davila University of Medicine and Pharmacy Bucharest, Bucharest, Romania
| | - Gabriel Constantinescu
- Emergency Hospital of Bucharest, Carol Davila University of Medicine and Pharmacy Bucharest, Bucharest, Romania
| | - Vasile Sandru
- Emergency Hospital of Bucharest, Carol Davila University of Medicine and Pharmacy Bucharest, Bucharest, Romania
| | - Engin Altintas
- Gastroenterology Department, Faculty of Medicine, Mersin University, Yenisehir/Mersin, Turkey
| | - Hatice Rizaoglu Balci
- Gastroenterology Department, Faculty of Medicine, Mersin University, Yenisehir/Mersin, Turkey
| | - Júlio Constantino
- Unidade HBP, Serviço de Cirurgia Geral, Centro Hospitalar Tondela-Viseu, Viseu, Portugal
| | - Débora Aveiro
- Unidade HBP, Serviço de Cirurgia Geral, Centro Hospitalar Tondela-Viseu, Viseu, Portugal
| | - Jorge Pereira
- Unidade HBP, Serviço de Cirurgia Geral, Centro Hospitalar Tondela-Viseu, Viseu, Portugal
| | - Suleyman Gunay
- İzmir Katip Çelebi University Atatürk Training and Research Hospital, Karabaglar/Izmir, Turkey
| | - Seda Misirlioglu Sucan
- İzmir Katip Çelebi University Atatürk Training and Research Hospital, Karabaglar/Izmir, Turkey
| | - Oleksiy Dronov
- General Surgery #1, Bogomolets National Medical University, Kiev, Ukraine
| | - Inna Kovalska
- General Surgery #1, Bogomolets National Medical University, Kiev, Ukraine
| | - Nikhil Bush
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Surinder Singh Rana
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | | | | | | | - Cristian Gheorghe
- "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania
- Clinical Institute Fundeni, Bucharest, Romania
| | - Philipp Göltl
- Department of Medicine II, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Michael Hirth
- Department of Medicine II, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Radu Bogdan Mateescu
- "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania
- Gastroenterology Department, Colentina Clinical Hospital Bucharest, Bucharest, Romania
| | - Geanina Papuc
- Gastroenterology Department, Colentina Clinical Hospital Bucharest, Bucharest, Romania
| | | | | | - Laura Mastrangelo
- Department of Surgery, AOU Sant'Orsola Malpighi, IRCCS Azienda Ospedaliera Universitaria, Bologna, Italy
| | - Elio Jovine
- Department of Surgery, AOU Sant'Orsola Malpighi, IRCCS Azienda Ospedaliera Universitaria, Bologna, Italy
| | - Weiwei Chen
- Department of Gastroenterology, Clinical Medical College, Yangzhou University, Yangzhou, Jiangsu, China
| | - Quping Zhu
- Department of Gastroenterology, Clinical Medical College, Yangzhou University, Yangzhou, Jiangsu, China
| | - Anita Gąsiorowska
- Department of Gastroenterology Medical, University of Lodz, Lodz, Poland
| | - Natalia Fabisiak
- Department of Gastroenterology Medical, University of Lodz, Lodz, Poland
| | - Mihailo Bezmarevic
- Department for Hepatobiliary and Pancreatic Surgery, Clinic for General Surgery, Military Medical Academy, University of Defense, Belgrade, Serbia
| | | | - Martina Cattani Mottes
- Department of Medicine, Gastroenterology, The Pancreas Institute, G.B. Rossi University Hospital, Verona, Italy
| | - Eun Kwang Choi
- Department of Internal Medicine, Jeju National University College of Medicine, Jeju, South Korea
| | - Peter Bánovčin
- Clinic of Internal Medicine - Gastroenterology, JFM CU, Jessenius Faculty of Medicine in Martin (JFM CU), Comenius University in Bratislava, Bratislava, Slovakia
| | - Lenka Nosáková
- Clinic of Internal Medicine - Gastroenterology, JFM CU, Jessenius Faculty of Medicine in Martin (JFM CU), Comenius University in Bratislava, Bratislava, Slovakia
| | | | - Ali Kchaou
- Habib Bourguiba University Hospital, Sfax, Tunisia
| | | | - Marco V Marino
- General Surgery Department, Azienda Ospedaliera Ospedali Riuniti Villa Sofia-Cervello, Palermo, Italy
| | | | | | - Marcus Hollenbach
- Division of Gastroenterology, University of Leipzig Medical Center, Leipzig, Germany
| | - Pavol Molcan
- Hepatology and Gastroenterology Department of Roosevelt Hospital, Banska Bystrica, Slovakia
| | - Orestis Ioannidis
- 4th Department of Surgery, Medical School, Aristotle University of Thessaloniki, General Hospital "George Papanikolaou", Thessaloniki, Greece
| | - Mark Valerievich Tokarev
- Sklifosovsky Institute for Clinical Medicine, Sechenov First Moscow State Medical University, Moscow, Russia
| | - Ali Tüzün Ince
- Hospital of Bezmialem Vakif University, School of Medicine, Istanbul, Turkey
| | | | - Shamil Galeev
- Saint Luke Clinical Hospital, St. Petersburg, Russia
| | | | - Ville Sallinen
- Department of Transplantation and Liver Surgery, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Petr Pencik
- Centrum péče o zažívací trakt, Vítkovická Nemocnice a.s., Ostrava, Czech Republic
| | - Judit Bajor
- Division of Gastroenterology, First Department of Medicine, Medical School, University of Pécs, Pécs, Hungary
| | - Patricia Sarlós
- Division of Gastroenterology, First Department of Medicine, Medical School, University of Pécs, Pécs, Hungary
| | - Roland Hágendorn
- Division of Gastroenterology, First Department of Medicine, Medical School, University of Pécs, Pécs, Hungary
| | - Szilárd Gódi
- Division of Gastroenterology, First Department of Medicine, Medical School, University of Pécs, Pécs, Hungary
| | - Imre Szabó
- Division of Gastroenterology, First Department of Medicine, Medical School, University of Pécs, Pécs, Hungary
| | - József Czimmer
- Division of Gastroenterology, First Department of Medicine, Medical School, University of Pécs, Pécs, Hungary
| | - Gabriella Pár
- Division of Gastroenterology, First Department of Medicine, Medical School, University of Pécs, Pécs, Hungary
| | - Anita Illés
- Division of Gastroenterology, First Department of Medicine, Medical School, University of Pécs, Pécs, Hungary
| | - Nándor Faluhelyi
- Department of Medical Imaging, Medical School, University of Pécs, Pécs, Hungary
| | - Péter Kanizsai
- Department of Emergency Medicine, Medical School, University of Pécs, Pécs, Hungary
| | - Tamás Nagy
- Department of Laboratory Medicine, Medical School, University of Pécs, Pécs, Hungary
| | - Alexandra Mikó
- Institute for Translational Medicine, Medical School, University of Pécs, Pécs, Hungary
| | - Balázs Németh
- Department of Medicine, University of Szeged, Szeged, Hungary
| | | | | | - Márta Varga
- Department of Gastroenterology, BMKK Dr Rethy Pal Hospital, Békéscsaba, Hungary
| | - Imola Török
- County Emergency Clinical Hospital of Târgu Mures - Gastroenterology Clinic and University of Medicine, Pharmacy, Sciences and Technology "George Emil Palade", Targu Mures, Romania
| | - János Novák
- Pándy Kálmán Hospital of Békés County, Gyula, Hungary
| | - Árpád Patai
- Markusovszky University Teaching Hospital, Szombathely, Hungary
| | - János Sümegi
- Borsod-Abaúj-Zemplén County Hospital and University Teaching Hospital, Miskolc, Hungary
| | - Csaba Góg
- Healthcare Center of County Csongrád, Makó, Hungary
| | - Mária Papp
- Department of Gastroenterology, Institute of Internal Medicine, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Bálint Erőss
- Institute for Translational Medicine, Medical School, University of Pécs, Pécs, Hungary
- Institute of Pancreatic Diseases, Semmelweis University, Budapest, Hungary
| | - Szilárd Váncsa
- Institute for Translational Medicine, Medical School, University of Pécs, Pécs, Hungary
- Institute of Pancreatic Diseases, Semmelweis University, Budapest, Hungary
- Department of Laboratory Medicine, Semmelweis University, Budapest, Hungary
| | - Brigitta Teutsch
- Institute for Translational Medicine, Medical School, University of Pécs, Pécs, Hungary
- Department of Laboratory Medicine, Semmelweis University, Budapest, Hungary
| | - Katalin Márta
- Institute of Pancreatic Diseases, Semmelweis University, Budapest, Hungary
| | - Péter Jenő Hegyi
- Institute of Pancreatic Diseases, Semmelweis University, Budapest, Hungary
| | - Tamás Tornai
- Institute of Pancreatic Diseases, Semmelweis University, Budapest, Hungary
| | - Balázs Lázár
- Institute of Pancreatic Diseases, Semmelweis University, Budapest, Hungary
| | - Tamás Hussein
- Institute of Pancreatic Diseases, Semmelweis University, Budapest, Hungary
| | - Dorottya Tarján
- Institute of Pancreatic Diseases, Semmelweis University, Budapest, Hungary
| | - Mónika Lipp
- Institute of Pancreatic Diseases, Semmelweis University, Budapest, Hungary
| | - Beáta Kovács
- Institute of Pancreatic Diseases, Semmelweis University, Budapest, Hungary
| | - Orsolya Urbán
- Institute of Pancreatic Diseases, Semmelweis University, Budapest, Hungary
| | - Emese Fürst
- Institute of Pancreatic Diseases, Semmelweis University, Budapest, Hungary
| | - Edina Tari
- Institute of Pancreatic Diseases, Semmelweis University, Budapest, Hungary
| | - Ibolya Kocsis
- Department of Laboratory Medicine, Semmelweis University, Budapest, Hungary
| | - Pál Maurovich-Horvát
- MTA-SE Cardiovascular Imaging Research Group, Medical Imaging Centre, Semmelweis University, Budapest, Hungary
| | - Balázs Tihanyi
- Department for Surgery, Hungarian Defence Forces - Medical Centre, Budapest, Hungary
| | - Orsolya Eperjesi
- Institute of Pancreatic Diseases, Semmelweis University, Budapest, Hungary
| | - Zita Kormos
- Institute of Pancreatic Diseases, Semmelweis University, Budapest, Hungary
| | - Pál Ákos Deák
- Medical Imaging Centre, Department of Radiology, Semmelweis University, Budapest, Hungary
| | - Andrea Párniczky
- Centre for Translational Medicine, Semmelweis University, Budapest, Hungary
- Institute for Translational Medicine, Medical School, University of Pécs, Pécs, Hungary
- Heim Pál National Pediatric Institute, Budapest, Hungary
| | - Péter Hegyi
- Centre for Translational Medicine, Semmelweis University, Budapest, Hungary.
- Institute for Translational Medicine, Medical School, University of Pécs, Pécs, Hungary.
- Institute of Pancreatic Diseases, Semmelweis University, Budapest, Hungary.
- Translational Pancreatology Research Group, Interdisciplinary Centre of Excellence for Research Development and Innovation, University of Szeged, Szeged, Hungary.
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Khan E, Chakrabarty S, Shariff S, Bardhan M. Genetics and Genomics of Chronic Pancreatitis with a Focus on Disease Biology and Molecular Pathogenesis. Glob Med Genet 2023; 10:324-334. [PMID: 38025192 PMCID: PMC10665123 DOI: 10.1055/s-0043-1776981] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2023] Open
Abstract
Chronic pancreatitis is a long-term fibroinflammatory condition of the pancreas with varying incidences across countries. The recent increase in its occurrence implies the involvement of genetic, hereditary, and unconventional risk factors. However, there is a lack of updated literature on recent advances in genetic polymorphisms of chronic pancreatitis. Therefore, this review aims to present recent findings on the genetic implications of chronic pancreatitis based on individual gene mechanisms and to discuss epigenetics and epistasis involved in the disease. Four mechanisms have been implicated in the pathogenesis of chronic pancreatitis, including premature activation of proteases, endoplasmic reticulum stress, ductal pathway dysfunction, and inflammatory pathway dysfunction. These mechanisms involve genes such as PRSS1, PRSS2, SPINK, CEL, PNLIP, PNLIPRP2, CFTR, CaSR, CLDN2, Alpha 1 antitrypsin, and GGT1 . Studying genetic polymorphisms on the basis of altered genes and their products may aid clinicians in identifying predispositions in patients with and without common risk factors. Further research may also identify associations between genetic predispositions and disease staging or prognosis, leading to personalized treatment protocols and precision medicine.
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Affiliation(s)
- Erum Khan
- Department of Neurology, Alzheimer's Disease Research Center, The university of Alabama at Birmingham, Birmingham, United States
| | - Soura Chakrabarty
- Department of Pathology, University of Cambridge, Cambridge, United Kingdom
| | | | - Mainak Bardhan
- Department of Medical Oncology, Miami Cancer Institute, Baptist Health South Florida, Miami, Florida, United States
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Vinge-Holmquist O, Benth JŠ, Arnø E, Langbach O, Røkke O. Increased incidence and reduced mortality after first attack of acute pancreatitis over an 18-year period. Scand J Gastroenterol 2023; 58:1534-1541. [PMID: 37455363 DOI: 10.1080/00365521.2023.2235452] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Accepted: 07/05/2023] [Indexed: 07/18/2023]
Abstract
AIMS To determine time trends in the incidence and etiology of acute pancreatitis and identify predictors for in-hospital mortality. PATIENTS AND METHODS Retrospective study of 1722 patients with acute pancreatitis admitted to Akershus University Hospital between January 2000 and December 2017. Data were obtained from electronic patient files and computed tomography scans. We estimated a logistic regression model to assess differences in associations between patient characteristics and in-hospital mortality in two time periods, 2000-2009 (first period) and 2010-2018 (second period). RESULTS First attack of acute pancreatitis (FAAP) was identified in 1579 patients (91.7%). The incidence of FAAP increased from 20.1/100,000 during the first period to 27.7/100,000 in the second period (p = .011). Etiology showed no differences between the two time periods. Gallstone was the most frequent etiology (47.2%). In total, 187 patients (11.8%) had necrotizing pancreatitis; more in the second period compared to the first (14.2 vs. 7.7%; p < .001). The overall mortality rate was 3.9%. Mortality rates decreased for both inflammatory and necrotizing pancreatitis during the study period. Age and comorbidity according to Charlson Comorbidity Index (CCI) were predictors of in-hospital mortality (OR 1.07, 95% CI 0.07; 0.40 and 13.58, 95% CI 3.88; 47.52), as were alcohol and organ failure (OR 7.20, 95% CI 2.02; 25.67 and OR 34.15, 95% CI 8.94; 130.53, respectively). CONCLUSIONS The incidence of FAAP is increasing in southeast Norway. The etiology has remained unchanged over an 18-year period, with gallstones being the most frequent cause. The outcomes for both inflammatory and necrotic pancreatitis are improving.
