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Bu M, Zhang Y, Xie X, Li K, Li G, Tong Z, Li W. Influencing factor analysis and clinical efficacy of early intervention in severe acute pancreatitis with persistent organ failure. Sci Rep 2025; 15:16230. [PMID: 40346177 PMCID: PMC12064800 DOI: 10.1038/s41598-025-98532-9] [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: 11/08/2024] [Accepted: 04/14/2025] [Indexed: 05/11/2025] Open
Abstract
This study aims to analyze the risk factors requiring early intervention in severe acute pancreatitis (SAP) patients with persistent organ failure and evaluate the clinical outcomes following treatment. This was a retrospective observational study. Inverse probability treatment weighting using propensity score methods was employed to balance baseline characteristics. Univariate and multivariate logistic regression analyses were performed to identify risk factors associated with early intervention. Smooth curve fitting was applied to explore potential relationships between variables and intervention timing. Threshold effect analysis was conducted to identify the optimal inflection point in nonlinear relationship. A total of 310 patients were included in this study. Compared to the standard treatment group (n = 162), the early intervention group (n = 148) had a higher proportion of multiple organ failure (77.1% vs. 63.6%, P = 0.021) and higher mortality (27.7% vs. 16.0%, P = 0.013), but early intervention was not significantly associated with adverse outcome (OR 1.52, 95% CI 0.71-3.26, P = 0.283). Risk factors associated with early intervention included computed tomography severity index, SOFA score, intra-abdominal pressure (IAP), and remifentanil equivalents. Among these, the SOFA score showed a negative linear relationship with intervention timing, while distinct threshold effects were observed between IAP, remifentanil equivalents, and intervention timing. One week after intervention, most patients showed improved organ function, along with reduced requirements for sedation and analgesia, as well as decreased C-reactive protein level levels and IAP (all P < 0.05). SAP patients requiring early intervention tended to have higher disease severity. Although early intervention can improve short-term organ function, reduce IAP, and lower analgesic requirements, its impact on reducing mortality remains uncertain.
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Affiliation(s)
- Minchun Bu
- Medical College of Yangzhou University, Yangzhou, 225000, Jiangsu Province, People's Republic of China
- Department of Critical Care Medicine, Center of Severe Acute Pancreatitis (CSAP), Jinling Hospital, Medical School of Nanjing University, No. 305 Zhongshan East Road, Nanjing, 210000, Jiangsu Province, People's Republic of China
| | - Yun Zhang
- Medical College of Yangzhou University, Yangzhou, 225000, Jiangsu Province, People's Republic of China
- The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou, Jiangsu, China
| | - Xiaochun Xie
- Department of Critical Care Medicine, Nanjing Drum Tower Hospital, Nanjing, Jiangsu, China
| | - Kaiming Li
- Jinling Clinical Medical College, Nanjing University of Chinese Medicine, Nanjing, Jiangsu, China
| | - Gang Li
- Department of Critical Care Medicine, Center of Severe Acute Pancreatitis (CSAP), Jinling Hospital, Medical School of Nanjing University, No. 305 Zhongshan East Road, Nanjing, 210000, Jiangsu Province, People's Republic of China.
| | - Zhihui Tong
- Department of Critical Care Medicine, Center of Severe Acute Pancreatitis (CSAP), Jinling Hospital, Medical School of Nanjing University, No. 305 Zhongshan East Road, Nanjing, 210000, Jiangsu Province, People's Republic of China
| | - Weiqin Li
- Medical College of Yangzhou University, Yangzhou, 225000, Jiangsu Province, People's Republic of China.
- Department of Critical Care Medicine, Center of Severe Acute Pancreatitis (CSAP), Jinling Hospital, Medical School of Nanjing University, No. 305 Zhongshan East Road, Nanjing, 210000, Jiangsu Province, People's Republic of China.
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Chen X, Zhong R, Hu B. Mitochondrial dysfunction in the pathogenesis of acute pancreatitis. Hepatobiliary Pancreat Dis Int 2025; 24:76-83. [PMID: 38212158 DOI: 10.1016/j.hbpd.2023.12.008] [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: 08/10/2023] [Accepted: 12/25/2023] [Indexed: 01/13/2024]
Abstract
The mechanism of cell damage during acute pancreatitis (AP) has not been fully elucidated, and there is still a lack of specific or effective treatments. Increasing evidence has implicated mitochondrial dysfunction as a key event in the pathophysiology of AP. Mitochondrial dysfunction is closely related to calcium (Ca2+) overload, intracellular adenosine triphosphate depletion, mitochondrial permeability transition pore openings, loss of mitochondrial membrane potential, mitophagy damage and inflammatory responses. Mitochondrial dysfunction is an early triggering event in the initiation and development of AP, and this organelle damage may precede the release of inflammatory cytokines, intracellular trypsin activation and vacuole formation of pancreatic acinar cells. This review provides further insight into the role of mitochondria in both physiological and pathophysiological aspects of AP, aiming to improve our understanding of the underlying mechanism which may lead to the development of therapeutic and preventive strategies for AP.
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Affiliation(s)
- Xia Chen
- Department of Gastroenterology and Hepatology, West China Hospital, Sichuan University, Chengdu 610041, China; Department of Gastroenterology, Clinical Medical College and The First Affiliated Hospital of Chengdu Medical College, Chengdu 610500, China
| | - Rui Zhong
- Department of Gastroenterology, Clinical Medical College and The First Affiliated Hospital of Chengdu Medical College, Chengdu 610500, China
| | - Bing Hu
- Department of Gastroenterology and Hepatology, West China Hospital, Sichuan University, Chengdu 610041, China.
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Chen L, Wang N, Yao W, Zhao C, Tao J, Ma G, Ma C, Wang Z. Efficacy analysis of pancreatic duct stenting in treating severe acute pancreatitis: a retrospective study. Eur J Med Res 2025; 30:19. [PMID: 39780239 PMCID: PMC11716043 DOI: 10.1186/s40001-024-02250-3] [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: 08/26/2024] [Accepted: 12/22/2024] [Indexed: 01/11/2025] Open
Abstract
BACKGROUND This study aims to evaluate the clinical efficacy of pancreatic duct stenting in the treatment of SAP, providing reference for clinical diagnosis and treatment. METHODS A retrospective analysis was conducted on clinical data from patients with SAP admitted to the General Hospital of Ningxia Medical University from June 1, 2019 to December 31, 2022. A total of 51 patients were included (33 males, 18 females). Patients were divided into two groups based on treatment: the control group (n = 28) receiving conventional treatment and the stent group (n = 23) undergoing pancreatic duct stenting in addition to conventional treatment. Data collected and analyzed include demographic information, rates of late local complications, late surgical interventions, new-onset OF, infected pancreatic necrosis and new-onset systemic complications. Specific outcomes measured were incidences of new-onset respiratory, renal and circulatory failure, single and multiple OF, sepsis, ACS, abdominal hypertension, and pancreatogenic encephalopathy, as well as use of ≥ 3 types of antibiotics, time of antibiotic use, time of analgesic administration, oral refeeding, length of hospital stay, ICU care, and length of ICU stay. These indicators were used to assess the therapeutic efficacy of pancreatic duct stenting. RESULTS All 23 patients in the stent group successfully underwent stenting. The incidence of new-onset OF and new-onset systemic complications was significantly lower in the stent group compared to the control group (χ2 = 4.96, 6.65, P < 0.05). However, no significant differences were observed between the groups regarding late local complications, infected pancreatic necrosis, and late surgical intervention (χ2 = 0.22, 0.002, 0.024, P > 0.05). Notably, two patients in the control group required additional procedures due to inadequate drainage, with one undergoing endoscopic debridement and the other, laparotomy. Mortality rates were 3 (10.7%) in the control group and 4 (17.4%) in the stent group, with no statistically significant difference (P > 0.05). Furthermore, significant differences were noted in new-onset respiratory failure, single OF, sepsis, abdominal hypertension, time of analgesic administration, oral refeeding, length of enzyme inhibitor use, and hospitalization expenses (χ2 = 3.94, 4.37, 5.79, 4.79; Z = - 2.008, - 4.176, - 4.165, - 2.309; P < 0.05). No significant differences were found in new-onset renal, circulatory, multiple OF, ACS, pancreatogenic encephalopathy, use of ≥ 3 types of antibiotics, time of antibiotic use, length of hospital stay, ICU care, and length of ICU stay (P > 0.05). CONCLUSIONS Pancreatic duct stenting effectively reduces the incidence of new-onset systemic complications and OF in SAP, preventing further deterioration. Pancreatic duct stenting can alleviate symptoms, shorten oral refeeding, and promote patient recovery. TRIAL REGISTRATION This study was recorded as a single-center, retrospective case-control study (ChiCTR1900025833).
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Affiliation(s)
| | - Ning Wang
- Ningxia Medical University, Yinchuan, 710004, China
| | - Weijie Yao
- Ningxia Medical University, Yinchuan, 710004, China.
- Department of Hepatobiliary Surgery, General Hospital of Ningxia Medical University, Yinchuan, 710004, China.
| | - Chengsi Zhao
- Department of Hepatobiliary Surgery, General Hospital of Ningxia Medical University, Yinchuan, 710004, China
| | - Jiahang Tao
- Ningxia Medical University, Yinchuan, 710004, China
| | - Gubai Ma
- Ningxia Medical University, Yinchuan, 710004, China
| | - Chengwang Ma
- Ningxia Medical University, Yinchuan, 710004, China
| | - Zuozheng Wang
- Department of Hepatobiliary Surgery, General Hospital of Ningxia Medical University, Yinchuan, 710004, China.
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Zhang S, Chen Z, Hu C, Zhu P, Jin T, Li L, Lin Z, Shi N, Zhang X, Xia Q, Deng L. The Clinical Characteristics and Outcomes of Acute Pancreatitis Are Different in Elderly Patients: A Single-Center Study over a 6-Year Period. J Clin Med 2024; 13:4829. [PMID: 39200971 PMCID: PMC11355819 DOI: 10.3390/jcm13164829] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2024] [Revised: 08/04/2024] [Accepted: 08/14/2024] [Indexed: 09/02/2024] Open
Abstract
Objectives: This study aims to analyze the clinical characteristics of elderly patients with acute pancreatitis (AP) and investigate the effects of age on the clinical outcomes of AP. Methods: Patients aged ≥ 18 years with AP admitted within 72 h from 1 September 2013 to 31 August 2019 were included. Patients were divided into elderly (≥60 years) and non-elderly (<60 years) groups. Clinical data and outcomes were compared. Results: A total of 756 elderly and 4896 non-elderly patients with AP were included. The elderly patients had different etiological distributions and more severe clinical markers and scores. Age was an independent risk factor for mortality [odds ratio (OR): 2.911, 95% CI: 1.801-4.706, p < 0.001], intensive care unit admission (OR: 1.739, 95% CI: 1.126-2.685, p = 0.013), persistent organ failure (OR: 1.623, 95% CI: 1.326-1.987, p < 0.001), multiple organ failure (OR: 1.757, 95% CI: 1.186-2.604, p = 0.005), and infection (OR: 2.451, 95% CI: 1.994-3.013, p < 0.001). Adjusted multiple logistic regression and trend analysis confirmed the risk of the age for the outcomes. The deaths of elderly patients showed a biphasic pattern with peaks in the first and fifth weeks, in contrast to the single peak in the first week in the non-elderly patients. Conclusions: Elderly patients with AP were associated with worse clinical outcomes. It is crucial to devote considerable attention to the optimization of therapeutic approaches to reduce late mortality in this group of patients.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - Qing Xia
- West China Centre of Excellence for Pancreatitis, Institute of Integrated Traditional Chinese and Western Medicine, West China Hospital, Sichuan University, Chengdu 610041, China; (S.Z.); (Z.C.); (C.H.); (P.Z.); (T.J.); (L.L.); (Z.L.); (N.S.); (X.Z.)
| | - Lihui Deng
- West China Centre of Excellence for Pancreatitis, Institute of Integrated Traditional Chinese and Western Medicine, West China Hospital, Sichuan University, Chengdu 610041, China; (S.Z.); (Z.C.); (C.H.); (P.Z.); (T.J.); (L.L.); (Z.L.); (N.S.); (X.Z.)
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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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Dejonckheere M, Antonelli M, Arvaniti K, Blot K, CreaghBrown B, de Lange DW, De Waele J, Deschepper M, Dikmen Y, Dimopoulos G, Eckmann C, Francois G, Girardis M, Koulenti D, Labeau S, Lipman J, Lipovestky F, Maseda E, Montravers P, Mikstacki A, Paiva J, Pereyra C, Rello J, Timsit J, Vogelaers D, Blot S, the Abdominal Sepsis Study (AbSeS) group on behalf of the Trials Group of the European Society of Intensive Care Medicine. Epidemiology and risk factors for mortality in critically ill patients with pancreatic infection. JOURNAL OF INTENSIVE MEDICINE 2024; 4:81-93. [PMID: 38263964 PMCID: PMC10800767 DOI: 10.1016/j.jointm.2023.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Revised: 06/16/2023] [Accepted: 06/23/2023] [Indexed: 01/25/2024]
Abstract
Background The AbSeS-classification defines specific phenotypes of patients with intra-abdominal infection based on the (1) setting of infection onset (community-acquired, early onset, or late-onset hospital-acquired), (2) presence or absence of either localized or diffuse peritonitis, and (3) severity of disease expression (infection, sepsis, or septic shock). This classification system demonstrated reliable risk stratification in intensive care unit (ICU) patients with intra-abdominal infection. This study aimed to describe the epidemiology of ICU patients with pancreatic infection and assess the relationship between the components of the AbSeS-classification and mortality. Methods This was a secondary analysis of an international observational study ("AbSeS") investigating ICU patients with intra-abdominal infection. Only patients with pancreatic infection were included in this analysis (n=165). Mortality was defined as ICU mortality within 28 days of observation for patients discharged earlier from the ICU. Relationships with mortality were assessed using logistic regression analysis and reported as odds ratio (OR) and 95% confidence interval (CI). Results The overall mortality was 35.2% (n=58). The independent risk factors for mortality included older age (OR=1.03, 95% CI: 1.0 to 1.1 P=0.023), localized peritonitis (OR=4.4, 95% CI: 1.4 to 13.9 P=0.011), and persistent signs of inflammation at day 7 (OR=9.5, 95% CI: 3.8 to 23.9, P<0.001) or after the implementation of additional source control interventions within the first week (OR=4.0, 95% CI: 1.3 to 12.2, P=0.013). Gram-negative bacteria were most frequently isolated (n=58, 49.2%) without clinically relevant differences in microbial etiology between survivors and non-survivors. Conclusions In pancreatic infection, a challenging source/damage control and ongoing pancreatic inflammation appear to be the strongest contributors to an unfavorable short-term outcome. In this limited series, essentials of the AbSeS-classification, such as the setting of infection onset, diffuse peritonitis, and severity of disease expression, were not associated with an increased mortality risk.ClinicalTrials.gov number: NCT03270345.
