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Sargon K, Al-Sabea N, Elango A, Scarbrough B, Wong J, Ebrahim S. Atypical presentation of painless acute pancreatitis: A case report. World J Clin Cases 2025; 13:101008. [DOI: 10.12998/wjcc.v13.i17.101008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2024] [Revised: 10/28/2024] [Accepted: 01/21/2025] [Indexed: 02/18/2025] Open
Abstract
BACKGROUND Painless acute pancreatitis (PAP) is a slowly progressive disease that involves inflammation, scarring, and thickening of pancreatic cells, which can happen due to either alcohol, idiopathic, or genetic. Clinicians usually miss PAP due to lack of pain and additional symptoms of hypotension and fever can lead to an infectious work-up instead. In this case report, we discuss the importance of the rapid discovery of this condition to prevent devastating complications like diabetes, necrotizing pancreatitis, or even death.
CASE SUMMARY A 47-years old male with past medical history of hypotension and alcohol abuse presented for loss of consciousness. Patient was found with pinpoint pupils, hypoglycemia, and hypotensive. He received Narcan, dextrose, and IV fluids and became responsive. In the emergency department, the patient was hypotensive and the physical exam was only significant for diaphoresis. Patient denied abdominal or radiating pain. Labs significant for elevated lipase, metabolic acidosis, and hyponatremia with imaging positive for AP without chronic inflammation. Based on imaging, lipase and absence of pain, PAP was diagnosed. Patient had multiple episodes of hypoglycemia and remained hypotensive requiring pressor support and intubation. After intubation, he had pulseless electrical activity cardiac arrest. Return of spontaneous circulation achieved but the patient had worsening acidosis, acute kidney injury, liver injury, and bandemia. Empiric antibiotics started, dexamethasone, and maxed on five pressors and transferred to the medical intensive care unit for management of severe AP (SAP).
CONCLUSION This case report featured PAP without chronic inflammation which is an even rarer disease than PAP which progressed to SAP.
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Affiliation(s)
- Keon Sargon
- Department of Internal Medicine, Mount Sinai Hospital, Chicago, IL 60609, United States
| | - Nadeem Al-Sabea
- Department of Internal Medicine, Mount Sinai Hospital, Chicago, IL 60609, United States
| | - Arnold Elango
- Department of Internal Medicine, Mount Sinai Hospital, Chicago, IL 60609, United States
| | - Brent Scarbrough
- Department of Internal Medicine, Mount Sinai Hospital, Chicago, IL 60609, United States
| | - Jamesina Wong
- Department of Internal Medicine, Mount Sinai Hospital, Chicago, IL 60609, United States
| | - Simran Ebrahim
- Department of Internal Medicine, Mount Sinai Hospital, Chicago, IL 60609, United States
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Bouça-Machado T, Araújo Teixeira JP, Rebelo P, Barbosa E, Pedersen JB, Drewes AM, Olesen SS. Comparison of acute pancreatitis and acute on chronic pancreatitis: a retrospective cohort study. Eur J Gastroenterol Hepatol 2025; 37:433-438. [PMID: 39976002 DOI: 10.1097/meg.0000000000002928] [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] [Indexed: 02/21/2025]
Abstract
BACKGROUND Acute on chronic pancreatitis (ACP) shares a similar clinical presentation with acute pancreatitis (AP) and is often diagnosed and treated in the same way. However, these two conditions may have distinct clinical risk profiles and prognoses. There is currently limited evidence available regarding the specific characteristics of ACP. METHODS This retrospective cohort study included all adult patients admitted with a diagnosis of AP or ACP between 2017 and 2019 at two tertiary referral centers. The primary outcome was disease severity as defined by the Atlanta classification. Secondary outcomes included the presence of local and systemic complications, organ failure, ICU admission, and mortality. Differences in outcomes between ACP and AP were compared using multivariate logistic regression models, with results presented as odds ratios (ORs). RESULTS We included 1163 patients, 90% of whom had AP and 10% had ACP. ACP patients were predominantly male (81 vs. 46%; P < 0.001), whereas AP patients were older (mean age 62.6 vs. 56.5 years, P < 0.001). ACP patients had lower amylase and lipase levels ( P < 0.001). Multivariate analysis showed no difference in the risk of moderate or severe pancreatitis (OR, 1.15; 95% CI, 0.66-1.98; P = 0.615). ACP patients had a higher risk of local complications (predominantly pseudocysts) (OR, 1.71; 95% CI, 1.00-2.92; P = 0.049) and a lower risk of organ failure ( P = 0.019) and ICU admission ( P = 0.005). CONCLUSION Our study confirms previous observations that ACP has a more favorable in-hospital prognosis than AP and extends these findings to a modern European setting.
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Affiliation(s)
- Tiago Bouça-Machado
- Department of Surgery, São João University Hospital, Porto, Portugal
- Faculty of Medicine of the University of Porto
| | - João Paulo Araújo Teixeira
- Department of Surgery, São João University Hospital, Porto, Portugal
- Faculty of Medicine of the University of Porto
| | - Paula Rebelo
- Department of Surgery, São João University Hospital, Porto, Portugal
| | - Elisabete Barbosa
- Department of Surgery, São João University Hospital, Porto, Portugal
- Faculty of Medicine of the University of Porto
| | - Jan Bech Pedersen
- Department of Surgery, Aalborg University Hospital, Aalborg, Denmark
| | - Asbjørn Mohr Drewes
- Department of Gastroenterology and Hepatology, Mech-Sense & Centre for Pancreatic Diseases, Aalborg University Hospital, Aalborg, Denmark
| | - Søren Schou Olesen
- Department of Gastroenterology and Hepatology, Mech-Sense & Centre for Pancreatic Diseases, Aalborg University Hospital, Aalborg, Denmark
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Wang Y, Dai GF, Xiao WB, Shi JS, Lin BW, Lin JD, Xiao XJ. Effects of continuous venous-venous hemofiltration with or without hemoperfusion on patients with hypertriglyceride acute pancreatitis. Clin Res Hepatol Gastroenterol 2025; 49:102572. [PMID: 40107658 DOI: 10.1016/j.clinre.2025.102572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2025] [Revised: 02/18/2025] [Accepted: 03/15/2025] [Indexed: 03/22/2025]
Abstract
BACKGROUND The role of continuous venous-venous hemofiltration (CVVH) and combined CVVH with hemoperfusion (HP) in patients with acute pancreatitis (AP) is diverse. We hypothesized HP+CVVH, rather than CVVH alone, could have significant benefits in hypertriglyceridemia (HTG)-AP patients. METHODS This single-center retrospective study included 347 patients with hypertriglyceride (HTH) -AP treated from January 2020 to December 2023. We assessed the association of short- and long-term outcomes (including incidence of systemic and local complications, length of ICU and hospital stays, and costs) between the HP+CVVH and CVVH groups. A subgroup analysis was performed to explore the effects of heterogeneity upon the incidence of severe AP (SAP). RESULTS Among 86 included patients, 40 received HP+CVVH therapy, and 46 received CVVH. Subgroup analysis revealed a lower incidence of severe AP after HP+CVVH therapy in patients with high procalcitonin, C-reactive protein, and interleukin-6 levels (46.4 % vs. 80.0 %, p = 0.019; 33.3 % vs. 72.7 %, p = 0.010; 37.5 % vs. 79.2 %, respectively). A significantly decreased hospital length of stay (LOS) in the HP+CVVH group was observed (10.40 [8.63-12.17] vs. 15.48 [13.02-17.94] days, p = 0.001). Furthermore, HP+CVVH showed a tendency towards lower hospital costs than CVVH ($5128 [4312-5943] vs. $8168 [6416-9920], p = 0.001). No significant differences were observed in the incidence of systemic or local complications, recurrence rates, or quality of life. CONCLUSIONS The use of HP+CVVH yielded superior outcomes in terms of the incidence of SAP compared to that of CVVH, for HTG-AP patients with a high inflammatory burden.
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Affiliation(s)
- Ying Wang
- Department of Intensive Care Units, the First Affiliated Hospital, Fujian Medical University, Fuzhou 350005, China; Department of Intensive Care Units, National Regional Medical Center, Binhai Campus of the First Affiliated Hospital, Fujian Medical University, Fuzhou 350212, China
| | - Gao-Fan Dai
- Department of Intensive Care Units, the First Affiliated Hospital, Fujian Medical University, Fuzhou 350005, China; Department of Intensive Care Units, National Regional Medical Center, Binhai Campus of the First Affiliated Hospital, Fujian Medical University, Fuzhou 350212, China
| | - Wen-Biao Xiao
- Department of Intensive Care Units, the First Affiliated Hospital, Fujian Medical University, Fuzhou 350005, China; Department of Intensive Care Units, National Regional Medical Center, Binhai Campus of the First Affiliated Hospital, Fujian Medical University, Fuzhou 350212, China
| | - Jing-Shi Shi
- Department of Intensive Care Units, the First Affiliated Hospital, Fujian Medical University, Fuzhou 350005, China; Department of Intensive Care Units, National Regional Medical Center, Binhai Campus of the First Affiliated Hospital, Fujian Medical University, Fuzhou 350212, China
| | - Bing-Wen Lin
- Department of Intensive Care Units, the First Affiliated Hospital, Fujian Medical University, Fuzhou 350005, China; Department of Intensive Care Units, National Regional Medical Center, Binhai Campus of the First Affiliated Hospital, Fujian Medical University, Fuzhou 350212, China
| | - Jian-Dong Lin
- Department of Intensive Care Units, the First Affiliated Hospital, Fujian Medical University, Fuzhou 350005, China; Department of Intensive Care Units, National Regional Medical Center, Binhai Campus of the First Affiliated Hospital, Fujian Medical University, Fuzhou 350212, China.
| | - Xiong-Jian Xiao
- Department of Intensive Care Units, the First Affiliated Hospital, Fujian Medical University, Fuzhou 350005, China; Department of Intensive Care Units, National Regional Medical Center, Binhai Campus of the First Affiliated Hospital, Fujian Medical University, Fuzhou 350212, China.
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Sutar P, Pethe A, Kumar P, Tripathi D, Maity D. Hydrogel Innovations in Biosensing: A New Frontier for Pancreatitis Diagnostics. Bioengineering (Basel) 2025; 12:254. [PMID: 40150718 PMCID: PMC11939681 DOI: 10.3390/bioengineering12030254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2024] [Revised: 02/24/2025] [Accepted: 02/27/2025] [Indexed: 03/29/2025] Open
Abstract
Pancreatitis is a prominent and severe type of inflammatory disorder that has grabbed a lot of scientific and clinical interest to prevent its onset. It should be detected early to avoid the development of serious complications, which occur due to long-term damage to the pancreas. The accurate measurement of biomarkers that are released from the pancreas during inflammation is essential for the detection and early treatment of patients with severe acute and chronic pancreatitis, but this is sub-optimally performed in clinically relevant practices, mainly due to the complexity of the procedure and the cost of the treatment. Clinically available tests for the early detection of pancreatitis are often time-consuming. The early detection of pancreatitis also relates to disorders of the exocrine pancreas, such as cystic fibrosis in the hereditary form and cystic fibrosis-like syndrome in the acquired form of pancreatitis, which are genetic disorders with symptoms that can be correlated with the overexpression of specific markers such as creatinine in biological fluids like urine. In this review, we studied how to develop a minimally invasive system using hydrogel-based biosensors, which are highly absorbent and biocompatible polymers that can respond to specific stimuli such as enzymes, pH, temperature, or the presence of biomarkers. These biosensors are helpful for real-time health monitoring and medical diagnostics since they translate biological reactions into quantifiable data. This paper also sheds light on the possible use of Ayurvedic formulations along with hydrogels as a treatment strategy. These analytical devices can be used to enhance the early detection of severe pancreatitis in real time.
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Affiliation(s)
- Prerna Sutar
- School of Health Sciences and Technology, UPES, Bidholi Campus, Dehradun 248007, Uttarakhand, India
| | - Atharv Pethe
- School of Health Sciences and Technology, UPES, Bidholi Campus, Dehradun 248007, Uttarakhand, India
| | - Piyush Kumar
- School of Health Sciences and Technology, UPES, Bidholi Campus, Dehradun 248007, Uttarakhand, India
| | - Divya Tripathi
- School of Health Sciences and Technology, UPES, Bidholi Campus, Dehradun 248007, Uttarakhand, India
| | - Dipak Maity
- Integrated Nanosystems Development Institute, Indiana University Indianapolis, Indianapolis, IN 46202, USA
- Department of Chemistry and Chemical Biology, Indiana University Indianapolis, Indianapolis, IN 46202, USA
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Ergin AS, Uzdoğan A, Gültekin S, Turhan T, Akgül Ö. The utilization of serum thrombopoietin levels as an early biomarker in determining severe acute biliary pancreatitis. ULUS TRAVMA ACIL CER 2025; 31:214-220. [PMID: 40052310 PMCID: PMC11894239 DOI: 10.14744/tjtes.2024.23583] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2024] [Revised: 10/05/2024] [Accepted: 12/08/2024] [Indexed: 03/14/2025]
Abstract
BACKGROUND This study aimed to evaluate the efficacy of thrombopoietin (TPO), a growth factor and acute-phase reactant, as an early prognostic marker for predicting disease severity in patients with acute biliary pancreatitis. METHODS A total of 72 patients with acute pancreatitis admitted to the Ankara Numune Training and Research Hospital, General Surgery Department, were included in the study. The severity of acute pancreatitis was classified using the 2012 Revised Atlanta Classification, and blood samples were collected from each patient within the first six hours of hospitalization to measure TPO levels. TPO levels were then compared to C-reactive protein (CRP) levels and other prognostic scoring systems. RESULTS According to the Atlanta Classification, TPO levels were found to be statistically significant in distinguishing severe pancreatitis from moderate and mild cases. When evaluating the sensitivity and specificity ratios of serum TPO levels in predicting the severity of acute pancreatitis, a value of 81.61 pg/dL was identified, with a 86.6% sensitivity and 69% specificity. In our study, the accuracy of TPO levels in detecting severe pancreatitis was compared with other scoring systems. The Balthazar scoring system had the highest precision (area under the curve [AUC]: 0.905) in receiver operating characteristic (ROC) curve analysis for severe pancreatitis (95% confidence interval). Serum TPO levels were identified as the second strongest predictors of severe acute pancreatitis (AUC: 0.831). CONCLUSION These findings suggest that TPO is a valuable early marker and prognostic indicator for predicting disease severity in patients with acute biliary pancreatitis. However, further randomized studies with larger patient cohorts are still required.
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Affiliation(s)
- Ahmet Sencer Ergin
- Department of General Surgery, Bağcılar Training and Research Hospital, İstanbul-Türkiye
| | - Andaç Uzdoğan
- Biochemistry Clinic, Ankara Bilkent City Hospital, Ankara-Türkiye
| | - Serap Gültekin
- Anesthesiology Clinic, Marmaris State Hospital, Muğla-Türkiye
| | - Turan Turhan
- Biochemistry Clinic, Ankara Bilkent City Hospital, Ankara-Türkiye
| | - Özgür Akgül
- Department of General Surgery, Ankara Bilkent City Hospital, Ankara-Türkiye
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Liu PC, Teng KTY, Lin TL, Sung CH, Cheng TL, Chou CC. Assessment of point-of-care quantitative serum canine pancreatic lipase testing for diagnosing acute pancreatitis in dogs. Front Vet Sci 2025; 12:1421103. [PMID: 40012749 PMCID: PMC11860965 DOI: 10.3389/fvets.2025.1421103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2024] [Accepted: 01/21/2025] [Indexed: 02/28/2025] Open
Abstract
Introduction Current point-of-care testing for canine-specific pancreatic lipase (CPL) provides semi-quantitative measurements with binary results. Recently, a commercial point-of-care testing method (Vcheck CPL) that offers quantitative measurement of CPL has emerged. However, clinical studies on its value (or utility) are limited. Therefore, this study aimed to evaluate the clinical utility of this commercial point-of-care CPL in diagnosing dogs with suspected acute pancreatitis and to assess its correlation with a commercial semi-quantitative test and other clinicopathological variables. Methods A prospective observational study included 33 dogs with suspected acute pancreatitis and 20 clinically healthy dogs. Serum Vcheck CPL and SNAP ® cPL were tested, and clinical consensus scores were determined by 5 internists. Eleven dogs with suspected acute pancreatitis underwent follow-up testing during hospitalization. The intra-class correlation coefficient (ICC) was used for statistical analysis to assess the agreement between assays and the internists' consensus score. Results Dogs with suspected acute pancreatitis had significantly higher serum Vcheck CPL (median: 843 μg/L, range: 77-2001, p < 0.0001) than healthy control dogs (median: 94 μg/L, range: 49-294). By day 3 of hospitalization, serum Vcheck CPL had significantly decreased in dogs with suspected acute pancreatitis compared to day 1. The ICC score between the clinical consensus score, Vcheck CPL, and SNAP ® cPL was 0.75, indicating good agreement. Serum Vcheck CPL concentration was significantly correlated with serum concentrations of amylase, lipase, creatinine, ALP, and CRP. Discussion This study found good agreement between Vcheck CPL and SNAP ® cPL. This quantitative Vcheck CPL testing could serve as an adjunctive tool in diagnosing dogs with acute pancreatitis.