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Affiliation(s)
- O Vinge-Holmquist
- Department of Digestive Surgery, Akershus University Hospital, Lorenskog, Norway
- Department of Digestive Surgery, St Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Jūratė Šaltytė Benth
- Institute of Clinical Medicine, Campus Ahus, University of Oslo and Health Services Research Unit, Akershus University Hospital, Lorenskog, Norway
| | - E Arnø
- Department of Radiology, Akershus University Hospital, Lorenskog, Norway
| | - O Langbach
- Department of Digestive Surgery, Akershus University Hospital, Lorenskog, Norway
| | - O Røkke
- Department of Digestive Surgery, Akershus University Hospital, Lorenskog, Norway
- Medical Faculty, University of Oslo, Oslo, Norway
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13
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Hidalgo NJ, Pando E, Mata R, Fernandes N, Villasante S, Barros M, Herms D, Blanco L, Balsells J, Charco R. Impact of comorbidities on hospital mortality in patients with acute pancreatitis: a population-based study of 110,021 patients. BMC Gastroenterol 2023; 23:81. [PMID: 36949385 PMCID: PMC10035222 DOI: 10.1186/s12876-023-02730-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Accepted: 03/16/2023] [Indexed: 03/24/2023] Open
Abstract
BACKGROUND The impact of pre-existing comorbidities on acute pancreatitis (AP) mortality is not clearly defined. Our study aims to determine the trend in AP hospital mortality and the role of comorbidities as a predictor of hospital mortality. METHODS We analyzed patients aged ≥ 18 years hospitalized with AP diagnosis between 2016 and 2019. The data have been extracted from the Spanish National Hospital Discharge Database of the Spanish Ministry of Health. We performed a univariate and multivariable analysis of the association of age, sex, and comorbidities with hospital mortality in patients with AP. The role of the Charlson and Elixhauser comorbidity indices as predictors of mortality was evaluated. RESULTS A total of 110,021 patients diagnosed with AP were hospitalized during the analyzed period. Hospital mortality was 3.8%, with a progressive decrease observed in the years evaluated. In multivariable analysis, age ≥ 65 years (OR: 4.11, p < 0.001), heart disease (OR: 1.73, p < 0.001), renal disease (OR: 1.99, p < 0.001), moderate-severe liver disease (OR: 2.86, p < 0.001), peripheral vascular disease (OR: 1.43, p < 0.001), and cerebrovascular disease (OR: 1.63, p < 0.001) were independent risk factors for mortality. The Charlson > 1.5 (OR: 2.03, p < 0.001) and Elixhauser > 1.5 (OR: 2.71, p < 0.001) comorbidity indices were also independently associated with mortality, and ROC curve analysis showed that they are useful for predicting hospital mortality. CONCLUSIONS Advanced age, heart disease, renal disease, moderate-severe liver disease, peripheral vascular disease, and cerebrovascular disease before admission were independently associated with hospital mortality. The Charlson and Elixhauser comorbidity indices are useful for predicting hospital mortality in AP patients.
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Affiliation(s)
- Nils Jimmy Hidalgo
- Universitat Autonoma de Barcelona, Barcelona, Spain
- Department of Hepato-Pancreato-Biliary and Transplant Surgery, Hospital Universitari Vall d'Hebron, Passeig de La Vall d'Hebron, 119-129. 08035, Barcelona, Spain
| | - Elizabeth Pando
- Universitat Autonoma de Barcelona, Barcelona, Spain.
- Department of Hepato-Pancreato-Biliary and Transplant Surgery, Hospital Universitari Vall d'Hebron, Passeig de La Vall d'Hebron, 119-129. 08035, Barcelona, Spain.
| | - Rodrigo Mata
- Department of Hepato-Pancreato-Biliary and Transplant Surgery, Hospital Universitari Vall d'Hebron, Passeig de La Vall d'Hebron, 119-129. 08035, Barcelona, Spain
| | - Nair Fernandes
- Department of Hepato-Pancreato-Biliary and Transplant Surgery, Hospital Universitari Vall d'Hebron, Passeig de La Vall d'Hebron, 119-129. 08035, Barcelona, Spain
| | - Sara Villasante
- Department of Hepato-Pancreato-Biliary and Transplant Surgery, Hospital Universitari Vall d'Hebron, Passeig de La Vall d'Hebron, 119-129. 08035, Barcelona, Spain
| | - Marta Barros
- Department of Hepato-Pancreato-Biliary and Transplant Surgery, Hospital Universitari Vall d'Hebron, Passeig de La Vall d'Hebron, 119-129. 08035, Barcelona, Spain
| | - Daniel Herms
- Department of Hepato-Pancreato-Biliary and Transplant Surgery, Hospital Universitari Vall d'Hebron, Passeig de La Vall d'Hebron, 119-129. 08035, Barcelona, Spain
| | - Laia Blanco
- Department of Hepato-Pancreato-Biliary and Transplant Surgery, Hospital Universitari Vall d'Hebron, Passeig de La Vall d'Hebron, 119-129. 08035, Barcelona, Spain
| | - Joaquim Balsells
- Department of Hepato-Pancreato-Biliary and Transplant Surgery, Hospital Universitari Vall d'Hebron, Passeig de La Vall d'Hebron, 119-129. 08035, Barcelona, Spain
| | - Ramon Charco
- Department of Hepato-Pancreato-Biliary and Transplant Surgery, Hospital Universitari Vall d'Hebron, Passeig de La Vall d'Hebron, 119-129. 08035, Barcelona, Spain
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14
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Predictors of poor outcomes after cholecystectomy in gallstone pancreatitis: NSQIP analysis of 30-day morbidity and mortality. LANGENBECK'S ARCHIVES OF SURGERY 2022; 408:5. [PMID: 36585495 DOI: 10.1007/s00423-022-02731-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Accepted: 10/15/2022] [Indexed: 01/01/2023]
Abstract
BACKGROUND Contemporary nationwide outcomes of gallstone pancreatitis (GSP) managed by cholecystectomy at the index hospitalization are limited. This study aims to define the rate of 30-day morbidity and mortality and identify associated perioperative risk factors in patients undergoing cholecystectomy for GSP. METHODS Patients from the ACS-NSQIP database with GSP without pancreatic necrosis, who underwent cholecystectomy during the index hospitalization from 2017 to 2019 were selected. Factors associated with 30-day morbidity and mortality were analyzed. RESULTS Of the 4021 patients identified, 1375 (34.5%) were male, 2891 (71.9%) were White, 3923 (97.6%) underwent laparoscopic surgery, and 52.4 years (SD ± 18.9) was the mean age. There were 155 (3.8%) patients who developed morbidity and 15 (0.37%) who died within 30 days of surgery. In bivariate regression analysis, both 30-day morbidity and mortality were associated with older age, elevated pre-operative BUN, hypertension, chronic obstructive pulmonary disease, congestive heart failure, acute kidney injury, and dyspnea. ASA of I or II and laparoscopic surgery were protective against 30-day morbidity and mortality. In multivariable regression analysis, factors independently associated with increased 30-day morbidity included preoperative SIRS/sepsis [OR: 1.68 (95% CI: 1.01-2.79), p = 0.048], and age [OR: 1.03 (95% CI: 1.01-1.04), p = 0.001]. Factors associated with increased 30-day mortality included tobacco use [OR: 8.62 (95% CI: 2.11-35.19), p = 0.003] and age [OR: 1.10 (95% CI: 1.04-1.17), p = 0.002]. CONCLUSIONS Patients with GSP without pancreatic necrosis can undergo cholecystectomy during the index admission with very low risk of 30-day morbidity or mortality.
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Nikkola A, Mäkelä KA, Herzig KH, Mutt SJ, Prasannan A, Seppänen H, Lehtimäki T, Kähönen M, Raitakari O, Seppälä I, Pakkanen P, Nordback I, Sand J, Laukkarinen J. Pancreatic Secretory Trypsin Inhibitor (SPINK1) Gene Mutation in Patients with Acute Alcohol Pancreatitis (AAP) Compared to Healthy Controls and Heavy Alcohol Users without Pancreatitis. Int J Mol Sci 2022; 23:ijms232415726. [PMID: 36555366 PMCID: PMC9778821 DOI: 10.3390/ijms232415726] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Revised: 11/27/2022] [Accepted: 12/06/2022] [Indexed: 12/14/2022] Open
Abstract
Only 3-5% of heavy alcohol users develop acute alcohol pancreatitis (AAP). This suggests that additional triggers are required to initiate the inflammatory process. Genetic susceptibility contributes to the development of AAP, and SPINK1 mutation is a documented risk factor. We investigated the prevalence of the SPINK1(N34S) mutation in patients with AAP compared to heavy alcohol users who had never suffered an episode of pancreatitis. Blood samples for the mutational analysis from patients with first episode (n = 60) and recurrent AAP (n = 43) and from heavy alcohol users without a history of AAP (n = 98) as well as from a control population (n = 1914) were obtained. SPINK1 mutation was found in 8.7% of the patients with AAP. The prevalence was significantly lower in healthy controls (3.4%, OR 2.72; 1.32-5.64) and very low in alcoholics without pancreatitis (1.0%, OR 9.29; 1.15-74.74). In a comparison adjusted for potential cofounders between AAP patients and alcoholics, SPINK1 was found to be an independent marker for AAP. The prevalence of the SPINK1 mutation is overrepresented in AAP patients and very low in alcoholics without pancreatitis. This finding may play a role in understanding the variable susceptibility to AAP found in heavy alcohol users.
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Affiliation(s)
- Anssi Nikkola
- Department of Gastroenterology and Alimentary Tract Surgery, Tampere University Hospital, 33520 Tampere, Finland; (A.N.); (J.S.)
- Faculty of Medicine and Health Technology, Tampere University, 33014 Tampere, Finland; (T.L.); (M.K.); (P.P.); (I.N.)
| | - Kari Antero Mäkelä
- Research Unit of Biomedicine, Oulu University, 90220 Oulu, Finland; (K.A.M.); (K.-H.H.); (S.J.M.); (A.P.)
| | - Karl-Heinz Herzig
- Research Unit of Biomedicine, Oulu University, 90220 Oulu, Finland; (K.A.M.); (K.-H.H.); (S.J.M.); (A.P.)
- Medical Research Center Oulu, Oulu University, Oulu University Hospital, 90220 Oulu, Finland
- Department of Pediatric Gastroenterology and Metabolic Diseases, Poznan University of Medical Sciences, 60-572 Poznan, Poland
| | - Shivaprakash Jagalur Mutt
- Research Unit of Biomedicine, Oulu University, 90220 Oulu, Finland; (K.A.M.); (K.-H.H.); (S.J.M.); (A.P.)
| | - Aishwarya Prasannan
- Research Unit of Biomedicine, Oulu University, 90220 Oulu, Finland; (K.A.M.); (K.-H.H.); (S.J.M.); (A.P.)
| | - Hanna Seppänen
- Department of Surgery, Helsinki University Hospital, 00260 Helsinki, Finland;
| | - Terho Lehtimäki
- Faculty of Medicine and Health Technology, Tampere University, 33014 Tampere, Finland; (T.L.); (M.K.); (P.P.); (I.N.)
- Fimlab Laboratories, Department of Clinical Chemistry, 33520 Tampere, Finland;
- Finnish Cardiovascular Research Center, 33520 Tampere, Finland
| | - Mika Kähönen
- Faculty of Medicine and Health Technology, Tampere University, 33014 Tampere, Finland; (T.L.); (M.K.); (P.P.); (I.N.)
- Finnish Cardiovascular Research Center, 33520 Tampere, Finland
- Department of Clinical Physiology, Tampere University Hospital, 33520 Tampere, Finland
| | - Olli Raitakari
- Centre for Population Health Research, University of Turku and Turku University Hospital, 20521 Turku, Finland;
- Research Centre of Applied and Preventive Cardiovascular Medicine, University of Turku, 20014 Turku, Finland
- Department of Clinical Physiology and Nuclear Medicine, Turku University Hospital, 20521 Turku, Finland
| | - Ilkka Seppälä
- Fimlab Laboratories, Department of Clinical Chemistry, 33520 Tampere, Finland;
| | - Pihla Pakkanen
- Faculty of Medicine and Health Technology, Tampere University, 33014 Tampere, Finland; (T.L.); (M.K.); (P.P.); (I.N.)
- Department of Otorhinolaryngology-Head and Neck Surgery, Helsinki University Hospital, 00260 Helsinki, Finland
| | - Isto Nordback
- Faculty of Medicine and Health Technology, Tampere University, 33014 Tampere, Finland; (T.L.); (M.K.); (P.P.); (I.N.)
| | - Juhani Sand
- Department of Gastroenterology and Alimentary Tract Surgery, Tampere University Hospital, 33520 Tampere, Finland; (A.N.); (J.S.)
| | - Johanna Laukkarinen
- Department of Gastroenterology and Alimentary Tract Surgery, Tampere University Hospital, 33520 Tampere, Finland; (A.N.); (J.S.)
- Faculty of Medicine and Health Technology, Tampere University, 33014 Tampere, Finland; (T.L.); (M.K.); (P.P.); (I.N.)
- Correspondence: ; Tel.:+358-3-311-64314
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He W, Wang G, Yu B, Xia L, Zhu Y, Liu P, Chen H, Kong R, Zhu Y, Sun B, Lu N. Elevated hypertriglyceridemia and decreased gallstones in the etiological composition ratio of acute pancreatitis as affected by seasons and festivals: A two-center real-world study from China. Front Cell Infect Microbiol 2022; 12:976816. [PMID: 36506025 PMCID: PMC9730824 DOI: 10.3389/fcimb.2022.976816] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Accepted: 09/26/2022] [Indexed: 11/27/2022] Open
Abstract
Objective The purpose of this study was to observe the annual variation in the etiology of acute pancreatitis (AP) and its relationship with seasons and festivals. Methods From 2011 to 2017, 5146 adult patients with AP were studied, including 4110 patients from the First Affiliated Hospital of Nanchang University (South center) and 1036 patients from the First Affiliated Hospital of Harbin Medical University (North center). We analyzed the overall annual variation in the etiology of AP and then compared the differences in etiology between the two regions, as well as the effects of seasons and festivals on the etiology of AP. Results Gallstones, hypertriglyceridemia (HTG) and alcohol were the top three etiologies of AP. Gallstone AP showed a downward trend (P<0.001), and HTG-AP and alcohol AP showed an upward trend (both P<0.01). Among the etiologies of AP, gallstones and HTG were affected by seasons and festivals. The composition ratio of HTG-AP increased, while gallstone AP decreased in winter and in months with long holidays (all P<0.01). The composition ratio of gallstone AP in the south center was higher than that in the north center (59.5% vs. 49%), especially in summer (62.9% vs. 44.0%) and autumn (61.5% vs. 45.7%, all P<0.001). Conclusions The composition ratio of HTG-AP increased while gallstone AP decreased in the past 7 years, and they were affected by seasons and festivals.