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Affiliation(s)
- Marie Dejonckheere
- Department of Internal Medicine and Pediatrics, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Massimo Antonelli
- Department of Anesthesiology, Intensive Care and Emergency Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Università Cattolica del Sacro Cuore, Rome, Italy
| | - Kostoula Arvaniti
- Intensive Care Unit, Papageorgiou University Affiliated Hospital, Thessaloníki, Greece
| | - Koen Blot
- Department of Internal Medicine and Pediatrics, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
- Department of Epidemiology and Public Health, Sciensano, Ixelles, Belgium
| | - Ben CreaghBrown
- Surrey Perioperative Anaesthetic Critical Care Collaborative Research Group (SPACeR), Royal Surrey County Hospital, Guildford, UK
- Department of Clinical and Experimental Medicine, University of Surrey, Guildford, UK
| | - Dylan W. de Lange
- Department of Intensive Care Medicine, University Medical Center Utrecht, University Utrecht, Utrecht, the Netherlands
| | - Jan De Waele
- Department of Internal Medicine and Pediatrics, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
- Department of Intensive Care Medicine, Ghent University Hospital, Ghent, Belgium
| | - Mieke Deschepper
- Data Science Institute, Ghent University Hospital, Ghent, Belgium
| | - Yalim Dikmen
- Department of Anesthesiology and Reanimation, Cerrahpasa School of Medicine, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - George Dimopoulos
- 3rd Department of Critical Care, “EVGENIDIO” Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Christian Eckmann
- Department of General, Visceral and Thoracic Surgery, Klinikum Hannoversch-Muenden, Goettingen University, Göttingen, Germany
| | - Guy Francois
- Division of Scientific Affairs-Research, European Society of Intensive Care Medicine, Brussels, Belgium
| | - Massimo Girardis
- Anesthesia and Intensive Care Department, University Hospital of Modena, Modena, Italy
| | - Despoina Koulenti
- UQ Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia
- 2nd Critical Care Department, Attikon University Hospital, Athens, Greece
| | - Sonia Labeau
- Department of Internal Medicine and Pediatrics, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
- Department of Nursing, Faculty of Education, Health and Social Work, University College Ghent, Ghent, Belgium
| | - Jeffrey Lipman
- Jamieson Trauma Institute, The University of Queensland, Brisbane, QLD, Australia
- Nimes University Hospital, University of Montpellier, Nimes, France
| | - Fernando Lipovestky
- Critical Care Department, Hospital of the Interamerican Open University (UAI), Buenos Aires, Argentina
| | - Emilio Maseda
- Surgical Critical Care, Department of Anesthesia, Hospital Universitario La Paz-IdiPaz, Madrid, Spain
| | - Philippe Montravers
- Université de Paris, INSERM, UMR-S 1152-PHERE, Paris, France
- Anesthesiology and Critical Care Medicine, Bichat-Claude Bernard University Hospital, HUPNSV, AP-HP, Paris, France
| | - Adam Mikstacki
- Faculty of Health Sciences, Poznan University of Medical Sciences, Poznan, Poland
- Department of Anaesthesiology and Intensive Therapy, Regional Hospital in Poznan, Poznan, Poland
| | - JoseArtur Paiva
- Intensive Care Department, Centro Hospitalar Universitario S. Joao, Faculty of Medicine, University of Porto, Grupo Infecao e Sepsis, Porto, Portugal
| | - Cecilia Pereyra
- Intensive Care Unit from Hospital Interzonal General de Agudos “Prof Dr Luis Guemes”, Buenos Aires, Argentina
| | - Jordi Rello
- Ciberes and Vall d'Hebron Institute of Research, Barcelona, Spain
| | - JeanFrancois Timsit
- Université Paris-Cité, IAME, INSERM 1137, Paris, France
- AP-HP, Hôpital Bichat, Medical and Infection Diseases ICU (MI2), Paris, France
| | - Dirk Vogelaers
- Department of Internal Medicine and Pediatrics, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
- Department of General Internal Medicine and Infectious Diseases, AZ Delta, Roeselare, Belgium
| | - Stijn Blot
- Department of Internal Medicine and Pediatrics, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
- UQ Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia
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Hu WM, Hua TR, Zhang YL, Chen GR, Song K, Pendharkar S, Wu D, Windsor JA. Prognostic significance of organ failure and infected pancreatic necrosis in acute pancreatitis: An updated systematic review and meta-analysis. J Dig Dis 2023; 24:648-659. [PMID: 38037512 DOI: 10.1111/1751-2980.13243] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2023] [Revised: 10/15/2023] [Accepted: 11/21/2023] [Indexed: 12/02/2023]
Abstract
OBJECTIVES In patients with acute pancreatitis (AP), minimally invasive treatment and the step-up approach have been widely used to deal with infected pancreatic necrosis (IPN) in the last decade. It is unclear whether IPN has become a less important determinant of mortality relative to organ failure (OF). We aimed to statistically aggregate recent evidence from published studies to determine the relative importance of IPN and OF as determinants of mortality in patients with AP (PROSPERO: CRD42020176989). METHODS Relevant studies were sourced from MEDLINE and EMBASE databases. Relative risk (RR) or weighted mean difference (WMD) was analyzed as outcomes. A two-sided P value of less than 0.05 was regarded as statistical significance. RESULTS Forty-three studies comprising 11 601 patients with AP were included. The mortality was 28% for OF patients and 24% for those with IPN. Patients with OF without IPN had a significantly higher risk of mortality compared to those with IPN but without OF (RR 3.72, P < 0.0001). However, patients with both OF and IPN faced the highest risk of mortality. Additionally, IPN increased length of stay in hospital for OF patients (WMD 28.75, P = 0.032). CONCLUSION Though IPN remains a significant concern, which leads to increased morbidity and longer hospital stay, it is a less critical mortality determinant compared to OF in AP.
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Affiliation(s)
- Wen Mo Hu
- Department of Gastroenterology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Tian Rui Hua
- Department of Gastroenterology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yue Lun Zhang
- Medical Research Center, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- Clinical Epidemiology Unit, International Clinical Epidemiology Network, Beijing, China
| | - Guo Rong Chen
- Department of Gastroenterology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Kai Song
- Department of Gastroenterology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Sayali Pendharkar
- Surgical and Translational Research Centre, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Dong Wu
- Department of Gastroenterology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- Clinical Epidemiology Unit, International Clinical Epidemiology Network, Beijing, China
| | - John A Windsor
- Surgical and Translational Research Centre, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
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Evaluation of acute pancreatitis based on BISAP scoring system: A cohort study of 50 cases. ACTA MEDICA MARTINIANA 2022. [DOI: 10.2478/acm-2022-0016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Abstract
Background/Aim
Acute pancreatitis is encountered in both medical and surgical specialty. Assessment of severity and grading is done using radiological investigations mostly like ultrasonography or CECT. We present a study to assess the severity of Acute Pancreatitis based on Bedside Index for Severity in Acute Pancreatitis (BISAP) scoring system.
Material & Methods
The study was conducted on 50 patients presenting with acute pancreatitis who were included as per inclusion criteria and a detailed history, clinical examination and blood investigation performed. Data like serum amylase, serum lipase, serum calcium, blood urea nitrogen (BUN), pleural effusion and systemic inflammatory response syndrome (SIRS) was collected from the patients. Based on data collected in 24 hours of hospitalization, BISAP score was calculated.
Results
Results showed that no significant temperature rise, pancreatic necrosis, SIRS or impaired mental status in patients with BISAP severity of <=3. However, patients having BISAP score >3, factors like BUN, age, pleural effusion, and organ failure show significant correlation. Also on comparative analysis of patients showed that the hospital stay, respiratory rate, pulse and laboratory markers (blood urea, serum creatinine, serum amylase, serum lipase) were significantly higher in patients with BISAP score ≥3.
Conclusion
BISAP score is an easy, quick and bedside method to assess the severity of acute pancreatitis and predict its mortality. It is easy bedside procedure that can be done in every setup.
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Singh S, Prakash S, Kaushal D, Chahal H, Sood A. Percutaneous Catheter Drainage in Acute Infected Necrotizing Pancreatitis: A Real-World Experience at a Tertiary Care Hospital in North India. Cureus 2022; 14:e27994. [PMID: 36120245 PMCID: PMC9469754 DOI: 10.7759/cureus.27994] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/14/2022] [Indexed: 12/02/2022] Open
Abstract
Introduction Open necrosectomy in acute infected necrotizing pancreatitis is associated with very high mortality and morbidity. Moreover, if it is performed before four weeks, the benefits are limited. In this study, we evaluated the safety and efficacy of percutaneous catheter drainage (PCD) in patients with acute infected necrotizing pancreatitis. Methods It was a single-center, observational study, where all consecutive patients with proven or probable infected acute necrotizing pancreatitis in whom PCD was performed were studied. The patients who failed to respond to PCD underwent open necrosectomy. Baseline characteristics and the outcome of all included patients, including complications of PCD, were studied. Results A total of 46 patients (males=36, females=10) underwent PCD over a period of 18 months. Fifteen (32.60%) patients succumbed to their illness. PCD benefitted a total of 31 (67.39%) patients; in 17 (36.95%) patients, it worked as a standalone therapy, while in 14 (30.43%) patients, additional surgery was required where it helped to delay the surgery. Median days at which PCD and surgery were performed were 17.5 days (range: 2-28 days) and 33 days (range: 7-70 days), respectively. Lower mean arterial pressure at presentation, presence of multiorgan failure, more than 50% necrosis, higher baseline creatinine and bilirubin levels, and an early surgery were markers of increased mortality. Three (6.5%) patients had PCD-related complications, out of which only one required active intervention. Conclusion PCD in infected acute pancreatic necrosis is safe and effective. In one-third of the patients, it worked as standalone therapy, and in the rest it delayed the surgery beyond four weeks, thereby preventing the complications associated with early aggressive debridement.
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Tran A, Fernando SM, Rochwerg B, Inaba K, Bertens KA, Engels PT, Balaa FK, Kubelik D, Matar M, Lenet TI, Martel G. Prognostic factors associated with development of infected necrosis in patients with acute necrotizing or severe pancreatitis-A systematic review and meta-analysis. J Trauma Acute Care Surg 2022; 92:940-948. [PMID: 34936587 DOI: 10.1097/ta.0000000000003502] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/08/2022]
Abstract
PURPOSE Acute pancreatitis is a potentially life-threatening condition with a wide spectrum of clinical presentation and illness severity. An infection of pancreatic necrosis (IPN) results in a more than twofold increase in mortality risk as compared with patients with sterile necrosis. We sought to identify prognostic factors for the development of IPN among adult patients with severe or necrotizing pancreatitis. METHODS We conducted this prognostic review in accordance with systematic review methodology guidelines. We searched six databases from inception through March 21, 2021. We included English language studies describing prognostic factors associated with the development of IPN. We pooled unadjusted odds ratio (uOR) and adjusted odds ratios (aOR) for prognostic factors using a random-effects model. We assessed risk of bias using the Quality in Prognosis Studies tool and certainty of evidence using the GRADE approach. RESULTS We included 31 observational studies involving 5,210 patients. Factors with moderate or higher certainty of association with increased IPN risk include older age (uOR, 2.19; 95% confidence interval [CI], 1.39-3.45, moderate certainty), gallstone etiology (aOR, 2.35; 95% CI, 1.36-4.04, high certainty), greater than 50% necrosis of the pancreas (aOR, 3.61; 95% CI, 2.15-6.04, high certainty), delayed enteral nutrition (aOR, 2.09; 95% CI, 1.26-3.47, moderate certainty), multiple or persistent organ failure (aOR, 11.71; 95% CI, 4.97-27.56, high certainty), and invasive mechanical ventilation (uOR, 12.24; 95% CI, 2.28-65.67, high certainty). CONCLUSION This meta-analysis confirms the association between several clinical early prognostic factors and the risk of IPN development among patients with severe or necrotizing pancreatitis. These findings provide the foundation for the development of an IPN risk stratification tool to guide more targeted clinical trials for prevention or early intervention strategies. LEVEL OF EVIDENCE Systematic review and meta-analysis, Level IV.
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Affiliation(s)
- Alexandre Tran
- From the Department of Surgery (A.T., K.A.B., F.K.B., D.K., M.M., T.I.L., G.M.), School of Epidemiology and Public Health (A.T., T.I.L., G.M.), Division of Critical Care, Department of Medicine (A.T., S.M.F., D.K.), Department of Emergency Medicine (S.M.F.), University of Ottawa, Ottawa; Department of Medicine (B.R.), Department of Health Research Methods, Evidence, and Impact (B.R.), McMaster University, Hamilton, ON, Canada; Division of Acute Care Surgery, Department of Surgery (K.I.), University of Southern California, Los Angeles, California; Division of General Surgery, Department of Surgery (P.T.E.), and Division of Critical Care, Department of Medicine (P.T.E.), McMaster University, Hamilton, Canada
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11
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Beyer G, Hoffmeister A, Michl P, Gress TM, Huber W, Algül H, Neesse A, Meining A, Seufferlein TW, Rosendahl J, Kahl S, Keller J, Werner J, Friess H, Bufler P, Löhr MJ, Schneider A, Lynen Jansen P, Esposito I, Grenacher L, Mössner J, Lerch MM, Mayerle J. S3-Leitlinie Pankreatitis – Leitlinie der Deutschen Gesellschaft für Gastroenterologie, Verdauungs- und Stoffwechselkrankheiten (DGVS) – September 2021 – AWMF Registernummer 021-003. ZEITSCHRIFT FUR GASTROENTEROLOGIE 2022; 60:419-521. [PMID: 35263785 DOI: 10.1055/a-1735-3864] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
- Georg Beyer
- Medizinische Klinik und Poliklinik II, LMU Klinikum, Ludwig-Maximilians-Universität München, Deutschland
| | - Albrecht Hoffmeister
- Bereich Gastroenterologie, Klinik und Poliklinik für Onkologie, Gastroenterologie, Hepatologie Pneumologie und Infektiologie, Universitätsklinikum Leipzig, Deutschland
| | - Patrick Michl
- Universitätsklinik u. Poliklinik Innere Medizin I mit Schwerpunkt Gastroenterologie, Universitätsklinikum Halle, Deutschland
| | - Thomas Mathias Gress
- Klinik für Gastroenterologie und Endokrinologie, Universitätsklinikum Gießen und Marburg, Deutschland
| | - Wolfgang Huber
- Comprehensive Cancer Center München TUM, II. Medizinische Klinik und Poliklinik, Klinikum rechts der Isar, Technische Universität München, München, Deutschland
| | - Hana Algül
- Comprehensive Cancer Center München TUM, II. Medizinische Klinik und Poliklinik, Klinikum rechts der Isar, Technische Universität München, München, Deutschland
| | - Albrecht Neesse
- Klinik für Gastroenterologie, gastrointestinale Onkologie und Endokrinologie, Universitätsmedizin Göttingen, Deutschland
| | - Alexander Meining
- Medizinische Klinik und Poliklinik II Gastroenterologie und Hepatologie, Universitätsklinikum Würzburg, Deutschland
| | | | - Jonas Rosendahl
- Universitätsklinik u. Poliklinik Innere Medizin I mit Schwerpunkt Gastroenterologie, Universitätsklinikum Halle, Deutschland
| | - Stefan Kahl
- Klinik für Innere Medizin m. Schwerpkt. Gastro./Hämat./Onko./Nephro., DRK Kliniken Berlin Köpenick, Deutschland
| | - Jutta Keller
- Medizinische Klinik, Israelitisches Krankenhaus, Hamburg, Deutschland
| | - Jens Werner
- Klinik für Allgemeine, Viszeral-, Transplantations-, Gefäß- und Thoraxchirurgie, Universitätsklinikum München, Deutschland
| | - Helmut Friess
- Klinik und Poliklinik für Chirurgie, Klinikum rechts der Isar, München, Deutschland
| | - Philip Bufler
- Klinik für Pädiatrie m. S. Gastroenterologie, Nephrologie und Stoffwechselmedizin, Charité Campus Virchow-Klinikum - Universitätsmedizin Berlin, Deutschland
| | - Matthias J Löhr
- Department of Gastroenterology, Karolinska, Universitetssjukhuset, Stockholm, Schweden
| | - Alexander Schneider
- Klinik für Gastroenterologie und Hepatologie, Klinikum Bad Hersfeld, Deutschland
| | - Petra Lynen Jansen
- Deutsche Gesellschaft für Gastroenterologie, Verdauungs- und Stoffwechselkrankheiten (DGVS), Berlin, Deutschland
| | - Irene Esposito
- Pathologisches Institut, Heinrich-Heine-Universität und Universitätsklinikum Duesseldorf, Duesseldorf, Deutschland
| | - Lars Grenacher
- Conradia Radiologie München Schwabing, München, Deutschland
| | - Joachim Mössner
- Bereich Gastroenterologie, Klinik und Poliklinik für Onkologie, Gastroenterologie, Hepatologie Pneumologie und Infektiologie, Universitätsklinikum Leipzig, Deutschland
| | - Markus M Lerch
- Klinik für Innere Medizin A, Universitätsmedizin Greifswald, Deutschland.,Klinikum der Ludwig-Maximilians-Universität (LMU) München, Deutschland
| | - Julia Mayerle
- Medizinische Klinik und Poliklinik II, LMU Klinikum, Ludwig-Maximilians-Universität München, Deutschland
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12
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Monitoring Approach of Fatality Risk Factors for Patients with Severe Acute Pancreatitis Admitted to the Intensive Care Unit. A Retrospective, Monocentric Study. Diagnostics (Basel) 2021; 11:diagnostics11112013. [PMID: 34829360 PMCID: PMC8625923 DOI: 10.3390/diagnostics11112013] [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: 07/07/2021] [Revised: 10/21/2021] [Accepted: 10/26/2021] [Indexed: 11/29/2022] Open
Abstract
Acute pancreatitis is an unpredictable disease affecting the pancreas and it is characterized by a wide range of symptoms and modified lab tests, thus there is a continuing struggle to classify this disease and to find risk factors associated with a worse outcome. The main objective of this study was to identify the risk factors associated with the fatal outcome of the intensive care unit’s patients diagnosed and admitted for severe acute pancreatitis, the secondary objective was to investigate the prediction value for the death of different inflammatory markers at the time of their admission to the hospital. This retrospective study included all the patients with a diagnosis of acute pancreatitis admitted to the Intensive Care Unit of the Emergency County Hospital Timisoara between 1 January 2016 and 31 May 2021. The study included 53 patients diagnosed with severe acute pancreatitis, out of which 21 (39.6%) survived and 32 (60.4%) died. For the neutrophils/lymphocytes ratio, a cut-off value of 12.4 was found. When analyzing age, we found out that age above 52 years old can predict mortality, and for the platelets/lymphocytes ratio, a cut-off value of 127 was found. Combining the three factors we get a new model for predicting mortality, with an increased performance, AUROC = 0.95, p < 0.001. Multiple persistent organ failure, age over 50, higher values of C reactive protein, and surgery were risk factors for death in the patients with severe acute pancreatitis admitted to the intensive care unit. The model design from the neutrophils/lymphocytes ratio, platelets/lymphocytes ratio, and age proved to be the best in predicting mortality in severe acute pancreatitis.