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Affiliation(s)
- Pin-Chen Liu
- Department of Veterinary Medicine, College of Veterinary Medicine, National Chung Hsing University, Taichung, Taiwan
- Veterinary Medical Teaching Hospital, College of Veterinary Medicine, National Chung Hsing University, Taichung, Taiwan
| | - Kendy Tzu-yun Teng
- Department of Veterinary Medicine, College of Veterinary Medicine, National Chung Hsing University, Taichung, Taiwan
- The iEGG and Animal Biotechnology Research Center, National Chung Hsing University, Taichung, Taiwan
| | - Tsia-Lu Lin
- Department of Veterinary Medicine, College of Veterinary Medicine, National Chung Hsing University, Taichung, Taiwan
| | - Chi-Hsuan Sung
- Department of Veterinary Medicine, College of Veterinary Medicine, National Chung Hsing University, Taichung, Taiwan
| | - Tsun-Li Cheng
- Veterinary Medical Teaching Hospital, College of Veterinary Medicine, National Chung Hsing University, Taichung, Taiwan
| | - Chi-Chung Chou
- Department of Veterinary Medicine, College of Veterinary Medicine, National Chung Hsing University, Taichung, Taiwan
- Department and Graduate Institute of Pharmacology, National Defense Medical Center, Taipei, Taiwan
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Abramov R, Derkach E, Sokolovski B, Gilshtein H. Impact of obstructive jaundice on outcomes in acute biliary pancreatitis: a retrospective study. Eur J Trauma Emerg Surg 2025; 51:52. [PMID: 39856254 DOI: 10.1007/s00068-024-02695-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2024] [Accepted: 11/10/2024] [Indexed: 01/27/2025]
Abstract
OBJECTIVE To examine the effects of obstructive jaundice on the outcomes of patients with acute biliary pancreatitis. METHODS A retrospective chart review was conducted on 332 cases of acute biliary pancreatitis admitted to Rambam Health Care Campus, Israel, from January 1st, 2018, to December 31st, 2021. Patients were categorized based on the presence or absence of obstructive jaundice. Various clinical, laboratory, and radiological parameters were analyzed, including severity prediction scores, length of stay, interventions, and complications. RESULTS Obstructive jaundice was observed in 136 patients, while 196 patients had no jaundice. Initial predictive scores (Ranson and Glasgow-Imrie) indicated higher severity in the jaundiced group, but this difference did not translate into significant variations in the final outcomes. Endoscopic procedures and sonography were more frequently performed in jaundiced patients, affecting the diagnosis and management. Cholecystectomy was performed sooner in the jaundiced group, leading to fewer recurrent admissions. CONCLUSION The outcomes of jaundiced and non-jaundiced patients with acute biliary pancreatitis were found to be similar, despite initial predictions of worse outcomes in the jaundiced population. A lower threshold for initiation of rigorous treatment, including more frequent endoscopic procedures, administration of antibiotics and early surgical intervention may facilitate these results. Further studies with a larger sample size and long-term follow-up are warranted to validate these findings.
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Affiliation(s)
- Roi Abramov
- Department of General Surgery, Rambam Health Care Campus, HaAliya HaShniya 8, Haifa, Israel.
| | - Elena Derkach
- Department of General Surgery, Rambam Health Care Campus, HaAliya HaShniya 8, Haifa, Israel
| | - Boris Sokolovski
- Medical Imaging Division, Rambam Health Care Campus, Haifa, Israel
- The Department of Medical Imaging Sciences, University of Haifa, Haifa, Israel
| | - Hayim Gilshtein
- Department of General Surgery, Rambam Health Care Campus, HaAliya HaShniya 8, Haifa, Israel
- Colorectal Unit, Rambam Health Care Campus, Haifa, Israel
- Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
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Wu H, Liao B, Ji T, Huang J, Ma K, Luo Y. Diagnostic value of CRP for predicting the severity of acute pancreatitis: a systematic review and meta-analysis. Biomarkers 2024; 29:494-503. [PMID: 39417604 DOI: 10.1080/1354750x.2024.2415463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2024] [Accepted: 10/04/2024] [Indexed: 10/19/2024]
Abstract
BACKGROUND C-reactive protein (CRP) is a pentameric protein commonly used as a biomarker of inflammation or stress response which can be obtained during routine blood tests. Therefore, we conducted a systematic review and meta-analysis to explore its ability to predict the severity of acute pancreatitis (AP). This meta-analysis was registered in the PROSPERO system (registration number: CRD42022353769). METHODS 41 studies with 6156 cases of acute pancreatitis, retrieved from PubMed, Cochrane Library, Springer, and Embase databases, were incorporated. We calculated the pooled estimates for predicting the severity of acute pancreatitis based on CRP levels. We also calculated the combined negative likelihood ratio (NLR), combined positive likelihood ratio (PLR) and combined diagnostic odds ratio (DOR) using a bivariate mixed model. Sensitivity analysis was used to examine the robustness of the results. Factors associated with heterogeneity were identified by meta-regression analysis. A summary operating characteristic (SROC) curve was generated to assess the diagnostic value of CRP in predicting severe acute pancreatitis. Fagan's test was used to calculate likelihood ratios and post-test probabilities, and publication bias was gauged by asymmetry tests. RESULTS SROC analysis yielded an AUC of 0.85 (95%CI: 0.81-0.88) with a sensitivity of 0.76 (95%CI: 0.69-0.83) and specificity of 0.79 (95%CI: 0.74-0.83). The combined NLR, PLR and DOR were 0.30 (0.23-0.40), 3.66 (2.94-4.55) and 12.19 (8.05-18.44) respectively. Sensitivity analysis demonstrated the stability of our results after omitting any study. Finally, meta-regression analysis indicated that the description of the reference test, prospective design, blinding method and spectrum of the disease could account for heterogeneity in this meta-analysis. CONCLUSION CRP has significant value as a biomarker for assessing AP severity. Besides, other parameters such as patient history, physical signs, and imaging should be considered to determine disease severity.
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Affiliation(s)
- Hongsheng Wu
- Hepatobiliary Pancreatic Surgery Department, Huadu District People's Hospital of Guangzhou, Guangzhou, China
| | - Biling Liao
- Hepatobiliary Pancreatic Surgery Department, Huadu District People's Hospital of Guangzhou, Guangzhou, China
| | - Tengfei Ji
- Hepatobiliary Pancreatic Surgery Department, Huadu District People's Hospital of Guangzhou, Guangzhou, China
| | - Jianbin Huang
- Hepatobiliary Pancreatic Surgery Department, Huadu District People's Hospital of Guangzhou, Guangzhou, China
| | - Keqiang Ma
- Hepatobiliary Pancreatic Surgery Department, Huadu District People's Hospital of Guangzhou, Guangzhou, China
| | - Yumei Luo
- Hepatobiliary Pancreatic Surgery Department, Huadu District People's Hospital of Guangzhou, Guangzhou, China
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Zhang J, Weng X. Development of a Nomogram to Predict the Risk for Acute Necrotizing Pancreatitis. Gut Liver 2024; 18:915-923. [PMID: 38384201 PMCID: PMC11391142 DOI: 10.5009/gnl230403] [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: 10/04/2023] [Revised: 11/15/2023] [Accepted: 11/21/2023] [Indexed: 02/23/2024] Open
Abstract
Background/Aims Necrotizing pancreatitis (NP) presents a more severe clinical trajectory and increased mortality compared to edematous pancreatitis. Prompt identification of NP is vital for patient prognosis. A risk prediction model for NP among Chinese patients has been developed and validated to aid in early detection. Methods A retrospective analysis was performed on 218 patients with acute pancreatitis (AP) to examine the association of various clinical variables with NP. The least absolute shrinkage and selection operator (LASSO) regression was utilized to refine variables and select predictors. Subsequently, a multivariate logistic regression was employed to construct a predictive nomogram. The model's accuracy was validated using bootstrap resampling (n=500) and its calibration assessed via a calibration curve. The model's clinical utility was evaluated through decision curve analysis. Results Of the 28 potential predictors analyzed in 218 AP patients, the incidence of NP was 25.2%. LASSO regression identified 14 variables, with procalcitonin, triglyceride, white blood cell count at 48 hours post-admission, calcium at 48 hours post-admission, and hematocrit at 48 hours post-admission emerging as independent risk factors for NP. The resulting nomogram accurately predicted NP risk with an area under the curve of 0.822, sensitivity of 82.8%, and specificity of 76.4%. The bootstrap-validated area under the curve remained at 0.822 (95% confidence interval, 0.737 to 0.892). This model exhibited excellent calibration and demonstrated greater predictive efficacy and clinical utility for NP than APACHE II, Ranson, and BISAP. Conclusions We have developed a prediction nomogram of NP that is of great value in guiding clinical decision.
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Affiliation(s)
- Junchao Zhang
- Department of Gastroenterology, Xiamen Hospital of Traditional Chinese Medicine, Xiamen, China
| | - Xiaxia Weng
- Department of Gastroenterology, Xiamen Hospital of Traditional Chinese Medicine, Xiamen, China
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Mititelu A, Grama A, Colceriu MC, Benţa G, Popoviciu MS, Pop TL. Role of Interleukin 6 in Acute Pancreatitis: A Possible Marker for Disease Prognosis. Int J Mol Sci 2024; 25:8283. [PMID: 39125854 PMCID: PMC11311934 DOI: 10.3390/ijms25158283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2024] [Revised: 07/24/2024] [Accepted: 07/27/2024] [Indexed: 08/12/2024] Open
Abstract
Acute pancreatitis (AP) is a significant cause of morbidity, even in children, and is frequently associated with systemic manifestations. There are many cytokines involved in the inflammatory response characteristic of this disease. Interleukin 6 (IL-6) is one of the most important cytokines involved in AP, beginning from cellular injury and continuing to the systemic inflammatory response and distant organ involvement. IL-6 is a multifunctional cytokine that regulates acute-phase response and inflammation. It is produced by various cells and exerts its biological role on many cells through its high-affinity complex receptor. IL-6 has been investigated as a predicting maker for severe forms of AP. Many studies have validated the use of IL-6 serum levels in the first 48 h as a reliable marker for severe evolution and multisystemic involvement. Still, it has not been used in daily practice until now. This review discusses the main binding mechanisms by which IL-6 triggers cellular response and the AP pathogenetic mechanisms in which IL-6 is involved. We then emphasize the promising role of IL-6 as a prognostic marker, which could be added as a routine marker at admission in children with AP.
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Affiliation(s)
- Alexandra Mititelu
- 2nd Pediatric Discipline, Department of Mother and Child, Iuliu Hatieganu University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania; (A.M.); (M.-C.C.); (G.B.); (T.L.P.)
| | - Alina Grama
- 2nd Pediatric Discipline, Department of Mother and Child, Iuliu Hatieganu University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania; (A.M.); (M.-C.C.); (G.B.); (T.L.P.)
- 2nd Pediatric Clinic, Emergency Clinical Hospital for Children, 400177 Cluj-Napoca, Romania
| | - Marius-Cosmin Colceriu
- 2nd Pediatric Discipline, Department of Mother and Child, Iuliu Hatieganu University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania; (A.M.); (M.-C.C.); (G.B.); (T.L.P.)
| | - Gabriel Benţa
- 2nd Pediatric Discipline, Department of Mother and Child, Iuliu Hatieganu University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania; (A.M.); (M.-C.C.); (G.B.); (T.L.P.)
| | | | - Tudor Lucian Pop
- 2nd Pediatric Discipline, Department of Mother and Child, Iuliu Hatieganu University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania; (A.M.); (M.-C.C.); (G.B.); (T.L.P.)
- 2nd Pediatric Clinic, Emergency Clinical Hospital for Children, 400177 Cluj-Napoca, Romania
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11
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Ren W, Zou K, Huang S, Xu H, Zhang W, Shi X, Shi L, Zhong X, Peng Y, Tang X, Lü M. Prediction of in-hospital Mortality of Intensive Care Unit Patients with Acute Pancreatitis Based on an Explainable Machine Learning Algorithm. J Clin Gastroenterol 2024; 58:619-626. [PMID: 37712768 DOI: 10.1097/mcg.0000000000001910] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Accepted: 07/16/2023] [Indexed: 09/16/2023]
Abstract
BACKGROUND AND AIM Acute pancreatitis (AP) is potentially fatal. Therefore, early identification of patients at a high mortality risk and timely intervention are essential. This study aimed to establish an explainable machine-learning model for predicting in-hospital mortality of intensive care unit (ICU) patients with AP. METHODS Data on patients with AP, including demographics, vital signs, laboratory tests, comorbidities, treatment, complication, and severity scores, were extracted from the Medical Information Mart for Intensive Care IV (MIMIC-IV) and the eICU collaborative research database (eICU-CRD). Based on the data from MIMIC-IV, we used the least absolute shrinkage and selection operator algorithm to select variables and then established 9 machine-learning models and screened the optimal model. Data from the eICU-CRD were used for external validation. The area under the receiver operating characteristic curve (AUC), sensitivity, specificity, accuracy, decision curve, and calibration plots were used to assess the models' efficacy. Shapley's additive explanation values were used to explain the model. RESULTS Gaussian naive Bayes (GNB) model had the best performance on the data from MIMIC-IV, with an AUC, accuracy, sensitivity, and specificity of 0.840, 0.787, 0.839, and 0.792, respectively. The GNB model also performed well on the data from the eICU-CRD, with an AUC, accuracy, sensitivity, and specificity of 0.862, 0.833, 0.848, and 0.763, respectively. According to Shapley's additive explanation values, the top 4 predictive factors were maximum red cell distribution width, minimum saturation of blood oxygen, maximum blood urea nitrogen, and the Sequential Organ Failure Assessment score. CONCLUSION The GNB model demonstrated excellent performance and generalizability in predicting mortality in ICU patients with AP. Therefore, it can identify patients at a high mortality risk.
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Affiliation(s)
- Wensen Ren
- Department of Gastroenterology, the Affiliated Hospital of Southwest Medical University
- Nuclear Medicine and Molecular Imaging Key Laboratory of Sichuan Province, Luzhou
| | - Kang Zou
- Department of Gastroenterology, the Affiliated Hospital of Southwest Medical University
- Nuclear Medicine and Molecular Imaging Key Laboratory of Sichuan Province, Luzhou
| | - Shu Huang
- Department of Gastroenterology, Lianshui County People's Hospital
- Department of Gastroenterology, Lianshui People's Hospital of Kangda College Affiliated to Nanjing Medical University, Huaian, China
| | - Huan Xu
- Department of Gastroenterology, the Affiliated Hospital of Southwest Medical University
- Nuclear Medicine and Molecular Imaging Key Laboratory of Sichuan Province, Luzhou
| | - Wei Zhang
- Department of Gastroenterology, the Affiliated Hospital of Southwest Medical University
- Nuclear Medicine and Molecular Imaging Key Laboratory of Sichuan Province, Luzhou
| | - Xiaomin Shi
- Department of Gastroenterology, the Affiliated Hospital of Southwest Medical University
- Nuclear Medicine and Molecular Imaging Key Laboratory of Sichuan Province, Luzhou
| | - Lei Shi
- Department of Gastroenterology, the Affiliated Hospital of Southwest Medical University
- Nuclear Medicine and Molecular Imaging Key Laboratory of Sichuan Province, Luzhou
| | - Xiaolin Zhong
- Department of Gastroenterology, the Affiliated Hospital of Southwest Medical University
- Nuclear Medicine and Molecular Imaging Key Laboratory of Sichuan Province, Luzhou
| | - Yan Peng
- Department of Gastroenterology, the Affiliated Hospital of Southwest Medical University
- Nuclear Medicine and Molecular Imaging Key Laboratory of Sichuan Province, Luzhou
| | - Xiaowei Tang
- Department of Gastroenterology, the Affiliated Hospital of Southwest Medical University
- Nuclear Medicine and Molecular Imaging Key Laboratory of Sichuan Province, Luzhou
| | - Muhan Lü
- Department of Gastroenterology, the Affiliated Hospital of Southwest Medical University
- Nuclear Medicine and Molecular Imaging Key Laboratory of Sichuan Province, Luzhou
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12
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Mathai MJ, Reddy M VS, Shetty V. Analysis of the Accuracy of the Modified CT Severity Index in Predicting Clinical Outcomes in Acute Pancreatitis: A Cross-Sectional Study. Cureus 2024; 16:e56123. [PMID: 38618334 PMCID: PMC11015064 DOI: 10.7759/cureus.56123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/12/2024] [Indexed: 04/16/2024] Open
Abstract
OBJECTIVE To evaluate the accuracy of the modified CT severity index (MCTSI) in predicting the severity of acute pancreatitis and to prognosticate the clinical outcomes. METHODS AND MATERIALS The study was conducted at a tertiary health center between January 2021 and June 2023. A total of 150 consecutive patients with clinical/laboratory features suggestive of acute pancreatitis were included in the study and underwent a contrast-enhanced CT scan within 24 hours of admission. Based on their MCTSI score, these patients had conservative or surgical/endoscopic treatment. Clinical outcomes were assessed in terms of recovery, development of complications, or death. The receiver operating characteristic curve and descriptive statistics were computed to determine the sensitivity and specificity. The data were analyzed using SPSS version 16 software (SPSS Inc., Chicago, IL), and an attempt was made to evaluate the accuracy of MCTSI in predicting these clinical outcomes. RESULTS The mean age of patients in our study was 49.21 ± 11.02 years. Out of the 150 included patients, 103 were men and 47 were women. Compared to 11.68% of severe acute pancreatitis patients who died, 88.32% recovered. The area under the curve was determined as 0.865, based on which the MCTSI score predicted acute pancreatitis clinical outcome with 64% sensitivity and 92% specificity. The MCTSI demonstrated value in predicting clinical outcomes with a p-value of 0.043 ± 0.012 (p < 0.05) in the recovered patients while p = 0.032 ± 0.012 for patients who succumbed. The p-value for MCTSI in predicting complications was p = 0.0012 ± 0.0008 (p < 0.05). CONCLUSION Our study was able to demonstrate the high level of accuracy of the MCTSI score in predicting complications and clinical outcomes, especially in patients with severe acute pancreatitis. The MCTSI serves as a valuable asset in the preliminary evaluation of acute pancreatitis, thereby facilitating appropriate management.