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Affiliation(s)
- Wenhua He
- Department of Gastroenterology, Pancreatic Disease Centre, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Gang Wang
- Department of Pancreatic and Biliary Surgery, The First Affiliated Hospital of Harbin Medical University, Harbin, China,Key Laboratory of Hepatosplenic Surgery, Ministry of Education, The First Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Bingjun Yu
- Department of Gastroenterology, Pancreatic Disease Centre, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Liang Xia
- Department of Gastroenterology, Pancreatic Disease Centre, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Yong Zhu
- Department of Gastroenterology, Pancreatic Disease Centre, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Pi Liu
- Department of Gastroenterology, Pancreatic Disease Centre, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Hua Chen
- Department of Pancreatic and Biliary Surgery, The First Affiliated Hospital of Harbin Medical University, Harbin, China,Key Laboratory of Hepatosplenic Surgery, Ministry of Education, The First Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Rui Kong
- Department of Pancreatic and Biliary Surgery, The First Affiliated Hospital of Harbin Medical University, Harbin, China,Key Laboratory of Hepatosplenic Surgery, Ministry of Education, The First Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Yin Zhu
- Department of Gastroenterology, Pancreatic Disease Centre, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Bei Sun
- Department of Pancreatic and Biliary Surgery, The First Affiliated Hospital of Harbin Medical University, Harbin, China,Key Laboratory of Hepatosplenic Surgery, Ministry of Education, The First Affiliated Hospital of Harbin Medical University, Harbin, China,*Correspondence: Bei Sun, ; Nonghua Lu,
| | - Nonghua Lu
- Department of Gastroenterology, Pancreatic Disease Centre, The First Affiliated Hospital of Nanchang University, Nanchang, China,*Correspondence: Bei Sun, ; Nonghua Lu,
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17
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Wang Q, Chen Y, Huang P, Su D, Gao F, Fu X, Fu B. The Clinical Characteristics and Outcome of Elderly Patients With Acute Pancreatitis. Pancreas 2022; 51:1284-1291. [PMID: 37099768 DOI: 10.1097/mpa.0000000000002192] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/28/2023]
Abstract
OBJECTIVES This study aimed to identify the risk factors for the progression of acute pancreatitis (AP) to severe acute pancreatitis (SAP) and death in elderly patients. METHODS This was a single-center retrospective study conducted in a tertiary teaching hospital. Data on patient demographics, comorbidities, duration of hospitalization, complications, interventions, and mortality rates were collected. RESULTS Between January 2010 and January 2021, 2084 elderly patients with AP were included in this study. The mean age of the patients was 70.0 years (standard deviation, 7.1 years). Among them, 324 (15.5%) had SAP and 105 died (5.0%). The 90-day mortality rate in the SAP group was significantly higher than that in the AP group (P < 0.0001). Multivariate regression analysis revealed that trauma, hypertension, and smoking were risk factors for SAP. After multivariate adjustment, acute respiratory distress syndrome, acute kidney injury, sepsis, organ perforation, and abdominal hemorrhage were associated with higher 90-day mortality. CONCLUSIONS Traumatic pancreatitis, hypertension, and smoking are independent risk factors for SAP in elderly patients. Acute respiratory distress syndrome, acute kidney injury, sepsis, organ perforation, and abdominal hemorrhage are independent risk factors for death in elderly patients with AP.
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18
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Lin XY, Zeng Y, Zhang ZC, Lin ZH, Chen LC, Ye ZS. Incidence and clinical characteristics of hypertriglyceridemic acute pancreatitis: A retrospective single-center study. World J Gastroenterol 2022; 28:3946-3959. [PMID: 36157550 PMCID: PMC9367230 DOI: 10.3748/wjg.v28.i29.3946] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Revised: 04/25/2022] [Accepted: 07/06/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND The incidence of hypertriglyceridemic acute pancreatitis (HTG-AP) has increased yearly, but updated population-based estimates on the incidence of HTG-AP are lacking. Reducing serum triglyceride (TG) levels quickly is crucial in the early treatment of HTG-AP. Decreased serum TG levels are treated by non-invasive methods, which include anti-lipidemic agents, heparin, low-molecular weight heparin, and insulin, and invasive methods, such as blood purification including hemoperfusion (HP), plasmapheresis, and continuous renal replacement therapy. However, authoritative guidelines have not been established. Early selection of appropriate treatment is important and beneficial in controlling the development of HTG-AP.
AIM To evaluate the effect between patients treated with intravenous insulin (INS) and HP to guide clinical treatment.
METHODS We retrospectively reviewed 371 patients with HTG-AP enrolled in the Department of Fujian Provincial Hospital form April 2012 to March 2021. The inpatient medical and radiologic records were reviewed to determine clinical features, severity, complications, mortality, recurrence rate, and treatment. Multivariate logistic regression analyses were used to analyze risk factors for severe HTG-AP. Propensity score matching was used to compare the clinical outcomes of INS and HP.
RESULTS A total of 371 patients met the HTG-AP criteria. The incidence of HTG-AP was increased by approximately 2.6 times during the 10 years (8.4% in April 2012-March 2013 and 22.3% in April 2020-March 2021). The highest incidence rate of acute pancreatitis was observed for men in the age group of 30-39 years. The amylase level was elevated in 80.1% of patients but was only three times the normal value in 46.9% of patients. The frequency of severe acute pancreatitis (26.9%), organ failure (31.5%), rate of recurrence (32.9%), and mortality (3.0%) of HTG-AP was high. Improved Marshall score, modified computed tomography severity index score, baseline TG, baseline amylase, C-reactive protein (CRP), albumin, aspartate aminotransferase, low-density lipoprotein cholesterol, urea nitrogen, creatinine, calcium, hemoglobin, free triiodothyronine, admission to intensive care unit, and mortality were significantly different between patients with different grades of severity (P < 0.050). Multivariate logistic regression analysis confirmed that high CRP [P = 0.005, odds ratio (OR) = 1.011, 95%CI: 1.003-1.019], low calcium (P = 0.003, OR = 0.016, 95%CI: 0.001-0.239), and low albumin (P = 0.023, OR = 0.821, 95%CI: 0.693-0.973) were risk factors of severe HTG-AP. After propensity score matching adjusted by sex, age, severity of HTG-AP, and baseline TG, the serum TG significantly decreased in patients treated with INS (P < 0.000) and HP (P < 0.000) within 48 h. However, the clearance rate of TG (57.24 ± 33.70% vs 56.38 ± 33.61%, P = 0.927) and length of stay (13.04 ± 7.92 d vs 12.35 ± 6.40 d, P = 0.730) did not differ between the two groups.
CONCLUSION The incidence of HTG-AP exhibited a significant increase, remarkable severity, and recurrent trend. Patients with mild and moderately severe acute pancreatitis can be treated effectively with INS safely and effectively without HP.
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Affiliation(s)
- Xue-Yan Lin
- Department of Gastroenterology, Fujian Provincial Hospital, Fujian Medical University Provincial of Clinical Medicine, Fuzhou 350001, Fujian Province, China
| | - Yi Zeng
- Department of Gastrointestinal Surgical Oncology, Fujian Cancer Hospital, Fujian Medical University Cancer Hospital, Fuzhou 350014, Fujian Province, China
| | - Zheng-Chao Zhang
- Department of Emergency Surgery, Fujian Provincial Hospital, Fujian Medical University Provincial of Clinical Medicine, Fuzhou 350001, Fujian Province, China
| | - Zhi-Hui Lin
- Department of Gastroenterology, Fujian Provincial Hospital, Fujian Medical University Provincial of Clinical Medicine, Fuzhou 350001, Fujian Province, China
| | - Lu-Chuan Chen
- Department of Gastrointestinal Surgical Oncology, Fujian Cancer Hospital, Fujian Medical University Cancer Hospital, Fuzhou 350014, Fujian Province, China
| | - Zai-Sheng Ye
- Department of Gastrointestinal Surgical Oncology, Fujian Cancer Hospital, Fujian Medical University Cancer Hospital, Fuzhou 350014, Fujian Province, China
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Characteristics and clinical outcomes of patients over 80 years of age with acute pancreatitis. Eur Geriatr Med 2022; 13:1013-1022. [PMID: 35246826 DOI: 10.1007/s41999-022-00631-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2021] [Accepted: 02/16/2022] [Indexed: 10/18/2022]
Abstract
BACKGROUND In this study, we aimed to compare differences in disease course, etiology of acute pancreatitis admission to the intensive care unit, in-hospital mortality, disease severity, and local and systemic complications between patients aged ≥ 80 years (octogenarians) and patients aged between 65 and 79 years (non-octogenarians), all of whom were being followed with the diagnosis of acute pancreatitis. METHODS Patients aged 65 years and older with a diagnosis of acute biliary pancreatitis were included in the study. Clinical findings, routine laboratory test results, and imaging findings of all patients were reviewed retrospectively via the hospital's records system. RESULTS Of a total of 402 enrolled patients, 238 (59.2%) were female. Mean age was 77.1 ± 7.37 years. Pancreatitis after endoscopic retrograde cholangiopancreatography was detected more frequently among octogenarians than non-octogenarians (12.9% versus 5.3%, respectively; p = 0.007). Levels of blood urea nitrogen, creatinine, and total bilirubin were higher among octogenarians, while lymphocyte, calcium, and albumin levels were lower. The frequency of patients without local complications was higher among octogenarians than non-octogenarians (75.5% versus 63.6%, respectively; p = 0.013). Necrosis was less frequent in the octogenarian group than the non-octogenarian group (2.6% versus 8.9%, respectively; p = 0.012). Mild acute pancreatitis was higher in the octogenarian group, while moderate acute pancreatitis was higher in the non-octogenarian group (p = 0.028 and p = 0.012, respectively). CONCLUSION The frequencies of prolonged hospitalization, intensive care unit admission, and in-hospital mortality were similar in the octogenarian and non-octogenarian groups. In terms of disease severity, mild acute pancreatitis was higher in the octogenarian group, while moderate acute pancreatitis was higher in the non-octogenarian group.
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Sun Y, Jin J, Zhu A, Hu H, Lu Y, Zeng Y, Jing D. Risk Factors for Recurrent Pancreatitis After First Episode of Acute Pancreatitis. Int J Gen Med 2022; 15:1319-1328. [PMID: 35173470 PMCID: PMC8841459 DOI: 10.2147/ijgm.s344863] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2021] [Accepted: 12/30/2021] [Indexed: 12/12/2022] Open
Abstract
Background Methods Results Conclusion
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Affiliation(s)
- Yingying Sun
- Department of Gastroenterology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 201600, People’s Republic of China
| | - Jie Jin
- Department of Geriatrics, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200080, People’s Republic of China
| | - Aying Zhu
- Department of Gastroenterology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 201600, People’s Republic of China
| | - Hong Hu
- Department of Gastroenterology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 201600, People’s Republic of China
| | - Yingying Lu
- Department of Gastroenterology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 201600, People’s Republic of China
| | - Yue Zeng
- Department of Gastroenterology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 201600, People’s Republic of China
| | - Dadao Jing
- Department of Gastroenterology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 201600, People’s Republic of China
- Correspondence: Dadao Jing, Department of Gastroenterology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, NO. 650 Xinsongjiang Road, Shanghai, 201600, People’s Republic of China, Tel +86-13816958050, Email
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Snarska J, Fiedorowicz E, Rozmus D, Wroński K, Latacz M, Kordulewska N, Płomiński J, Grzybowski R, Savelkoul HFJ, Kostyra E, Cieślińska A. TPH1 gene polymorphism rs211105 is associated with serotonin and tryptophan hydroxylase 1 concentrations in acute pancreatitis patients. BMC Gastroenterol 2021; 21:426. [PMID: 34772352 PMCID: PMC8588706 DOI: 10.1186/s12876-021-02012-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Accepted: 11/02/2021] [Indexed: 11/25/2022] Open
Abstract
Background The role of serotonin and its metabolic pathway in proper functioning of the pancreas has not been thoroughly investigated yet in acute pancreatitis (AP) patients. Tryptophan hydroxylase (TPH) as the rate-limiting enzyme of serotonin synthesis has been considered for possible associations in various diseases. Single-nucleotide polymorphisms (SNPs) in TPH genes have been already described in associations with psychiatric and digestive system disorders. This study aimed to explore the association of a rs211105 (T/G) polymorphism in TPH1 gene with tryptophan hydroxylase 1 concentrations in blood serum in a population of acute pancreatitis patients, and to investigate this association with acute pancreatitis susceptibility. Results Our data showed an association between the presence of the T allele at the position rs211105 (OR = 2.47, 95 % CI 0.94–6.50, p = 0.06) under conditions of a decreased AP incidence. For TT and GT genotypes in the control group, the lowest concentration of TPH was associated with higher serotonin levels (TT: Rs = − 0.415, p = 0.0018; GT: Rs = − 0.457, p = 0.0066), while for the AP group the highest levels of TPH among the TT genotype were associated with lower levels of serotonin (TT: Rs = − 0.749, p < 0.0001, and in the GG genotype higher levels of TPH were associated with higher levels of serotonin (GG: Rs = − 0.738, p = 0.037). Conclusions Here, a new insight in the potential role of a selected genetic factor in pancreatitis development was shown. Not only the metabolic pathway of serotonin, but also factors affecting serotonin synthesis may be interesting and important points in acute pancreatitis.