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13
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Hollenbach M, Feisthammel J, Hoffmeister A. [Interventional endoscopic treatment in acute pancreatitis]. Internist (Berl) 2021; 62:1055-1064. [PMID: 34546400 DOI: 10.1007/s00108-021-01154-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/19/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Acute pancreatitis (AP) represents a frequent gastrointestinal diseases. Approximately 80% of patients have a mild course of the disease and conservative treatment is sufficient; however, 20% of patients develop a severe AP with local and systemic complications. This article focuses on the currently recommended endoscopic management of severe AP. OBJECTIVE Classification of AP by the revised Atlanta classification and the occurrence of local or systemic complications. Summary of current evidence with respect to endoscopic management. MATERIAL AND METHODS Inspection of the current literature from specialist journals and current guidelines. RESULTS The AP is classified as mild, moderate or severe based on systemic (hypotension, renal failure, lung failure) and/or local complications, such as acute peripancreatic fluid collections (APFC), peripancreatic pseudocysts (PPC), acute necrotic collections (ANC) and walled-off necrosis (WON). In recent years the staged endoscopic treatment of infected ANC, WON and PPC has become established. The initial step is the endoscopic ultrasound-guided puncture and drainage with plastic or lumen-apposing metal stents. For solid components or insufficient drainage, a transgastric endoscopic necrosectomy is recommended. The treatment of severe AP requires an interdisciplinary management in specialized centers and regular re-evaluation of the therapeutic efficacy. CONCLUSION Interventional endoscopy has become established as the standard for treatment of severe AP.
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Affiliation(s)
- Marcus Hollenbach
- Bereich Gastroenterologie, Klinik für Onkologie, Gastroenterologie, Hepatologie, Pneumologie und Infektiologie, Department für Innere Medizin, Neurologie und Dermatologie, Universitätsklinikum Leipzig AöR, Liebigstr. 20, 04103, Leipzig, Deutschland.
| | - Jürgen Feisthammel
- Bereich Gastroenterologie, Klinik für Onkologie, Gastroenterologie, Hepatologie, Pneumologie und Infektiologie, Department für Innere Medizin, Neurologie und Dermatologie, Universitätsklinikum Leipzig AöR, Liebigstr. 20, 04103, Leipzig, Deutschland
| | - Albrecht Hoffmeister
- Bereich Gastroenterologie, Klinik für Onkologie, Gastroenterologie, Hepatologie, Pneumologie und Infektiologie, Department für Innere Medizin, Neurologie und Dermatologie, Universitätsklinikum Leipzig AöR, Liebigstr. 20, 04103, Leipzig, Deutschland
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14
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Singh AK, Samanta J, Shukla J, Birda CL, Dhar J, Gupta P, Kumar-M P, Gupta V, Yadav TD, Sinha SK, Kochhar R. Impact of Different Patterns of Organ Failure on Mortality in Acute Necrotizing Pancreatitis. Pancreas 2021; 50:1030-1036. [PMID: 34629457 DOI: 10.1097/mpa.0000000000001880] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
OBJECTIVES Organ failure (OF) and infected necrosis (IN) are the most important predictors of mortality in necrotizing acute pancreatitis (AP). We studied the relationship between timing (onset and duration) and patterns of OF with mortality and the impact of IN on mortality. METHODS Consecutive patients with necrotizing AP between January 2017 and February 2020 were analyzed retrospectively for OF and its impact on outcome. Organ failure was divided as single OF, simultaneous multiple OF (SiMOF) and sequential multiple OF (SeMOF). Mortality was compared for timing of onset, total duration and patterns of OF. RESULTS Among 300 patients with necrotizing AP, 174 (58%) had OF. Mortality was not associated with onset of OF (P = 0.683) but with duration of OF (P = 0.006). Mortalities for single OF, SiMOF, and SeMOF were 11.8%, 30.4%, and 69.2% respectively (P < 0.001). On Cox proportional hazard analysis, adjusted hazard ratio of risk of mortality for OF with IN versus IN, SiMOF versus single OF and SeMOF versus single OF was 3.183, 2.878, and 8.956, respectively (P = 0.023, <0.030, and <0.001, respectively). CONCLUSIONS Duration of OF was associated with increased mortality and SeMOF had worse outcome than single OF and SiMOF.
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Affiliation(s)
| | | | | | | | | | | | | | - Vikas Gupta
- Department of Surgical Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Thakur Deen Yadav
- Department of Surgical Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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15
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Abstract
Acute pancreatitis is one of the most commonly encountered etiologies in the emergency setting, with a broad spectrum of findings that varies in severity from mild interstitial pancreas to severe forms with significant local and systemic complications that are associated with a substantial degree of morbidity and mortality. In this article the radiological aspect of the terminology and classification of acute pancreatitis are reviewed. The roles of ultrasound, computed tomography, and magnetic resonance imaging in the diagnosis and evaluation of acute pancreatitis and its complications are discussed. The authors present a practical image-rich guide, applying the revised Atlanta classification system, with the goal of facilitating radiologists to write a correct report, and reinforcing the radiologist’s role as a key member of a multidisciplinary team in treating patients with acute pancreatitis. Computed tomography is the most performed imaging test for acute pancreatitis. Nevertheless, MRI is useful in many specific situations, due to its superiority soft tissue contrast resolution and better assessment of biliary and pancreatic duct, for example in the ductal disconnection. The purpose if this article is to review recent advances in imaging acquisition and analytic techniques in the evaluation of AP.
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16
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Ke L, Dong X, Chen T, Doig GS, Li G, Ye B, Zhou J, Xiao X, Tong Z, Li W. Early on-demand drainage or standard management for acute pancreatitis patients with acute necrotic collections and persistent organ failure: A pilot randomized controlled trial. JOURNAL OF HEPATO-BILIARY-PANCREATIC SCIENCES 2021; 28:387-396. [PMID: 33595879 DOI: 10.1002/jhbp.915] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Revised: 01/15/2021] [Accepted: 01/30/2021] [Indexed: 12/17/2022]
Abstract
BACKGROUND/PURPOSE The current standard care for acute pancreatitis with acute necrotic collections (ANC) is to postpone invasive intervention for 4 weeks when indicated. However, in patients with persistent organ failure (POF), this delayed approach may prolong organ failure. In this study, we aimed to assess the feasibility and safety of earlier drainage for acute pancreatitis patients with ANC and POF. METHODS A single-center, randomized controlled trial was conducted. Eligible patients were randomly assigned to either the early on-demand (EOD) group or the standard management (SM) group. Within 21 days of randomization, early drainage was triggered by unremitted or worsening organ failure in the EOD group. The primary endpoint was a composite of major complications/death during 90-days follow-up. RESULTS Thirty patients were randomized. Within 21 days of randomization, eight of the 15 patients (53%) in the EOD group underwent percutaneous drainage compared to four of the 15 patients (27%) in the SM group (P = 0.26). The primary outcome occurred in three of the 15 (20%) patients in the EOD group and seven of the 15(46.7%) in the controls (P = 0.25, relative risk 0.43, 95%CI 0.14 to 1.35). CONCLUSIONS Although the EOD approach did not result in significant differences between groups, the primary outcome assessed in this trial demonstrated the potential for clinical benefits favoring early drainage.
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Affiliation(s)
- Lu Ke
- Department of Critical Care Medicine, Center of Severe Acute Pancreatitis (CSAP), School of Medicine, Jinling Hospital, Nanjing University, Nanjing, China.,National Institute of Healthcare Data Science at Nanjing University, Nanjing, China
| | - Xiaowu Dong
- Department of Critical Care Medicine, Center of Severe Acute Pancreatitis (CSAP), Jinling Hospital, Nanjing Medical University, Nanjing, China
| | - Tao Chen
- Tropical Clinical Trials Unit, Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Gordon S Doig
- Northern Clinical School Intensive Care Research Unit, Sydney Medical School, University of Sydney, Sydney, Australia
| | - Gang Li
- Department of Critical Care Medicine, Center of Severe Acute Pancreatitis (CSAP), School of Medicine, Jinling Hospital, Nanjing University, Nanjing, China
| | - Bo Ye
- Department of Critical Care Medicine, Center of Severe Acute Pancreatitis (CSAP), School of Medicine, Jinling Hospital, Nanjing University, Nanjing, China
| | - Jing Zhou
- Department of Critical Care Medicine, Center of Severe Acute Pancreatitis (CSAP), School of Medicine, Jinling Hospital, Nanjing University, Nanjing, China
| | - Xiaojia Xiao
- Department of Critical Care Medicine, Center of Severe Acute Pancreatitis (CSAP), The First School of Clinical Medicine, Jinling Hospital, Southern Medical University, Nanjing, China
| | - Zhihui Tong
- Department of Critical Care Medicine, Center of Severe Acute Pancreatitis (CSAP), School of Medicine, Jinling Hospital, Nanjing University, Nanjing, China
| | - Weiqin Li
- Department of Critical Care Medicine, Center of Severe Acute Pancreatitis (CSAP), School of Medicine, Jinling Hospital, Nanjing University, Nanjing, China.,National Institute of Healthcare Data Science at Nanjing University, Nanjing, China
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17
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Machicado JD, Gougol A, Tan X, Gao X, Paragomi P, Pothoulakis I, Talukdar R, Kochhar R, Goenka MK, Gulla A, Gonzalez JA, Singh VK, Ferreira M, Stevens T, Barbu ST, Nawaz H, Gutierrez SC, Zarnescu NO, Capurso G, Easler JJ, Triantafyllou K, Pelaez‐Luna M, Thakkar S, Ocampo C, de‐Madaria E, Cote GA, Wu BU, Conwell DL, Hart PA, Tang G, Papachristou GI. Mortality in acute pancreatitis with persistent organ failure is determined by the number, type, and sequence of organ systems affected. United European Gastroenterol J 2021; 9:139-149. [PMID: 33871926 PMCID: PMC8259236 DOI: 10.1002/ueg2.12057] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Accepted: 12/23/2020] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Persistent organ failure (POF) is the strongest determinant of mortality in acute pancreatitis (AP). There is a paucity of data regarding the impact of different POF attributes on mortality and the role of different characteristics of systemic inflammatory response syndrome (SIRS) in the risk of developing POF. OBJECTIVE We aimed to assess the association of POF dynamic features with mortality and SIRS characteristics with POF. METHODS We studied 1544 AP subjects prospectively enrolled at 22 international centers (APPRENTICE consortium). First, we estimated the association of onset, duration, and maximal score of SIRS with POF. Then, we evaluated the risk of mortality based on POF onset, duration, number, type, and sequence of organs affected. Analyses were adjusted for potential confounders. RESULTS 58% had SIRS, 11% developed POF, and 2.5% died. Early SIRS, persistent SIRS, and maximal SIRS score ≥ 3 were independently associated with higher risk of POF (p < 0.05). Mortality risk in POF was higher with two (33%, odds ratio [OR] = 10.8, 3.3-34.9) and three (48%, OR = 20.2, 5.9-68.6) organs failing, in comparison to single POF (4%). In subjects with multiple POF, mortality was higher when the cardiovascular and respiratory systems failed first or concurrently as compared to when the renal system failed first or concurrently with other organ (p < 0.05). In multivariate regression model, the number and sequence of organs affected in POF were associated with mortality (p < 0.05). Onset and duration of POF had no impact mortality. CONCLUSION In AP patients with POF, the risk of mortality is influenced by the number, type, and sequence of organs affected. These results are useful for future revisions of AP severity classification systems.