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Affiliation(s)
- Mathew John Mathai
- Department of General Surgery, Dr. D. Y. Patil Medical College, Hospital & Research Centre, Dr. D. Y. Patil Vidyapeeth, Pune, IND
| | - Vijay Sai Reddy M
- Department of General Surgery, Dr. D. Y. Patil Medical College, Hospital & Research Centre, Dr. D. Y. Patil Vidyapeeth, Pune, IND
| | - Varun Shetty
- Department of General Surgery, Dr. D. Y. Patil Medical College, Hospital & Research Centre, Dr. D. Y. Patil Vidyapeeth, Pune, IND
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Kumar NR, Balraj TA, Kempegowda SN, Prashant A. Multidrug-Resistant Sepsis: A Critical Healthcare Challenge. Antibiotics (Basel) 2024; 13:46. [PMID: 38247605 PMCID: PMC10812490 DOI: 10.3390/antibiotics13010046] [Citation(s) in RCA: 17] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2023] [Revised: 12/25/2023] [Accepted: 12/28/2023] [Indexed: 01/23/2024] Open
Abstract
Sepsis globally accounts for an alarming annual toll of 48.9 million cases, resulting in 11 million deaths, and inflicts an economic burden of approximately USD 38 billion on the United States healthcare system. The rise of multidrug-resistant organisms (MDROs) has elevated the urgency surrounding the management of multidrug-resistant (MDR) sepsis, evolving into a critical global health concern. This review aims to provide a comprehensive overview of the current epidemiology of (MDR) sepsis and its associated healthcare challenges, particularly in critically ill hospitalized patients. Highlighted findings demonstrated the complex nature of (MDR) sepsis pathophysiology and the resulting immune responses, which significantly hinder sepsis treatment. Studies also revealed that aging, antibiotic overuse or abuse, inadequate empiric antibiotic therapy, and underlying comorbidities contribute significantly to recurrent sepsis, thereby leading to septic shock, multi-organ failure, and ultimately immune paralysis, which all contribute to high mortality rates among sepsis patients. Moreover, studies confirmed a correlation between elevated readmission rates and an increased risk of cognitive and organ dysfunction among sepsis patients, amplifying hospital-associated costs. To mitigate the impact of sepsis burden, researchers have directed their efforts towards innovative diagnostic methods like point-of-care testing (POCT) devices for rapid, accurate, and particularly bedside detection of sepsis; however, these methods are currently limited to detecting only a few resistance biomarkers, thus warranting further exploration. Numerous interventions have also been introduced to treat MDR sepsis, including combination therapy with antibiotics from two different classes and precision therapy, which involves personalized treatment strategies tailored to individual needs. Finally, addressing MDR-associated healthcare challenges at regional levels based on local pathogen resistance patterns emerges as a critical strategy for effective sepsis treatment and minimizing adverse effects.
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Affiliation(s)
- Nishitha R. Kumar
- Department of Biochemistry, JSS Medical College and Hospital, JSS Academy of Higher Education & Research, Mysuru 570004, India; (N.R.K.); (S.N.K.)
| | - Tejashree A. Balraj
- Department of Microbiology, JSS Medical College and Hospital, JSS Academy of Higher Education & Research, Mysuru 570004, India;
| | - Swetha N. Kempegowda
- Department of Biochemistry, JSS Medical College and Hospital, JSS Academy of Higher Education & Research, Mysuru 570004, India; (N.R.K.); (S.N.K.)
| | - Akila Prashant
- Department of Biochemistry, JSS Medical College and Hospital, JSS Academy of Higher Education & Research, Mysuru 570004, India; (N.R.K.); (S.N.K.)
- Department of Medical Genetics, JSS Medical College and Hospital, JSS Academy of Higher Education & Research, Mysuru 570004, India
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Pavalean MC, Ionita-Radu F, Jinga M, Costache RS, Balaban DV, Patrasescu M, Chirvase M, Maniu I, Gaman L, Bucurica S. Ferritin and Ferritin-to-Hemoglobin Ratio as Promising Prognostic Biomarkers of Severity in Acute Pancreatitis-A Cohort Study. Biomedicines 2024; 12:106. [PMID: 38255211 PMCID: PMC10813292 DOI: 10.3390/biomedicines12010106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Revised: 12/22/2023] [Accepted: 01/02/2024] [Indexed: 01/24/2024] Open
Abstract
BACKGROUND Acute pancreatitis is an inflammation of the pancreas with variable outcomes depending on its severity. Multiple systems of prediction have been proposed, each with variable specificity and sensitivity and with uneven clinical use. Ferritin is a versatile protein associated with various acute and chronic conditions. AIMS In our study, we aimed to assess the association of serum ferritin and the ferritin-to-hemoglobin ratio (FHR) with the severity of acute pancreatitis. METHODS A retrospective study was conducted in our hospital from January 2020 to September 2022 and included 116 patients with acute pancreatitis (graded according to the revised Atlanta classification). Serum ferritin and FHR were determined next to established laboratory parameters in the first 24 h following admission (hematological parameters, amylase, lipase, C-reactive protein, D-dimers, lactate dehydrogenase). We performed a receiver operating characteristic curve analysis for potential predictors. Also, we made correlations and conducted univariate and multivariate analyses for all potential severity biomarkers. RESULTS The median values of serum ferritin and FHR differed significantly between patients with severe acute pancreatitis and mild cases (serum ferritin: 352.40 vs. 197.35 ng/mL, p = 0.011; FHR: 23.73 vs. 13.74, p = 0.002) and between patients with organ failure and those without organ failure (serum ferritin: 613.45 vs. 279.65 ng/mL, p = 0.000; FHR: 48.12 vs. 18.64, p = 0.000). The medians of the serum ferritin and FHR levels were significantly higher in non-survivors compared with survivors (serum ferritin: 717.71 vs. 305.67 ng/mL, p = 0.013; FHR: 52.73 vs. 19.58, p = 0.016). Serum ferritin and FHR were good predictors for organ failure and mortality, next to D-dimers and procalcitonin (AUC > 0.753 for organ failure and AUC > 0.794 for mortality). In univariate regression analysis, serum ferritin and FHR were independent variables for moderate-severe forms of acute pancreatitis. Still, adjusting the multivariate analysis, only FHR remained a significant predictor. The cut-offs for serum ferritin and FHR for predicting organ failure were 437.81 ng/mL (sensitivity, 71%; specificity, 75%) and 45.63 (sensitivity, 61%; specificity, 88%), and those for mortality during hospitalization were 516 ng/mL (sensitivity, 83%; specificity, 74%) and 51.58 (sensitivity, 66%; specificity, 86%). CONCLUSIONS Serum ferritin and the ferritin-to-hemoglobin ratio stood out in this study as valuable and accessible predictors of disease severity in the early assessment of acute pancreatitis, next to established severity serum markers (CRP, fibrinogen, D-dimers).
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Affiliation(s)
- Mihaela Cristina Pavalean
- Department of Cellular, Molecular Biology and Histology, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania;
| | - Florentina Ionita-Radu
- Department of Internal Medicine and Gastroenterology, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania; (F.I.-R.); (M.J.); (R.S.C.); (D.V.B.); (M.P.)
- Department of Gastroenterology, “Dr. Carol Davila” Central Military University Emergency Hospital, 010825 Bucharest, Romania;
| | - Mariana Jinga
- Department of Internal Medicine and Gastroenterology, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania; (F.I.-R.); (M.J.); (R.S.C.); (D.V.B.); (M.P.)
- Department of Gastroenterology, “Dr. Carol Davila” Central Military University Emergency Hospital, 010825 Bucharest, Romania;
| | - Raluca Simona Costache
- Department of Internal Medicine and Gastroenterology, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania; (F.I.-R.); (M.J.); (R.S.C.); (D.V.B.); (M.P.)
- Department of Gastroenterology, “Dr. Carol Davila” Central Military University Emergency Hospital, 010825 Bucharest, Romania;
| | - Daniel Vasile Balaban
- Department of Internal Medicine and Gastroenterology, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania; (F.I.-R.); (M.J.); (R.S.C.); (D.V.B.); (M.P.)
- Department of Gastroenterology, “Dr. Carol Davila” Central Military University Emergency Hospital, 010825 Bucharest, Romania;
| | - Mihaita Patrasescu
- Department of Internal Medicine and Gastroenterology, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania; (F.I.-R.); (M.J.); (R.S.C.); (D.V.B.); (M.P.)
- Department of Gastroenterology, “Dr. Carol Davila” Central Military University Emergency Hospital, 010825 Bucharest, Romania;
| | - Mirela Chirvase
- Department of Gastroenterology, “Dr. Carol Davila” Central Military University Emergency Hospital, 010825 Bucharest, Romania;
- Department of Urology, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania
| | - Ionela Maniu
- Research Team, Pediatric Clinical Hospital Sibiu, 550166 Sibiu, Romania;
- Department of Mathematics and Informatics, Faculty of Sciences, Lucian Blaga University Sibiu, 550012 Sibiu, Romania
| | - Laura Gaman
- Department of Biochemistry, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania
| | - Sandica Bucurica
- Department of Internal Medicine and Gastroenterology, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania; (F.I.-R.); (M.J.); (R.S.C.); (D.V.B.); (M.P.)
- Department of Gastroenterology, “Dr. Carol Davila” Central Military University Emergency Hospital, 010825 Bucharest, Romania;
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Capurso G, Ponz de Leon Pisani R, Lauri G, Archibugi L, Hegyi P, Papachristou GI, Pandanaboyana S, Maisonneuve P, Arcidiacono PG, de‐Madaria E. Clinical usefulness of scoring systems to predict severe acute pancreatitis: A systematic review and meta-analysis with pre and post-test probability assessment. United European Gastroenterol J 2023; 11:825-836. [PMID: 37755341 PMCID: PMC10637128 DOI: 10.1002/ueg2.12464] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2023] [Accepted: 08/05/2023] [Indexed: 09/28/2023] Open
Abstract
BACKGROUND Scoring systems for severe acute pancreatitis (SAP) prediction should be used in conjunction with pre-test probability to establish post-test probability of SAP, but data of this kind are lacking. OBJECTIVE To investigate the predictive value of commonly employed scoring systems and their usefulness in modifying the pre-test probability of SAP. METHODS Following PRISMA statement and MOOSE checklists after PROSPERO registration, PubMed was searched from inception until September 2022. Retrospective, prospective, cross-sectional studies or clinical trials on patients with acute pancreatitis defined as Revised Atlanta Criteria, reporting rate of SAP and using at least one score among Bedside Index for Severity in Acute Pancreatitis (BISAP), Acute Physiology and Chronic Health Examination (APACHE)-II, RANSON, and Systemic Inflammatory Response Syndrome (SIRS) with their sensitivity and specificity were included. Random effects model meta-analyses were performed. Pre-test probability and likelihood ratio (LR) were combined to estimate post-test probability on Fagan nomograms. Pooled severity rate was used as pre-test probability of SAP and pooled sensitivity and specificity to calculate LR and generate post-test probability. A priori hypotheses for heterogeneity were developed and sensitivity analyses planned. RESULTS 43 studies yielding 14,116 acute pancreatitis patients were included: 42 with BISAP, 30 with APACHE-II, 27 with Ranson, 8 with SIRS. Pooled pre-test probability of SAP ranged 16.6%-25.3%. The post-test probability of SAP with positive/negative score was 47%/6% for BISAP, 43%/5% for APACHE-II, 48%/5% for Ranson, 40%/12% for SIRS. In 18 studies comparing BISAP, APACHE-II, and Ranson in 6740 patients with pooled pre-test probability of SAP of 18.7%, post-test probability when scores were positive was 48% for BISAP, 46% for APACHE-II, 50% for Ranson. When scores were negative, post-test probability dropped to 7% for BISAP, 6% for Ranson, 5% for APACHE-II. Quality, design, and country of origin of the studies did not explain the observed high heterogeneity. CONCLUSIONS The most commonly used scoring systems to predict SAP perform poorly and do not aid in decision-making.
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Affiliation(s)
- Gabriele Capurso
- Pancreato‐Biliary Endoscopy and Endosonography DivisionPancreas Translational & Clinical Research CenterSan Raffaele Scientific Institute IRCCSVita‐Salute San Raffaele UniversityMilanItaly
| | - Ruggero Ponz de Leon Pisani
- Pancreato‐Biliary Endoscopy and Endosonography DivisionPancreas Translational & Clinical Research CenterSan Raffaele Scientific Institute IRCCSVita‐Salute San Raffaele UniversityMilanItaly
| | - Gaetano Lauri
- Pancreato‐Biliary Endoscopy and Endosonography DivisionPancreas Translational & Clinical Research CenterSan Raffaele Scientific Institute IRCCSVita‐Salute San Raffaele UniversityMilanItaly
| | - Livia Archibugi
- Pancreato‐Biliary Endoscopy and Endosonography DivisionPancreas Translational & Clinical Research CenterSan Raffaele Scientific Institute IRCCSVita‐Salute San Raffaele UniversityMilanItaly
| | - Peter Hegyi
- Centre for Translational MedicineSemmelweis UniversityBudapestHungary
- Institute of Pancreatic DiseasesSemmelweis UniversityBudapestHungary
- Translational Pancreatology Research GroupInterdisciplinary Centre of Excellence for Research Development and Innovation University of SzegedSzegedHungary
| | - Georgios I. Papachristou
- Division of Gastroenterology, Hepatology, and NutritionThe Ohio State UniversityWexner Medical CenterColumbusOhioUSA
| | - Sanjay Pandanaboyana
- Department of Hepato‐Pancreato‐Biliary and Transplant SurgeryThe Freeman HospitalNewcastle upon TyneTyne and WearUK
- Population Health Sciences InstituteNewcastle UniversityNewcastleUK
| | - Patrick Maisonneuve
- Division of Epidemiology and BiostatisticsIEO European Institute of OncologyMilanItaly
| | - Paolo Giorgio Arcidiacono
- Pancreato‐Biliary Endoscopy and Endosonography DivisionPancreas Translational & Clinical Research CenterSan Raffaele Scientific Institute IRCCSVita‐Salute San Raffaele UniversityMilanItaly
| | - Enrique de‐Madaria
- Gastroenterology DepartmentDr. Balmis General University HospitalISABIALAlicanteSpain
- Department of Clinical MedicineMiguel Hernández UniversityElcheSpain
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16
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Barrera Gutierrez JC, Greenburg I, Shah J, Acharya P, Cui M, Vivian E, Sellers B, Kedia P, Tarnasky PR. Severe Acute Pancreatitis Prediction: A Model Derived From a Prospective Registry Cohort. Cureus 2023; 15:e46809. [PMID: 37954725 PMCID: PMC10636501 DOI: 10.7759/cureus.46809] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/10/2023] [Indexed: 11/14/2023] Open
Abstract
Background Severe acute pancreatitis (SAP) has a mortality rate as high as 40%. Early identification of SAP is required to appropriately triage and direct initial therapies. The purpose of this study was to develop a prognostic model that identifies patients at risk for developing SAP of patients managed according to a guideline-based standardized early medical management (EMM) protocol. Methods This single-center study included all patients diagnosed with acute pancreatitis (AP) and managed with the EMM protocol Methodist Acute Pancreatitis Protocol (MAPP) between April 2017 and September 2022. Classification and regression tree (CART®; Professional Extended Edition, version 8.0; Salford Systems, San Diego, CA), univariate, and logistic regression analyses were performed to develop a scoring system for AP severity prediction. The accuracy of the scoring system was measured by the area under the receiver operating characteristic curve. Results A total of 516 patients with mild (n=436) or moderately severe and severe (n=80) AP were analyzed. CART analysis identified the cutoff values: creatinine (CR) (1.15 mg/dL), white blood cells (WBC) (10.5 × 109/L), procalcitonin (PCT) (0.155 ng/mL), and systemic inflammatory response system (SIRS). The prediction model was built with a multivariable logistic regression analysis, which identified CR, WBC, PCT, and SIRS as the main predictors of severity. When CR and only one other predictor value (WBC, PCT, or SIRS) met thresholds, then the probability of predicting SAP was >30%. The probability of predicting SAP was 72% (95%CI: 0.59-0.82) if all four of the main predictors were greater than the cutoff values. Conclusions Baseline laboratory cutoff values were identified and a logistic regression-based prognostic model was developed to identify patients treated with a standardized EMM who were at risk for SAP.