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Affiliation(s)
- Jadwiga Snarska
- Department of General Surgery, Faculty of Medical Sciences, University of Warmia and Mazury, Olsztyn, Poland
| | - Ewa Fiedorowicz
- Department of Biochemistry, Faculty of Biology and Biotechnology, University of Warmia and Mazury in Olsztyn, Olsztyn, Poland
| | - Dominika Rozmus
- Department of Biochemistry, Faculty of Biology and Biotechnology, University of Warmia and Mazury in Olsztyn, Olsztyn, Poland
| | - Konrad Wroński
- General and Colorectal Surgery Clinic, University Clinical Hospital of the Military Medical Academy - Central Veterans Hospital in Lodz, Lodz, Poland
| | - Maria Latacz
- Department of Biochemistry, Faculty of Biology and Biotechnology, University of Warmia and Mazury in Olsztyn, Olsztyn, Poland
| | - Natalia Kordulewska
- Department of Biochemistry, Faculty of Biology and Biotechnology, University of Warmia and Mazury in Olsztyn, Olsztyn, Poland
| | - Janusz Płomiński
- Department and Clinic of Orthopaedics and Traumatology, Collegium Medicum, University of Warmia and Mazury, 10-719, Olsztyn, Poland
| | - Roman Grzybowski
- Department and Clinic of Orthopaedics and Traumatology, Collegium Medicum, University of Warmia and Mazury, 10-719, Olsztyn, Poland
| | - Huub F J Savelkoul
- Cell Biology and Immunology Group, Department of Animal Sciences, Wageningen University and Research, Wageningen, Netherlands
| | - Elżbieta Kostyra
- Department of Biochemistry, Faculty of Biology and Biotechnology, University of Warmia and Mazury in Olsztyn, Olsztyn, Poland
| | - Anna Cieślińska
- Department of Biochemistry, Faculty of Biology and Biotechnology, University of Warmia and Mazury in Olsztyn, Olsztyn, Poland.
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The role of the BISAP score in predicting acute pancreatitis severity according to the revised Atlanta classification: a single tertiary care unit experience from Turkey. Acta Gastroenterol Belg 2021; 84:571-576. [PMID: 34965038 DOI: 10.51821/84.4.007] [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] [Indexed: 11/21/2022]
Abstract
BACKGROUND/AIMS In this study, we examine the utility of Bedside Index of Severity in Acute Pancreatitis (BISAP), which is an increasingly more commonly used simple and practical novel scoring system for predicting the prognosis and severity of the disease at presentation. MATERIALS AND METHODS Consecutive patients diagnosed with AP between January 2013 and December 2020 were evaluated retrospectively. The AP severity was assessed using the revised Atlanta classification (RAC). BISAP score, demographic characteristics, pancreatitis etiology, pancreatitis history, duration of hospital stay, and mortality rates of the patients were recorded. RESULTS A total of 1000 adult patients were included, of whom 589 (58.9%) were female and 411 (41.1%) were male. The mean age in female and male patients was 62.15 ± 17.79 and 58.1 ± 16.33 years, respectively (p >0.05). The most common etiological factor was biliary AP (55.8%), followed by idiopathic AP (23%). Based on RAC, 389 (38.9%), 418 (41.8%), and 193 (19.3%) patients had mild, moderate, and severe AP. Of the 1000 patients, 42 (4.2%) died. Significant predictors of mortality included advanced age (>65 y) (p=0.003), hypertension (p=0.007), and ischemic heart disease (p=0.001). A BISAP score of ≥3 had a sensitivity, specificity, positive predictive value, and negative predictive value (NPV) of 79.79%, 91.57%, 69.37%, and 94.99%, respectively, for determining SAP patients according to RAC. CONCLUSION BISAP is an effective scoring system with a high NPV in predicting the severity of AP in the early course of the disease in a Turkish population.
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Porges T, Shafat T, Sagy I, Schwarzfuchs D, Rahmani Tzvi-Ran I, Jotkowitz A, Barski L. Clinical Characteristics and Prognosis of Idiopathic Acute Pancreatitis. Rambam Maimonides Med J 2021; 12:RMMJ.10442. [PMID: 34270401 PMCID: PMC8284986 DOI: 10.5041/rmmj.10442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE Acute pancreatitis is a serious diagnosis with an increasing incidence in the Western world. In this study we sought to investigate the incidence of idiopathic AP and to compare clinical and prognostic characteristics of idiopathic cases with cases of AP with known etiology. METHODS In this retrospective study of adult hospitalized patients diagnosed with acute pancreatitis between 2012 and 2015, a comparison was made between admissions of patients with known etiology and those for whom no cause was found. Primary outcome was defined as composite outcome of 30-day mortality and complications. RESULTS Among 560 admissions of 437 patients with a primary diagnosis of acute pancreatitis, the main factors identified were gallstones (51.2%) and idiopathic pancreatitis (35.9%), with alcohol ranked third at only 4.8%. Mortality rate within 30 days of hospitalization was 2.9% and within one year was 7.1%. Use of lipid-lowering, anti-hypertensive, and anti-diabetic medications was more frequent among patients with "idiopathic" disease (70%, 68%, and 33% versus 59%, 56%, and 27%, respectively). Patients admitted with idiopathic AP, in comparison to patients with known AP etiology, had milder disease with shorter hospital stay (3 days versus 4, respectively), and less re-admission in 30 days (7.5% versus 21.2%). Idiopathic AP patients had better prognosis in terms of 30-day death and complication (HR 0.33, 95% CI 0.08-0.40, P<0.001). CONCLUSION Idiopathic disease is common among acute pancreatitis patients; the two study groups differed in severity of disease and prognosis. Common use of medications with doubtful value suggests possible under-diagnosis of drug-induced acute idiopathic pancreatitis.
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Affiliation(s)
- Tzvika Porges
- Internal Medicine Division F, Soroka University Medical Center, Beer-Sheva, Israel
| | - Tali Shafat
- Internal Medicine Division F, Soroka University Medical Center, Beer-Sheva, Israel
- Clinical Research Center, Soroka University Medical Center, Beer-Sheva, Israel
| | - Iftach Sagy
- Internal Medicine Division F, Soroka University Medical Center, Beer-Sheva, Israel
- Clinical Research Center, Soroka University Medical Center, Beer-Sheva, Israel
- Rheumatologic Unit, Soroka University Medical Center, Beer-Sheva, Israel
| | - Dan Schwarzfuchs
- Department of Emergency Medicine, Soroka University Medical Center, Beer-Sheva, Israel
| | | | - Alan Jotkowitz
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Leonid Barski
- Internal Medicine Division F, Soroka University Medical Center, Beer-Sheva, Israel
- To whom correspondence should be addressed. E-mail:
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Garcia SC, Toolis M, Ubels M, Mollah T, Paul E, Pandey A, Thia B, Wong T, Tiruvoipati R. Comparison of clinical characteristics and outcomes between alcohol-induced and gallstone-induced acute pancreatitis: An Australian retrospective observational study. SAGE Open Med 2021; 9:20503121211030837. [PMID: 34290866 PMCID: PMC8274077 DOI: 10.1177/20503121211030837] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Accepted: 06/18/2021] [Indexed: 02/05/2023] Open
Abstract
OBJECTIVES To compare the characteristics and outcomes of patients presenting to hospital with alcohol-induced and gallstone-induced acute pancreatitis. METHODS Retrospective study of all patients with alcohol-induced or gallstone-induced pancreatitis during the period 1 June 2012 to 31 May 2016. The primary outcome measure was hospital mortality. Secondary outcome measures included hospital length of stay, requirements for intensive care unit admission, intensive care unit mortality, mechanical ventilation, renal replacement therapy, requirement of inotropes and total parenteral nutrition. RESULTS A total of 642 consecutive patients (49% alcohol; 51% gallstone) were included. No statistically significant differences were found between alcohol-induced and gallstone-induced acute pancreatitis with respect to hospital mortality, requirement for intensive care unit admission, intensive care unit mortality and requirement for mechanical ventilation, renal replacement therapy, inotropes or total parenteral nutrition. There was significant difference in hospital length of stay (3.07 versus 4.84; p < 0.0001). On multivariable regression analysis, Bedside Index of Severity in Acute Pancreatitis score (estimate: 0.393; standard error: 0.058; p < 0.0001) and admission haematocrit (estimate: 0.025; standard error: 0.008; p = 0.002) were found to be independently associated with prolonged hospital length of stay. CONCLUSION Hospital mortality did not differ between patients with alcohol-induced and gallstone-induced acute pancreatitis. The duration of hospital stay was longer with gallstone-induced pancreatitis. Bedside Index of Severity in Acute Pancreatitis score and admission haematocrit were independently associated with hospital length of stay.
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Affiliation(s)
| | - Michael Toolis
- Department of Intensive Care Medicine, Frankston Hospital, Frankston, VIC, Australia
| | - Max Ubels
- Department of Intensive Care Medicine, Frankston Hospital, Frankston, VIC, Australia
| | - Taha Mollah
- Department of Intensive Care Medicine, Frankston Hospital, Frankston, VIC, Australia
| | - Eldho Paul
- Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC, Australia
- ANZIC-RC, Department of Epidemiology & Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Ashish Pandey
- Department of Intensive Care Medicine, Frankston Hospital, Frankston, VIC, Australia
| | - Brandon Thia
- Department of Intensive Care Medicine, Frankston Hospital, Frankston, VIC, Australia
| | - Tricia Wong
- Department of Intensive Care Medicine, Frankston Hospital, Frankston, VIC, Australia
| | - Ravindranath Tiruvoipati
- Department of Intensive Care Medicine, Frankston Hospital, Frankston, VIC, Australia
- Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC, Australia
- ANZIC-RC, Department of Epidemiology & Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
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Bastati N, Kristic A, Poetter-Lang S, Messner A, Herold A, Hodge JC, Schindl M, Ba-Ssalamah A. Imaging of inflammatory disease of the pancreas. Br J Radiol 2021; 94:20201214. [PMID: 34111970 PMCID: PMC8248196 DOI: 10.1259/bjr.20201214] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Increasingly acute and chronic pancreatitis (AP and CP) are considered a continuum of a single entity. Nonetheless, if, after flare-up, the pancreas shows no residual inflammation, it is classified as AP. CP is characterised by a long cycle of worsening and waning glandular inflammation without the pancreas ever returning to its baseline structure or function. According to the International Consensus Guidelines on Early Chronic Pancreatitis, pancreatic inflammation must last at least 6 months before it can be labelled CP. The distinction is important because, unlike AP, CP can destroy endocrine and exocrine pancreatic function, emphasising the importance of early diagnosis. As typical AP can be diagnosed by clinical symptoms plus laboratory tests, imaging is usually reserved for those with recurrent, complicated or CP. Imaging typically starts with ultrasound and more frequently with contrast-enhanced computed tomography (CECT). MRI and/or MR cholangiopancreatography can be used as a problem-solving tool to confirm indirect signs of pancreatic mass, differentiate between solid and cystic lesions, and to exclude pancreatic duct anomalies, as may occur with recurrent AP, or to visualise early signs of CP. MR cholangiopancreatography has replaced diagnostic endoscopic retrograde cholangiopancreatography (ERCP). However, ERCP, and/or endoscopic ultrasound (EUS) remain necessary for transpapillary biliary or pancreatic duct stenting and transgastric cystic fluid drainage or pancreatic tissue sampling, respectively. Finally, positron emission tomography-MRI or positron emission tomography-CT are usually reserved for complicated cases and/or to search for extra pancreatic systemic manifestations. In this article, we discuss a broad spectrum of inflammatory pancreatic disorders and the utility of various modalities in diagnosing acute and chronic pancreatitis.
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Affiliation(s)
- Nina Bastati
- Department of Biomedical Imaging and Image-guided Therapy, MedicalUniversity of Vienna, Vienna, Austria
| | - Antonia Kristic
- Department of Biomedical Imaging and Image-guided Therapy, MedicalUniversity of Vienna, Vienna, Austria
| | - Sarah Poetter-Lang
- Department of Biomedical Imaging and Image-guided Therapy, MedicalUniversity of Vienna, Vienna, Austria
| | - Alina Messner
- Department of Biomedical Imaging and Image-guided Therapy, MedicalUniversity of Vienna, Vienna, Austria
| | - Alexander Herold
- Department of Biomedical Imaging and Image-guided Therapy, MedicalUniversity of Vienna, Vienna, Austria
| | - Jacqueline C Hodge
- Department of Biomedical Imaging and Image-guided Therapy, MedicalUniversity of Vienna, Vienna, Austria
| | - Martin Schindl
- Department of Abdominal Surgery, Medical University of Vienna, Vienna, Austria
| | - Ahmed Ba-Ssalamah
- Department of Biomedical Imaging and Image-guided Therapy, MedicalUniversity of Vienna, Vienna, Austria
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Lu B, Cai Y, Yin J, Wang J, Jia Z, Hu W, Fang J. HSV encephalitis after successful minimally invasive debridement for infected pancreatic necrosis: A case of rare central nervous system complication. EUR J INFLAMM 2021. [DOI: 10.1177/20587392211000571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Patients with acute pancreatitis (AP) often suffer tough complications, some of which are fatal. The early diagnosis and definite treatment of central nervous system (CNS) complications have not been fully achieved yet, which seriously affects the mortality of severe acute pancreatitis (SAP). We present a case of infected pancreatic necrosis (IPN) in a 62-year Chinese man who developed acute herpes simplex encephalitis (HSE) caused by herpes simplex virus type 1 (HSV-1) after favorable minimally invasive retroperitoneal approaches (MIRAs). The patient was successfully treated with 115 days stayed in our hospital. The MIRAs included image-guided retroperitoneal percutaneous catheter drainage (PCD), nephroscopic pancreatic necrosectomy (NPN), and ultrasonic pneumatic lithotripsy system (UPLS) assisted non-narcotic sinus track necrosectomy (NSN). HSE is relatively rare and potentially life threatening. We attempt to discuss the probable risk factors and how the relatively rare HSE are related to the patients of SAP with latent HSV.