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Affiliation(s)
| | - Amir Gougol
- University of Pittsburgh Medical CenterPittsburghPennsylvaniaUSA
| | - Xiaoqing Tan
- Department of BiostatisticsGraduate School of Public HealthUniversity of PittsburghPittsburghPennsylvaniaUSA
| | - Xiaotian Gao
- Department of BiostatisticsGraduate School of Public HealthUniversity of PittsburghPittsburghPennsylvaniaUSA
| | - Pedram Paragomi
- University of Pittsburgh Medical CenterPittsburghPennsylvaniaUSA
| | | | | | - Rakesh Kochhar
- Postgraduate Institute of Medical Education and ResearchChandigarhIndia
| | | | - Aiste Gulla
- Institute of Clinical MedicineFaculty of MedicineVilnius UniversityVilniusLithuania
- Georgetown University HospitalWashington DCUSA
| | | | | | | | | | - Sorin T. Barbu
- University of Medicine and Pharmacy “Iuliu Hatieganu”Cluj‐NapocaRomania
| | - Haq Nawaz
- Eastern Maine Medical CenterBangorMaineUSA
| | | | - Narcis O. Zarnescu
- “Carol Davila” University of Medicine and PharmacyUniversity Emergency HospitalBucharestRomania
| | - Gabriele Capurso
- San Raffaele Scientific Institute (IRCCS)Vita Salute San Raffaele UniversityMilanItaly
- Andrea HospitalRomeItaly
| | | | | | - Mario Pelaez‐Luna
- Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán‐Universidad Autónoma de MexicoMexico CityMexico
| | | | - Carlos Ocampo
- Hospital General de Argudos “Dr. Cosme Argerich”Buenos AiresArgentina
| | - Enrique de‐Madaria
- Gastroenterology DepartmentAlicante University General HospitalISABIALAlicanteSpain
| | - Gregory A. Cote
- Medical University of South CarolinaCharlestonSouth CarolinaUSA
| | | | | | - Phil A. Hart
- The Ohio State University Wexner Medical CenterColumbusOhioUSA
| | - Gong Tang
- Department of BiostatisticsGraduate School of Public HealthUniversity of PittsburghPittsburghPennsylvaniaUSA
| | - Georgios I. Papachristou
- University of Pittsburgh Medical CenterPittsburghPennsylvaniaUSA
- The Ohio State University Wexner Medical CenterColumbusOhioUSA
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18
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Ausania F, Senra Del Río P, Borin A, Guzmán Suárez S, Rivera Irigoin R, Fort Martorell E, Concepción-Martín M, Del Val Antoñana A, Ferrández A, Grau García FJ, Ruiz Rebollo ML, Andreu EB, de-Madaria E. Factors associated with mortality in patients with infected pancreatic necrosis: the "surgery effect". Updates Surg 2020; 72:1097-1103. [PMID: 32306274 DOI: 10.1007/s13304-020-00764-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Accepted: 04/10/2020] [Indexed: 11/26/2022]
Abstract
Severe acute pancreatitis complicated by infection is associated with high mortality. Invasive treatment is indicated in the presence of infected (suspected) pancreatic and/or peripancreatic necrosis (IPN) in the absence of response to intensive medical support. Step-up approach (SUA) has been demonstrated to lower complication rate compared to upfront open surgery. However, this approach has not been associated with lower mortality, and no factors have been studied that could help to identify the high risk patients. In this study, we aimed to analyse those factors associated with mortality following the invasive treatment of IPN, focusing on the role of surgical necrosectomy. A retrospective and observational study based on a multicentre prospective database was conducted. The database was coordinated by the Hospital General Universitario de Alicante, Spain and the Spanish Association of Pancreatology. Demographics, clinical data, and laboratory and imaging findings were collected. Atlanta 2012 criteria were considered to classify acute necrotizing pancreatitis and for the definition of IPN. Step-up approach was used in all centres with the intention of avoiding surgery whenever possible. Surgical necrosectomy was performed by open approach. From January 2013 to October 2014, a total of 1655 patients with the diagnosis of acute pancreatitis were included in our database. 1081 were recruited for the final analysis. Out of them, 205 (19%) were classified into acute necrotizing pancreatitis. 77 (8.3%) patients underwent invasive treatment of INP and were included in our study. Overall mortality was 29.9%. Upfront endoscopic or percutaneous drainage was performed in 60 (77.9%) patients and mortality was 26.6%. Out of 60, 22 (36.6%) patients subsequently received rescue surgery; mortality in rescue surgery group was 18.3%. Upfront surgery was carried out in 17 (22.1%) patients; mortality in this group was 41%. At univariate analysis, surgical necrosectomy, extrapancreatic infection, immunosuppression and de-novo haemodialysis were associated with mortality. At multivariate analysis, only surgical necrosectomy was significantly associated with mortality (p = 0.002 OR 3.89). Surgical approach for IPN is associated with high mortality rate. However, these data should be interpreted with caution, since we are not able to assess whether this occurs due to the need of surgery as the only resort when the other approaches are not feasible or fail.
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Affiliation(s)
| | | | - Alex Borin
- Department of General and Pancreatic Surgery, Pancreas Institute, University and Hospital Trust of Verona, Verona, Italy.
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20
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Jiang X, Shi JY, Wang XY, Hu Y, Cui YF. The impacts of infectious complications on outcomes in acute pancreatitis: a retrospective study. Mil Med Res 2020; 7:38. [PMID: 32799919 PMCID: PMC7429726 DOI: 10.1186/s40779-020-00265-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2019] [Accepted: 07/24/2020] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND The occurrence of infectious complications characterizes the more severe forms of acute pancreatitis (AP) and is associated with high mortality. We investigated the effects of infection at different sites in patients with AP, including those with necrotizing pancreatitis (NP). METHODS We conducted a retrospective analysis of 285 patients who met the inclusion criteria for AP and were admitted to Tianjin Nankai Hospital between January 2016 and September 2019. According to the source of the culture positivity during hospitalization, patients were divided into four groups: sterile group(n = 148), pancreatic infection group(n = 65), extrapancreatic infection group(n = 22) and combined infection group(n = 50). The source of infection, microbiology, biochemical parameters and prognostic indicators were analyzed. RESULTS In terms of baseline characteristics, the four groups were similar in age, sex, aetiology, previous pancreatitis and diabetes. Compared with the severity of the disease in the other groups, the APACHE II scores(9.91 ± 4.65, 9.46 ± 5.05, respectively) and organ failure rate (40.9 and 50%, respectively)were higher in the extrapancreatic infection group and the combined infection group (P < 0.05). The frequency of surgical intervention and hospitalization time in patients with NP complicated with extrapancreatic infection was greatly increased (P < 0.05). Regarding the primary outcome, patients in the combined infection group had longer hospital stays (68.28 ± 51.80 vs 55.58 ± 36.24, P < 0.05) and higher mortality (24.0% vs 9.2%, P < 0.05) than patients in the pancreatic infection group. In addition, patients in the extrapancreatic infection group also showed high intensive care utilization (59.1%) and mortality rates (18.2%). Among the 137 AP patients with infection complications, 89 patients exhibited multidrug-resistant (MDR) microorganisms, and the mortality rate of patients with MDR bacterial infection was higher than that of patients with non-MDR bacterial infection (24.7% vs 3.6%, P = 0.001). CONCLUSION Clinicians should be aware that extrapancreatic infection (EPI) significantly aggravates the main outcome in pancreatic infection patients. Infection with MDR bacteria is also associated with AP mortality.
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Affiliation(s)
- Xun Jiang
- Tianjin Medical University, Tianjin, 300041 China
| | - Ji-Yu Shi
- Tianjin Medical University, Tianjin, 300041 China
| | - Xia-Yu Wang
- Tianjin Medical University, Tianjin, 300041 China
| | - Yong Hu
- Tianjin Medical University, Tianjin, 300041 China
| | - Yun-Feng Cui
- Tianjin Medical University, Tianjin, 300041 China
- Department of Surgery, Tianjin Nankai Hospital, Nankai Clinical School of Medicine, 122 Sanwei Road, Nankai district, Tianjin, 300110 China
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Wu H, Li J, Zhao J, Li S. A new scoring system can be applied to predict the organ failure related events in acute pancreatitis accurately and rapidly. Pancreatology 2020; 20:622-628. [PMID: 32273167 DOI: 10.1016/j.pan.2020.03.017] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2019] [Revised: 03/18/2020] [Accepted: 03/30/2020] [Indexed: 12/11/2022]
Abstract
AIM To establish a new scoring system to predict the organ failure (OF)-related events in acute pancreatitis (AP) with high accuracy and rapidity. BACKGROUND AP is a complicated immunological response that leads to multiple organ failure，but no single scoring system has so far effectively predicted the severity of OF-related events in AP. METHODS The research utilized a retrospective study including 1076 AP patients to establish the new scoring system and a prospective study of another 138 patients to verify it. All the laboratory parameters were measured at admission (within 72 h of disease onset). Dunnett'T3 test, univariate and multivariate ordinal logistic regressions were performed. ROC curves were drawn to calculate the cut-off value of the chosen factors and to validate the predictive value of the system. RESULTS Lactate dehydrogenase (LDH), creatinine (Cr), albumin (ALB) and calcium (Ca2+) made up the new system. The Area Under the Curve (AUC) of the system for OF was 0.904, and for persistent organ failure (POF) was 0.893 while that for death cases was 0.969. As a result, patients who scored 'zero' seemed to recover soon, who received a score '1-4' might have transient organ failure (TOF) but not POF. When the score was over 5, it was probable that patients would suffer POF, and even die if it exceeded 9. The test of the new scoring system proved it conducted well. CONCLUSION The new scoring system can accurately and promptly predict the OF-related events in AP.
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Affiliation(s)
- Heshui Wu
- Department of Pancreatic Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Jinsong Li
- Department of Thoracic Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Jingyuan Zhao
- Department of Pancreatic Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Shoukang Li
- Department of Thoracic Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China.
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Shi N, Liu T, de la Iglesia-Garcia D, Deng L, Jin T, Lan L, Zhu P, Hu W, Zhou Z, Singh V, Dominguez-Munoz JE, Windsor J, Huang W, Xia Q, Sutton R. Duration of organ failure impacts mortality in acute pancreatitis. Gut 2020; 69:604-605. [PMID: 31233394 PMCID: PMC7034341 DOI: 10.1136/gutjnl-2019-318241] [Citation(s) in RCA: 75] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2019] [Revised: 01/18/2019] [Accepted: 01/22/2019] [Indexed: 02/05/2023]
Affiliation(s)
- Na Shi
- Department and Laboratory of Integrated Traditional Chinese and Western Medicine, Sichuan Provincial Pancreatitis Centre and West China-Liverpool Biomedical Research Centre, West China Hospital, Sichuan University, Chengdu, China
| | - Tingting Liu
- Department and Laboratory of Integrated Traditional Chinese and Western Medicine, Sichuan Provincial Pancreatitis Centre and West China-Liverpool Biomedical Research Centre, West China Hospital, Sichuan University, Chengdu, China,Liverpool Pancreatitis Study Group, Royal Liverpool University Hospital and Institute of Translational Medicine, University of Liverpool, Liverpool, UK
| | | | - Lihui Deng
- Department and Laboratory of Integrated Traditional Chinese and Western Medicine, Sichuan Provincial Pancreatitis Centre and West China-Liverpool Biomedical Research Centre, West China Hospital, Sichuan University, Chengdu, China
| | - Tao Jin
- Department and Laboratory of Integrated Traditional Chinese and Western Medicine, Sichuan Provincial Pancreatitis Centre and West China-Liverpool Biomedical Research Centre, West China Hospital, Sichuan University, Chengdu, China
| | - Lan Lan
- West China Biomedical Big Data Centre, West China Hospital, Sichuan University, Chengdu, China
| | - Ping Zhu
- Department and Laboratory of Integrated Traditional Chinese and Western Medicine, Sichuan Provincial Pancreatitis Centre and West China-Liverpool Biomedical Research Centre, West China Hospital, Sichuan University, Chengdu, China
| | - Weiming Hu
- Department of Pancreatic Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Zongguang Zhou
- Institute of Digestive Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Vikesh Singh
- Pancreatitis Centre, Division of Gastroenterology, Johns Hopkins Medical Institutions, Baltimore, USA
| | | | - John Windsor
- Surgical and Translational Research Centre, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Wei Huang
- Department and Laboratory of Integrated Traditional Chinese and Western Medicine, Sichuan Provincial Pancreatitis Centre and West China-Liverpool Biomedical Research Centre, West China Hospital, Sichuan University, Chengdu, China,Liverpool Pancreatitis Study Group, Royal Liverpool University Hospital and Institute of Translational Medicine, University of Liverpool, Liverpool, UK
| | - Qing Xia
- Department and Laboratory of Integrated Traditional Chinese and Western Medicine, Sichuan Provincial Pancreatitis Centre and West China-Liverpool Biomedical Research Centre, West China Hospital, Sichuan University, Chengdu, China
| | - Robert Sutton
- Liverpool Pancreatitis Study Group, Royal Liverpool University Hospital and Institute of Translational Medicine, University of Liverpool, Liverpool, UK
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Choudhuri AH, Duggal S, Biswas PS, Uppal R. A Comparison of Acute Physiology and Chronic Health Evaluation II Score and Serum Procalcitonin Change for Predicting Mortality in Acute Pancreatitis. Indian J Crit Care Med 2020; 24:190-194. [PMID: 32435098 PMCID: PMC7225756 DOI: 10.5005/jp-journals-10071-23377] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Introduction The prediction of mortality in acute pancreatitis (AP) is a useful estimate for effective treatment. Scoring systems such as acute physiology and chronic health evaluation (APACHE) II, computed tomography (CT) severity index (CTSI), bedside index of severity in acute pancreatitis (BISAP), etc., are used for prediction. Biomarkers like C-reactive protein (CRP) and procalcitonin (PCT) are also considered useful for prognostication. The aim of this retrospective study was to correlate the changes in serum PCT level with APACHE II score between admission and 48 hours as mortality predictor in AP. Materials and methods The observational study was conducted in a cohort of 42 patients admitted consecutively in the seven-bedded general intensive care unit (ICU) of our institute between June 2016 and May 2018, with the diagnosis of AP. The APACHE II score and serum PCT level at admission and 48 hours were retrieved from the hospital database. The change in APACHE II and PCT level was compared between ICU “survivors” and “nonsurvivors.” The predictive accuracy of APACHE II and PCT was measured using area under receiver–operator characteristics (ROC) curve. A p value <0.05 was considered as significant. Results Of the 42 patients enrolled, 30 patients (71.42%) were survivors and 12 (28.58%) were nonsurvivors. The median APACHE II score in nonsurvivors increased from 16 (7–19) to 23 (11–29) and remained unchanged at 16 (9–19 at admission; 10–22 at 48 hours) in survivors. The median PCT levels increased from 3.8 (1.2–5.6) to 6.2 (1.9–12.5) in nonsurvivors and decreased from 3.8 (1.2–5.6) to 2.2 (0.6–2.9) in survivors. Serum PCT change compared better than the APACHE II score change among survivors (r = 0.455, p = 0.011) with a mean (±standard deviation SD) change of 1.41 (±1.59). Conclusion The change in serum PCT and APACHE II between admission and 48 hours correlates well and is useful for mortality prediction in AP. Serum PCT change compares better than APACHE II score change in survivors. How to cite this article Choudhuri AH, Duggal S, Biswas PS, Uppal R. A Comparison of Acute Physiology and Chronic Health Evaluation II Score and Serum Procalcitonin Change for Predicting Mortality in Acute Pancreatitis. Indian J Crit Care Med 2020;24(3):190–194.