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Affiliation(s)
| | - Ian Greenburg
- Gastroenterology Fellowship Program, Methodist Health System, Dallas, USA
| | - Jimmy Shah
- Methodist Digestive Institute, Methodist Health System, Dallas, USA
| | - Priyanka Acharya
- Clinical Research Institute, Methodist Health System, Dallas, USA
| | - Mingyang Cui
- Methodist Digestive Institute, Methodist Health System, Dallas, USA
| | - Elaina Vivian
- Performance Improvement, Methodist Health System, Dallas, USA
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Kim DH, Lukens FJ, Ko D, Kröner PT, Salazar M, Raimondo M, Palacios Argueta P. Modified Bedside Index for severity in acute pancreatitis (BISAP) score validation in the national inpatient sample database. Adv Med Sci 2023; 68:208-212. [PMID: 37329692 DOI: 10.1016/j.advms.2023.05.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Revised: 03/08/2023] [Accepted: 05/31/2023] [Indexed: 06/19/2023]
Abstract
PURPOSE The aim of this study was to build and validate modified score to be used in the healthcare cost and utilization project databases for further classification of acute pancreatitis (AP). MATERIALS AND METHODS The National Inpatient Sample database for the years 2016-2019 was queried for all primary adult discharge diagnoses of AP. An mBISAP score system was created utilizing the ICD-10CM codes for pleural effusion, encephalopathy, acute kidney injury, systemic inflammatory response, and age >60. Each was assigned a 1-point score. A multivariable regression analysis was built to test for mortality. Sensitivity and specificity analyses were performed for mortality. RESULTS A total of 1,160,869 primary discharges for AP were identified between 2016 and 2019. The pooled mortality rate was: 0.1%, 0.5%, 2.9%, 12.7%, 30.9% and 17.8% (P < 0.01), respectively for scores 0 to 5. Multivariable regression analysis showed increasing odds of mortality with each one-point increment: mBISAP score of 1 (adjusted odds ratio [aOR] 6.67; 95% confidence interval [CI] 4.69-9.48), score of 2 (aOR 37.87; 95% CI 26.05- 55.03), score of 3 (aOR 189.38; 95% CI 127.47-281.38), score of 4 (aOR 535.38; 95% CI 331.74-864.02), score of 5 (aOR 184.38; 95% CI 53.91-630.60). Using a cut-off of ≥3, sensitivity and specificity analyses reported 27.0% and 97.7%, respectively, with an area under the curve (AUC) of 0.811. CONCLUSION In this 4-year retrospective study of a US representative database, an mBISAP score was constructed showing increasing odds of mortality with each 1-point increase and a specificity of 97.7% for a cut-off of ≥3.
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Affiliation(s)
- Do Han Kim
- Universidad Francisco Marroquin, School of Medicine, Guatemala City, Guatemala
| | - Frank J Lukens
- Gastroenterology and Hepatology Department, Mayo Clinic Florida, Jacksonville, FL, USA
| | - Donghyun Ko
- Universidad Francisco Marroquin, School of Medicine, Guatemala City, Guatemala
| | - Paul T Kröner
- Department of Gastroenterology, Riverside Regional Medical Center, Newport News, VA, USA
| | - Miguel Salazar
- Gastroenterology and Hepatology Department, University of California Riverside, Riverside, CA, USA
| | - Massimo Raimondo
- Gastroenterology and Hepatology Department, Mayo Clinic Florida, Jacksonville, FL, USA
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18
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Dalal AD, Dalal YD, Rana DA. Modified computed tomography severity index in evaluation of acute pancreatitis and its correlation with clinical outcome: A prospective observational study from a tertiary care teaching hospital, India. Ann Afr Med 2023; 22:340-346. [PMID: 37417023 PMCID: PMC10445703 DOI: 10.4103/aam.aam_79_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Revised: 05/10/2022] [Accepted: 08/01/2022] [Indexed: 01/26/2023] Open
Abstract
Introduction Acute pancreatitis (AP) is one of the most common yet, the most complex and challenging abdominal emergencies encountered by clinicians globally. It runs an unpredictable course. One-fifth of all AP patients develop complications. Many prognostic predictive scoring systems are used for AP. The aim of our study was to evaluate the usefulness of modified computed tomography severity index (MCTSI) scores to predict the need for intensive care unit (ICU) stay, complications, and mortality in patients of AP. Methodology An observational, prospective study was conducted for 1 year. Fifty cases diagnosed as AP were included in this study. Contrast-enhanced computed tomography of the abdomen and pelvis was carried out in all patients. MCTSI was calculated according to CT findings. Patients' demographic details, clinical findings, duration of hospital stay, complications, and interventions were recorded. SPSS version 26.0 was used for statistical analysis. Results A. total of 50 patients were enrolled in the study. The mean age was 43.34 years. Total hospital stay was 9.02 ± 6.47 days, mean ward stay was 6.08 ± 2.73, and mean ICU stay was 2.94 ± 4.7 days. Five deaths were reported. There was a significant correlation between the necessity of ICU admission and grade of pancreatitis. There is significant correlation with age and ICU stay (r = 0.344, P = 0.014), age and ward stay (r = -0.340, P = 0.016), total duration of hospital stay and MCTSI score (r = 0.742, P = 0.000), duration of ward stay and MCTSI score (r = -0.442, P = 0.001), and strong correlation with duration of ICU stay and MCTSI score (r = 0.869, P = 0.000). A higher MCTSI score was significantly associated with the presence of local as well as systemic complications and with death (P = 0.0001). Conclusion Grading by modified CT severity index has a significant direct correlation with the necessity of ICU admission, duration of ICU stay, and total duration of hospital stay. A modified CT severity index can be used to predict the possibility of developing local and systemic complications as well as the need for interventions. Modified CTSI is a reliable predictor of clinical course and outcome in cases of acute pancreatitis.
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Affiliation(s)
- Archana D. Dalal
- Department of General Surgery, NHL Municipal Medical College, Ahmedabad, Gujarat, India
| | - Yagnya D. Dalal
- GCS Medical College, Hospital and Research Centre, Ahmedabad, Gujarat, India
| | - Devang A. Rana
- Department of Pharmacology, NHL Municipal Medical College, Ahmedabad, Gujarat, India
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Ak C, Kahraman R, Sayar S, Kilic ET, Adali G, Ozdil K. Prediction of Prognosis Acute Pancreatitis with Inflammatory Markers and Patient Characteristics Compared to the Scoring System: Real-Life Data. SISLI ETFAL HASTANESI TIP BULTENI 2023; 57:182-188. [PMID: 37899813 PMCID: PMC10600632 DOI: 10.14744/semb.2022.42966] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Revised: 12/11/2022] [Accepted: 12/26/2022] [Indexed: 10/31/2023]
Abstract
Objectives Acute pancreatitis (AP) is an inflammatory disease with a high morbidity and mortality rate. It is one of the most common causes of hospitalization among gastrointestinal system diseases. Inflammatory and other factors that predict the severity of AP are very important for patient management. This study will analyze the factors associated with the severity of AP. Methods The sample consisted of 514 patients. Demographic characteristics, comorbid diseases, causes of AP, body mass index (BMI), tobacco use, blood at admission, amylase, lipase, leukocyte, neutrophil, lymphocyte, C-reactive protein (CRP), mean platelet volume, red cell distribution width, albumin, calcium, and CRP values at 48th h were recorded. The bedside index of severity in AP (BISAP), Ranson score, neutrophil-lymphocyte ratio (NLR), and platelet-to-lymphocyte ratio (PLR) values was calculated and recorded. The relationship between these parameters and the severity of AP was analyzed according to the Atlanta classification. Results Participants had a mean age of 55±17.8 years. More than half the participants were women (n=272, 52.9%). Biliary causes were the most common etiological causes (n=299, 58.2%). Most participants had mild pancreatitis (n=416, 80.9%). The severity of AP was associated with tobacco use, high BMI, thrombocytosis, high NLR, high PLR, high 48th h CRP, hypoalbuminemia, hypocalcemia, aspartate aminotransferase/alanine aminotransferase ratio (AST/ALT ratio), and high Ranson and BISAP scores. Conclusion Biochemical markers that give rapid results in the early period can provide information about the severity of AP. We may develop new scores by combining these parameters.
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Affiliation(s)
- Cagatay Ak
- Department of Gastroenterology, Nigde Training and Research Hospital, Nigde, Türkiye
| | - Resul Kahraman
- Department of Gastroenterology, Health Sciences University, Umraniye Training and Research Hospital, Istanbul, Türkiye
| | - Suleyman Sayar
- Department of Gastroenterology, Health Sciences University, Umraniye Training and Research Hospital, Istanbul, Türkiye
| | - Ebru Tarikci Kilic
- Department of Anestesiology, Health Sciences University, Umraniye Training and Research Hospital, Istanbul, Türkiye
| | - Gupse Adali
- Department of Gastroenterology, Health Sciences University, Umraniye Training and Research Hospital, Istanbul, Türkiye
| | - Kamil Ozdil
- Department of Gastroenterology, Health Sciences University, Umraniye Training and Research Hospital, Istanbul, Türkiye
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20
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Stojanović M, Đurić M, Nenadić I, Dimić N, Bojić S, Stevanović P. Evaluation of Intra-Abdominal Hypertension Parameters in Patients with Acute Pancreatitis. Life (Basel) 2023; 13:1227. [PMID: 37374010 DOI: 10.3390/life13061227] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Revised: 05/04/2023] [Accepted: 05/17/2023] [Indexed: 06/29/2023] Open
Abstract
BACKGROUND Patients with acute pancreatitis develop numerous complications and organ damage due to increased intra-abdominal pressure (IAP). These extrapancreatic complications determine the clinical outcome of the disease. MATERIALS AND METHODS A total of 100 patients with acute pancreatitis were included in the prospective cohort study. Observed patients were divided into two groups according to their mean values of IAP (normal IAP values and elevated IAP values), which were compared with examined variables. Patients with intra-abdominal hypertension (IAH) were divided into four groups by IAP values, and those groups of patients were also compared with the examined variables. RESULTS Differences between body mass index (BMI) (p = 0.001), lactates (p = 0.006), and the Sequential Organ Failure Assessment (SOFA) score (p = 0.001) were statistically significant within all examined IAH groups. Differences between the mean arterial pressure (MAP) (p = 0.012) and filtration gradient (FG) (p < 0.001) were statistically significant between the first and second IAH groups in relation to the fourth. Differences in diuresis per hour (p = 0.022) showed statistical significance in relation to the first and third groups of IAH patients. CONCLUSIONS Changes in IAP values lead to changes in basic vital parameters MAP, APP, FG, diuresis per hour, and lactate levels in patients with acute pancreatitis. Early recognition of changes in the SOFA score accompanying an increase in the IAP value is essential.
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Affiliation(s)
- Maja Stojanović
- Department of Anesthesiology and Intensive Care, University Medical Center "Zvezdara", 11000 Belgrade, Serbia
- Medical Faculty, University of Belgrade, 11000 Belgrade, Serbia
| | - Marko Đurić
- Medical Faculty, University of Belgrade, 11000 Belgrade, Serbia
- Department of Anesthesiology and Intensive Care, Clinical Center of "Dr Dragiša Mišović", 11000 Belgrade, Serbia
| | - Irina Nenadić
- Medical Faculty, University of Belgrade, 11000 Belgrade, Serbia
- Department of Anesthesiology and Intensive Care, Clinical Center of "Dr Dragiša Mišović", 11000 Belgrade, Serbia
| | - Nemanja Dimić
- Medical Faculty, University of Belgrade, 11000 Belgrade, Serbia
- Department of Anesthesiology and Intensive Care, Clinical Center of "Dr Dragiša Mišović", 11000 Belgrade, Serbia
| | - Suzana Bojić
- Medical Faculty, University of Belgrade, 11000 Belgrade, Serbia
- Department of Anesthesiology and Intensive Care, Clinical Center of "Dr Dragiša Mišović", 11000 Belgrade, Serbia
| | - Predrag Stevanović
- Medical Faculty, University of Belgrade, 11000 Belgrade, Serbia
- Department of Anesthesiology and Intensive Care, Clinical Center of "Dr Dragiša Mišović", 11000 Belgrade, Serbia
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21
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Chaigneau T, Morello R, Vannier E, Musikas M, Piquet MA, Dupont B. Impact of sarcopenic obesity on predicting the severity of acute pancreatitis. Dig Liver Dis 2023:S1590-8658(23)00217-7. [PMID: 36849286 DOI: 10.1016/j.dld.2023.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Revised: 02/04/2023] [Accepted: 02/09/2023] [Indexed: 03/01/2023]
Abstract
BACKGROUND AND AIMS This work aimed to evaluate the impact of sarcopenia and sarcopenic obesity on the occurrence of severe pancreatitis and to study the performance of anthropometric indices to predict severe forms. METHODS We conducted a single-center retrospective study at Caen University Hospital between 2014 and 2017. Sarcopenia was assessed by measuring the psoas area on an abdominal scan. The psoas area /body mass index ratio reflected sarcopenic obesity. By normalizing the value to the body surface, we obtained an index called sarcopancreatic index, avoiding sex differences in measurements. RESULTS Among 467 included patients, 65 (13.9%) developed severe pancreatitis. The sarcopancreatic index was independently associated with the occurrence of severe pancreatitis (1.455 95% CI [1.028-2.061]; p = 0.035), as was the Visual Analog Scale, creatinine or albumin. The complication rate was not different depending on sarcopancreatic index value. Based on variables independently associated with the occurrence of severe pancreatitis, we constructed a score called Sarcopenia Severity Index. This score presented an area under the receiver operating characteristics curve of 0.84, comparable to the Ranson score (0.87) and superior to body mass index or the sarcopancreatic index to predict a severe form of acute pancreatitis. CONCLUSIONS Sarcopenic obesity seems to be associated with severe acute pancreatitis.
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Affiliation(s)
- Thomas Chaigneau
- Département d'Hepato-Gastroenterologie et Nutrition, Normandie Univ, UNICAEN, CHU de Caen Normandie, Avenue Côte de Nacre, 14033 CAEN, France
| | - Remy Morello
- Plateforme de Méthodologie, Normandie Univ, UNICAEN, CHU de Caen Normandie, 14000 CAEN, France
| | - Elise Vannier
- Département d'Hepato-Gastroenterologie et Nutrition, Normandie Univ, UNICAEN, CHU de Caen Normandie, Avenue Côte de Nacre, 14033 CAEN, France
| | - Marietta Musikas
- Département d'Hepato-Gastroenterologie et Nutrition, Normandie Univ, UNICAEN, CHU de Caen Normandie, Avenue Côte de Nacre, 14033 CAEN, France
| | - Marie-Astrid Piquet
- Département d'Hepato-Gastroenterologie et Nutrition, Normandie Univ, UNICAEN, CHU de Caen Normandie, Avenue Côte de Nacre, 14033 CAEN, France
| | - Benoît Dupont
- Département d'Hepato-Gastroenterologie et Nutrition, Normandie Univ, UNICAEN, CHU de Caen Normandie, Avenue Côte de Nacre, 14033 CAEN, France.
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Hidalgo NJ, Pando E, Alberti P, Mata R, Fernandes N, Adell M, Villasante S, Blanco L, Balsells J, Charco R. The role of high serum triglyceride levels on pancreatic necrosis development and related complications. BMC Gastroenterol 2023; 23:51. [PMID: 36829113 PMCID: PMC9955530 DOI: 10.1186/s12876-023-02684-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Accepted: 02/17/2023] [Indexed: 02/26/2023] Open
Abstract
BACKGROUND The relevance of elevated serum triglyceride (TG) levels in the early stages of acute pancreatitis (AP) not induced by hypertriglyceridemia (HTG) remains unclear. Our study aims to determine the role of elevated serum TG levels at admission in developing pancreatic necrosis. METHODS We analyzed the clinical data collected prospectively from patients with AP. According to TG levels measured in the first 24 h after admission, we stratified patients into four groups: Normal TG (< 150 mg/dL), Borderline-high TG (150-199 mg/dL), High TG (200-499 mg/dL) and Very high TG (≥ 500 mg/dL). We analyzed the association of TG levels and other risk factors with the development of pancreatic necrosis. RESULTS A total of 211 patients were included. In the Normal TG group: 122, in Borderline-high TG group: 38, in High TG group: 44, and in Very high TG group: 7. Pancreatic necrosis developed in 29.5% of the patients in the Normal TG group, 26.3% in the Borderline-high TG group, 52.3% in the High TG group, and 85.7% in the Very high TG group. The trend analysis observed a significant association between higher TG levels and pancreatic necrosis (p = 0.001). A multivariable analysis using logistic regression showed that elevated TG levels ≥ 200 mg/dL (High TG and Very high TG groups) were independently associated with pancreatic necrosis (OR: 3.27, 95% CI - 6.27, p < 0.001). CONCLUSIONS An elevated TG level at admission ≥ 200 mg/dl is independently associated with the development of pancreatic necrosis. The incidence of pancreatic necrosis increases proportionally with the severity of HTG.