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Affiliation(s)
- Bei Lu
- Department of Hepato-Pancreato-Biliary Surgery, Affiliated Hangzhou First People’s Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Yang Cai
- Department of Hepato-Pancreato-Biliary Surgery, Affiliated Hangzhou First People’s Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Junjie Yin
- Department of Hepato-Pancreato-Biliary Surgery, Affiliated Hangzhou First People’s Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Jingrui Wang
- Department of Hepato-Pancreato-Biliary Surgery, Affiliated Hangzhou First People’s Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Zhong Jia
- Department of Hepato-Pancreato-Biliary Surgery, Affiliated Hangzhou First People’s Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Wei Hu
- Department of Intensive Care Unit, Affiliated Hangzhou First People’s Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Jianhua Fang
- Department of Ultrasonography, Affiliated Hangzhou First People’s Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
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Sharma S, Nehme C, Aziz M, Weissman S, Khan A, Acharya A, Vohra I, Ghazaleh S, Nawras A, Adler DG. Acute biliary pancreatitis has better outcomes but increased resource utilization compared to acute alcohol-induced pancreatitis: insights from a nationwide study. Ann Gastroenterol 2021; 34:253-261. [PMID: 33654368 PMCID: PMC7903563 DOI: 10.20524/aog.2020.0559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Accepted: 09/01/2020] [Indexed: 11/11/2022] Open
Abstract
Background The differences in outcomes between acute biliary pancreatitis (ABP) and acute alcohol-induced pancreatitis (AAP) have not been well studied. We sought to examine the differences between ABP and AAP as regards to in-hospital outcomes and resource utilization, using a large nationwide database. Methods We queried the National Inpatient Sample databases 2016 and 2017 using the International Classification of Diseases, 10th revision, Clinical Modification (ICD-10-CM) coding system to identify the patients with a primary diagnosis of AAP and ABP. The primary outcome was all-cause in-hospital mortality. Secondary outcomes were hospital length of stay (LOS), hospitalization charge/cost, shock, acute kidney injury (AKI), intensive care unit (ICU) admission, and home discharge. Analysis was performed with STATA software. Results There was no significant difference in mortality between patients with AAP and ABP (0.42% vs. 0.82%, adjusted odds ratio [aOR] 0.95, 95% confidence interval [CI] 0.69-1.31; P=0.79). Patients with ABP had a significantly longer LOS (+0.48 days, P<0.001). Patients with ABP had significantly higher adjusted mean hospitalization charges ($+19,958, P<0.001) and costs ($+4,848, P<0.001). Patients with ABP had a significantly lower likelihood of shock (aOR 0.75, 95%CI 0.59-0.95; P=0.02), AKI (aOR 0.76, 95%CI 0.71-0.82; P<0.001) or ICU admission (aOR 0.74, 95%CI 0.62-0.88; P=0.001). They were more likely to be discharged home (aOR 1.26, 95%CI 1.18-1.34; P<0.001). Conclusion Although there was no difference in all-cause mortality, patients with ABP had better hospitalization outcomes but greater resource utilization.
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Affiliation(s)
- Sachit Sharma
- Department of Medicine, University of Toledo Medical Center, Toledo, OH (Sachit Sharma, Christian Nehme, Muhammad Aziz, Ashu Acharya, Sami Ghazaleh)
| | - Christian Nehme
- Department of Medicine, University of Toledo Medical Center, Toledo, OH (Sachit Sharma, Christian Nehme, Muhammad Aziz, Ashu Acharya, Sami Ghazaleh)
| | - Muhammad Aziz
- Department of Medicine, University of Toledo Medical Center, Toledo, OH (Sachit Sharma, Christian Nehme, Muhammad Aziz, Ashu Acharya, Sami Ghazaleh)
| | - Simcha Weissman
- Department of Medicine, Hackensack Meridian Health Palisades Medical Center, North Bergen, NJ (Simcha Weissman)
| | - Ahmad Khan
- Department of Medicine, West Virginia University Health Sciences Center Charleston Division, Charleston, WV (Ahmad Khan)
| | - Ashu Acharya
- Department of Medicine, University of Toledo Medical Center, Toledo, OH (Sachit Sharma, Christian Nehme, Muhammad Aziz, Ashu Acharya, Sami Ghazaleh)
| | - Ishaan Vohra
- Department of Medicine, John H. Stroger Jr, Hospital of Cook County, Chicago, IL (Ishaan Vohra)
| | - Sami Ghazaleh
- Department of Medicine, University of Toledo Medical Center, Toledo, OH (Sachit Sharma, Christian Nehme, Muhammad Aziz, Ashu Acharya, Sami Ghazaleh)
| | - Ali Nawras
- Department of Gastroenterology, The University of Toledo Medical Center, Toledo, OH (Ali Nawras)
| | - Douglas G Adler
- Department of Gastroenterology, University of Utah, Salt Lake City, UT (Douglas G. Adler), USA
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Evaluation of socioeconomic and healthcare disparities on same admission cholecystectomy after endoscopic retrograde cholangiopancreatography among patients with acute gallstone pancreatitis. Surg Endosc 2021; 36:274-281. [PMID: 33481109 DOI: 10.1007/s00464-020-08272-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2020] [Accepted: 12/23/2020] [Indexed: 10/22/2022]
Abstract
BACKGROUND Despite literature and guidelines recommending same admission cholecystectomy (CCY) after endoscopic retrograde cholangiopancreatography (ERCP) for patients with acute gallstone pancreatitis, clinical practice remains variable. The aim of this study was to investigate the role of clinical and socio-demographic factors in the management of acute gallstone pancreatitis. METHODS Patients with acute gallstone pancreatitis who underwent ERCP during hospitalization were reviewed from the U.S. Nationwide Inpatient Sample database between 2008 and 2014. Patients were classified by treatment strategy: ERCP + same admission CCY (ERCP + CCY) versus ERCP alone. Measured variables including age, race/ethnicity, Charlson Comorbidity Index (CCI), hospital type/region, insurance payer, household income, length of hospital stay (LOS), hospitalization cost, and in-hospital mortality were compared between cohorts using χ2 and ANOVA. Multivariable logistic regression was performed to identify specific predictors of same admission CCY. RESULTS A total of 205,012 patients (ERCP + CCY: n = 118,318 versus ERCP alone: n = 86,694) were analyzed. A majority (53.4%) of patients that did not receive same admission CCY were at urban-teaching hospitals. LOS was longer with higher associated costs for patients with same admission CCY [(6.8 ± 5.6 versus 6.4 ± 6.5 days; P < 0.001) and ($69,135 ± 65,913 versus $52,739 ± 66,681; P < 0.001)]. Mortality was decreased significantly for patients who underwent ERCP + CCY versus ERCP alone (0.4% vs 1.1%; P < 0.001). Multivariable regression demonstrated female gender, Black race, higher CCI, Medicare payer status, urban-teaching hospital location, and household income decreased the odds of undergoing same admission CCY + ERCP (all P < 0.001). CONCLUSION Based upon this analysis, multiple socioeconomic and healthcare-related disparities influenced the surgical management of acute gallstone pancreatitis. Further studies to investigate these disparities are indicated.
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Pitchumoni CS. Acute Pancreatitis. GERIATRIC GASTROENTEROLOGY 2021:1449-1481. [DOI: 10.1007/978-3-030-30192-7_55] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/05/2025]
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Ouyang G, Pan G, Liu Q, Wu Y, Liu Z, Lu W, Li S, Zhou Z, Wen Y. The global, regional, and national burden of pancreatitis in 195 countries and territories, 1990-2017: a systematic analysis for the Global Burden of Disease Study 2017. BMC Med 2020; 18:388. [PMID: 33298026 PMCID: PMC7726906 DOI: 10.1186/s12916-020-01859-5] [Citation(s) in RCA: 70] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2020] [Accepted: 11/19/2020] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Pancreatitis is a critical public health problem, and the burden of pancreatitis is increasing. We report the rates and trends of the prevalence, incidence, and years lived with disability (YLDs) for pancreatitis at the global, regional, and national levels in 195 countries and territories from 1990 to 2017, stratified by sex, age, and sociodemographic index (SDI). METHODS Data on pancreatitis were available from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2017. Numbers and age-standardized prevalence, incidence, and YLDs' rates per 100,000 population were estimated through a systematic analysis of modeled data from the 2017 GBD study. Both acute and chronic pancreatitis are being modeled separately in the GBD 2017; however, our data show acute and chronic pancreatitis together. Estimates were reported with uncertainty intervals (UIs). RESULTS Globally, in 2017, the age-standardized rates were 76.2 (95% UIs 68.9 to 83.4), 20.6 (19.2 to 22.1), and 4.5 (2.3 to 7.6) per 100,000 population for the point prevalence, incidence, and YLDs, respectively. From 1990 to 2017, the percent changes in the age-standardized prevalence and YLDs rates increased, whereas the age-standardized incidence rate decreased. The global prevalence increased with age up to 60-64 years and 44-49 years in females and males, respectively, and then decreased, with no significant difference between females and males. The global prevalence rate increased with age, peaking in the 95+ age group, with no difference between sexes. Generally, positive correlation between age-standardized YLDs and SDIs at the regional and national levels was observed. Slovakia (297.7 [273.4 to 325.3]), Belgium (274.3 [242.6 to 306.5]), and Poland (266.7 [248.2 to 284.4]) had the highest age-standardized prevalence rates in 2017. Taiwan (Province of China) (104.2% [94.8 to 115.2%]), Maldives (72.4% [66.5 to 79.2%]), and Iceland (64.8% [57.2 to 72.9%]) had the largest increases in age-standardized prevalence rates from 1990 to 2017. CONCLUSIONS Pancreatitis is a major public health issue worldwide. The age-standardized prevalence and YLDs rates increased, but the age-standardized incidence rate decreased from 1990 to 2017. Improving the quality of pancreatitis health data in all regions and countries is strongly recommended for better monitoring the burden of pancreatitis.
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Affiliation(s)
- Guoqing Ouyang
- Department of Hepatobiliary Surgery, Liuzhou People’s Hospital, Liuzhou, Guangxi China
| | - Guangdong Pan
- Department of Hepatobiliary Surgery, Liuzhou People’s Hospital, Liuzhou, Guangxi China
| | - Qiang Liu
- Department of Hepatobiliary Surgery, Liuzhou People’s Hospital, Liuzhou, Guangxi China
| | - Yongrong Wu
- Department of Hepatobiliary Surgery, Liuzhou People’s Hospital, Liuzhou, Guangxi China
| | - Zhen Liu
- Department of Hepatobiliary Surgery, Liuzhou People’s Hospital, Liuzhou, Guangxi China
| | - Wuchang Lu
- Department of Hepatobiliary Surgery, Liuzhou People’s Hospital, Liuzhou, Guangxi China
| | - Shuai Li
- Department of Hepatobiliary Surgery, Liuzhou People’s Hospital, Liuzhou, Guangxi China
| | - Zheng Zhou
- Department of Hepatobiliary Surgery, Liuzhou People’s Hospital, Liuzhou, Guangxi China
| | - Yu Wen
- Department of General Surgery, The Second Xiangya Hospital, Central South University, Changsha, Hunan China
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Alkareemy EAR, Ahmed LAW, El-Masry MA, Habib HA, Mustafa MH. Etiology, clinical characteristics, and outcomes of acute pancreatitis in patients at Assiut University Hospital. THE EGYPTIAN JOURNAL OF INTERNAL MEDICINE 2020. [DOI: 10.1186/s43162-020-00025-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Acute pancreatitis is one of the main causes of acute abdomen. It may cause multi-organ failure or even death. High morbidity and mortality are associated with it. The research study aimed at evaluating the clinical characteristics and results of acute pancreatitis in our community.
Results
Mean age of patients was 50.96 ± 9.71 years and 30 (60%) patients were males. Gallstone was the most frequent etiology (56%) followed by idiopathic pancreatitis (26%). The majority of patients improved and only four patients died. Old age, presence of comorbidities, and leucocytosis were risk factors for a severe attack while old ages, presence of comorbidities, severe pancreatitis, and presence of complications were associated with mortality.
Conclusion
Acute pancreatitis could have serious outcomes if not correctly and early managed. It is recommended to perform multicenter studies with a large sample of patients. A multi-disciplinary team is required to assess idiopathic pancreatitis.
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Maguire C, Agrawal D, Daley MJ, Douglass E, Rose DT. Rethinking Carbapenems: A Pharmacokinetic Approach for Antimicrobial Selection in Infected Necrotizing Pancreatitis. Ann Pharmacother 2020; 55:902-913. [PMID: 33135457 DOI: 10.1177/1060028020970124] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVE To provide an overview of pathophysiological changes to the pancreas during infected necrotizing pancreatitis (INP), optimal drug properties needed to penetrate the pancreas, human and animal studies supporting the use of antimicrobials, and carbapenem-sparing strategies in INP. DATA SOURCES A literature analysis of PubMed/MEDLINE was performed (from 1960 to September 2020) using the following key terms: infected necrotizing pancreatitis, necrotizing acute pancreatitis, and infected pancreatitis antimicrobial concentration. Individual antimicrobials were investigated with these search terms. STUDY SELECTION AND DATA EXTRACTION All relevant studies describing the management of INP, and human and animal pharmacokinetic (PK) data supporting antimicrobial use in the pancreas were reviewed for possible inclusion regardless of sample size or study design. DATA SYNTHESIS Piperacillin/tazobactam and cefepime achieve adequate pancreatic tissue concentrations in INP studies. A majority of the literature supporting carbapenem use in INP involves imipenem, and meropenem Monte Carlo simulations suggest that standard dosing regimens of meropenem may not achieve PK targets to eradicate Pseudomonas aeruginosa. RELEVANCE TO PATIENT CARE AND CLINICAL PRACTICE Carbapenems are often utilized for INP treatment based on guideline recommendations. This review discusses PK data, the history of carbapenem use in INP, and the pathophysiology of pancreatitis to suggest carbapenem-sparing strategies and provides stewardship tactics such as when to start antimicrobials, which empirical antimicrobial to use, and when to discontinue antimicrobials in the INP setting. CONCLUSIONS Noncarbapenem antipseudomonals, such as piperacillin/tazobactam and cefepime, are appropriate carbapenem-sparing options in INP, based on PK data, spectrum of activity, and risk of collateral damage.
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Affiliation(s)
| | - Deepak Agrawal
- Dell Medical School at the University of Texas, Austin, TX, USA
| | | | | | - Dusten T Rose
- Ascension Seton at Dell Seton Medical Center, Austin, TX, USA
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Panic N, Mihajlovic S, Vujasinovic M, Bulajic M, Löhr JM. Pancreatitis Associated with Viral Hepatitis: Systematic Review. J Clin Med 2020; 9:3309. [PMID: 33076353 PMCID: PMC7602572 DOI: 10.3390/jcm9103309] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Revised: 10/08/2020] [Accepted: 10/13/2020] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND We conducted a systematic review in order to summarize the available data on pancreatitis associated with viral hepatitis. METHODS A comprehensive literature search of Medline, Scopus and ISI Web of Science databases was conducted and papers eligible for the inclusion identified. RESULTS In total, 46 studies reporting data on 73 patients were included in the analysis. Most of the cases were diagnosed in Asia (57.53%), followed by North America (23.29%), and Europe (13.70%). Most of the patients were affected by hepatitis A virus (HAV) (42.47%), followed by hepatitis E virus (HEV) (28.77%), hepatitis B virus (HBV) (8.22%), and hepatitis C virus (HCV) (1.37%), while 17.81% at the time of diagnosis were classified as affected by "hepatitis virus". Pancreatitis was severe in 32.88% of cases. The respiratory system was affected in 2.74% of patients, 6.85% experienced renal failure, while 5.48% experienced a multiorgan dysfunction syndrome (MODS). Four patients (5.48%) needed pancreatic surgery. Despite the treatment, 21.92% of patients died. We identified fulminant hepatitis (p < 0.0001), MODS (p < 0.0001) and severe pancreatitis (p < 0.0001) to be significantly more present in patients who died in comparison to cured ones. CONCLUSION Increased awareness of pancreatic involvement in viral hepatitis is needed because it can have a substantial impact on therapeutic approaches and outcomes.