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Affiliation(s)
- Anirban Hom Choudhuri
- Department of Anaesthesiology and Intensive Care, GB Pant Institute of Postgraduate Medical Education and Research, New Delhi, India
| | - Sakshi Duggal
- Department of Anaesthesiology and Intensive Care, GB Pant Institute of Postgraduate Medical Education and Research, New Delhi, India
| | - Partha S Biswas
- Department of Psychiatry, GB Pant Institute of Postgraduate Medical Education and Research, New Delhi, India
| | - Rajeev Uppal
- Department of Anaesthesiology and Intensive Care, GB Pant Institute of Postgraduate Medical Education and Research, New Delhi, India
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24
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Zhang FX, Li ZL, Zhang ZD, Ma XC. Prognostic value of red blood cell distribution width for severe acute pancreatitis. World J Gastroenterol 2019; 25:4739-4748. [PMID: 31528098 PMCID: PMC6718036 DOI: 10.3748/wjg.v25.i32.4739] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2019] [Revised: 07/02/2019] [Accepted: 07/19/2019] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Severe acute pancreatitis (SAP) is a common condition in the intensive care unit (ICU) and has a high mortality. Early evaluation of the severity and prognosis is very important for SAP therapy. Recently, red blood cell distribution (RDW) was associated with mortality of sepsis patients and could be used as a predictor of prognosis. Similarly, RDW may be associated with the prognosis of SAP patients and be used as a prognostic indicator for SAP patients.
AIM To investigate the prognostic value of RDW for SAP patients.
METHODS We retrospectively enrolled SAP patients admitted to the ICU of the First Affiliated Hospital of China Medical University from June 2015 to June 2017. According to the prognosis at 90 d, SAP patients were divided into a survival group and a non-survival group. RDW was extracted from a routine blood test. Demographic parameters and RDW were recorded and compared between the two groups. The receiver operator characteristic (ROC) curve was constructed and Cox regression analysis was performed to investigate the prognostic value of RDW for SAP patients.
RESULTS In this retrospective cohort study, 42 SAP patients were enrolled, of whom 22 survived (survival group) and 20 died (non-survival group). The baseline parameters were comparable between the two groups. The coefficient of variation of RDW (RDW-CV), standard deviation of RDW (RDW-SD), Acute Physiology and Chronic Health Evaluation II (APACHE II) score, and Sequential Organ Failure Assessment (SOFA) score were significantly higher in the non-survival group than in the survival group (P < 0.05). The RDW-CV and RDW-SD were significantly correlated with the APACHE II score and SOFA score, respectively. The areas under the ROC curves (AUCs) of RDW-CV and RDW-SD were all greater than those of the APACHE II score and SOFA score, among which, the AUC of RDW-SD was the greatest. The results demonstrated that RDW had better prognostic value for predicting the mortality of SAP patients. When the RDW-SD was greater than 45.5, the sensitivity for predicting prognosis was 77.8% and the specificity was 70.8%. Both RDW-CV and RDW-SD could be used as independent risk factors to predict the mortality of SAP patients in multivariate logistic regression analysis and univariate Cox proportional hazards regression analysis, similar to the APACHE II and SOFA scores.
CONCLUSION The RDW is greater in the non-surviving SAP patients than in the surviving patients. RDW is significantly correlated with the APACHE II and SOFA scores. RDW has better prognostic value for SAP patients than the APACHE II and SOFA scores and could easily be used by clinicians for the treatment of SAP patients.
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Affiliation(s)
- Fang-Xiao Zhang
- Department of Critical Care Medicine, First Affiliated Hospital of China Medical University, Shenyang 110001, Liaoning Province, China
| | - Zhi-Liang Li
- Department of Critical Care Medicine, First Affiliated Hospital of China Medical University, Shenyang 110001, Liaoning Province, China
| | - Zhi-Dan Zhang
- Department of Critical Care Medicine, First Affiliated Hospital of China Medical University, Shenyang 110001, Liaoning Province, China
| | - Xiao-Chun Ma
- Department of Critical Care Medicine, First Affiliated Hospital of China Medical University, Shenyang 110001, Liaoning Province, China
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Da-Cheng-Qi Decoction Alleviates Intestinal Injury in Rats with Severe Acute Pancreatitis by Inhibiting the JAK2-STAT3 Signaling Pathway. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2019; 2019:3909468. [PMID: 31485245 PMCID: PMC6710798 DOI: 10.1155/2019/3909468] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Accepted: 07/17/2019] [Indexed: 02/08/2023]
Abstract
Objective To investigate the effect of Da-Cheng-Qi decoction (DCQD) on treating intestinal injury in rats with severe acute pancreatitis (SAP), based on the Janus kinase 2 (JAK2)/signal transducers and transcription 3 (STAT3) signaling pathway. Methods Rats were randomly divided into the SAP group, SAP + ruxolitinib (JAK2 inhibitor) group, SAP + Stattic (STAT3 inhibitor) group, SAP + DCQD group, and sham operation group. They were further divided into 3-hour, 6-hour, 12-hour, and 18-hour subgroups. Levels of amylase and the inflammatory cytokines tumor necrosis factor-α, interleukin 6, interleukin 10, and interleukin 4 in plasma were tested. The messenger ribonucleic acid (mRNA) expression of JAK2 and STAT3 and the protein expression of phosphorylated JAK2 (p-JAK2) and phosphorylated STAT3 (p-STAT3) in the pancreas and terminal ileum tissues were examined. Results Rats with SAP had severe changes in plasma levels of amylase and inflammatory cytokines and showed an overexpression of JAK2 mRNA, STAT3 mRNA, p-JAK2 protein, and p-STAT3 protein in the pancreas and terminal ileum. The events could be downregulated by treatment with DCQD, JAK2 inhibitor, and STAT3 inhibitor. Conclusions In rats with SAP, DCQD ameliorated inflammatory cytokines and intestinal injury, which may be closely associated with the inhibition of the JAK2/STAT3 signaling pathway.
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Leppäniemi A, Tolonen M, Tarasconi A, Segovia-Lohse H, Gamberini E, Kirkpatrick AW, Ball CG, Parry N, Sartelli M, Wolbrink D, van Goor H, Baiocchi G, Ansaloni L, Biffl W, Coccolini F, Di Saverio S, Kluger Y, Moore E, Catena F. 2019 WSES guidelines for the management of severe acute pancreatitis. World J Emerg Surg 2019; 14:27. [PMID: 31210778 PMCID: PMC6567462 DOI: 10.1186/s13017-019-0247-0] [Citation(s) in RCA: 411] [Impact Index Per Article: 68.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2019] [Accepted: 05/27/2019] [Indexed: 02/08/2023] Open
Abstract
Although most patients with acute pancreatitis have the mild form of the disease, about 20-30% develops a severe form, often associated with single or multiple organ dysfunction requiring intensive care. Identifying the severe form early is one of the major challenges in managing severe acute pancreatitis. Infection of the pancreatic and peripancreatic necrosis occurs in about 20-40% of patients with severe acute pancreatitis, and is associated with worsening organ dysfunctions. While most patients with sterile necrosis can be managed nonoperatively, patients with infected necrosis usually require an intervention that can be percutaneous, endoscopic, or open surgical. These guidelines present evidence-based international consensus statements on the management of severe acute pancreatitis from collaboration of a panel of experts meeting during the World Congress of Emergency Surgery in June 27-30, 2018 in Bertinoro, Italy. The main topics of these guidelines fall under the following topics: Diagnosis, Antibiotic treatment, Management in the Intensive Care Unit, Surgical and operative management, and Open abdomen.
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Affiliation(s)
- Ari Leppäniemi
- Abdominal Center, Helsinki University Hospital Meilahti, Haartmaninkatu 4, FI-00029 Helsinki,, Finland
| | - Matti Tolonen
- Abdominal Center, Helsinki University Hospital Meilahti, Haartmaninkatu 4, FI-00029 Helsinki,, Finland
| | - Antonio Tarasconi
- Department of Emergency Surgery, Parma Maggiore Hospital, Parma, Italy
| | | | - Emiliano Gamberini
- Anesthesia and Intensive Care Medicine, Maurizio Bufalini Hospital, Cesena, Italy
| | | | - Chad G. Ball
- Foothills Medical Centre & the University of Calgary, Calgary, AB Canada
| | - Neil Parry
- London Health Sciences Centre, London, ON Canada
| | | | - Daan Wolbrink
- Radboud University Nijmegen, Nijmegen, The Netherlands
| | | | - Gianluca Baiocchi
- Surgical Clinic, Department of Experimental and Clinical Sciences, University of Brescia, Brescia, Italy
| | - Luca Ansaloni
- General, Emergency and Trauma Surgery Department, Bufalini hospital, Cesena, Italy
| | - Walter Biffl
- Trauma and Acute Care Surgery, Scripps memorial Hospital, La Jolla, CA USA
| | - Federico Coccolini
- General, Emergency and Trauma Surgery Department, Bufalini hospital, Cesena, Italy
| | | | - Yoram Kluger
- Division of General Surgery, Rambam Health Care Campus, Haifa, Israel
| | - Ernest Moore
- Trauma Surgery, Denver Health Medical Center, Denver, CO USA
| | - Fausto Catena
- Department of Emergency Surgery, Parma Maggiore Hospital, Parma, Italy
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Schepers NJ, Bakker OJ, Besselink MG, Ahmed Ali U, Bollen TL, Gooszen HG, van Santvoort HC, Bruno MJ. Impact of characteristics of organ failure and infected necrosis on mortality in necrotising pancreatitis. Gut 2019; 68:1044-1051. [PMID: 29950344 DOI: 10.1136/gutjnl-2017-314657] [Citation(s) in RCA: 280] [Impact Index Per Article: 46.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2017] [Revised: 05/29/2018] [Accepted: 06/03/2018] [Indexed: 12/12/2022]
Abstract
OBJECTIVE In patients with pancreatitis, early persisting organ failure is believed to be the most important cause of mortality. This study investigates the relation between the timing (onset and duration) of organ failure and mortality and its association with infected pancreatic necrosis in patients with necrotising pancreatitis. DESIGN We performed a post hoc analysis of a prospective database of 639 patients with necrotising pancreatitis from 21 hospitals. We evaluated the onset, duration and type of organ failure (ie, respiratory, cardiovascular and renal failure) and its association with mortality and infected pancreatic necrosis. RESULTS In total, 240 of 639 (38%) patients with necrotising pancreatitis developed organ failure. Persistent organ failure (ie, any type or combination) started in the first week in 51% of patients with 42% mortality, in 13% during the second week with 46% mortality and in 36% after the second week with 29% mortality. Mortality in patients with persistent multiple organ failure lasting <1 week, 1-2 weeks, 2-3 weeks or longer than 3 weeks was 43%, 38%, 46% and 52%, respectively (p=0.68). Mortality was higher in patients with organ failure alone than in patients with organ failure and infected pancreatic necrosis (44% vs 29%, p=0.04). However, when excluding patients with very early mortality (within 10 days of admission), patients with organ failure with or without infected pancreatic necrosis had similar mortality rates (28% vs 34%, p=0.33). CONCLUSION In patients with necrotising pancreatitis, early persistent organ failure is not associated with increased mortality when compared with persistent organ failure which develops further on during the disease course. Furthermore, no association was found between the duration of organ failure and mortality.
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Affiliation(s)
- Nicolien J Schepers
- Department of Gastroenterology and Hepatology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Olaf J Bakker
- Department of Surgery, St. Antonius Hospital, Nieuwegein, The Netherlands
| | - Marc G Besselink
- Department of Surgery, Academic Medical Center, Amsterdam, The Netherlands
| | - Usama Ahmed Ali
- Department of Surgery, University Medical Center, Utrecht, The Netherlands
| | - Thomas L Bollen
- Department of Radiology, St. Antonius Hospital, Nieuwegein, The Netherlands
| | - Hein G Gooszen
- Department of Operation Rooms and Evidence Based Surgery, Radboud University Nijmegen Medical Center, Nijmegen, The Netherlands
| | | | - Marco J Bruno
- Department of Gastroenterology and Hepatology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
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The product value of serum albumin and prothrombin time activity could be a useful biomarker for severity prediction in AP: An ordinal retrospective study. Pancreatology 2019; 19:230-236. [PMID: 30765164 DOI: 10.1016/j.pan.2019.02.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2018] [Revised: 02/01/2019] [Accepted: 02/02/2019] [Indexed: 12/11/2022]
Abstract
AIM To appraise the predictive function of 'the product value of serum albumin and prothrombin time activity' (PAA) on admission for the organ failure related events of acute pancreatitis (AP). BACKGROUND 789 patients with AP were included in this retrospective study. 468 patients generated transient organ failure (TOF). 242 were diagnosed with persistent organ failure (POF), of which 63 patients died. STUDY All the values of laboratory parameters were measured upon admission to hospital. Dunnett'T3 test, Uni- and multi-variate ordinal logistic regression were used. ROC curve was utilized to evaluate the ultimate predictive values. RESULTS Among the patients with 4 different levels of severity of acute pancreatitis, PAA observably reduced as the disease aggravated (32.20 vs 29.56 vs 23.54 vs 17.89). PAA was also an independent risk factor for the aggravation of AP (OR: 0.873, 95% CI: 0.848, 0.899; p < 0.01). The Area Under the Curve (AUC) of PAA for OF was 0.828 (0.783, 0.872), 0.828 for POF (0.790, 0.865) and 0.905 for death cases (0.862, 0.948). CONCLUSION The product value of serum albumin and prothrombin time activity is a good predictor of the severity, especially the events related to organ failure of acute pancreatitis.
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Jha AK, Goenka MK, Kumar R, Suchismita A. Endotherapy for pancreatic necrosis: An update. JGH Open 2019; 3:80-88. [PMID: 30834345 PMCID: PMC6386747 DOI: 10.1002/jgh3.12109] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2018] [Revised: 09/28/2018] [Accepted: 10/11/2018] [Indexed: 12/16/2022]
Abstract
Approximately 20% of patients with acute pancreatitis develop pancreatic necrosis. The presence of necrosis in a pancreatic collection significantly worsens the prognosis. Pancreatic necrosis is associated with high mortality and morbidity. In the last few decades, there has been a significant revolution in the treatment of infected pancreatic necrosis. A step-up approach has been proposed, from less invasive procedures to the operative intervention. Minimally invasive treatment modalities such as endoscopic drainage and necrosectomy, percutaneous drainage, and minimally invasive surgery have recently replaced open surgical necrosectomy as the first-line treatment option. Endoscopic intervention for pancreatic necrosis is being increasingly performed with good success and a lower complication rate. However, techniques of endotherapy are still not uniform and vary as per local expertise, and there are still many unresolved questions with regard to the interventions in patients with pancreatic necrosis. The objective of this paper is to critically review the literature and update the concepts of endoscopic interventional therapy of pancreatic necrosis.