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Affiliation(s)
- Nils Jimmy Hidalgo
- grid.7080.f0000 0001 2296 0625Universitat Autonoma de Barcelona, Bellaterra, Spain ,grid.411083.f0000 0001 0675 8654Department of Hepato-Pancreato-Biliary and Transplant Surgery, Hospital Universitari Vall d’Hebron, 119 Passeig de la Vall d’Hebron, 08035 Barcelona, Spain
| | - Elizabeth Pando
- Universitat Autonoma de Barcelona, Bellaterra, Spain. .,Department of Hepato-Pancreato-Biliary and Transplant Surgery, Hospital Universitari Vall d'Hebron, 119 Passeig de la Vall d'Hebron, 08035, Barcelona, Spain.
| | - Piero Alberti
- grid.411083.f0000 0001 0675 8654Department of Hepato-Pancreato-Biliary and Transplant Surgery, Hospital Universitari Vall d’Hebron, 119 Passeig de la Vall d’Hebron, 08035 Barcelona, Spain
| | - Rodrigo Mata
- grid.411083.f0000 0001 0675 8654Department of Hepato-Pancreato-Biliary and Transplant Surgery, Hospital Universitari Vall d’Hebron, 119 Passeig de la Vall d’Hebron, 08035 Barcelona, Spain
| | - Nair Fernandes
- grid.411083.f0000 0001 0675 8654Department of Hepato-Pancreato-Biliary and Transplant Surgery, Hospital Universitari Vall d’Hebron, 119 Passeig de la Vall d’Hebron, 08035 Barcelona, Spain
| | - Montse Adell
- grid.411083.f0000 0001 0675 8654Department of Hepato-Pancreato-Biliary and Transplant Surgery, Hospital Universitari Vall d’Hebron, 119 Passeig de la Vall d’Hebron, 08035 Barcelona, Spain
| | - Sara Villasante
- grid.411083.f0000 0001 0675 8654Department of Hepato-Pancreato-Biliary and Transplant Surgery, Hospital Universitari Vall d’Hebron, 119 Passeig de la Vall d’Hebron, 08035 Barcelona, Spain
| | - Laia Blanco
- grid.411083.f0000 0001 0675 8654Department of Hepato-Pancreato-Biliary and Transplant Surgery, Hospital Universitari Vall d’Hebron, 119 Passeig de la Vall d’Hebron, 08035 Barcelona, Spain
| | - Joaquim Balsells
- grid.411083.f0000 0001 0675 8654Department of Hepato-Pancreato-Biliary and Transplant Surgery, Hospital Universitari Vall d’Hebron, 119 Passeig de la Vall d’Hebron, 08035 Barcelona, Spain
| | - Ramon Charco
- grid.411083.f0000 0001 0675 8654Department of Hepato-Pancreato-Biliary and Transplant Surgery, Hospital Universitari Vall d’Hebron, 119 Passeig de la Vall d’Hebron, 08035 Barcelona, Spain
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23
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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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Chen X, Ning J, Li Q, Kuang W, Jiang H, Qin S. Prediction of acute pancreatitis complications using routine blood parameters during early admission. Immun Inflamm Dis 2022; 10:e747. [PMID: 36444624 PMCID: PMC9695081 DOI: 10.1002/iid3.747] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Revised: 10/16/2022] [Accepted: 11/06/2022] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND There have been many reports on biomarkers for predicting the severity of acute pancreatitis (AP), but few studies on biomarkers for predicting complications; some simple and inexpensive indicators, in particular, are worth exploring. METHODS We retrospectively collected clinical data of 809 AP patients, including medical history and results of routine blood tests, and grouped them according to the occurrence of complications. Differences in clinical characteristics between groups with and without complications were compared using t-test or χ2 test. Receiver operating curve (ROC) and area under the curve were calculated to evaluate the ability of predicting the occurrence of complications for the routine blood parameters with statistical differences. Then, through univariate and multivariate analyses, independent risk factors closely associated with complications were identified. Finally, we built a three-parameter prediction system and evaluated its ability to predict AP complications. RESULTS Compared with the group without complications, the patients in the complication group had higher white blood cells, neutrophils, C-reactive protein, and erythrocyte sedimentation rate (ESR), and lower red blood cells and hemoglobin (Hb) (all p < .05), and most of them had severe pancreatitis. In addition, pseudocysts were more common in patients with alcoholic etiology, recurrence, low BMI, and high platelet (PLT) and plateletocrit. Acute respiratory failure was more common in patients with first onset and high mean PLT volume (MPV). Sepsis was more common in patients with lipogenic etiology, high MPV, and low lymphocytes. Infectious pancreatic necrosis was more common in patients with alcoholic etiology. Acute renal failure was more common in patients with monocytes and high MPV and low PLT. Multivariate analysis showed that PLT and ESR were risk factors for pseudocyst development. The ROC showed that the combination of Hb, PLT and ESR had a significantly higher predictive ability for pseudocyst than the single parameter. CONCLUSION Routine blood parameters can be used to predict the complications of AP. A predictive model combining ESR, PLT, and Hb may be an effective tool for identifying pseudocysts in AP patients.
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Affiliation(s)
- Xiubing Chen
- Department of GastroenterologyThe First Affiliated Hospital of Guangxi Medical UniversityNanningChina
| | - Jing Ning
- Department of GastroenterologyThe First Affiliated Hospital of Guangxi Medical UniversityNanningChina
| | - Qing Li
- Department of GastroenterologyThe First Affiliated Hospital of Guangxi Medical UniversityNanningChina
| | - Wenxi Kuang
- Department of GastroenterologyThe First Affiliated Hospital of Guangxi Medical UniversityNanningChina
| | - Haixing Jiang
- Department of GastroenterologyThe First Affiliated Hospital of Guangxi Medical UniversityNanningChina
| | - Shanyu Qin
- Department of GastroenterologyThe First Affiliated Hospital of Guangxi Medical UniversityNanningChina
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Muacevic A, Adler JR, Tatar C, Idiz UO, Demircioğlu MK, Çiçek ME, Yildiz I. The Potential Role of Model for End-Stage Liver Disease (MELD)-Sodium Score in Predicting the Severity of Acute Pancreatitis. Cureus 2022; 14:e33198. [PMID: 36742275 PMCID: PMC9891313 DOI: 10.7759/cureus.33198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/31/2022] [Indexed: 01/02/2023] Open
Abstract
Background and aim Acute pancreatitis is a common inflammation of the pancreas which can be severe and even potentially mortal. High rates of mortality showed the importance of immediate identification of patients at high risk and led the clinicians to refer to various scoring systems. Our aim was to investigate a clinical predictive model using the Model for End-Stage Liver Disease-Sodium (MELD-sodium) scoring system, adapting it to acute pancreatitis patients referring to the systemic inflammatory nature of the disease and potential multi-organ failures in severe form. Methods Our multicenter study was designed retrospectively. The medical records were reviewed for the period of two years. Demographics, biochemical results, MELD-sodium scores and mortality rates were analysed. Results MELD-sodium score was found to be statistically correlated with both mortality and the severity of pancreatitis (p<0.001) and significant difference between both mild and severe (p<0.001), moderate and severe groups (p<0.001). Mortality was found to be significantly higher in patients with MELD-Na score when the cut-off value was accepted as '≥11'. Conclusion We found that MELD-sodium score was significantly associated with both severity of disease and mortality rates and also significantly effective between both mild/severe and moderate/severe groups which may be a guide for future multi-center reviews with larger patient and control groups, which can define the potential role of this non-invasive and easy-to-use predictive model in acute pancreatitis patients.
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The role of combined hematological inflammatory indices in predicting poor outcomes in patients with acute pancreatitis. JOURNAL OF CONTEMPORARY MEDICINE 2022. [DOI: 10.16899/jcm.1137585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Aim
The aim of the instant study is to evaluate the predictability of AISI, NLPR, and SIRI in patients with acute pancreatitis, which predicts more than 7 days of hospitalization, the need for intensive care, and 30-day mortality.
Material and Method
This retrospective observational study was conducted in patients diagnosed with acute pancreatitis who applied to the emergency medicine clinic of XXX Hospital between July 15, 2017 and February 15, 2021.Statistical analysis was performed using SPSS v. 26.0.
Results
The study included 592 patients, 58.3% of which were women. A statistically significant difference was found between high NLPR, and hospital stay longer than 7 days (p = 0.01). No statistically significant correlation was found between AISI and SIRI and the length of hospital stay (p = 0.16, p = 0.19, respectively). There was a statistically significant correlation between high NLPR, and mortality (p = 0.03). No statistically significant correlation was found between AISI, SIRI, and mortality (p = 0.866, p = 0.311, respectively). There was a statistically significant correlation between high NLPR, and hospitalization in the intensive care unit (p = 0.018) No statistically significant relationship was found between AISI, SIRI, and admission to the intensive care unit (p = 0.89, p = 0.6, respectively).
Conclusion
Acute pancreatitis is an inflammatory process that requires serious approach. Hematological parameters are helpful in predicting the prognosis, but there is a need for differently developed hematological indices in managing acute pancreatitis.
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Sui Y, Zhao Z, Zhang Y, Zhang T, Li G, Liu L, Tan H, Sun B, Li L. Fibrinogen-like Protein 1 as a Predictive Marker for the Incidence of Severe Acute Pancreatitis and Infectious Pancreatic Necrosis. MEDICINA (KAUNAS, LITHUANIA) 2022; 58:medicina58121753. [PMID: 36556955 PMCID: PMC9785826 DOI: 10.3390/medicina58121753] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/02/2022] [Revised: 11/17/2022] [Accepted: 11/22/2022] [Indexed: 12/05/2022]
Abstract
Background and Objectives: Acute pancreatitis (AP) is defined as an acute inflammatory disorder of the pancreas and is a common gastrointestinal disease. Since currently used indicators lack specifics and cannot accurately reflect the phase of disease, better diagnostic approaches need to be explored. Fibrinogen-like protein 1 (FGL-1) is a reactant in acute inflammatory diseases and is increased in the plasma of AP patients. In the current study, we aim to investigate the clinical benefits of FGL-1 in predicting the severity of AP and infected pancreatic necrosis (IPN), which can improve the diagnostic efficiency of AP. Materials and Methods: In this study, 63 patients diagnosed with AP from December 2018 to September 2019 were enrolled. Regarding the severity of AP, patients were separated into severe acute pancreatitis (SAP, n = 12) and No-SAP groups (n = 51). On the basis of infective conditions, patients were divided into IPN (n = 9) and No-IPN (n = 54) groups. The demographic data (sex and age) and blood parameters (WBC, HCT, glucose, calcium, FIB, APTT, PCT, CRP, and FGL-1) were retrospectively analyzed. Results: The plasma FGL-1 levels were increased in both SAP (p < 0.01) and IPN (p < 0.05) subgroups compared to the healthy control group. Multivariate analysis showed that elevated plasma FGL-1 (p < 0.01) and PCT levels (p < 0.05) within 72 h after the onset of AP were positively correlated with the severity of AP, while increased plasma FGL-1 (p < 0.01) and CRP (p < 0.05) levels were positively correlated with the occurrence of IPN. The combination of FGL-1 and PCT showed superiority to both individual markers in SAP prediction. However, the combination of FGL-1 and CRP showed no diagnostic advantage over CRP in IPN prediction. Conclusions: Plasma FGL-1 within 72 h after the onset could be used for the stratification of AP and its infectious complications. The combination of PCT and FGL-1 presents an enormous advantage for the early identification of SAP.
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Affiliation(s)
- Yuhang Sui
- Department of Pancreatic and Biliary Surgery, The First Affiliated Hospital of Harbin Medical University, Harbin 150001, China
| | - Zhongjie Zhao
- Department of Pancreatic and Biliary Surgery, The First Affiliated Hospital of Harbin Medical University, Harbin 150001, China
| | - Yang Zhang
- Department of Pancreatic and Biliary Surgery, The First Affiliated Hospital of Harbin Medical University, Harbin 150001, China
- Department of Abdominal Surgery, Guiqian International General Hospital, Guiyang 550024, China
| | - Tao Zhang
- Department of Pancreatic and Biliary Surgery, The First Affiliated Hospital of Harbin Medical University, Harbin 150001, China
| | - Guanqun Li
- Department of Pancreatic and Biliary Surgery, The First Affiliated Hospital of Harbin Medical University, Harbin 150001, China
| | - Liwei Liu
- Department of Pancreatic and Biliary Surgery, The First Affiliated Hospital of Harbin Medical University, Harbin 150001, China
| | - Hongtao Tan
- Department of Pancreatic and Biliary Surgery, The First Affiliated Hospital of Harbin Medical University, Harbin 150001, China
- Key Laboratory of Hepatosplenic Surgery, Ministry of Education, Harbin 150001, China
| | - Bei Sun
- Department of Pancreatic and Biliary Surgery, The First Affiliated Hospital of Harbin Medical University, Harbin 150001, China
- Key Laboratory of Hepatosplenic Surgery, Ministry of Education, Harbin 150001, China
- Correspondence: (B.S.); (L.L.)
| | - Le Li
- Department of Pancreatic and Biliary Surgery, The First Affiliated Hospital of Harbin Medical University, Harbin 150001, China
- Key Laboratory of Hepatosplenic Surgery, Ministry of Education, Harbin 150001, China
- Correspondence: (B.S.); (L.L.)
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Li J, Chen Z, Li L, Lai T, Peng H, Gui L, He W. Interleukin-6 is better than C-reactive protein for the prediction of infected pancreatic necrosis and mortality in patients with acute pancreatitis. Front Cell Infect Microbiol 2022; 12:933221. [PMID: 36467730 PMCID: PMC9716459 DOI: 10.3389/fcimb.2022.933221] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2022] [Accepted: 09/12/2022] [Indexed: 09/16/2023] Open
Abstract
INTRODUCTION This study aimed to identify whether interleukin-6 (IL-6) is better than C-reactive protein (CRP) for the prediction of severe acute pancreatitis (SAP), infected pancreatic necrosis (IPN), and mortality. METHODS Sixty-seven patients with acute pancreatitis (AP) who were hospitalized within 48 h of onset and received serum CRP and IL-6 tests from September 2018 to September 2019 were included. Spearman's correlation was performed to assess their associations with severity. The areas under the curve (AUCs) for the prediction of SAP, organ failure, pancreatic necrosis, IPN, and mortality were estimated using receiver operating characteristic curves. RESULT Serum CRP and IL-6 levels were significantly positively correlated with the severity of AP (p < 0.05). The AUC for the prediction of SAP based on the CRP level was 0.78 (95% CI, 0.66-0.89) and that based on the IL-6 level was 0.69 (95% CI, 0.56-0.82). For the prediction of organ failure and pancreatic necrosis, CRP was more accurate than IL-6 (AUC 0.80 vs. 0.72 and 0.75 vs. 0.68, respectively). However, CRP was less accurate than IL-6 for predicting mortality and IPN (AUC 0.70 vs. 0.75 and 0.65 vs. 0.81, respectively). Systemic inflammatory response syndrome plus CRP was more accurate than systemic inflammatory response syndrome plus IL-6 (AUC 0.79 vs. 0.72) for the prediction of SAP. CONCLUSIONS IL-6 was more accurate than CRP for predicting mortality and IPN in patients with AP.
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Affiliation(s)
| | | | | | | | | | | | - Wenhua He
- Pancreatic Disease Centre, Department of Gastroenterology, The First Affiliated Hospital of Nanchang University, Nanchang, China
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ACEHAN S, SATAR S, GÜLEN M, TOPTAS FİRAT B, AKA SATAR D, TAŞ A. 65 yaş üstü hastalarda puanlama sistemlerinin şiddetli akut pankreatiti ve mortaliteyi erken öngörme açısından değerlendirilmesi. CUKUROVA MEDICAL JOURNAL 2022. [DOI: 10.17826/cumj.1121730] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Purpose: The aim of this study is to investigate the power of disease severity scores to predict the development of Severe Acute Pancreatitis (SAP) and mortality in the early period over 65 years old diagnosed with acute pancreatitis in the emergency department.
Materials and Methods: We calculated RANSON (on admission) and Computed Tomography Severity Index (CTSI) in addition to Bedside Index for Severity in Acute Pancreatitis (BISAP) score on admission to the emergency department.
Results: One hundred and sixty patients (46.9% over 80 years of age) were included in the study. We observed statistically higher length of hospitalization, longer duration of stay in the intensive care unit, SAP and higher mortality in patients over 80 years of age. When we examined the ROC curve, we determined that the AUC values of the BISAP score were highest in both SAP and mortality estimation (AUC: 0.911, 95% CI 0.861-0.962; AUC: 0.918, 95% CI 0.864-0.9722, respectively). Binary logistic analysis indicated a 4.7-fold increased risk for SAP and a 12.3-fold increased mortality for each unit increase in BISAP score value.
Conclusion: BISAP may be a good predictor for SAP and mortality estimation on admission to the emergency department in patients over 65 years of age with acute pancreatitis.