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Affiliation(s)
- Nikola Panic
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia; (N.P.); (S.M.)
- Digestive Endoscopy Unit, University Clinic “Dr Dragisa Misovic-Dedinje”, 11000 Belgrade, Serbia
- Department for Digestive Diseases, Karolinska University Hospital, 14186 Stockholm, Sweden;
| | - Sladjana Mihajlovic
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia; (N.P.); (S.M.)
| | - Miroslav Vujasinovic
- Department for Digestive Diseases, Karolinska University Hospital, 14186 Stockholm, Sweden;
| | | | - Johannes-Matthias Löhr
- Department for Digestive Diseases, Karolinska University Hospital, 14186 Stockholm, Sweden;
- CLINTEC, Karolinska Institutet, 14186 Stockholm, Sweden
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Kayar Y, Dertli R, Konur S. Clinical outcomes of acute pancreatitis in elderly patients: An experience of single tertiary center. Pancreatology 2020; 20:1296-1301. [PMID: 32900631 DOI: 10.1016/j.pan.2020.06.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Revised: 06/03/2020] [Accepted: 06/10/2020] [Indexed: 12/11/2022]
Abstract
BACKGROUND Although well understanding the course of diseases in geriatric population is of paramount importance in order to provide the optimal treatment, there is only a few studies with controversial results that have been conducted about the course and outcomes of acute pancreatitis (AP) in elderly. We aimed to compare clinical outcomes of AP disease in geriatric age group and to evaluate the risk factors affecting outcomes. METHODS A total of 336 patients diagnosed with AP, hospitalized and followed-up in our hospital between July/2013-February/2019 were included in this study. Patients aged 65 years and over were assessed as elderly population. Patients' demographic data, comorbidities, duration of hospitalization, local systemic complications, and mortality rates were documented. RESULTS 196(58.3%) of the patients were female with a mean age of 54.1 ± 17.9 years. The number of patients was 114(33.9%) in the elderly group and 222(66.1%) in the non-elderly group. Although there was no significant difference between both groups in terms of abscess, pseudocyst and necrosis, pancreatic necrosis and systemic complications were higher in the elderly group (p < 0.05). The durations of oral intake and hospitalization were longer, the mortality rate and severity of AP according to the Ranson and Atlanta criteria were significantly higher in the geriatric population (p < 0.05). In addition, age and severity of AP were found to be independent predictive factors of developing complications. CONCLUSIONS Early recognition of AP is important in the geriatric population. Clinical and laboratory investigations, and early diagnosis in severe patients will be largely helpful in providing close follow-up and the optimal treatment.
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Affiliation(s)
- Yusuf Kayar
- Saglik Bilimleri University, Van Education and Research Hospital, Department of Internal Medicine, Clinic of Gastroenterology and Hepatology, Van, Turkey.
| | - Ramazan Dertli
- Saglik Bilimleri University, Van Education and Research Hospital, Department of Internal Medicine, Clinic of Gastroenterology and Hepatology, Van, Turkey
| | - Sevki Konur
- Saglik Bilimleri University, Van Education and Research Hospital, Department of Internal Medicine, Van, Turkey
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Extrapancreatic infections are common in acute pancreatitis and they are related to organ failure: a population-based study. Eur J Gastroenterol Hepatol 2020; 32:1293-1300. [PMID: 32675778 DOI: 10.1097/meg.0000000000001847] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND Although the impact of pancreatic infections in acute pancreatitis has been studied extensively, there are no population-based data on extrapancreatic infections and their potential relation to organ failure. We aimed to study the occurrence of pancreatic and extrapancreatic bacterial infections in acute pancreatitis and their relation to patient outcome. PATIENTS AND METHODS All patients with first-time acute pancreatitis from 2003 to 2012 in a defined area in Sweden were retrospectively evaluated. Data on acute pancreatitis severity, organ failure, infections, and in-hospital mortality were collected. RESULTS Overall, 304 bacterial infections occurred in 248/1457 patients (17%). Fifteen percent had extrapancreatic and 2% had pancreatic infections. The lungs (35%), the urinary tract (24%), and the bile ducts (18%) were the most common sites of extrapancreatic infections. Organ failure, severe acute pancreatitis, and in-hospital mortality were more common in patients with vs those without (pancreatic/extrapancreatic) infections (P < 0.05). Organ failure and severe acute pancreatitis occurred more frequently in pancreatic vs extrapancreatic infections (70% vs 34%, P < 0.001 and 67% vs 28%, P < 0.001), but in-hospital mortality did not differ between the two groups (7.4% vs 6.8%, P = 1.0). Both pancreatic and extrapancreatic infections were independent predictors of organ failure (P < 0.05). Out of culture-positive infections, 18% were due to antibiotic-resistant bacteria, without any significant difference between extrapancreatic vs pancreatic infections (P > 0.05). About two out of five infections were of nosocomial origin. CONCLUSION Extrapancreatic infections occurred in 15% and pancreatic infections in 2% of patients with first-time acute pancreatitis. Both pancreatic and extrapancreatic infections were independent predictors of organ failure, leading to increased mortality.
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Progression to recurrent acute pancreatitis after a first attack of acute pancreatitis in adults. Pancreatology 2020; 20:1340-1346. [PMID: 32972837 DOI: 10.1016/j.pan.2020.09.006] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Revised: 08/11/2020] [Accepted: 09/05/2020] [Indexed: 12/11/2022]
Abstract
PURPOSE Patients with a first attack of acute pancreatitis (AP) can develop recurrent acute pancreatitis (RAP). Hence, this study aimed to investigate the clinical features of the disease and the risk factors for RAP. METHODS We performed a retrospective study of 522 patients from Jan 1 to Dec 31, 2006. All patients with AP were followed for 36 months. The primary end point was the rate of RAP. The secondary end points were the risk factors that were evaluated by Cox regression analysis. The cumulative risk of RAP was assessed using Kaplan-Meier analysis. RESULTS 56 of the 522 patients (10.7%) developed RAP. Among those RAP patients, 37 (7.1%) experienced one relapse, 10 (1.9%) experienced two relapses, and 9 (1.7%) experienced three or more relapses. Univariate analysis indicated that age (p = 0.016), male sex, etiology of AP (p = 0.001), local complications (p = 0.001) and Length of stay (LOS) (p = 0.007) were associated with RAP. Multivariate analysis with the Cox proportional hazards model showed that male sex (HR = 2.486, 95% CI, 0.169-0.960, p = 0.04), HTG-associated etiology (HR = 5.690, 95% CI, 2.138-15.146, p = 0.001), alcohol-associated etiology (HR = 5.867, 95% CI, 1.446-23.803, p = 0.013) and current local complications at index admission (HR = 8.917, 95% CI, 3.650-21.789, p = 0.001) were significant independent risk factors for RAP. CONCLUSIONS A first attack of AP led to RAP in 10.7% of patients within 3 years. Male sex was significantly associated with RAP. The etiologies of alcohol and HTG and local complications were the strongest risk factors for recurrent disease. Patients with these characteristics should be given special attention and followed-up closely.
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Abstract
OBJECTIVES Increasing data suggest that acute pancreatitis (AP) occurs more frequently among patients with inflammatory bowel diseases (IBDs) than in the non-IBD population; however, currently no comprehensive meta-analysis is available. METHODS Systematic literature search was conducted in 4 major databases. We included observational studies sampling from the general population. Basic study characteristics and crude incidences of AP were extracted. Pooled odds ratios (ORs) with 95% confidence interval (CIs) were calculated using the random-effects model. Subgroups were set up by Crohn disease and ulcerative colitis. Heterogeneity was tested with I statistics. RESULTS Eight studies were eligible for the analysis. The odds of AP were 3 times higher in IBD (OR, 3.11; 95% CI, 2.93-3.30; I, 0.0%), significantly higher in Crohn disease than in ulcerative colitis (P < 0.001; OR, 4.12 vs OR, 2.61; I, 0.0%). The pooled annual incidence of AP in IBD was 210/100,000 person-years (95% CI, 84-392/100,000 person-years; I, 98.66%). CONCLUSIONS We confirmed that IBD elevates the risk of AP and of 100,000 IBD patients 210 AP cases are to be expected annually. Therefore, it is important to include pancreatic enzyme level measurements and radiological investigations in the workup of IBD patients with acute abdominal pain.
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Yu B, Li N, Li J, Wan J, He W, Zhu Y, Lu N. The Clinical Characteristics of Acute Pancreatitis in Gerontal Patients: A Retrospective Study. Clin Interv Aging 2020; 15:1541-1553. [PMID: 32982192 PMCID: PMC7493010 DOI: 10.2147/cia.s259920] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2020] [Accepted: 07/28/2020] [Indexed: 12/12/2022] Open
Abstract
Background The incidence of acute pancreatitis (AP) in ageing patients has increased in recent years, and results regarding the clinical outcomes of these patients are controversial. The aim of this study was to compare the clinical outcomes of AP in ageing patients over 60 years old. Methods Eighty patients aged ≥80 years (oldest group) were compared to 393 patients aged 60 to 79 years (older group). The clinical course and biochemical and radiological data were evaluated. The primary endpoints were mortality rate, intensive care unit (ICU) admission rate and in-hospital length of stay (LOS). The secondary endpoints were the incidence of operative treatment and complications of AP. Results Abdominal pain (61.3% vs 46.3%, P=0.013) was less common in the oldest group. Jaundice (17.5% vs 8.9%, P=0.021) and dyspnoea (26.3% vs 11.5%, P=0.001) were more obvious in the oldest group than in the older group. The mean BMI was lower in the oldest group than in the older group (21.07±3.18 vs 22.36±2.89, P = 0.001). Age over 80 years (P=0.011) and organ failure (P<0.05) were independent risk factors for mortality. More severe AP (P=0.001), abdominal pain (P=0.033) and organ failure (P<0.05) were associated with the ICU admission rate. Age over 80 years (P=0.001), more severe AP (P=0.001), female sex (P=0.018), jaundice (P=0.038), operative treatment (P<0.05) and organ failure (P<0.05) were risk factors for increased LOS. Conclusion The oldest group had a higher death rate and longer LOS than the older group. More attention should be given to the clinical symptoms of this frail population. We propose that more comprehensive and goal-directed attendant diagnostic procedures should be performed to detect the disease early and to improve the outcomes of ageing patients.
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Affiliation(s)
- Bingjun Yu
- Department of Gastroenterology, The First Affiliated Hospital of Nanchang University, Nanchang 330006, Jiangxi Province, People's Republic of China
| | - Nianshuang Li
- Department of Gastroenterology, The First Affiliated Hospital of Nanchang University, Nanchang 330006, Jiangxi Province, People's Republic of China
| | - Jiarong Li
- Department of Gastroenterology, The First Affiliated Hospital of Nanchang University, Nanchang 330006, Jiangxi Province, People's Republic of China
| | - Jianhua Wan
- Department of Gastroenterology, The First Affiliated Hospital of Nanchang University, Nanchang 330006, Jiangxi Province, People's Republic of China
| | - Wenhua He
- Department of Gastroenterology, The First Affiliated Hospital of Nanchang University, Nanchang 330006, Jiangxi Province, People's Republic of China
| | - Yin Zhu
- Department of Gastroenterology, The First Affiliated Hospital of Nanchang University, Nanchang 330006, Jiangxi Province, People's Republic of China
| | - Nonghua Lu
- Department of Gastroenterology, The First Affiliated Hospital of Nanchang University, Nanchang 330006, Jiangxi Province, People's Republic of China
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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: 1.0] [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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Konur S, Ozkahraman A, Surmeli N, Gunduz I, Iliklerden UH, Dertli R, Kayar Y. The Severity of Acute Pancreatitis According to Modified Balthazar Classification in Patients With Pancreatic Cancer. TUMORI JOURNAL 2020; 106:356-361. [PMID: 32811352 DOI: 10.1177/0300891620948961] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
OBJECTIVE Although acute pancreatitis (AP) is a self-limited disease under supportive and medical treatment, it can have life-threatening potential in some patients. Results of studies reporting outcomes of AP-associated pancreatic malignancy are controversial. The aim of this study was to evaluate the severity and prognosis of pancreatic cancer (PC)-related AP by modified Balthazar score. METHODS A total of 354 patients hospitalized and followed up in our clinic between 2013 and 2019 were included in the study. Demographic data of all patients were recorded. The etiology of all cases was determined. According to the etiology, the cases were divided into 2 groups: AP related to pancreatic malignancy and AP due to nonmalignant causes. The patients underwent computed tomography of the abdomen within the first 12 hours of admission and after 3 to 7 days. Patients were evaluated and classified by modified Balthazar classification. RESULTS Malignancy-related AP was detected in 18 (5.1%) patients. A total of 336 cases (94.9%) were related to nonmalignant causes. There was no statistically significant difference in the severity of AP in both groups at admission and after 3 days (p > 0.05). The changes (regression, progression, or no change) in the disease severity at the first and the subsequent imaging were examined. There was no significant relationship between the 2 groups (p > 0.05). CONCLUSION AP may be the clinical manifestation of PC or PC may induce AP in various ways. It was shown that the underlying malignancy did not adversely affect the severity and course of AP.