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Affiliation(s)
- Ashish K Jha
- Department of GastroenterologyIndira Gandhi Institute of Medical SciencesPatnaIndia
| | - Mahesh K Goenka
- Department of Gastrosciences, Institute of Gastrosciences, Apollo Gleneagles HospitalKolkataIndia
| | - Ramesh Kumar
- Department of Gastroenterology, All India Institute of Medical SciencesPatnaIndia
| | - Arya Suchismita
- Department of PediatricsIndira Gandhi Institute of Medical SciencesPatnaIndia
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Siddappa PK, Kochhar R, Sarotra P, Medhi B, Jha V, Gupta V. Neutrophil gelatinase-associated lipocalin: An early biomarker for predicting acute kidney injury and severity in patients with acute pancreatitis. JGH OPEN 2018; 3:105-110. [PMID: 31061884 PMCID: PMC6487831 DOI: 10.1002/jgh3.12112] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/08/2018] [Revised: 10/15/2018] [Accepted: 10/25/2018] [Indexed: 12/12/2022]
Abstract
Background and Aim Acute kidney injury (AKI) in severe acute pancreatitis (SAP) has a high mortality rate. Traditionally used serum creatinine is an insensitive biomarker for the early detection of AKI. We aimed to study the role of plasma and urinary neutrophil gelatinase‐associated lipocalin (NGAL) in predicting AKI and a severe course in patients with acute pancreatitis (AP). Methods Consecutive patients of AP who presented within 72 h of symptom onset and age‐ and gender‐matched healthy controls were included. Urinary and serum NGAL levels [enzyme‐linked immunosorbent assay (ELISA)] were evaluated within 24 h of and 72 h after admission and once in controls. Urine and serum NGAL levels were correlated with development of AKI, severity, and outcomes of AP. Results Fifty patients with AP and 30 controls were enrolled. The mean serum and urine NGAL levels in patients on day 1 were significantly higher than the serum and urine NGAL levels in controls (P < 0.001). After excluding patients with AKI on day 1 (n = 10), both serum and urinary NGAL levels on days 1 and 3 were significantly higher in patients who subsequently developed AKI (n = 11) compared to those who did not (n = 29) (P = 0.02, 0.01 and P < 0.001, 0.03). A urinary NGAL level of 221.03 ng/mL on day 1 predicted AKI with a sensitivity and specificity of 82 and 80%, respectively (AUC = 0.9). Mean serum and urinary NGAL levels on day 1 were significantly elevated in patients with SAP compared to those without SAP (P = 0.04 and <0.001). Conclusion NGAL levels in urine and serum can predict severity of AP and development of AKI.
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Affiliation(s)
- Pradeep K Siddappa
- Department of Gastroenterology Postgraduate Institute of Medical Education and Research Chandigarh India
| | - Rakesh Kochhar
- Department of Gastroenterology Postgraduate Institute of Medical Education and Research Chandigarh India
| | - Pooja Sarotra
- Department of Pharmacology Postgraduate Institute of Medical Education and Research Chandigarh India
| | - Bikas Medhi
- Department of Pharmacology Postgraduate Institute of Medical Education and Research Chandigarh India
| | - Vivekanand Jha
- Department of Nephrology Postgraduate Institute of Medical Education and Research Chandigarh India
| | - Vikas Gupta
- Department of Surgery Postgraduate Institute of Medical Education and Research Chandigarh India
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31
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Devani K, Charilaou P, Radadiya D, Brahmbhatt B, Young M, Reddy C. Acute pancreatitis: Trends in outcomes and the role of acute kidney injury in mortality- A propensity-matched analysis. Pancreatology 2018; 18:870-877. [PMID: 30337224 DOI: 10.1016/j.pan.2018.10.002] [Citation(s) in RCA: 50] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2018] [Revised: 10/01/2018] [Accepted: 10/04/2018] [Indexed: 12/11/2022]
Abstract
OBJECTIVES To assess national trends of AP (acute pancreatitis) admissions, outcomes, prevalence of AKI (acute kidney injury) in AP, and impact of AKI on inpatient mortality. METHODS We queried the Nationwide Inpatient Sample database from 2003 to 2012 to identify AP admissions using ICD-9-CM codes. After excluding patients with missing information on age, gender, and inpatient mortality, we used ICD-9-CM codes to identify complications of AP, specifically AKI. We examined trends with survey-weighted multivariable regressions and analyzed predictors of AKI and inpatient mortality by multivariate logistic regression. Additionally, both AKI and non-AKI groups were propensity-matched and regressed against mortality. RESULTS A total of 3,466,493 patients (1.13% of all discharges) were hospitalized with AP, of which 7.9% had AKI. AP admissions increased (1.02%→1.26%) with rise in concomitant AKI cases (4.1%→11.7%) from year 2003-2012. Mortality rate decreased (1.8%→1.1%) in the AP patients with a substantial decline noted in AKI subgroup (17.4%→6.4%) during study period. Length of stay (LOS) and cost of hospitalization decreased (6.1→5.2 days and $13,654 to $10,895, respectively) in AKI subgroup. Complications such as AKI (OR: 6.08, p < 0.001), septic shock (OR: 46.52, p < 0.001), and acute respiratory failure (OR: 22.72, p < 0.001) were associated with higher mortality. AKI, after propensity matching, was linked to 3-fold increased mortality (propensity-matched OR: 3.20, P < 0.001). CONCLUSION Mortality, LOS, and cost of hospitalization in AP has decreased during the study period, although hospitalization and AKI prevalence has increased. AKI is independently associated with higher mortality.
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Affiliation(s)
- Kalpit Devani
- Division of Gastroenterology, Department of Internal Medicine, East Tennessee State University, Johnson City, TN, USA.
| | - Paris Charilaou
- Saint Peter's University Hospital/Rutgers, Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | - Dhruvil Radadiya
- Department of Internal Medicine, East Tennessee State University, Johnson City, TN, USA
| | | | - Mark Young
- Division of Gastroenterology, Department of Internal Medicine, East Tennessee State University, Johnson City, TN, USA
| | - Chakradhar Reddy
- Division of Gastroenterology, Department of Internal Medicine, East Tennessee State University, Johnson City, TN, USA
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32
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Gurusamy KS, Debray TPA, Rompianesi G. Prognostic models for predicting the severity and mortality in people with acute pancreatitis. Cochrane Database Syst Rev 2018; 2018:CD013026. [PMCID: PMC6494466 DOI: 10.1002/14651858.cd013026] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
This is a protocol for a Cochrane Review (Prognosis). The objectives are as follows: The primary objective is to synthesise available evidence from external validation studies evaluating the predictive accuracy of clinical scoring systems (measured on admission and up to 48 hours following admission) for severity and mortality within six months in people with acute pancreatitis. The secondary objective is to compare different risk thresholds of available scoring systems (i.e. the level at which the risk of severe acute pancreatitis or mortality is considered to be high) to predict severity and mortality within six months in people with acute pancreatitis. For both objectives, we will explore differences in patient populations, length of follow‐up, and study design as potential sources of between‐study heterogeneity.
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Affiliation(s)
- Kurinchi Selvan Gurusamy
- Royal Free Campus, UCL Medical SchoolDepartment of SurgeryRoyal Free HospitalRowland Hill StreetLondonUKNW3 2PF
| | - Thomas P A Debray
- Julius Center for Health Sciences and Primary CareCochrane NetherlandsPO Box 855003508 GA UtrechtUtrechtNetherlands
| | - Gianluca Rompianesi
- University of Modena and Reggio EmiliaInternational Doctorate School in Clinical and Experimental MedicineModenaItaly
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Zubia-Olaskoaga F, Maraví-Poma E, Urreta-Barallobre I, Ramírez-Puerta MR, Mourelo-Fariña M, Marcos-Neira MP, García-García MÁ. Development and validation of a multivariate prediction model for patients with acute pancreatitis in Intensive Care Medicine. Pancreatology 2018; 18:161-167. [PMID: 29395619 DOI: 10.1016/j.pan.2018.01.008] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2017] [Revised: 12/14/2017] [Accepted: 01/22/2018] [Indexed: 12/11/2022]
Abstract
BACKGROUND/OBJECTIVES Development and validation of a multivariate prediction model for patients with acute pancreatitis (AP) admitted in Intensive Care Units (ICU). METHODS A prospective multicenter observational study, in 1 year period, in 46 international ICUs (EPAMI study). PATIENTS adults admitted to an ICU with AP and at least one organ failure. INTERVENTIONS Development of a multivariate prediction model, using the worst data of the stay in ICU, based in multivariate analysis, simple imputation in a development cohort. The model was validated in another cohort. RESULTS 374 patients were included (mortality of 28.9%). Variables with statistical significance in multivariate analysis were age, no alcoholic and no biliary etiology, development of shock, development of respiratory failure, need of continuous renal replacement therapy, and intra-abdominal pressure. The model created with these variables presented an AUC of ROC curve of 0.90 (CI 95% 0.81-0.94) in the validation cohort. We developed a multivariable prediction model, and AP cases could be classified as low mortality risk (between 2 and 9.5 points, mortality of 1.35%), moderate mortality risk (between 10 and 12.5 points, 28.92% of mortality), and high mortality risk (13 points of more, mortality of 88.37%). Our model presented better AUC of ROC curve than APACHE II (0.91 vs 0.80) and SOFA in the first 24 h (0.91 vs 0.79). CONCLUSIONS We developed and validated a multivariate prediction model, which can be applied in any moment of the stay in ICU, with better discriminatory power than APACHE II and SOFA in the first 24 h.
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Affiliation(s)
- Felix Zubia-Olaskoaga
- Intensive Care Unit, Donostia University Hospital, Department of Medicine, Euskal Herriko Unibertsitatea- University of the Basque Country, Donostia-San Sebastian, Spain.
| | - Enrique Maraví-Poma
- Emeritus Intensive Care - B, Complejo Hospitalario de Navarra, Medical Talent Sports Program, University of Navarra, Pamplona, Spain
| | - Iratxe Urreta-Barallobre
- Clinical Epidemiology Unit, CASPe, CIBER-ESP, IIS BioDonostia, Donostia University Hospital, Donostia-San Sebastian, Spain
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Lu XG, Kang X, Zhan LB, Kang LM, Fan ZW, Bai LZ. Circulating miRNAs as biomarkers for severe acute pancreatitis associated with acute lung injury. World J Gastroenterol 2017; 23:7440-7449. [PMID: 29151698 PMCID: PMC5685850 DOI: 10.3748/wjg.v23.i41.7440] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2017] [Revised: 08/23/2017] [Accepted: 09/19/2017] [Indexed: 02/06/2023] Open
Abstract
AIM To identify circulating micro (mi)RNAs as biological markers for prediction of severe acute pancreatitis (SAP) with acute lung injury (ALI).
METHODS Twenty-four serum samples were respectively collected and classified as SAP associated with ALI and SAP without ALI, and the miRNA expression profiles were determined by microarray analysis. These miRNAs were validated by quantitative reverse transcription-polymerase chain reaction, and their putative targets were predicted by the online software TargetScan, miRanda and PicTar database. Gene ontology (GO) and Kyoto encyclopedia of genes and genomes (commonly known as KEGG) were used to predict their possible functions and pathways involved.
RESULTS We investigated 287 miRNAs based on microarray data analysis. Twelve miRNAs were differentially expressed in the patients with SAP with ALI and those with SAP without ALI. Hsa-miR-1260b, 762, 22-3p, 23b and 23a were differently up-regulated and hsa-miR-550a*, 324-5p, 484, 331-3p, 140-3p, 342-3p and 150 were differently down-regulated in patients with SAP with ALI compared to those with SAP without ALI. In addition, 85 putative target genes of the significantly dysregulated miRNAs were found by TargetScan, miRanda and PicTar. Finally, GO and pathway network analysis showed that they were mainly enriched in signal transduction, metabolic processes, cytoplasm and cell membranes.
CONCLUSION This is the first study to identify 12 circulating miRNAs in patients with SAP with ALI, which may be biomarkers for prediction of ALI after SAP.
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Affiliation(s)
- Xiao-Guang Lu
- Department of Emergency, Zhongshan Hospital, Dalian University, Dalian 116001, Liaoning Province, China
| | - Xin Kang
- Department of Emergency, Zhongshan Hospital, Dalian University, Dalian 116001, Liaoning Province, China
| | - Li-Bin Zhan
- College of Basic Medicine, Nanjing University of Chinese Medicine, Nanjing 210000, Jiangsu Province, China
| | - Li-Min Kang
- Department of Hepatobiliary and Pancreatic Surgery, Puer People’s Hospital, Puer 665000, Yunnan Province, China
| | - Zhi-Wei Fan
- Department of Emergency, Zhongshan Hospital, Dalian University, Dalian 116001, Liaoning Province, China
| | - Li-Zhi Bai
- Department of Emergency, Zhongshan Hospital, Dalian University, Dalian 116001, Liaoning Province, China
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Cui J, Xiong J, Zhang Y, Peng T, Huang M, Lin Y, Guo Y, Wu H, Wang C. Serum lactate dehydrogenase is predictive of persistent organ failure in acute pancreatitis. J Crit Care 2017; 41:161-165. [PMID: 28554094 DOI: 10.1016/j.jcrc.2017.05.001] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2017] [Revised: 04/27/2017] [Accepted: 05/03/2017] [Indexed: 02/08/2023]
Abstract
PURPOSE Elevated serum lactate dehydrogenase (LDH) has been reported in a serious of clinical diseases. However, the relationship between LDH and the incidence of persistent organ failure (POF) in acute pancreatitis (AP) has not been characterized. MATERIALS AND METHODS A total of 105 patients with AP who presented within 72h from symptom onset between 2014 and 2015 were included in this retrospective study. Demographic parameters and laboratory data on admission were compared between patients with and without POF. Multivariable logistic regression analyses were utilized to evaluate the prognostic value of LDH for predicting POF. RESULTS 21 patients were diagnosed with POF. Compared to non-POF, patients with POF showed a significantly higher value of serum LDH on admission (741.57±331.72 vs. 296.08±135.73U/L, P<0.001). After multivariate logistic analysis, LDH remained an independent risk factor for POF (Hazard ratio 4.38, 95%CI: 1.42-13.47; P=0.010). A LDH value of 647U/L predicted POF with an area under the curve (AUC) of 0.876, a sensitivity with 76.2% and specificity with 98.8%, respectively. CONCLUSIONS Our results indicate that serum LDH on admission is independently associated with POF in AP and may serve as a potential prognostic factor.
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Affiliation(s)
- Jing Cui
- Department of Pancreatic Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China.
| | - Jiongxin Xiong
- Department of Pancreatic Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
| | - Yushun Zhang
- Department of Pancreatic Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China.
| | - Tao Peng
- Department of Pancreatic Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
| | - Min Huang
- Department of Pancreatic Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
| | - Yan Lin
- Department of Pancreatic Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
| | - Yao Guo
- Department of Pancreatic Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
| | - Heshui Wu
- Department of Pancreatic Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
| | - Chunyou Wang
- Department of Pancreatic Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
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36
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Li S, Zhang Y, Li M, Xie C, Wu H. Serum albumin, a good indicator of persistent organ failure in acute pancreatitis. BMC Gastroenterol 2017; 17:59. [PMID: 28446147 PMCID: PMC5406910 DOI: 10.1186/s12876-017-0615-8] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2016] [Accepted: 04/17/2017] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND To evaluate the predictive value of serum albumin (ALB) for persistent organ failure (POF) in acute pancreatitis (AP). METHODS We selected 158 patients with AP in this retrospective study from Jan.1st, 2015 to Dec.31st, 2015. Forty-six patients were diagnosed with POF. All the values of laboratory parameters were measured upon admission to hospital. And 48 h after admission, we examined serum albumin of each patient again, called 'ALB2'. Uni-and multi-variate logistic regression were used to evaluate the impact of ALB to predict POF. RESULTS The median age of the whole population was 48 years and 53.8% were male. The admission-time albumin of AP patients with POF was distinctly lower than patients without POF (28.9 (25.3-33.1) g/L vs. 38.5 (34.0-40.1) g/L, p < 0.001). In uni-variate analysis, WBC, PT, GLU, LDH, ALB, ALB2, BUN, Ca, HDL-C and Ranson were significantly associated with POF. After multivariate regression, ALB remained an independent prognostic factor for POF in AP (OR: 0.748, 95%CI: 0.645-0.868; p < 0.05). The AUC for ALB is 0.873 (0.808, 0.938), even larger than that for Ranson, 0.845 (0.634, 0.913). CONCLUSIONS We identified serum albumin predictive to persistent organ failure in acute pancreatitis.