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Affiliation(s)
- Selen ACEHAN
- Adana City Training and Research Hospital, Department of Emergency Medicine
| | - Salim SATAR
- Adana City Training and Research Hospital, Department of Emergency Medicine
| | - Müge GÜLEN
- Adana City Training and Research Hospital, Department of Emergency Medicine
| | - Basak TOPTAS FİRAT
- Aksaray University Training and Research Hospital, Department of Emergency Medicine, Aksaray, Turkey
| | - Deniz AKA SATAR
- Adana City Training and Research Hospital, IVF Unit, Adana, Turkey,
| | - Adnan TAŞ
- Adana City Training and Research Hospital, Department of Gastroenterology, Adana, Turkey,
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Wu B, Yang J, Dai Y, Xiong L. Combination of the BISAP Score and miR-155 is Applied in Predicting the Severity of Acute Pancreatitis. Int J Gen Med 2022; 15:7467-7474. [PMID: 36187163 PMCID: PMC9519123 DOI: 10.2147/ijgm.s384068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Accepted: 09/14/2022] [Indexed: 11/24/2022] Open
Abstract
Purpose To evaluate the predictive value of combination of Bedside Index for Severity in AP (BISAP) score and miR-155 for the severity of acute pancreatitis (AP). Patients and Methods A total of 1046 AP patients were divided into control group and case group according to the severity of AP [mild and moderately severe AP vs severe AP (SAP)]. Demographic data, comorbidities, clinical characteristics and laboratory data were collected. Multivariate analysis was conducted for the variables with two-sided P<0.10 in univariate analysis to identify independent associated factors for progression to SAP in AP patients. The predictive values were evaluated using receiver operating characteristic (ROC) curve, and the area under curve (AUC) was compared using Z test. Results A total of 117 (11.2%) patients were evaluated as SAP. Univariate analysis showed that there were significant differences in age, hypertension, ICU admission, hospital stay, Leukocytes, CRP, BUN, BISAP score and miR-155 between case group and control group (P<0.05), and the P value of Fibrinogen was <0.10. Multivariate analysis showed that the BISAP score, BUN, Leukocytes, age and CRP were independent risk factors for progression to SAP among AP patients after adjusting for hypertension, ICU admission, hospital stay and Fibrinogen, while miR-155 was a protective factor. The ROC curves demonstrated the AUCs of BISAP score, miR-155 and their combination were 0.842 (SE: 0.017, 95% CI: 0.809–0.874), 0.751 (SE: 0.022, 95% CI: 0.708–0.793) and 0.945 (SE: 0.007, 95% CI: 0.931–0.959), respectively. Z test showed that the AUC of combination prediction was significantly higher than that of individual predictions (0.945 vs 0.842, Z=5.602, P<0.001; 0.945 vs 0.751, Z=8.403, P<0.001). The sensitivity, specificity and negative predictive value (NPV) of combination prediction were 95.7%, 93.6% and 99.4%, respectively. Conclusion The combination of the BISAP score and miR-155 should be utilized to elevate the predictive value for the severity of AP in clinic.
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Affiliation(s)
- Bing Wu
- Department of Critical Care Medicine, Jiangjin Central Hospital, Chongqing, People’s Republic of China
| | - Jun Yang
- Department of Critical Care Medicine, Jiangjin Central Hospital, Chongqing, People’s Republic of China
| | - Yonghong Dai
- Department of Critical Care Medicine, Jiangjin Central Hospital, Chongqing, People’s Republic of China
| | - Le Xiong
- Department of Critical Care Medicine, Jiangjin Central Hospital, Chongqing, People’s Republic of China
- Correspondence: Le Xiong, Department of Critical Care Medicine, Jiangjin Central Hospital, No. 725, Jiangzhou Road, Dingshan Street, Jiangjin District, Chongqing, 402260, People’s Republic of China, Tel +86-2347521342, Email
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Chen L, Jiang J. The Diagnostic Value of Procalcitonin in Patients with Severe Acute Pancreatitis: A Meta-Analysis. THE TURKISH JOURNAL OF GASTROENTEROLOGY : THE OFFICIAL JOURNAL OF TURKISH SOCIETY OF GASTROENTEROLOGY 2022; 33:722-730. [PMID: 36134549 PMCID: PMC9524488 DOI: 10.5152/tjg.2022.22098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Accepted: 04/27/2022] [Indexed: 11/22/2022]
Abstract
The role of procalcitonin in diagnosing severe acute pancreatitis has not been clearly assessed. This meta-analysis aims to evaluate the overall diagnostic accuracy of procalcitonin as a biomarker for severe acute pancreatitis. Medline (via PubMed), Embase, Web of Science, Cochrane Library, China National Knowledge Infrastructure, and China WanFang Data were searched systematically for prospective studies reporting procalcitonin as a diagnostic marker of severe acute pancreatitis before August 31, 2021. Sensitivity, specificity, and other measures of the accuracy of procalcitonin in the diagnosis of severe acute pancreatitis were pooled by Stata 15.0 software. Heterogeneity was evaluated by I2 test, and the quality of included studies was evaluated by using the Quality Assessment of Diagnostic Accuracy Studies-2 system. Further, the sources of heterogeneity were verified using meta-regression and subgroup analysis, and the publication bias was evaluated by the Deeks' funnel plot. A total of 18 studies meeting the inclusion criteria were included, containing 1764 patients. The pooled sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, diagnostic odds ratio, and area under the receiver operating characteristic curve of procalcitonin for diagnosing severe acute pancreatitis were as follows: 0.80 (95% CI: 0.73-0.86), 0.84 (95% CI: 0.78-0.88), 4.95 (95% CI: 3.46-7.09), 0.23 (95% CI: 0.16-0.34), 21.26 (95% CI: 11.09-40.74), 0.89 (95% CI: 0.86-0.92). Also, P > .05 suggested no significant publication bias. Current evidence indicates that procalcitonin has good sensitivity and diagnostic accuracy for severe acute pancreatitis. However, the findings should be carefully used as routine evidence in diagnosing patients with severe acute pancreatitis alone because of the limited number of included studies and high heterogeneity.
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Affiliation(s)
- Lipeng Chen
- Department of Gastroenterology, Zhejiang Hospital, Hangzhou, Zhejiang, China
| | - Jianbo Jiang
- Department of Gastroenterology, Zhejiang Hospital, Hangzhou, Zhejiang, China
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Zou M, Yang Z, Fan Y, Gong L, Han Z, Ji L, Hu X, Wu D. Gut microbiota on admission as predictive biomarker for acute necrotizing pancreatitis. Front Immunol 2022; 13:988326. [PMID: 36105818 PMCID: PMC9466706 DOI: 10.3389/fimmu.2022.988326] [Citation(s) in RCA: 43] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Accepted: 08/11/2022] [Indexed: 12/12/2022] Open
Abstract
Background Acute necrotizing pancreatitis (NP), a severe form of acute pancreatitis (AP), has higher mortality and worse outcome than non-necrotizing pancreatitis (non-NP). Infected NP is a devastating subgroup of NP. To date neither NP nor infected NP has robust prediction strategies, which may delay early recognition and timely intervention. Recent studies revealed correlations between disturbed gut microbiota and AP severity. Some features of intestinal microbiota have the potential to become biomarkers for NP prediction. Methods We performed 16S rRNA sequencing to analyze gut microbiota features in 20 healthy controls (HC), and 58 AP patients on hospital admission. The AP patients were later classified into NP and non-NP groups based on subsequent diagnostic imaging features. Random forest regression model and ROC curve were applied for NP and infected NP prediction. PIRCUSt2 was used for bacterial functional pathway prediction analysis. Results We found that the three groups (HC, NP, and non-NP) had distinct microorganism composition. NP patients had reduced microbial diversity, higher abundance of Enterobacteriales, but lower abundance of Clostridiales and Bacteroidales compared with the non-NP group. Correlation analyses displayed that intestine bacterial taxonomic alterations were related to severity, ICU admission, and prognosis. By pathway prediction, species more abundant in NP patients had positive correlation with synthesis and degradation of ketone bodies, and benzoate degradation. Enterococcus faecium (ASV2) performed best in discriminating NP and non-NP patients. Finegoldia magna (ASV3) showed the maximal prediction capacity among all ASVs and had comparable accuracy with Balthazar CT to detect patients with infected NP. Conclusions Our study suggests that NP patients have distinct intestinal microbiota on admission compared to non-NP patients. Dysbiosis of intestinal microbiota might influence NP progression through ketone body or benzoate metabolism. Enterococcus faecium and Finegoldia magna are potential predictors for NP and infected NP. Our findings explore biomarkers which may inform clinical decision-making in AP and shed light on further studies on NP pathophysiology and management.
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Affiliation(s)
- Menglian Zou
- Department of Gastroenterology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Zihan Yang
- Department of Gastroenterology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Yue Fan
- Department of Medical Research Center, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science & Peking Union Medical College, Beijing, China
| | - Liang Gong
- Department of Gastroenterology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Ziying Han
- Department of Gastroenterology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Li Ji
- Department of Gastroenterology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Xiaomin Hu
- Department of Medical Research Center, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science & Peking Union Medical College, Beijing, China
- *Correspondence: Dong Wu, ; Xiaomin Hu,
| | - Dong Wu
- Department of Gastroenterology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
- *Correspondence: Dong Wu, ; Xiaomin Hu,
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He Y, Hu C, Liu S, Xu M, Liang G, Du D, Liu T, Cai F, Chen Z, Tan Q, Deng L, Xia Q. Anti-Inflammatory Effects and Molecular Mechanisms of Shenmai Injection in Treating Acute Pancreatitis: Network Pharmacology Analysis and Experimental Verification. Drug Des Devel Ther 2022; 16:2479-2495. [PMID: 35941928 PMCID: PMC9356589 DOI: 10.2147/dddt.s364352] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Accepted: 07/20/2022] [Indexed: 11/23/2022] Open
Abstract
Background Acute pancreatitis (AP) is an inflammatory disorder of the exocrine pancreas without specific treatment. Shenmai injection (SMI) was reported to eliminate the severity of experimental AP. This study aimed to explore the mechanisms underlying the synergistic protective effects of SMI on AP based on network pharmacology and experimental validation. Methods Network pharmacology analysis and molecular docking based on identified components were performed to construct the potential therapeutic targets and pathways. The principal components of SMI were detected via ultra-high-performance liquid chromatography-coupled with quadrupole time-of-flight mass spectrometry (UHPLC-QTOF/MS). Effect of SMI and the identified components on cellular injury and IL6/STAT3 signaling was assessed on mouse pancreatic acinar cell line 266–6 cells. Finally, 4% sodium taurocholate (NaT) was used to induce AP model to assess the effects of SMI in treating AP and validate the potential molecular mechanisms. Results By searching the TCMSP and ETCM databases, 119 candidate components of SMI were obtained. UHPLC-QTOF/MS analysis successfully determined the representative components of SMI: ginsenoside Rb1, ginsenoside Rg1, ginsenoside Re, and ophiopogonin D. Fifteen hub targets and eight related pathways were obtained to establish the main pharmacology network. Subnetwork analysis and molecular docking indicated that the effects of these four main SMI components were mostly related to the interleukin (IL) 6/STAT3 pathway. In vitro, SMI, ginsenoside Rb1, ginsenoside Rg1, ginsenoside Re, and ophiopogonin D increased the cell viability of NaT-stimulated mouse pancreatic acinar 266–6 cells and decreased IL6 and STAT3 expression. In vivo, 10 mL/kg SMI significantly alleviated the pancreatic histopathological changes and the expression of IL6 and STAT3 in the AP mice. Conclusion This study demonstrated SMI may exert anti-inflammatory effects against AP by suppressing IL6/STAT3 activation, thus providing a basis for its potential use in clinical practice and further study in treating AP.
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Affiliation(s)
- Yanqiu He
- Pancreatitis Centre, Department and Laboratory of Integrated Traditional Chinese and Western Medicine, West China Hospital, Sichuan University, Chengdu, People’s Republic of China
| | - Cheng Hu
- Pancreatitis Centre, Department and Laboratory of Integrated Traditional Chinese and Western Medicine, West China Hospital, Sichuan University, Chengdu, People’s Republic of China
| | - Shiyu Liu
- Pancreatitis Centre, Department and Laboratory of Integrated Traditional Chinese and Western Medicine, West China Hospital, Sichuan University, Chengdu, People’s Republic of China
| | - Mingjie Xu
- Pancreatitis Centre, Department and Laboratory of Integrated Traditional Chinese and Western Medicine, West China Hospital, Sichuan University, Chengdu, People’s Republic of China
| | - Ge Liang
- Laboratory of Clinical Proteomics and Metabolomics, Institutes for Systems Genetics, Frontiers Science Center for Disease-Related Molecular Network, West China Hospital, Sichuan University, Chengdu, People’s Republic of China
| | - Dan Du
- Advanced Mass Spectrometry Center, Research Core Facility, Frontiers Science Center for Disease-Related Molecular Network, West China Hospital, Sichuan University, Chengdu, People’s Republic of China
| | - Tingting Liu
- Pancreatitis Centre, Department and Laboratory of Integrated Traditional Chinese and Western Medicine, West China Hospital, Sichuan University, Chengdu, People’s Republic of China
| | - Fei Cai
- Pancreatitis Centre, Department and Laboratory of Integrated Traditional Chinese and Western Medicine, West China Hospital, Sichuan University, Chengdu, People’s Republic of China
| | - Zhiyao Chen
- Pancreatitis Centre, Department and Laboratory of Integrated Traditional Chinese and Western Medicine, West China Hospital, Sichuan University, Chengdu, People’s Republic of China
| | - Qingyuan Tan
- Pancreatitis Centre, Department and Laboratory of Integrated Traditional Chinese and Western Medicine, West China Hospital, Sichuan University, Chengdu, People’s Republic of China
| | - Lihui Deng
- Pancreatitis Centre, Department and Laboratory of Integrated Traditional Chinese and Western Medicine, West China Hospital, Sichuan University, Chengdu, People’s Republic of China
- Correspondence: Lihui Deng, Pancreatitis Centre, Department and Laboratory of Integrated Traditional Chinese and Western Medicine, West China Hospital, Sichuan University, Chengdu, People’s Republic of China, Email
| | - Qing Xia
- Pancreatitis Centre, Department and Laboratory of Integrated Traditional Chinese and Western Medicine, West China Hospital, Sichuan University, Chengdu, People’s Republic of China
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Durmuş ET, Akdağ İ, Yıldız M. Diabetes is an independent predictor of severe acute pancreatitis. Postgrad Med 2022; 134:711-716. [PMID: 35866439 DOI: 10.1080/00325481.2022.2105613] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
OBJECTIVES We aimed to determine the effect of diabetes mellitus (DM) on the severity of acute pancreatitis (AP) and whether diabetes is a predictor of severe acute pancreatitis (SAP). METHODS A total of 181 patients diagnosed with a first attack of AP in our hospital were retrospectively evaluated. AP severity was evaluated and compared between diabetic and non-diabetic patients. Independent factors predicting SAP were identified with a binary logistic regression model. RESULTS Of the 164 patients [108 (65.9%) women, 56 (34.1%) men] enrolled in the study, 35 patients (21.3%) had been diagnosed with DM, while 129 (78.7%) did not have DM. SAP, necrotizing pancreatitis, and local complications were observed to be more common among diabetic patients compared to non-diabetic patients (all P<0.001), while the incidences of systemic complications and transient or persistent organ failure were similar between the groups. The incidences of DM and cancer were higher in the SAP group (P<0.001 and P=0.033, respectively). The presence of DM (OR: 3.246, 95% CI: 1.278-8.244, P=0.013), high (≥3) Ranson score (OR: 3.529, 95% CI: 1.342-9.280, P=0.011), and high maximum C-reactive protein level (OR: 1.005, 95% CI: 1.001-1.010, P=0.046) were independent risk factors predicting SAP. CONCLUSION DM is both a risk factor for SAP and an independent predictor of SAP. Evaluation of the presence of DM at the time of diagnosis can help predict SAP in a considerably early phase.