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Affiliation(s)
- Sevki Konur
- Department of Internal Medicine, Van Education and Research Hospital, Van, Turkey
| | - Adnan Ozkahraman
- Department of Internal Medicine, Van Education and Research Hospital, Van, Turkey
| | - Neslihan Surmeli
- Nutrition and Diets Unit, Health High School, Van Yüzüncü Yıl University, Van, Turkey
| | - Ihsan Gunduz
- Department of Surgery of Gastroenterology, Van Education and Research Hospital, Van, Turkey
| | | | - Ramazan Dertli
- Department of Gastroenterology, Van Education and Research Hospital, Van, Turkey
| | - Yusuf Kayar
- Department of Gastroenterology, Van Education and Research Hospital, Van, Turkey
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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: 17] [Impact Index Per Article: 3.4] [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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Valverde-López F, Ortega-Suazo EJ, Wilcox CM, Fernandez- Cano MC, Martínez-Cara JG, Redondo-Cerezo E. Endoscopic ultrasound as a diagnostic and predictive tool in idiopathic acute pancreatitis. Ann Gastroenterol 2020; 33:305-312. [PMID: 32382235 PMCID: PMC7196619 DOI: 10.20524/aog.2020.0464] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2019] [Accepted: 02/01/2020] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Endoscopic ultrasound (EUS) is useful in the diagnostic workup of idiopathic acute pancreatitis but its role as a predictor of recurrence has not been thoroughly assessed. Our aim was to study the performance of EUS in idiopathic acute pancreatitis, its impact on the natural history of the disease, and the factors related to recurrence. METHODS Patients with idiopathic acute pancreatitis referred to our endoscopy unit were enrolled and followed, with assessment of the performance of endoscopic retrograde cholangiopancreatography (ERCP), cholecystectomy, and the incidence of recurrence. EUS findings and recurrence rates were compared between patients with a first episode or recurrent attacks and in patients with previous cholecystectomy versus those with gallbladder in situ. RESULTS One hundred six patients were included (mean follow up: 53.59±27.79 months). Biliary disease related to stones was the most common finding on EUS (49.1%), and patients referred for recurrent attacks showed the highest recurrence rate during follow up (57.1%). ERCP or cholecystectomy reduced recurrences to 14.3% in patients with biliary disease. Age under 65 (odds ratio [OR] 3.56, 95% confidence interval [CI] 1.21-10.44; P=0.02), previous cholecystectomy (OR 3.19, 95%CI 1.11-9.17; P=0.03), and no lithiasis on EUS (OR 2.87, 95%CI 1.04-7.87; P=0.04) were independent risks factors for recurrence. CONCLUSIONS EUS-directed ERCP/cholecystectomy was associated with lower relapse rates in idiopathic acute pancreatitis. Along with age and gallbladder status, it provides predictive information about recurrence likelihood.
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Affiliation(s)
- Francisco Valverde-López
- Department of Gastroenterology and Hepatology, “Virgen de las Nieves” University Hospital, Complejo Hospitalario Universitario de Granada, Granada, Spain (Francisco Valverde-López, Eva Julissa Ortega-Suazo, Maria Carmen Fernandez-Cano, Juan Gabriel Martínez-Cara, Eduardo Redondo-Cerezo)
| | - Eva Julissa Ortega-Suazo
- Department of Gastroenterology and Hepatology, “Virgen de las Nieves” University Hospital, Complejo Hospitalario Universitario de Granada, Granada, Spain (Francisco Valverde-López, Eva Julissa Ortega-Suazo, Maria Carmen Fernandez-Cano, Juan Gabriel Martínez-Cara, Eduardo Redondo-Cerezo)
| | - Charles Mel Wilcox
- Division of Gastroenterology and Hepatology and Pancreaticobiliary Center, University of Alabama at Birmingham, USA (Charles Mel Wilcox)
| | - Maria Carmen Fernandez- Cano
- Department of Gastroenterology and Hepatology, “Virgen de las Nieves” University Hospital, Complejo Hospitalario Universitario de Granada, Granada, Spain (Francisco Valverde-López, Eva Julissa Ortega-Suazo, Maria Carmen Fernandez-Cano, Juan Gabriel Martínez-Cara, Eduardo Redondo-Cerezo)
| | - Juan Gabriel Martínez-Cara
- Department of Gastroenterology and Hepatology, “Virgen de las Nieves” University Hospital, Complejo Hospitalario Universitario de Granada, Granada, Spain (Francisco Valverde-López, Eva Julissa Ortega-Suazo, Maria Carmen Fernandez-Cano, Juan Gabriel Martínez-Cara, Eduardo Redondo-Cerezo)
| | - Eduardo Redondo-Cerezo
- Department of Gastroenterology and Hepatology, “Virgen de las Nieves” University Hospital, Complejo Hospitalario Universitario de Granada, Granada, Spain (Francisco Valverde-López, Eva Julissa Ortega-Suazo, Maria Carmen Fernandez-Cano, Juan Gabriel Martínez-Cara, Eduardo Redondo-Cerezo)
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Yasuda H, Horibe M, Sanui M, Sasaki M, Suzuki N, Sawano H, Goto T, Ikeura T, Takeda T, Oda T, Ogura Y, Miyazaki D, Kitamura K, Chiba N, Ozaki T, Yamashita T, Koinuma T, Oshima T, Yamamoto T, Hirota M, Sato M, Miyamoto K, Mine T, Misumi T, Takeda Y, Iwasaki E, Kanai T, Mayumi T. Etiology and mortality in severe acute pancreatitis: A multicenter study in Japan. Pancreatology 2020; 20:307-317. [PMID: 32198057 DOI: 10.1016/j.pan.2020.03.001] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Revised: 02/20/2020] [Accepted: 03/04/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND/OBJECTIVES Severe acute pancreatitis (SAP) has a high mortality rate despite ongoing attempts to improve prognosis through a various therapeutic modalities. This study aimed to delineate etiology-based routes that may guide clinical decisions for the treatment of SAP. METHODS Using data from a recent retrospective multicenter study in Japan, we analyzed the association between clinical outcomes, mainly in-hospital mortality and pancreatic infection, and various etiologies while considering confounding factors. We performed additional multivariate analyses and built decision tree models. RESULTS The 1097 participating patients were classified into the following groups by etiology: alcohol (n = 436, 39.7%); cholelithiasis (n = 230, 21.0%); idiopathic (n = 227, 20.7%); and others (n = 204, 18.6%). Mortality at hospital discharge was 8.4%, 12.2%, 16.7%, and 16.2% in the alcohol, cholelithiasis, idiopathic, and others groups, respectively. According to multivariable analysis, early enteral nutrition (EN) was significantly associated with reduced in-hospital mortality only in the cholelithiasis group. However, there was a consistent association between age and the need for mechanical ventilation and increased mortality, regardless of etiology. Our decision tree models presented different contributing factors depending on the etiology and patient background. Interaction analysis showed that EN and the use of prophylactic antibiotics may influence these results differently according to etiology. CONCLUSIONS No study has yet used comprehensive models to investigate etiology-related prognostic factors for SAP; our results can, therefore, be used as a reference for improving clinical decisions.
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Affiliation(s)
- Hideto Yasuda
- Department of Intensive Care Medicine, Kameda Medical Center, 929, Higashi-chou, Kamogawa-shi, Chiba, Japan; Department of Clinical Research Education and Training Unit, Keio University Hospital Clinical and Translational Research Center (CTR), Shinanomachi 35, Shinjuku-ku, Tokyo, Japan
| | - Masayasu Horibe
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Keio University School of Medicine, 35, Shinanomachi, Shinjuku-ku, Tokyo, Japan; Department of Gastroenterology and Hepatology, Tokyo Metropolitan Tama Medical Center, 2-8-29, Musashidai, Fuchu City, Tokyo, Japan
| | - Masamitsu Sanui
- Department of Anesthesiology and Critical Care Medicine, Jichi Medical University Saitama Medical Center, 1-847 Amanumacho, Omiya-ku, Saitama, Japan.
| | - Mitsuhito Sasaki
- Department of Hepatobiliary and Pancreatic Oncology, National Cancer Center Hospital, 5-1-1, Tsukiji, Chuo-ku, Tokyo, Japan
| | - Naoya Suzuki
- Department of Emergency and Critical Care Medicine, Japanese Red Cross Musashino Hospital, 1-26-1, Kyounancho, Musasino City, Tokyo, Japan
| | - Hirotaka Sawano
- Senri Critical Care Medical Center, Osaka Saiseikai Senri Hospital, 1-1-6 Tsukumodai, Suita, Osaka, Japan
| | - Takashi Goto
- Department of Anesthesiology and Intensive Care, Hiroshima City Hiroshima Citizens Hospital, 7-33, Motomachi, Naka-ku, Hiroshima City, Hiroshima, Japan
| | - Tsukasa Ikeura
- Department of Gastroenterology and Hepatology, Kansai Medical University, 2-5-1, Shinmachi, Hirakata, Osaka, Japan
| | - Tsuyoshi Takeda
- Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, Japan
| | - Takuya Oda
- Department of General Internal Medicine, Iizuka Hospital, 3-83 Yoshiomachi, Iizuka-shi, Fukuoka, Japan
| | - Yuki Ogura
- Department of Gastroenterology and Hepatology, Tokyo Metropolitan Tama Medical Center, 2-8-29, Musashidai, Fuchu City, Tokyo, Japan
| | - Dai Miyazaki
- Advanced Emergency Medical and Critical Care Center, Japanese Redcross Maebashi Hospital, 3-21-36, Asahi-cho, Maebashi City, Gunma, Japan; Department of Medicine, Harima Rehabiritation Program Center, 675-1297, 544 Sousa, Yahata-chou, Kakogawa-city, Hyogo, Japan
| | - Katsuya Kitamura
- Department of Gastroenterology and Hepatology, Tokyo Medical University Hachioji Medical Center, 1163 Tatemachi, Hachioji-shi, Tokyo, Japan; Division of Gastroenterology, Department of Medicine, Showa University School of Medicine, 1-5-8 Hatanodai, Shinagawa-ku, Tokyo, Japan
| | - Nobutaka Chiba
- Department of Emergency and Critical Care Medicine, Nihon University Hospital, 1-6 Kanda-Surugadai, Chiyoda-ku, Tokyo, Japan
| | - Tetsu Ozaki
- Department of Acute Care and General Medicine, Saiseikai Kumamoto Hospital, 5-3-1, Chikami, Minami-ku, Kumamoto City, Kumamoto, Japan
| | - Takahiro Yamashita
- Emergency Medical Center, Fukuyama City Hospital, 5-23-1, Zaocho, Fukuyama City, Hiroshima, Japan; Acute Care Medical Center, Hyogo Prefectural Kakogawa Medical Center, 203 Kanno, Kanno-cho, Kakogawa City, Hyogo, Japan
| | - Toshitaka Koinuma
- Division of Intensive Care, Department of Anesthesiology and Intensive Care Medicine, Jichi Medical University School of Medicine, 3311-1 Yakushiji, Shimotsuke, Tochigi, Japan
| | - Taku Oshima
- Department of Emergency and Critical Care Medicine, Chiba University Graduate School of Medicine, 1-8-1, Inohana, Chuo-ku, Chiba City, Chiba, Japan
| | - Tomonori Yamamoto
- Department of Traumatology and Critical Care Medicine, Osaka City University, Graduate School of Medicine, 1-4-3 Asahimachi, Abenoku, Osaka City, Osaka, Japan
| | - Morihisa Hirota
- Division of Gastroenterology, Tohoku Medical and Pharmaceutical University, 1-15-1 Fukumuro, Miyagino-ku, Sendai, Miyagi, Japan
| | - Mizuki Sato
- Department of Critical Care and Emergency Medicine, Kurashiki Central Hospital, 1-1-1, Miwa, Kurashiki City, Okayama, Japan
| | - Kyohei Miyamoto
- Department of Emergency and Critical Care Medicine, Wakayama Medical University, 811-1, Kimiidera, Wakayama-City, Wakayama, Japan
| | - Tetsuya Mine
- Department of Gastroenterology, Tokai University School of Medicine, 143 Shimokasuya, Isehara, Kanagawa, Japan
| | - Takuyo Misumi
- Department of Anesthesiology, Kobe University Hospital, 7-5-2 Kusunoki-cho, Chuo-ku, Kobe City, Japan
| | - Yuki Takeda
- Internal Medicine (Gastroenterology), Tokyo Rosai Hospital, 4-13-21, Ohmori-Minami, Ohta-ku, Tokyo, Japan
| | - Eisuke Iwasaki
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Keio University School of Medicine, 35, Shinanomachi, Shinjuku-ku, Tokyo, Japan
| | - Takanori Kanai
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Keio University School of Medicine, 35, Shinanomachi, Shinjuku-ku, Tokyo, Japan
| | - Toshihiko Mayumi
- Department of Emergency Medicine, School of Medicine University of Occupational and Environmental Health, 1-1, Iseigaoka, Yahata Nishi, KitaKyushu, Fukuoka, Japan
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Ćeranić DB, Zorman M, Skok P. Interleukins and inflammatory markers are useful in predicting the severity of acute pancreatitis. Bosn J Basic Med Sci 2020; 20:99-105. [PMID: 31242405 PMCID: PMC7029213 DOI: 10.17305/bjbms.2019.4253] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2019] [Accepted: 06/05/2019] [Indexed: 12/12/2022] Open
Abstract
Acute pancreatitis (AP) is a disease with significant morbidity and mortality. The aim of this study was to evaluate the predictive role of inflammatory markers, particularly interleukins (ILs), in the course of AP and to determine the frequency of etiologic factors of AP. We included patients with AP who were treated at our institution from May 1, 2012 to January 31, 2015. Different laboratory parameters, including ILs, and the severity scoring systems Ranson's criteria and Bedside Index of Severity in Acute Pancreatitis (BISAP) were analyzed. AP was classified into mild and severe, and independent parameters were compared between these groups. The predictive performance of each parameter was evaluated using receiver operating characteristic (ROC) curves and the area under the ROC curve (AUC). A binomial logistic regression was performed to evaluate Ranson's criteria and IL6, IL8, and IL10 (at admission and after 48 hours) in the course of AP. Overall, 96 patients were treated, 59 (61.5%) males and 37 (38.5%) females, average age 62.5 ± 16.8 years (range 22-91 years). The best predictor for the severity of AP was IL6, measured 48 hours after admission (AUC = 0.84). Other useful predictors of the severity of AP were lactate dehydrogenase (p < 0.001), serum glucose (p < 0.006), and difference in the platelet count (p < 0.001) between admission and after 48 hours (p < 0.001), hemoglobin (p < 0.027) and erythrocytes (p < 0.029). The major causes of AP were gallstones and alcohol consumption. According to our results, IL6 and Ranson score are important predictors of the severity of AP.
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Affiliation(s)
- Davorin Branislav Ćeranić
- Department of Gastroenterology, Division of Internal Medicine, University Medical Centre Maribor, Maribor, Slovenia.
| | - Milan Zorman
- Faculty of Electrical Engineering and Computer Science, University of Maribor, Maribor, Slovenia.
| | - Pavel Skok
- Department of Gastroenterology, Division of Internal Medicine, University Medical Centre Maribor; Faculty of Medicine, University of Maribor, Maribor, Slovenia.