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Affiliation(s)
- Shoukang Li
- Pancreatic Disease Institute, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 430022, Wuhan, Hubei Province, People's Republic of China
| | - Yushun Zhang
- Pancreatic Disease Institute, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 430022, Wuhan, Hubei Province, People's Republic of China
| | - Mengjiao Li
- Department of Endocrinology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 430022, Wuhan, Hubei Province, People's Republic of China
| | - Chao Xie
- Pancreatic Disease Institute, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 430022, Wuhan, Hubei Province, People's Republic of China
| | - Heshui Wu
- Pancreatic Disease Institute, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 430022, Wuhan, Hubei Province, People's Republic of China.
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Peng T, Peng X, Huang M, Cui J, Zhang Y, Wu H, Wang C. Serum calcium as an indicator of persistent organ failure in acute pancreatitis. Am J Emerg Med 2017; 35:978-982. [PMID: 28291705 DOI: 10.1016/j.ajem.2017.02.006] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2016] [Accepted: 02/03/2017] [Indexed: 02/06/2023] Open
Abstract
AIM Decreased level of serum calcium was commonly seen in critical illness. Hypocalcemia was significantly more frequent in patients with severe form of acute pancreatitis (AP), and a negative correlation was observed between endotoxemia and serum calcium in AP. AP patients with persistent organ failure (POF) show an extremely high mortality. The association underlying calcium and POF in AP has not been characterized. METHODS We conducted a retrospective cohort study of adult patients who presented within 72hours from symptom onset of AP at our center between January 2014 and May 2015. Demographic parameters on admission, organ failure assessment, laboratory data and in-hospital mortality were compared between patients with and without POF. Uni-and multi-variate logistic regression analyses were utilized to evaluated the predictive ability of serum calcium. RESULTS A total of 128 consecutive AP patients, including 29 with POF, were included. Compared to patients without POF, patients with POF showed a significantly lower value of serum calcium on admission (2.11±0.46 vs. 1.55±0.36mmol/L, P<0.001). After multivariate logistic analysis, serum calcium remained an independent risk factor for POF (Hazard ratio 0.21, 95% confident interval: 0.08-0.58; P=0.002). A calcium value of 1.97mmol/L predicted POF with an area under the curve (AUC) of 0.888, a sensitivity with 89.7% and specificity with 74.8%, respectively. CONCLUSION Our results indicate that serum calcium on admission is independently associated with POF in AP and may serve as a potential prognostic factor.
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Affiliation(s)
- Tao Peng
- Pancreatic Disease Institute, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, Hubei Province, People's Republic of China
| | - Xin Peng
- Cancer Center, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, Hubei Province, People's Republic of China
| | - Min Huang
- Pancreatic Disease Institute, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, Hubei Province, People's Republic of China
| | - Jing Cui
- Pancreatic Disease Institute, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, Hubei Province, People's Republic of China
| | - Yushun Zhang
- Pancreatic Disease Institute, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, Hubei Province, People's Republic of China.
| | - Heshui Wu
- Pancreatic Disease Institute, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, Hubei Province, People's Republic of China
| | - Chunyou Wang
- Pancreatic Disease Institute, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, Hubei Province, People's Republic of China
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Kamal A, Sinha A, Hutfless SM, Afghani E, Faghih M, Khashab MA, Lennon AM, Yadav D, Makary MA, Andersen DK, Kalloo AN, Singh VK. Hospital admission volume does not impact the in-hospital mortality of acute pancreatitis. HPB (Oxford) 2017; 19:21-28. [PMID: 27887788 DOI: 10.1016/j.hpb.2016.10.013] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2016] [Revised: 10/20/2016] [Accepted: 10/28/2016] [Indexed: 12/12/2022]
Abstract
BACKGROUND Multiple factors influence mortality in Acute Pancreatitis (AP). METHODS To evaluate the association of demographic, clinical, and hospital factors with the in-hospital mortality of AP using a population-based administrative database. The Maryland HSCRC database was queried for adult (≥18 years) admissions with primary diagnosis of AP between 1/94-12/10. Organ failure (OF), interventions, hospital characteristics and referral status were evaluated. RESULTS There were 72,601 AP admissions across 48 hospitals in Maryland with 885 (1.2%) deaths. A total of 1657 (2.3%) were transfer patients, of whom 101 (6.1%) died. Multisystem OF was present in 1078 (1.5%), of whom 306 (28.4%) died. On univariable analysis, age, male gender, transfer status, comorbidity, OF, all interventions, and all hospital characteristics were significantly associated with mortality; however, only age, transfer status, OF, interventions, and large hospital size were significant in the adjusted analysis. Patients with commercial health insurance had significantly less mortality than those with other forms of insurance (OR 0.65, 95% CI: 0.52, 0.82, p = 0.0002). CONCLUSION OF is the strongest predictor of mortality in AP after adjusting for demographic, clinical, and hospital characteristics. Admission to HV or teaching hospital has no survival benefit in AP after adjusting for OF and transfer status.
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Affiliation(s)
- Ayesha Kamal
- Division of Gastroenterology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Amitasha Sinha
- Division of Gastroenterology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Susan M Hutfless
- Division of Gastroenterology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Elham Afghani
- Center for Digestive Diseases, Cedars-Sinai Medical Center in Los Angeles, CA, USA
| | - Mahya Faghih
- Division of Gastroenterology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Mouen A Khashab
- Division of Gastroenterology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Anne Marie Lennon
- Division of Gastroenterology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Dhiraj Yadav
- Division of Gastroenterology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Martin A Makary
- Pancreatitis Center, Johns Hopkins University School of Medicine, Baltimore, MD, USA; Division of Surgical Oncology, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Dana K Andersen
- National Institutes of Digestive and Kidney Disease, National Institutes of Health, Bethesda, MD, USA
| | - Anthony N Kalloo
- Pancreatitis Center, Johns Hopkins University School of Medicine, Baltimore, MD, USA; Division of Gastroenterology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Vikesh K Singh
- Pancreatitis Center, Johns Hopkins University School of Medicine, Baltimore, MD, USA; Division of Gastroenterology, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
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Early differential diagnosis of the severity of acute pancreatitis. J Clin Monit Comput 2016; 31:1289-1297. [PMID: 27889842 DOI: 10.1007/s10877-016-9960-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2016] [Accepted: 11/14/2016] [Indexed: 01/21/2023]
Abstract
There is a great need for early verification of the severity of acute pancreatitis (AP). The early stage of pathogenesis of AP is characterized by endothelial dysfunction which could be determined by wavelet analysis of skin temperature (WAST) technique. The aim is to investigate whether the dysregulation of microvascular tone caused by endothelial dysfunction and detected by WAST can be a significant indicator in early differential diagnosis of AP severity. The WAST performed in the frequency range of 0.0095-0.02 Hz during the contralateral cold test. Forty nine patients with AP aged 19-65 participated in this study. The control group included 12 healthy volunteers aged 20-65. Dysregulation of vascular tone during the contralateral cold test was observed in all patients with AP. The basal amplitudes of skin temperature oscillations in patients with AP were much lower than in healthy volunteers and progressively decreased as the disease severity increased. In patients with mild and moderate AP only the vasodilator component is destroyed, but vasoconstriction still operates. In patients with severe AP both mechanisms of endothelial vascular tone regulation are destroyed. Patients with AP have abnormal microvascular reactions related to the endothelial mechanism of vascular tone regulation. Based on the initial values of amplitudes and the indices of vasoconstriction and postcold vasodilatation, the WAST method makes it possible to evaluate two related but different characteristics of the endothelial dysfunction in patients with AP on admission which can be a significant indicator in early differential diagnosis of AP severity.
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Efficacy of resistin and leptin in predicting persistent organ failure in patients with acute pancreatitis. Pancreatology 2016; 16:952-957. [PMID: 27654573 DOI: 10.1016/j.pan.2016.09.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2016] [Revised: 08/15/2016] [Accepted: 09/04/2016] [Indexed: 12/11/2022]
Abstract
BACKGROUND To investigate the accuracy of resistin, leptin and adiponectin levels in predicting persistent organ failure in patients with acute pancreatitis (AP). METHODS Data from 90 consecutive patients admitted to our hospital for AP were retrospectively collected from an ongoing prospective cohort study. The levels of adiponectin, leptin and resistin were measured and compared between patients with and without persistent organ failure. The accuracy of the adipokines in predicting persistent organ failure were compared with the patients' Acute Physiology and Chronic Health Evaluation II (APACHE-II) score, and were separately investigated in overweight and non-overweight groups. RESULTS Persistent organ failure occurred in 26.7% of the patients. The levels of resistin were significantly increased in AP patients with persistent organ failure, in both the overweight and the non-overweight subgroups. Resistin and APACHE-II score predicted persistent organ failure with comparable areas under the curve (AUC) of 0.72 and 0.75, respectively (p = 0.66). Resistin demonstrated similar accuracy with the APACHE-II score in predicting persistent organ failure in the overweight (0.69 vs. 0.66, p = 0.82) and non-overweight (0.76 vs. 0.87, p = 0.39) subgroups. There was no correlation between adiponectin and persistent organ failure, but a weak correlation between leptin and persistent organ failure was demonstrated. CONCLUSIONS Resistin and leptin levels, rather than adiponectin, correlate with persistent organ failure in patients with AP.
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Abstract
OBJECTIVES Severe acute pancreatitis (AP) is characterized by early microcirculation defects causing hypercoagulability. The purpose of this study was to evaluate the early predictive value of D-dimers in complicated AP. METHODS This was a prospective single-center study conducted between September 2010 and April 2012. All patients had AP for less than 48 hours duration at admission. The plasma D-dimer level was determined at admission and every 12 hours over 3 days and compared to other validated severity criteria. RESULTS Of 71 patients admitted with AP, 36 (53.1%) developed complicated AP. A threshold D-dimer level greater than 1474 ng/mL at 48 hours after pain onset was predictive of complications with an area under the curve (AUC) of 0.76. Combining D-dimers and C-reactive protein levels at 48 hours increased the prediction of complications (AUC of 0.83). At 36 hours, D-dimers greater than 1474 ng/mL predicted the occurrence of complications with an AUC of 0.75. CONCLUSIONS D-Dimer levels were predictive of complications of AP as early as 36 hours after the onset of pain. This simple and reproducible marker might be useful in clinical practice to improve the early management of complicated AP.
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Werge M, Novovic S, Schmidt PN, Gluud LL. Infection increases mortality in necrotizing pancreatitis: A systematic review and meta-analysis. Pancreatology 2016; 16:698-707. [PMID: 27449605 DOI: 10.1016/j.pan.2016.07.004] [Citation(s) in RCA: 130] [Impact Index Per Article: 14.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2016] [Revised: 06/07/2016] [Accepted: 07/06/2016] [Indexed: 02/09/2023]
Abstract
OBJECTIVES To assess the influence of infection on mortality in necrotizing pancreatitis. METHODS Eligible prospective and retrospective studies were identified through manual and electronic searches (August 2015). The risk of bias was assessed using the Newcastle-Ottawa Scale (NOS). Meta-analyses were performed with subgroup, sensitivity, and meta-regression analyses to evaluate sources of heterogeneity. RESULTS We included 71 studies (n = 6970 patients). Thirty-seven (52%) studies used a prospective design and 25 scored ≥5 points on the NOS suggesting a low risk of bias. Forty studies were descriptive and 31 studies evaluated invasive interventions. In total, 801 of 2842 patients (28%) with infected necroses and 537 of 4128 patients (13%) with sterile necroses died with an odds ratio [OR] of 2.57 (95% confidence interval [CI], 2.00-3.31) based on all studies and 2.02 (95%CI, 1.61-2.53) in the studies with the lowest bias risk. The OR for prospective studies was 2.96 (95%CI, 2.51-3.50). In sensitivity analyses excluding studies evaluating invasive interventions, the OR was 3.30 (95%CI, 2.81-3.88). Patients with infected necrosis and organ failure had a mortality of 35.2% while concomitant sterile necrosis and organ failure was associated with a mortality of 19.8%. If the patients had infected necrosis without organ failure the mortality was 1.4%. CONCLUSIONS Patients with necrotizing pancreatitis are more than twice as likely to die if the necrosis becomes infected. Both organ failure and infected necrosis increase mortality in necrotizing pancreatitis.
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Affiliation(s)
- Mikkel Werge
- Department of Gastroenterology and Gastrointestinal Surgery, Copenhagen University Hospital Hvidovre, Denmark
| | - Srdan Novovic
- Department of Gastroenterology and Gastrointestinal Surgery, Copenhagen University Hospital Hvidovre, Denmark
| | - Palle N Schmidt
- Department of Gastroenterology and Gastrointestinal Surgery, Copenhagen University Hospital Hvidovre, Denmark
| | - Lise L Gluud
- Department of Gastroenterology and Gastrointestinal Surgery, Copenhagen University Hospital Hvidovre, Denmark.
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Xu XD, Wang ZY, Zhang LY, Ni R, Wei FX, Han W, Zhang HH, Zhang YW, Wei ZG, Guo XH, Guo LQ, Ma JZ, Zhang YC. Acute Pancreatitis Classifications: Basis and Key Goals. Medicine (Baltimore) 2015; 94:e2182. [PMID: 26632905 PMCID: PMC4674208 DOI: 10.1097/md.0000000000002182] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
To explore the efficacy of the revised Atlanta classification (RACAP) and the determinant-based classification of acute pancreatitis severity (DBCAPS) on the basis of clinical data and feedback from patients with acute pancreatitis (AP). The authors retrospectively investigated a total of 573 patients with AP admitted to our hospital between December 2011 and December 2014. The definitions of severity and local complications in AP using RACAP and DBCAPS are presented and common points and mutual differences between the 2 groups are analyzed and discussed. Classification according to RACAP and DBCAPS found 86 (15%) and 178 (31.1%) mild cases (P < 0.01), 269 (46.9%) and 176 (30.7%) moderate cases (P < 0.01), and 218 (38.0%) and 219 (38.2%) severe cases (P = 0.95), respectively. A major contribution of DBCAPS is the introduction of a new type of severe AP, critical AP, identified in 4 patients (0.7%). Complications were observed in 313 RACAP-defined cases and 153 DBCAPS-defined cases (P < 0.01). Among the 313 RACAP-defined cases, acute peripancreatic fluid collection (236 patients, 75.40%), pancreatic pseudocysts (20 patients, 6.4%), acute necrotic collection (42 patients, 13.4%), and walled-off necrosis (15 patients, 4.8%) were observed. Among the 153 DBCAPS-defined cases, sterile peripancreatic necrosis (105 patients, 68.6%), sterile pancreatic necrosis (44 patients, 28.8%), infected peripancreatic necrosis (2 patients, 1.3%), and infected pancreatic necrosis (2/153 patients, 1.3%) were observed. Both classifications adopted organ failure and complications as determinants of severity. Revised Atlanta classification refined local complications and DBCAPS modified severity to include critical AP. In accordance with the demands of precision medicine, a combination of the 2 could be important for further clinical practice and scientific research.