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Affiliation(s)
- Elif Tutku Durmuş
- Department of Endocrinology and Metabolism, University of Health Sciences, Kecioren Training and Research Hospital, Ankara, Turkey
| | - İbrahim Akdağ
- Department of Internal Medicine, University of Health Sciences, Diskapi Yildirim Beyazit Training and Research Hospital, Ankara, Turkey
| | - Mehmet Yıldız
- Department of Internal Medicine, University of Health Sciences, Diskapi Yildirim Beyazit Training and Research Hospital, Ankara, Turkey
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Bardakcı O, Akdur G, Das M, Sıddıkoğlu D, Akdur O, Beyazit Y. Comparison of different risk stratification systems for prediction of acute pancreatitis severity in patients referred to the emergency department of a tertiary care hospital. ULUS TRAVMA ACIL CER 2022; 28:967-973. [PMID: 35775674 PMCID: PMC10493842 DOI: 10.14744/tjtes.2021.51892] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Accepted: 04/01/2021] [Indexed: 11/20/2022]
Abstract
BACKGROUND Prognostic prediction and estimation of severity at early stages of acute pancreatitis (AP) are crucial to reduce the complication rates and mortality. The objective of the present study is to evaluate the predicting ability of different clinical and radiological scores in AP. METHODS We retrospectively collected demographic and clinical data from 159 patients diagnosed with AP admitted to Canakkale Onsekiz Mart University Hospital between January 2017 and December 2019. Bedside index for severity AP (BISAP), and acute phys-iology and chronic health evaluation II (APACHE II) score at admission, Ranson and modified Glasgow Prognostic Score (mGPS) score at 48 h after admission were calculated. Modified computed tomography severity index (CTSI) was also calculated for each patient. Area under the curve (AUC) was calculated for each scoring system for predicting severe AP, pancreatic necrosis, length of hospital stay, and mortality by determining optimal cutoff points from the (ROC) curves. RESULTS mGPS and APACHE II had the highest AUC (0.929 and 0.823, respectively) to predict severe AP on admission with the best specificity and sensitivity. In predicting mortality BISAP (with a sensitivity, specificity, negative predictive value (NPV), and positive predictive value (PPV) of 75.0%, 70.9%, 98.2%, and 12.0%, respectively, [AUC: 0.793]) and APACHE II (with a sensitivity, specificity, NPV and PPV of 87.5%, 86.1%, 99.2%, and 25.0%, respectively, [AUC: 0.840]). CONCLUSION mGPS can be a valuable tool in predicting the patients more likely to develop severe AP and maybe somewhat better than BISAP score, APACHE II Ranson score, and mCTSI.
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Affiliation(s)
- Okan Bardakcı
- Department of Emergency Medicine, Çanakkale Onsekiz Mart University Faculty of Medicine, Çanakkale-Türkiye
| | - Gökhan Akdur
- Department of Emergency Medicine, Çanakkale Onsekiz Mart University Faculty of Medicine, Çanakkale-Türkiye
| | - Murat Das
- Department of Emergency Medicine, Çanakkale Onsekiz Mart University Faculty of Medicine, Çanakkale-Türkiye
| | - Duygu Sıddıkoğlu
- Department of Biostatistic, Çanakkale Onsekiz Mart University Faculty of Medicine, Çanakkale-Türkiye
| | - Okhan Akdur
- Department of Emergency Medicine, Çanakkale Onsekiz Mart University Faculty of Medicine, Çanakkale-Türkiye
| | - Yavuz Beyazit
- Department of Internal Medicine, Çanakkale Onsekiz Mart University Faculty of Medicine, Çanakkale-Türkiye
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He Q, Ding J, He S, Yu Y, Chen X, Li D, Chen F. The predictive value of procalcitonin combined with C-reactive protein and D dimer in moderately severe and severe acute pancreatitis. Eur J Gastroenterol Hepatol 2022; 34:744-750. [PMID: 35412505 PMCID: PMC9148668 DOI: 10.1097/meg.0000000000002376] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2021] [Accepted: 03/13/2022] [Indexed: 02/07/2023]
Abstract
OBJECTIVE The objective of this study is to investigate the predictive value of a parametric model constructed by using procalcitonin, C-reactive protein (CRP) and D dimer within 48 h after admission in moderately severe and severe acute pancreatitis. METHODS A total of 238 patients were enrolled, of which 170 patients were moderately severe and severe acute pancreatitis (MSAP+SAP). The concentrations of procalcitonin, CRP and D dimer within 48 h after admission were obtained. The predictive value of the parametric model, modified computed tomography severity index (MCTSI), bedside index for severity in acute pancreatitis (BISAP), Ranson score, Acute Physiology and Chronic Health Evaluation II (APACHE II) score, modified Marshall score and systemic inflammatory response syndrome (SIRS) score of all patients was calculated and compared. RESULTS The area under receiver operator characteristic curve, sensitivity, specificity, Youden index and critical value of the parametric model for predicting MSAP+SAP were 0.853 (95% CI, 0.804-0.903), 84.71%, 70.59%, 55.30% and 0.2833, respectively. The sensitivity of the parametric model was higher than that of MCTSI (84.00%), Ranson score (73.53%), BISAP (56.47%), APACHE II score (27.65%), modified Marshall score (17.06%) and SIRS score (78.24%); the specificity of it were higher than that of MCTSI (52.94%) and Ranson score (67.65%), but lower than BISAP (73.53%), APACHE II score (76.47%), modified Marshall score (100%)and SIRS score (100.00%). CONCLUSION The parametric model constructed by using procalcitonin 48 h, CRP 48 h and D dimer 48 h can be regarded as an evaluation model for predicting moderately severe and severe acute pancreatitis.
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Affiliation(s)
- QiYong He
- Digestive Department, the First Affiliated Hospital of Fujian Medical University
| | - Jian Ding
- Digestive Department, Minnan branch, the First Affiliated Hospital of Fujian Medical University
| | - ShanShan He
- Digestive Department, the First Affiliated Hospital of Fujian Medical University
| | - YunWen Yu
- Digestive Department, the First Affiliated Hospital of Fujian Medical University
| | - XiaoPing Chen
- Department of Statistics, College of Mathematics and Informatics & FJKLMAA, Fujian Normal University
| | - Dan Li
- Digestive Department, Union Hospital of Fujian Medical University, Fujian, People’s Republic of China
| | - FengLin Chen
- Digestive Department, Union Hospital of Fujian Medical University, Fujian, People’s Republic of China
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Prakash S, Soni S, Tekwani N. Validity of the Adapted Waterlow Score as a Tool in Predicting Adverse Outcomes in Acute Pancreatitis When Compared With the Ranson Score and Serum CRP Levels. Cureus 2022; 14:e25908. [PMID: 35844315 PMCID: PMC9278896 DOI: 10.7759/cureus.25908] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/13/2022] [Indexed: 11/05/2022] Open
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Alberti P, Pando E, Mata R, Cirera A, Fernandes N, Hidalgo N, Gomez-Jurado MJ, Vidal L, Dopazo C, Blanco L, Gómez C, Caralt M, Balsells J, Charco R. The role of procalcitonin as a prognostic factor for acute cholangitis and infections in acute pancreatitis: a prospective cohort study from a European single center. HPB (Oxford) 2022; 24:875-884. [PMID: 34802942 DOI: 10.1016/j.hpb.2021.10.016] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Revised: 10/16/2021] [Accepted: 10/27/2021] [Indexed: 12/12/2022]
Abstract
BACKGROUND Infection in acute pancreatitis will worsen the disease prognosis. The aim of our study was to analyze the role of procalcitonin as a prognostic biomarker for infections and clinical severity. METHOD A prospective single-cohort observational study of patients diagnosed of acute pancreatitis (n = 152) was designed. PCT determination was tested on admission (first 72 h). Infections (biliary, extrapancreatic and infected pancreatic necrosis), need for antibiotics, urgent ERCP and severity scores for acute pancreatitis was assessed. ROC curves were designed and the area under the curve was calculated. Logistic regression for multivariate analysis was performed to evaluate the association between procalcitonin optimal cut-off level and major complications. RESULTS PCT >0.68 mg/dL had higher incidence of global infection, acute cholangitis, bacteraemia, infected pancreatic necrosis, use of antibiotics in general, and need for urgent ERCP. In the multivariate regressions analysis, PCT >0.68 mg/dL at admission demonstrated to be a strong risk factor for complications in acute pancreatitis. DISCUSSION PCT levels can be used as a reliable laboratory test to predict infections and the clinical severity of acute pancreatitis. High levels of PCT predict antibiotics prescription as well as the need for urgent ERCP in patients with concomitant clinically severe cholangitis.
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Affiliation(s)
- Piero Alberti
- Hepato-Pancreato-Biliary and Transplantation Department, Hospital Val D'Hebron, Barcelona, Spain
| | - Elizabeth Pando
- Hepato-Pancreato-Biliary and Transplantation Department, Hospital Val D'Hebron, Barcelona, Spain.
| | - Rodrigo Mata
- Hepato-Pancreato-Biliary and Transplantation Department, Hospital Val D'Hebron, Barcelona, Spain
| | - Arturo Cirera
- Hepato-Pancreato-Biliary and Transplantation Department, Hospital Val D'Hebron, Barcelona, Spain
| | - Nair Fernandes
- Hepato-Pancreato-Biliary and Transplantation Department, Hospital Val D'Hebron, Barcelona, Spain
| | - Nils Hidalgo
- Hepato-Pancreato-Biliary and Transplantation Department, Hospital Val D'Hebron, Barcelona, Spain
| | - María J Gomez-Jurado
- Hepato-Pancreato-Biliary and Transplantation Department, Hospital Val D'Hebron, Barcelona, Spain
| | - Laura Vidal
- Hepato-Pancreato-Biliary and Transplantation Department, Hospital Val D'Hebron, Barcelona, Spain
| | - Cristina Dopazo
- Hepato-Pancreato-Biliary and Transplantation Department, Hospital Val D'Hebron, Barcelona, Spain
| | - Laia Blanco
- Hepato-Pancreato-Biliary and Transplantation Department, Hospital Val D'Hebron, Barcelona, Spain
| | - Concepción Gómez
- Hepato-Pancreato-Biliary and Transplantation Department, Hospital Val D'Hebron, Barcelona, Spain
| | - Mireia Caralt
- Hepato-Pancreato-Biliary and Transplantation Department, Hospital Val D'Hebron, Barcelona, Spain
| | - Joaquim Balsells
- Hepato-Pancreato-Biliary and Transplantation Department, Hospital Val D'Hebron, Barcelona, Spain
| | - Ramón Charco
- Hepato-Pancreato-Biliary and Transplantation Department, Hospital Val D'Hebron, Barcelona, Spain
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Kiss S, Pintér J, Molontay R, Nagy M, Farkas N, Sipos Z, Fehérvári P, Pecze L, Földi M, Vincze Á, Takács T, Czakó L, Izbéki F, Halász A, Boros E, Hamvas J, Varga M, Mickevicius A, Faluhelyi N, Farkas O, Váncsa S, Nagy R, Bunduc S, Hegyi PJ, Márta K, Borka K, Doros A, Hosszúfalusi N, Zubek L, Erőss B, Molnár Z, Párniczky A, Hegyi P, Szentesi A. Early prediction of acute necrotizing pancreatitis by artificial intelligence: a prospective cohort-analysis of 2387 cases. Sci Rep 2022; 12:7827. [PMID: 35552440 PMCID: PMC9098474 DOI: 10.1038/s41598-022-11517-w] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Accepted: 04/07/2022] [Indexed: 12/21/2022] Open
Abstract
Pancreatic necrosis is a consistent prognostic factor in acute pancreatitis (AP). However, the clinical scores currently in use are either too complicated or require data that are unavailable on admission or lack sufficient predictive value. We therefore aimed to develop a tool to aid in necrosis prediction. The XGBoost machine learning algorithm processed data from 2387 patients with AP. The confidence of the model was estimated by a bootstrapping method and interpreted via the 10th and the 90th percentiles of the prediction scores. Shapley Additive exPlanations (SHAP) values were calculated to quantify the contribution of each variable provided. Finally, the model was implemented as an online application using the Streamlit Python-based framework. The XGBoost classifier provided an AUC value of 0.757. Glucose, C-reactive protein, alkaline phosphatase, gender and total white blood cell count have the most impact on prediction based on the SHAP values. The relationship between the size of the training dataset and model performance shows that prediction performance can be improved. This study combines necrosis prediction and artificial intelligence. The predictive potential of this model is comparable to the current clinical scoring systems and has several advantages over them.
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Affiliation(s)
- Szabolcs Kiss
- Doctoral School of Clinical Medicine, Faculty of Medicine, University of Szeged, Szeged, 6720, Hungary.,Institute for Translational Medicine, Szentágothai Research Centre, Medical School, University of Pécs, Szigeti út 12., II. Emelet, Pécs, 7624, Hungary.,Heim Pál National Pediatric Institute, Üllői út 86, Budapest, 1089, Hungary
| | - József Pintér
- Human and Social Data Science Lab, Budapest University of Technology and Economics, Műegyetem rkp. 3, Budapest, 1111, Hungary
| | - Roland Molontay
- Human and Social Data Science Lab, Budapest University of Technology and Economics, Műegyetem rkp. 3, Budapest, 1111, Hungary.,Stochastics Research Group, Hungarian Academy of Sciences, Budapest University of Technology and Economics, Egry József u. 1, Budapest, 1111, Hungary
| | - Marcell Nagy
- Human and Social Data Science Lab, Budapest University of Technology and Economics, Műegyetem rkp. 3, Budapest, 1111, Hungary
| | - Nelli Farkas
- Institute for Translational Medicine, Szentágothai Research Centre, Medical School, University of Pécs, Szigeti út 12., II. Emelet, Pécs, 7624, Hungary.,Institute of Bioanalysis, Medical School, University of Pécs, Honvéd u. 1, Pécs, 7624, Hungary
| | - Zoltán Sipos
- Institute for Translational Medicine, Szentágothai Research Centre, Medical School, University of Pécs, Szigeti út 12., II. Emelet, Pécs, 7624, Hungary
| | - Péter Fehérvári
- Institute for Translational Medicine, Szentágothai Research Centre, Medical School, University of Pécs, Szigeti út 12., II. Emelet, Pécs, 7624, Hungary.,Department of Biomathematics and Informatics, University of Veterinary Medicine, István u. 2, Budapest, 1078, Hungary
| | - László Pecze
- Institute for Translational Medicine, Szentágothai Research Centre, Medical School, University of Pécs, Szigeti út 12., II. Emelet, Pécs, 7624, Hungary
| | - Mária Földi
- Doctoral School of Clinical Medicine, Faculty of Medicine, University of Szeged, Szeged, 6720, Hungary.,Institute for Translational Medicine, Szentágothai Research Centre, Medical School, University of Pécs, Szigeti út 12., II. Emelet, Pécs, 7624, Hungary.,Heim Pál National Pediatric Institute, Üllői út 86, Budapest, 1089, Hungary
| | - Áron Vincze
- Division of Gastroenterology, First Department of Medicine, Medical School, University of Pécs, Ifjúság út 13, Pécs, 7624, Hungary
| | - Tamás Takács
- Department of Medicine, University of Szeged, Kálvária sgt. 57, Szeged, 6725, Hungary
| | - László Czakó
- Department of Medicine, University of Szeged, Kálvária sgt. 57, Szeged, 6725, Hungary
| | - Ferenc Izbéki
- Department of Internal Medicine, Szent György Teaching Hospital of County Fejér, Seregélyesi út 3, Székesfehérvár, 8000, Hungary
| | - Adrienn Halász
- Doctoral School of Clinical Medicine, Faculty of Medicine, University of Szeged, Szeged, 6720, Hungary.,Department of Internal Medicine, Szent György Teaching Hospital of County Fejér, Seregélyesi út 3, Székesfehérvár, 8000, Hungary
| | - Eszter Boros
- Department of Internal Medicine, Szent György Teaching Hospital of County Fejér, Seregélyesi út 3, Székesfehérvár, 8000, Hungary
| | - József Hamvas
- Bajcsy-Zsilinszky Hospital, Maglódi út 89-91, Budapest, 1106, Hungary
| | - Márta Varga
- Department of Gastroenterology, BMKK Dr Rethy Pal Hospital, Gyulai út 18, Békéscsaba, 5600, Hungary
| | - Artautas Mickevicius
- Vilnius University Hospital Santaros Clinics, Clinics of Abdominal Surgery, Nephrourology and Gastroenterology, Faculty of Medicine, Vilnius University, Santariškių g. 2, 08410, Vilnius, Lithuania
| | - Nándor Faluhelyi
- Department of Medical Imaging, Medical School, University of Pécs, Ifjúság út 13, Pécs, 7624, Hungary
| | - Orsolya Farkas
- Department of Medical Imaging, Medical School, University of Pécs, Ifjúság út 13, Pécs, 7624, Hungary
| | - Szilárd Váncsa
- Institute for Translational Medicine, Szentágothai Research Centre, Medical School, University of Pécs, Szigeti út 12., II. Emelet, Pécs, 7624, Hungary.,Centre for Translational Medicine, Semmelweis University, Üllői út 26, Budapest, 1085, Hungary
| | - Rita Nagy
- Institute for Translational Medicine, Szentágothai Research Centre, Medical School, University of Pécs, Szigeti út 12., II. Emelet, Pécs, 7624, Hungary.,Heim Pál National Pediatric Institute, Üllői út 86, Budapest, 1089, Hungary.,Centre for Translational Medicine, Semmelweis University, Üllői út 26, Budapest, 1085, Hungary
| | - Stefania Bunduc
- Centre for Translational Medicine, Semmelweis University, Üllői út 26, Budapest, 1085, Hungary.,Doctoral School, Carol Davila University of Medicine and Pharmacy, Bulevardul Eroii Sanitari 8, 050474, Bucharest, Romania
| | - Péter Jenő Hegyi
- Centre for Translational Medicine, Semmelweis University, Üllői út 26, Budapest, 1085, Hungary.,Division of Pancreatic Diseases, Heart and Vascular Center, Semmelweis University, Baross u. 23, Budapest, 1082, Hungary
| | - Katalin Márta
- Centre for Translational Medicine, Semmelweis University, Üllői út 26, Budapest, 1085, Hungary.,Division of Pancreatic Diseases, Heart and Vascular Center, Semmelweis University, Baross u. 23, Budapest, 1082, Hungary
| | - Katalin Borka
- Centre for Translational Medicine, Semmelweis University, Üllői út 26, Budapest, 1085, Hungary.,2nd Department of Pathology, Semmelweis University, Üllői út 93, Budapest, 1091, Hungary
| | - Attila Doros
- Centre for Translational Medicine, Semmelweis University, Üllői út 26, Budapest, 1085, Hungary.,Department of Transplantation and Surgery, Semmelweis University, Baross u. 23, Budapest, 1082, Hungary
| | - Nóra Hosszúfalusi
- Centre for Translational Medicine, Semmelweis University, Üllői út 26, Budapest, 1085, Hungary.,Department of Internal Medicine and Hematology, Semmelweis University, Szentkirályi u. 46, Budapest, 1088, Hungary
| | - László Zubek
- Centre for Translational Medicine, Semmelweis University, Üllői út 26, Budapest, 1085, Hungary.,Department of Anaesthesiology and Intensive Therapy, Semmelweis University, Üllői út 78, Budapest, 1082, Hungary
| | - Bálint Erőss
- Centre for Translational Medicine, Semmelweis University, Üllői út 26, Budapest, 1085, Hungary.,Division of Pancreatic Diseases, Heart and Vascular Center, Semmelweis University, Baross u. 23, Budapest, 1082, Hungary
| | - Zsolt Molnár
- Centre for Translational Medicine, Semmelweis University, Üllői út 26, Budapest, 1085, Hungary.,Department of Anaesthesiology and Intensive Therapy, Semmelweis University, Üllői út 78, Budapest, 1082, Hungary.,Department of Anaesthesiology and Intensive Therapy, Poznan University of Medical Sciences, ul. św. Marii Magdaleny 14, 61861, Poznan, Wielkopolska, Poland
| | - Andrea Párniczky
- Institute for Translational Medicine, Szentágothai Research Centre, Medical School, University of Pécs, Szigeti út 12., II. Emelet, Pécs, 7624, Hungary.,Heim Pál National Pediatric Institute, Üllői út 86, Budapest, 1089, Hungary
| | - Péter Hegyi
- Institute for Translational Medicine, Szentágothai Research Centre, Medical School, University of Pécs, Szigeti út 12., II. Emelet, Pécs, 7624, Hungary.,Centre for Translational Medicine, Semmelweis University, Üllői út 26, Budapest, 1085, Hungary.,Division of Pancreatic Diseases, Heart and Vascular Center, Semmelweis University, Baross u. 23, Budapest, 1082, Hungary
| | - Andrea Szentesi
- Doctoral School of Clinical Medicine, Faculty of Medicine, University of Szeged, Szeged, 6720, Hungary. .,Institute for Translational Medicine, Szentágothai Research Centre, Medical School, University of Pécs, Szigeti út 12., II. Emelet, Pécs, 7624, Hungary.