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Quero G, Covino M, Ojetti V, Fiorillo C, Rosa F, Menghi R, Laterza V, Candelli M, Franceschi F, Alfieri S. Acute pancreatitis in oldest old: a 10-year retrospective analysis of patients referred to the emergency department of a large tertiary hospital. Eur J Gastroenterol Hepatol 2020; 32:159-165. [PMID: 31651648 DOI: 10.1097/meg.0000000000001570] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
OBJECTIVE Contrasting results are reported on the clinical course of acute pancreatitis (AP) in the geriatric population. The aim of this study is to compare the AP clinical outcomes between patients aged from 65 to 79 years and those over 80 years. METHODS A total of 115 patients over 80 years (oldest old) were compared to a group of 236 patients aged 65-79 years (elderly). Clinicodemographic, biochemical, and radiological data were reviewed. The primary outcome was to compare the overall mortality. Secondary outcomes included intensive care unit (ICU) admission, in-hospital length of stay (LOS), and need for surgical procedures. RESULTS Laboratory values at admission were similar between the two groups. Over 80 patients presented a lower rate of abdominal symptoms (68.7% vs. 81.4%; P = 0.008), a higher mortality (14.8% vs. 3.5%; P = 0.003), and ICU admission (13.9% vs. 3.8%; P = 0.001) rates. Median LOS was comparable between the two groups. Multivariate analysis identified age [odds ratio (OR): 3.56; 95% confidence interval (CI): 1.502-8.46; P = 0.004], a higher Ranson score (OR: 3.22; 95% CI: 1.24-8.39; P = 0.016), and the absence of abdominal pain (OR: 2.94; 95% CI: 1.25-6.87; P = 0.013) as independent predictors of mortality. Conversely, only age (OR: 3.83; 95% CI: 1.55-9.44; P = 0.003) and a more severe AP (OR: 3.56; 95% CI: 1.95-6.89; P = 0.041) were recognized as influencing ICU admission. Only the operative treatment (OR: 2.805; 95% CI: 1.166-5.443; P = 0.037) was evidenced as independent risk factor for LOS (OR: 3.74; 95% CI: 1.031-6.16; P = 0.003). CONCLUSION Oldest old patients have a higher mortality and ICU admission rate as compared to the other subgroups of elderly. Early diagnosis and prompt treatment are key elements to improve outcomes in this frailer population.
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Affiliation(s)
- Giuseppe Quero
- Digestive Surgery Unit, Department of Surgery, CRMP (Gemelli Pancreatic Advanced Research Center)
| | - Marcello Covino
- Emergency Medicine - Fondazione Policlinico Universitario A. Gemelli, IRCCS
| | - Veronica Ojetti
- Emergency Medicine - Fondazione Policlinico Universitario A. Gemelli, IRCCS
- Università Cattolica del Sacro Cuore, Roma
| | - Claudio Fiorillo
- Digestive Surgery Unit, Department of Surgery, CRMP (Gemelli Pancreatic Advanced Research Center)
| | - Fausto Rosa
- Digestive Surgery Unit, Department of Surgery, CRMP (Gemelli Pancreatic Advanced Research Center)
| | - Roberta Menghi
- Digestive Surgery Unit, Department of Surgery, CRMP (Gemelli Pancreatic Advanced Research Center)
| | - Vito Laterza
- Digestive Surgery Unit, Department of Surgery, CRMP (Gemelli Pancreatic Advanced Research Center)
| | - Marcello Candelli
- Emergency Medicine - Fondazione Policlinico Universitario A. Gemelli, IRCCS
| | - Francesco Franceschi
- Emergency Medicine - Fondazione Policlinico Universitario A. Gemelli, IRCCS
- Università Cattolica del Sacro Cuore, Roma
| | - Sergio Alfieri
- Digestive Surgery Unit, Department of Surgery, CRMP (Gemelli Pancreatic Advanced Research Center)
- Università Cattolica del Sacro Cuore, Roma
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Ketwaroo G, Sealock RJ, Freedman S, Hart PA, Othman M, Wassef W, Banks P, Vege SS, Gardner T, Yadav D, Sheth S, Kanwal F. Quality of Care Indicators in Patients with Acute Pancreatitis. Dig Dis Sci 2019; 64:2514-2526. [PMID: 31152333 DOI: 10.1007/s10620-019-05674-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2018] [Accepted: 05/15/2019] [Indexed: 02/06/2023]
Abstract
BACKGROUND Acute pancreatitis (AP) is a common and expensive condition. Improving quality of care in AP is vital to minimizing cost and improving patient outcomes. However, there has been little work accomplished toward developing and validating explicit quality indicators (QIs) in AP. AIMS To define quality of care in patients with AP by developing explicit QIs using standardized techniques. METHODS We used the UCLA/RAND Delphi panel approach to combine a comprehensive literature review with the collective judgment of experts to identify a defined set of process measures for AP. RESULTS We produced 164 candidate QIs after a comprehensive literature review. After Delphi review, 75 had a median rating ≥ 7. We excluded 11 QIs where the disagreement index exceeded 1.0 and combined indicators overlapping in content to produce a final list of 22 QIs. Overall, 8 QIs related to diagnosis, prevention, or determination of etiology, 2 QIs focused on determination of severity, 3 QIs captured fluid resuscitation, 2 QIs measured nutrition, 1 QI use of antibiotics, and 6 QIs captured endoscopic or surgical management. CONCLUSIONS We have developed 22 QIs spanning the spectrum of AP management including diagnosis, risk stratification, and pharmacological and endoscopic therapy. These QIs will facilitate future quality improvement by practitioners and organizations who treat patients with AP and further identify areas that are amenable to improvement to enhance patient care. We anticipate that this QI set will represent the first step in determining a framework for demonstrating value in the care of patients with AP.
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Affiliation(s)
- Gyanprakash Ketwaroo
- Department of Medicine, Michael E. DeBakey VA Medical Center, 2002 Holcombe Blvd, Houston, TX, 77030, USA.
- Department of Medicine, Baylor College of Medicine, Houston, TX, USA.
| | | | - Steven Freedman
- Division of Gastroenterology, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Phil A Hart
- Division of Gastroenterology, Hepatology, and Nutrition, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Mohamed Othman
- Department of Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Wahid Wassef
- Division of Gastroenterology, University of Massachusetts Medical School, Worcester, MA, USA
| | - Peter Banks
- Brigham and Women's Hospital, Boston, MA, USA
| | - Santhi Swaroop Vege
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, USA
| | | | - Dhiraj Yadav
- Department of Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Sunil Sheth
- Division of Gastroenterology, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Fasiha Kanwal
- Department of Medicine, Michael E. DeBakey VA Medical Center, 2002 Holcombe Blvd, Houston, TX, 77030, USA
- Department of Medicine, Baylor College of Medicine, Houston, TX, USA
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Samanta J, Dhaka N, Gupta P, Singh AK, Yadav TD, Gupta V, Sinha SK, Kochhar R. Comparative study of the outcome between alcohol and gallstone pancreatitis in a high-volume tertiary care center. JGH Open 2019; 3:338-343. [PMID: 31406928 PMCID: PMC6684514 DOI: 10.1002/jgh3.12169] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2018] [Revised: 02/03/2019] [Accepted: 02/04/2019] [Indexed: 12/16/2022]
Abstract
BACKGROUND AND AIM The two most common etiologies of acute pancreatitis (AP) are alcohol and gallstone. Whether etiology contributes to the outcome in patients with AP is an unresolved issue, more so in the severe form of the disease. The aim is to study the effects of the etiological factors of alcohol and gallstone on the disease course and the role of etiology in the subgroup of severe AP. METHODS Consecutive patients of AP with alcohol or gallstone etiology were included. Various severity parameters and various outcome measures, such as need for organ support, intensive care, surgical or radiological intervention, hospital stay, and mortality, were evaluated between the two groups. RESULTS Of the 759 patients, alcoholic pancreatitis was seen in 368 (48.5%), while gallstone disease was observed in 246 (32.4%). Gallstone pancreatitis occurred in older age (P < 0.0001), had a higher female predilection (P < 0.001), and a higher body mass index (P = 0.002) compared to alcohol pancreatitis. Both groups were similar in terms of development of various organ failures and various severity assessment scores. Alcoholic AP had higher rates of necrosis (P = 0.05) and the need for percutaneous catheter drainage (P = 0.02). Outcome measures such as length of hospital stay, need for intensive care, organ support, surgical intervention, or mortality were similar between the two groups. Subset analysis of severe AP (303 patients) showed no difference between the two etiologies with regard to outcome. CONCLUSION The outcome of AP was independent of the etiology of the disease, alcohol or gallstone, and more so in the severe form of the disease. The number of local complications tends to be slightly higher in the alcoholic group.
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Affiliation(s)
- Jayanta Samanta
- Department of GastroenterologyPostgraduate Institute of Medical Education and ResearchChandigarhIndia
| | - Narendra Dhaka
- Department of GastroenterologyPostgraduate Institute of Medical Education and ResearchChandigarhIndia
| | - Pankaj Gupta
- Department of GastroenterologyPostgraduate Institute of Medical Education and ResearchChandigarhIndia
| | - Anupam K Singh
- Department of GastroenterologyPostgraduate Institute of Medical Education and ResearchChandigarhIndia
| | - Thakur D Yadav
- Department of General SurgeryPostgraduate Institute of Medical Education and ResearchChandigarhIndia
| | - Vikas Gupta
- Department of General SurgeryPostgraduate Institute of Medical Education and ResearchChandigarhIndia
| | - Saroj K Sinha
- Department of GastroenterologyPostgraduate Institute of Medical Education and ResearchChandigarhIndia
| | - Rakesh Kochhar
- Department of GastroenterologyPostgraduate Institute of Medical Education and ResearchChandigarhIndia
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Pereira R, Eslick G, Cox M. Endoscopic Ultrasound for Routine Assessment in Idiopathic Acute Pancreatitis. J Gastrointest Surg 2019; 23:1694-1700. [PMID: 31197695 DOI: 10.1007/s11605-019-04272-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2019] [Accepted: 05/17/2019] [Indexed: 01/31/2023]
Abstract
BACKGROUND Acute pancreatitis (AP) is one of the most common general acute surgical presentations. Current recommendations are that idiopathic acute pancreatitis (IAP) should account for no more than 20% of AP cases. Some studies suggest gallbladder microlithiasis is the aetiology in up to 75% of IAP patients. Endoscopic ultrasound (EUS) has been reported to be effective in the detection of microlithiasis and choledocholithiasis as well as pancreatic parenchymal, ductal and ampullary disorders. The aims of this study were to evaluate the usefulness of EUS in establishing aetiology in IAP patients and to assess if there is a role for EUS in the selection criteria for laparoscopic cholecystectomy to treat a potential biliary cause in IAP patients. METHODS A systematic review following PRISMA guideline was performed to gather data on patients with IAP undergoing EUS for further investigation. Three databases (MEDLINE, PubMed, and EMBASE) were searched to 28 July 2018. RESULTS Our systematic review included 28 studies, comprising 1850 patients with an initial diagnosis of IAP prior to having EUS. Diagnosis of a potential aetiology or associated pancreatic pathology was established in 1095 (62%, p < 0.001) of cases. A biliary aetiology (microlithiasis or choledocholithiasis) was found in 37%. Chronic pancreatitis and associated pancreatic findings (dilated pancreatic duct, pancreatic duct stricture or stone) were found in 21%. Pancreatic neoplasms were found in 6%. Of the patients who had identifiable biliary pathology on EUS that proceeded to cholecystectomy, 2% had a recurrence of AP during a mean follow-up period of 20.5 months. CONCLUSIONS There is a likely role for the routine use of EUS in the assessment of patients with IAP. The routine use of EUS may decrease the proportion of cases with a diagnosis of IAP. EUS may provide better selection criteria for laparoscopic cholecystectomy in patients with an initial diagnosis of IAP.
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Affiliation(s)
- Ryan Pereira
- The Whiteley-Martin Research Unit, Discipline of Surgery, The University of Sydney, Clinical Sciences Building, Nepean Hospital, P. O. Box 67, Penrith, NSW, 2751, Australia
- Department of Surgery, Princess Alexandra Hospital, Brisbane, QLD, Australia
| | - Guy Eslick
- The Whiteley-Martin Research Unit, Discipline of Surgery, The University of Sydney, Clinical Sciences Building, Nepean Hospital, P. O. Box 67, Penrith, NSW, 2751, Australia
| | - Michael Cox
- The Whiteley-Martin Research Unit, Discipline of Surgery, The University of Sydney, Clinical Sciences Building, Nepean Hospital, P. O. Box 67, Penrith, NSW, 2751, Australia.
- Department of Surgery, Nepean Hospital, Sydney, NSW, Australia.
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50
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Chatila AT, Bilal M, Guturu P. Evaluation and management of acute pancreatitis. World J Clin Cases 2019; 7:1006-1020. [PMID: 31123673 PMCID: PMC6511926 DOI: 10.12998/wjcc.v7.i9.1006] [Citation(s) in RCA: 70] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2019] [Revised: 03/19/2018] [Accepted: 03/26/2019] [Indexed: 02/05/2023] Open
Abstract
Acute pancreatitis (AP) is one of the most common gastrointestinal causes for hospi-talization in the United States. In 2015, AP accounted for approximately 390000 hospitalizations. The burden of AP is only expected to increase over time. Despite recent advances in medicine, pancreatitis continues to be associated with a substantial morbidity and mortality. The most common cause of AP is gallstones, followed closely by alcohol use. The diagnosis of pancreatitis is established with any two of three following criteria: (1) Abdominal pain consistent with that of AP; (2) Serum amylase and/or lipase greater than three times the upper limit of normal; and (3) Characteristics findings seen in cross-sectional abdominal imaging. Multiple criteria and scoring systems have been established for assessing severity of AP. The cornerstones of management include aggressive intravenous hydration, appropriate nutrition and pain management. Endoscopic retrograde cholangiopancreatography and surgery are important aspects in management of acute gallstone pancreatitis. We provide a comprehensive review of evaluation and management of AP.
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Affiliation(s)
- Ahmed T Chatila
- Department of Internal Medicine, The University of Texas Medical Branch, Galveston, TX 77555, United States
| | - Mohammad Bilal
- Division of Gastroenterology and Hepatology, The University of Texas Medical Branch, Galveston, TX 77555, United States
| | - Praveen Guturu
- Division of Gastroenterology and Hepatology, the University of Texas Medical Branch, Galveston, TX 77555, United States
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