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Affiliation(s)
- Xiao Dong Xu
- From the Department of General Surgery (XDX, ZYW, RN, FXW, WH, HHZ, YWZ, ZGW, XHG, LQG, JZM, YCZ), Hepato-Biliary-Pancreatic Institute (XDX, ZYW, RN, FXW, WH, HHZ, YWZ, ZGW, XHG, LQG, JZM, YCZ), Department of Hepatology, Lanzhou University Second Hospital, Lanzhou, China (LYZ)
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Clinical outcomes of combined necrotizing pancreatitis versus extrapancreatic necrosis alone. Pancreatology 2015; 16:57-65. [PMID: 26626203 DOI: 10.1016/j.pan.2015.10.010] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2015] [Revised: 10/25/2015] [Accepted: 10/28/2015] [Indexed: 12/11/2022]
Abstract
INTRODUCTION Extrapancreatic necrosis (EPN) alone, i.e., in the absence of pancreatic parenchyma necrosis has gradually come to be regarded as a separate entity of acute necrotizing pancreatitis (ANP). However, data regarding the prognostic significance of EPN are quite limited, and the outcomes of interventions for patients with EPN alone are not well elucidated. The aim of this study was to explore the differences in the outcomes of patients with EPN alone and patients with both the pancreatic parenchyma and extrapancreatic necrosis (combined necrosis). METHODS From January 2009 to December 2013, a total of 334 patients with ANP who had received interventions in the West China Hospital in China were included. Based on the extent of necrosis as assessed with contrast-enhanced CT, the patients were divided into Group 1 (n = 285) in which the necrosis involved both the pancreatic parenchyma and extrapancreatic tissues (combined necrosis) and Group 2 (n = 49) in which the necrosis involved only the extrapancreatic tissues. Additionally, Group 3 included 443 patients with interstitial pancreatitis who were also included in the analyses. The demographic characteristics, support treatment information, organ failure information, infection necrosis, persistent systemic inflammatory response syndrome (SIRS) in the first week of onset, CT severity index, and intervention types, as well as the postoperative stay lengths, ICU utility, and complications were collected and compared. RESULTS Compared with the patients in Group 1, the patients in Group 2 suffered less persistent SIRS in the first week of onset (12/24.5% vs. 145/50.9%; P < 0.05), less persistent organ failure (6/12.2% vs. 95/33.3%; P < 0.05), less persistent multiple organ failure (3/6.1% vs. 67/23.5%; P < 0.05), and less bacteremia (5/10.2% vs. 107/37.5%; P < 0.001). The intervention types were significantly different between the two groups (P < 0.001); initial open necrosectomy was performed in 174/61.6% and 8/16.3% of the patients in Groups 1 and 2, respectively, and initial percutaneous catheter drainage (PCD) was performed in 73/25.6% and 29/59.2% of the patients in the two respective groups. Second open necrosectomies following PCD were required in 61/83.5% and 9/31.0% of the patients in Groups 1 and 2, respectively (P < 0.001). A greater number of patients in Group 1 were diagnosed with infected necrosis (204/71.6% vs. 10/20.4%; P < 0.001) and had to be sent to the ICU for further postoperative care (221/77.5% vs. 23/46.9%; P < 0.001). The postoperative stay was longer for Group 1 (median: 43.0 vs. 26.5 days; P < 0.001). Residual necrotic tissue or abscess was the most common postoperative complication in both groups. The mortality was higher in Group 1 (52/18.2% vs. 1/2.1%; P < 0.05). Compared with the patients in Group 2, the patients with interstitial pancreatitis exhibited milder courses and better outcomes. Subgroup comparisons with Group 1 indicated that early multiple organ failure was significantly associated with higher mortality. CONCLUSION The patients with EPN alone exhibited significantly better prognoses than those with combined necrosis, and EPN alone should be regarded as a separate group of acute necrotizing pancreatitis. Open necrosectomy can be avoided in the majority of patients with EPN alone, who receive PCD as the initial first intervention.
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Affiliation(s)
- Ayesha Kamal
- Division of Gastroenterology, Department of Medicine, *,Department of Gastroenterology, Johns Hopkins Hospital, 600 N Wolfe St, Blalock 406, Baltimore MD 21287 †
| | - Vikesh K Singh
- Division of Gastroenterology, Department of Medicine, *,Pancreatitis Center, ‡ and
| | - Atif Zaheer
- Pancreatitis Center, ‡ and.,Russell H. Morgan Department of Radiology and Radiological Science, § Johns Hopkins Medical Institutions, Baltimore, Md
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Guo Q, Li M, Chen Y, Hu W. Determinant-based classification and revision of the Atlanta classification, which one should we choose to categorize acute pancreatitis? Pancreatology 2015; 15:331-6. [PMID: 26045244 DOI: 10.1016/j.pan.2015.05.467] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2015] [Revised: 05/05/2015] [Accepted: 05/18/2015] [Indexed: 12/11/2022]
Abstract
BACKGROUND Two new systems of acute pancreatitis (AP) severity classification, namely, the determinant-based classification (DBC) and the revision of the Atlanta classification (RAC), were recently published. Information is lacking on the differences between the two systems. METHODS We analyzed data from adult patients with AP (973 episodes), admitted to West China Hospital from July 2012 through March 2013. We validated and compared the DBC and RAC systems by investigating the discordances between the RAC and DBC. RESULTS Using the RAC system, 66%, 27%, and 7% of the patients were categorized as mild, moderately severe, and severe, respectively. Using the DBC system, 83%, 7%, 7%, and 2% patients were determined to have mild, moderate, severe, and critical AP, respectively. The mortality and ICU admission rates were similar between the subgroups of the severe category under the RAC system. The severe and critical categories had similar mortality rates [35% (7/20) vs. 29% (20/70), P = 0.59] based on DBC. A subgroup of severe category of DBC (IPN and no persistent OF) had significantly lower mortality rate than the other two subgroups of severe category of DBC (SPN and persistent OF; persistent OF and no PN) [0% (0/18) vs. 29% (10/34) vs. 56% (10/18), P < 0.05]. CONCLUSION Some subgroups of severe categories under the DBC system did not accurately reflected clinical outcomes. RAC seemed to be a better choice to guide the selection of patient populations for clinical research and provide a more accurate description of AP classification in the clinical setting than DBC.
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Affiliation(s)
- Qiang Guo
- Pancreatic Surgery, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan Province, China
| | - Mao Li
- Pancreatic Surgery, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan Province, China
| | - Yang Chen
- Pancreatic Surgery, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan Province, China
| | - Weiming Hu
- Pancreatic Surgery, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan Province, China.
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Guo Q, Li A, Xia Q, Hu W. Late infection of pancreatic necrosis: A separate entity in necrotizing pancreatitis with low mortality. Pancreatology 2015; 15:360-5. [PMID: 26028333 DOI: 10.1016/j.pan.2015.05.459] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2014] [Revised: 05/05/2015] [Accepted: 05/07/2015] [Indexed: 02/05/2023]
Abstract
BACKGROUND Several studies have examined on the timing of the onset of infected necrosis and organ failure. The duration of these two complications and the effects of different durations of these two complications have not been mentioned. Our aim was to investigate the durations of these two complications and the corresponding effects of the different durations. METHODS A post-hoc analysis was performed on a prospective database containing 578 patients with necrotizing pancreatitis. The patients who received intervention were divided into subgroups based on different durations of the two complications, and the outcomes were compared. RESULTS The mortality rate in patients with late infection (occurred after 30 days) was lower than in the early (infection occurred within 30 days) group (3% vs. 22%, P < 0.05). The mortality rate in patients with long duration (>7 days) of infection before intervention was similar with those patients with short duration (≤7 days) of infection (6/27 vs. 11/74; P = 0.38). The mortality rate in patients with long duration (>7 days) of organ failure before intervention was higher than in patients with short duration (≤7 days) of organ failure (31/99 vs. 18/184; P < 0.001). CONCLUSION Patients with late developed infection of pancreatic necrosis showed significantly better prognosis than patients with early infection. The duration of organ failure before intervention was correlated with mortality of necrotizing pancreatitis.
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Affiliation(s)
- Qiang Guo
- Pancreatic Surgery, West China Hospital, Sichuan University, Chengdu, 610041 Sichuan Province, China
| | - Ang Li
- Pancreatic Surgery, West China Hospital, Sichuan University, Chengdu, 610041 Sichuan Province, China
| | - Qing Xia
- Department of Integrated Traditional Chinese and Western Medicine, West China Hospital, Sichuan University, Chengdu, 610041 Sichuan Province, China
| | - Weiming Hu
- Pancreatic Surgery, West China Hospital, Sichuan University, Chengdu, 610041 Sichuan Province, China.
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Yang Z, Zhang Y, Dong L, Yang C, Gou S, Yin T, Wu H, Wang C. The Reduction of Peripheral Blood CD4+ T Cell Indicates Persistent Organ Failure in Acute Pancreatitis. PLoS One 2015; 10:e0125529. [PMID: 25938229 PMCID: PMC4418709 DOI: 10.1371/journal.pone.0125529] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2014] [Accepted: 03/13/2015] [Indexed: 12/16/2022] Open
Abstract
OBJECTIVE Few data are available on the potential role of inflammatory mediators and T lymphocytes in persistent organ failure (POF) in acute pancreatitis (AP). We conducted a retrospective study to characterize their role in the progression of POF in AP. METHODS A total of 69 AP patients presented within 24 hours from symptom onset developing organ failure (OF) on admission were included in our study. There were 39 patients suffering from POF and 30 from transient OF (TOF). On the 1st, 3rd and 7th days after admission, blood samples were collected for biochemical concentration monitoring including serum IL-1β, IL-6, TNF-α and high-sensitivity C-reactive protein (hs-CRP). The proportions of peripheral CD4(+) and CD8(+) T lymphocytes were assessed based on flow cytometry simultaneously. RESULTS Patients with POF showed a significantly higher value of IL-1β and hs-CRP on day 7 compared with the group of TOF (P < 0.05). Proportions of CD4(+) T cells on days 1, 3, 7 and CD4(+)/ CD8(+) ratio on day 1 were statistically lower in the group of POF patients (P < 0.05). A CD4(+) T cell proportion of 30.34% on day 1 predicted POF with an area under the curve (AUC) of 0.798, a sensitivity with 61.54% and specificity with 90.00%, respectively. CONCLUSIONS The reduction of peripheral blood CD4(+) T lymphocytes is associated with POF in AP, and may act as a potential predictor.
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Affiliation(s)
- Zhiyong Yang
- Pancreatic Disease Institute, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, People’s Republic of China
| | - Yushun Zhang
- Pancreatic Disease Institute, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, People’s Republic of China
| | - Liming Dong
- Pancreatic Disease Institute, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, People’s Republic of China
| | - Chong Yang
- Pancreatic Disease Institute, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, People’s Republic of China
| | - Shanmiao Gou
- Pancreatic Disease Institute, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, People’s Republic of China
| | - Tao Yin
- Pancreatic Disease Institute, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, People’s Republic of China
| | - Heshui Wu
- Pancreatic Disease Institute, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, People’s Republic of China
| | - Chunyou Wang
- Pancreatic Disease Institute, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, People’s Republic of China
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Ke L, Tong ZH, Li WQ, Wu C, Li N, Windsor JA, Li JS, Petrov MS. Predictors of critical acute pancreatitis: a prospective cohort study. Medicine (Baltimore) 2014; 93:e108. [PMID: 25380082 PMCID: PMC4616279 DOI: 10.1097/md.0000000000000108] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Critical acute pancreatitis (CAP) has recently emerged as the most ominous severity category of acute pancreatitis (AP). As such there have been no studies specifically designed to evaluate predictors of CAP. In this study, we aimed to evaluate the accuracy of 4 parameters (Acute Physiology and Chronic Health Evaluation [APACHE] II score, C-reactive protein [CRP], D-dimer, and intra-abdominal pressure [IAP]) for predicting CAP early after hospital admission. During the study period, data on patients with AP were prospectively collected and D-dimer, CRP, and IAP levels were measured using standard methods at admission whereas the APACHE II score was calculated within 24 hours of hospital admission. The receiver-operating characteristic (ROC) curve analysis was applied and the likelihood ratios were calculated to evaluate the predictive accuracy. A total of 173 consecutive patients were included in the analysis and 47 (27%) of them developed CAP. The overall hospital mortality was 11% (19 of 173). APACHE II score ≥11 and IAP ≥13 mm Hg showed significantly better overall predictive accuracy than D-dimer and CRP (area under the ROC curve-0.94 and 0.92 vs. 0.815 and 0.667, correspondingly). The positive likelihood ratio of APACHE II score is excellent (9.9) but of IAP is moderate (4.2). The latter can be improved by adding CRP (5.8). In conclusion, of the parameters studied, APACHE II score and IAP are the best available predictors of CAP within 24 hours of hospital admission. Given that APACHE II score is rather cumbersome, the combination of IAP and CRP appears to be the most practical way to predict critical course of AP early after hospital admission.
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Affiliation(s)
- Lu Ke
- Department of General Surgery (LK, ZT, WL, CW, NL, JL), Jinling Hospital, Nanjing University School of Medicine, Nanjing, China; and Department of Surgery (JAW, MSP), University of Auckland, Auckland, New Zealand
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Guo Q, Li A, Xia Q, Lu H, Ke N, Du X, Zhang Z, Hu W. Timing of intervention in necrotizing pancreatitis. J Gastrointest Surg 2014; 18:1770-6. [PMID: 25091844 DOI: 10.1007/s11605-014-2606-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2014] [Accepted: 07/22/2014] [Indexed: 02/06/2023]
Abstract
BACKGROUND The best available evidence suggests that surgical intervention should be delayed where possible until four weeks after the onset of pancreatitis. Subgroups that may benefit from early or delayed intervention have not been identified. METHODS This study reviewed a prospective database with 223 patients of necrotizing pancreatitis who received intervention. A subgroup analysis was performed to compare the results of different surgical timing. RESULTS The median timing of intervention was 32 days. The mortality rates in the early (≤30 days) intervention and delayed intervention (>30 days) groups were 21% (28/136) and 10% (9/87), respectively (P = 0.04). In patients with persistent early organ failure, mortality and re-intervention rates were higher in the early group compared with the delayed group (23/61 vs. 3/21, P = 0.04; 17/61 vs. 2/21, P = 0.01). In patients without persistent early organ failure who underwent treatment, mortality rates, and re-intervention rates were similar between the early group and delayed group (5/75 vs. 6/66, P = 0.59; 7/75 vs. 3/66, P = 0.27). In patients with infected necrosis, mortality rate was similar with the early group and delayed group (17/77 vs. 7/57, P = 0.14). CONCLUSION Early intervention in patients without persistent organ failure showed similar outcomes with patients who received delayed intervention.
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Affiliation(s)
- Qiang Guo
- Pancreatic Surgery, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan Province, China
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