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Chauhan R, Saxena N, Kapur N, Kardam D. Comparison of modified Glasgow-Imrie, Ranson, and Apache II scoring systems in predicting the severity of acute pancreatitis. POLISH JOURNAL OF SURGERY 2022; 95:6-12. [PMID: 36806163 DOI: 10.5604/01.3001.0015.8384] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
<b>Aim:</b> The course of acute pancreatitis is variable with patients at risk of poor outcomes. The purpose of this study was to compare Modified Glasgow-Imrie, Ranson, and APACHE II scoring systems in predicting the severity of acute pancreatitis. </br></br> <b> Material and Methods: </b> After a brief history, clinical examination and qualifying inclusion criteria, 70 patients (41 women, 29 men) diagnosed with acute pancreatitis were included in the study. The three scores were calculated for each patient and evaluated for their role in the assessment of specific outcomes. </br></br> <b>Results:</b> 34.3% patients were diagnosed with severe acute pancreatitis, while 65.7% patients had mild acute pancreatitis. A strong positive correlation was found between all the prognostic scores and the severity of disease. In the prediction of the severity of disease according to AUC, it was found that Glasgow-Imrie score had an AUC of 0.864 (0.7560.973), followed very closely by APACHE II score with an AUC of 0.863 (0.7580.968). APACHE II had the highest sensitivity (79.17%) in predicting severity while Glasgow-Imrie score was the most specific (97.83%) of all the scores. Patients with a Glasgow-Imrie score above the cut-off value of 3 had more complications and a longer hospital stay. </br></br> <b>Conclusion:</b> The Glasgow-Imrie score was comparable to APACHE II score and better than Ranson score statistically in predicting the severity of acute pancreatitis. Its administration in predicting the severity of acute pancreatitis is recommended.
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Affiliation(s)
- Rohit Chauhan
- Department of General & Minimally Invasive Surgery, Atal Bihari Vajpayee Institute of Medical Sciences & Dr. Ram Manohar Lohia Hospital, New Delhi, India
| | - Neeraj Saxena
- Department of General & Minimally Invasive Surgery, Atal Bihari Vajpayee Institute of Medical Sciences & Dr. Ram Manohar Lohia Hospital, New Delhi, India
| | - Neeti Kapur
- Department of General & Minimally Invasive Surgery, Atal Bihari Vajpayee Institute of Medical Sciences & Dr. Ram Manohar Lohia Hospital, New Delhi, India
| | - Dinesh Kardam
- Department of General & Minimally Invasive Surgery, Atal Bihari Vajpayee Institute of Medical Sciences & Dr. Ram Manohar Lohia Hospital, New Delhi, India
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Walker H, Melling J, Jones M, Melling CV. C-reactive protein accurately predicts severity of acute pancreatitis in children. J Pediatr Surg 2022; 57:759-764. [PMID: 34493377 DOI: 10.1016/j.jpedsurg.2021.08.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Revised: 08/17/2021] [Accepted: 08/18/2021] [Indexed: 01/15/2023]
Abstract
INTRODUCTION Predicting severity of acute pancreatitis enables optimization of care, reducing morbidity and length of stay. Modified adult scoring systems have not been able to adequately predict severity in children. METHODS This was a retrospective study of children presenting with a first episode of acute pancreatitis from 2002 to 2020 in a single tertiary paediatric surgical centre. Serum markers including CRP at 48 h of admission were analysed. Promising biomarkers underwent ROC (Receiver Operating Curve) analysis, and these were compared to the modified Glasgow Pancreas Score. An AUC (Area Under Curve) > 0.90 was taken as an excellent predictor of severity. RESULTS Data of 59 children were analysed, median age 13 years. 22 patients (37%) had a severe episode. ROC analysis demonstrated CRP as the best predictor of severity giving an AUC of 0.92. Optimum cut off value for CRP was 107.5 mg/L (p < 0.0001) producing sensitivity of 91%, specificity of 84%. This was superior to the modified Glasgow Pancreas score, which produced a sensitivity of 36% and specificity of 100%. CONCLUSION We have shown that a CRP value of > 108 mg/L within 48 h of admission can be used to predict severity of acute pancreatitis in children with greater accuracy than current scoring systems. TYPE OF STUDY Diagnostic test. LEVEL OF EVIDENCE Level I.
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Affiliation(s)
- Hamish Walker
- Department of Paediatric Surgery, Alder Hey Children's NHS Foundation Trust, Eaton Rd, Liverpool, L12 2AP, United Kingdom.
| | - James Melling
- Department of Colorectal Surgery, Warrington and Halton Hospitals NHS Trust, Lovely Lane, Warrington WA5 1QG, United Kingdom
| | - Matthew Jones
- Department of Paediatric Surgery, Alder Hey Children's NHS Foundation Trust, Eaton Rd, Liverpool, L12 2AP, United Kingdom
| | - Charlotte Victoria Melling
- Department of Paediatric Surgery, Alder Hey Children's NHS Foundation Trust, Eaton Rd, Liverpool, L12 2AP, United Kingdom
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Blood Urea Nitrogen as a Prognostic Marker in Severe Acute Pancreatitis. DISEASE MARKERS 2022; 2022:7785497. [PMID: 35392494 PMCID: PMC8983180 DOI: 10.1155/2022/7785497] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/26/2021] [Accepted: 03/10/2022] [Indexed: 12/12/2022]
Abstract
Objectives To explore independent risk factors with good and early predictive power for SAP severity and prognosis. Methods Patients with SAP were enrolled at Central South University Xiangya Hospital between April 2017 and May 2021 and used as the training cohort. From June 2021 to February 2022, all patients with SAP were defined as external patients for validation. Patients were grouped by survival status at a 30-day posthospital admission and then compared in terms of basic information and laboratory tests to screen the independent risk factors. Results A total of 249 patients with SAP were enrolled in the training cohort. The all-cause mortality rate at a 30-day postadmission was 25.8% (51/198). Blood urea nitrogen (BUN) levels were significantly higher in the mortality group (20.45 [interquartile range (IQR), 19.7] mmol/L) than in the survival group (6.685 [IQR, 6.3] mmol/L; P < 0.001). After propensity score matching (PSM), the BUN level was still higher in the mortality group than in the survival group (18.415 [IQR, 19.555] mmol/L vs. 10.63 [IQR, 6.03] mmol/L; P = 0.005). The area under the curve (AUC) of the receiver operating characteristic curve (ROC) of BUN was 0.820 (95% confidence interval, 0.721–0.870; P < 0.001). The optimal BUN level cut-off for predicting a 30-day all-cause mortality was 10.745 mmol/L. Moreover, patients with SAP were grouped according to BUN levels and stratified according to optimal cut-off value. Patients with high BNU levels were associated with significantly higher rates of invasive mechanical ventilation (before PSM: 61.8% vs. 20.6%, P < 0.001; after PSM: 71.1% vs. 32%, P = 0.048) and a 30-day all-cause mortality (before PSM: 44.9% vs. 6.9%, P < 0.001; after PSM: 60% vs. 34.5%, P = 0.032) than those with low BNU levels before or after PSM. The effectiveness of BUN as a prognostic marker was further validated using ROC curves for the external validation set (n = 49). The AUC of BUN was 0.803 (95% CI, 0.655–0.950; P = 0.011). It showed a good ability to predict a 30-day all-cause mortality in patients with SAP. We also observed similar results regarding disease severity, including the Acute Physiology and Chronic Health Evaluation II score (before PSM: 16 [IQR, 8] vs. 8 [IQR, 6], P < 0.001; after PSM: 18 [IQR, 10] vs. 12 [IQR, 7], P < 0.001), SOFA score (before PSM: 7 [IQR, 5] vs. 3 [IQR, 3], P < 0.001; after PSM: 8 [IQR, 5] vs. 5 [IQR, 3.5], P < 0.001), and mMarshall score (before PSM: 4 [IQR, 3] vs. 3 [IQR, 1], P < 0.001; after PSM: 5 [IQR, 2.5] vs. 3 [IQR, 1], P < 0.001). There was significant increase in intensive care unit occupancy in the high BUN level group before PSM (93.3% vs. 73.1%, P < 0.001), but not after PSM (97.8% vs. 86.2%, P = 0.074). Conclusions Our results showed that BUN levels within 24 h after hospital admission were independent risk factors for a 30-day all-cause death in patients with SAP.
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Vest M, Grewal H, Shaukat T, Landry I, Nso N, O'Connor J, Rizzo V. Acute Pancreatitis and Prognosticating Its Severity in Young Adults: A Case Report. Cureus 2022; 14:e22749. [PMID: 35371853 PMCID: PMC8971073 DOI: 10.7759/cureus.22749] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/01/2022] [Indexed: 11/05/2022] Open
Abstract
Acute pancreatitis develops into mild acute, moderately severe, and severe forms in multiple clinical scenarios. The severity assessment of pancreatitis relies on various scoring systems, including CT Severity Index (CTSI), Multiple Organ Dysfunction Syndrome (MODS), Acute Physiology and Chronic Health Evaluation II (APACHE-II), Bedside Index for Severity in Acute Pancreatitis (BISAP), Systemic Inflammatory Response Syndrome (SIRS), Multiple Organ System Score (MOSS), Glasgow score, and Ranson's Criteria (RC). This case report corresponds to a 20-year-old male with acute pancreatitis of unknown etiology. The RC scoring method produced two points, which could not prognosticate the possible severity of acute pancreatitis in the young patient. The hospital course included intubation with mechanical ventilation and ICU management.
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Lyu Y, Cheng Y, Wang B, Zhao S, Chen L. Safety of early same-admission laparoscopic cholecystectomy for acute mild biliary pancreatitis. A retrospective study for acute pancreatitis. Wideochir Inne Tech Maloinwazyjne 2022; 17:150-155. [PMID: 35251400 PMCID: PMC8886477 DOI: 10.5114/wiitm.2021.105575] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2020] [Accepted: 03/21/2021] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION As the standard procedure for the surgical treatment for gallbladder stones, we investigated the controversy surrounding the optimal time for laparoscopic cholecystectomy (LC) for acute mild biliary pancreatitis (AMBP). AIM To further address the optimal timing of LC, we conducted a retrospective study comparing early (< 72 h, group I) with delayed (> 72 h, group II) LC for AMBP during the same admission. MATERIAL AND METHODS This retrospective study included medical records of all patients who were admitted with a diagnosis of acute mild biliary pancreatitis at Dongyang People's Hospital from July 2011 to June 2019. RESULTS A total of 119 patients were divided into an early LC group (group I; 52 patients) and a control group (group II; 67 patients). Conversion to open cholecystectomy (COC) was performed in 17 patients (6 patients in group I and 11 patients in group II, p = 0.62). There were no significant differences in terms of estimated blood loss and duration of surgery (p = 0.08 and p = 0.64, respectively). The overall hospital stay in group I was significantly shorter than in group II (10.86 ±3.21 vs. 13.29 ±4.51 days, p = 0.001). Compared with postoperative bile leakage (p = 0.72) and postoperative morbidity (p = 0.97) and mortality, there were no significant differences between the groups. CONCLUSIONS Early LC during the same admission is safe for acute mild biliary pancreatitis and has the advantage of shortening overall hospital stay. There was no significant increase in COC, bile duct injury, and complications.
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Affiliation(s)
- Yunxiao Lyu
- Department of Hepatobiliary Surgery, Afliated Dongyang Hospital of Wenzhou Medical University, Dongyang, Zhejiang Province, China
| | - Yunxiao Cheng
- Department of Hepatobiliary Surgery, Afliated Dongyang Hospital of Wenzhou Medical University, Dongyang, Zhejiang Province, China
| | - Bin Wang
- Department of Hepatobiliary Surgery, Afliated Dongyang Hospital of Wenzhou Medical University, Dongyang, Zhejiang Province, China
| | - Sicong Zhao
- Department of Hepatobiliary Surgery, Afliated Dongyang Hospital of Wenzhou Medical University, Dongyang, Zhejiang Province, China
| | - Liang Chen
- Department of Hepatobiliary Surgery, Afliated Dongyang Hospital of Wenzhou Medical University, Dongyang, Zhejiang Province, China
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Formanchuk T, Shaprinskiy V, Formanchuk A. Clinical and simple laboratory data associated with fatal outcomes in patients with acute pancreatitis. ACTA FACULTATIS MEDICAE NAISSENSIS 2022. [DOI: 10.5937/afmnai39-32308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Abstract
Aims. The aim of the study was to evaluate the association of mortality in acute pancreatitis with clinical and simple laboratory data received on the day of admission. Patients and methods. In our retrospective study, the clinical and laboratory parameters of 99 patients with moderate and severe acute pancreatitis were analyzed. All patients were divided into two groups: deceased and survivors. Results. We did not find a significant difference in age and gender distribution between the comparison groups. However, a significant predominance of alcoholic etiology of acute pancreatitis, early hospitalization (up to 6 hours from the onset of the disease) of patients, and the number of necrotizing infected type in the deceased group were found. Concomitant pathology did not significantly differ in comparison groups. In patients from the deceased group, the total number of all complications was significantly higher than in the group of survivors-21 (100%) and 42 (53.8%) (p = 0.0001), respecting. Among the laboratory parameters determined on the day of admission, in the deceased group, there was a significant increase in stabs to 19.8 ± 9.8 and ESR, AST to 225.3 ± 47.5 U/L, urea to 11.2 ± 7.7 mmol/L, and creatinine to 173.6 ± 26.1 mmol/L. Conclusion. The alcoholic genesis of acute pancreatitis, necrotizing infected type of inflammation of the pancreas, presence of late complications, and comorbidities were significantly higher in the deceased group. The levels of stabs, ESR, AST, urea, and creatinine determined on the admission significantly dominated in the deceased group, which requires further study for the prediction of mortality of acute pancreatitis.
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Formanchuk T, Lapshyn H, Pokidko M, Formanchuk A, Vovchuk I. The relationship between neutrophil-lymphocyte ratio and clinal laboratory data in acute pancreatitis. ACTA FACULTATIS MEDICAE NAISSENSIS 2022. [DOI: 10.5937/afmnai39-34988] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
Introduction: Neutrophil-lymphocyte ratio (NLR) is one of the laboratory biomarkers used in clinical practice to predict severity and mortality of acute pancreatitis (AP), however, there is currently insufficient information about the changes of NLR in the dynamics in relationship with other clinical and laboratory data. Aims: To assess the relationship between NLR values and other demographics, clinical and simple laboratory data in patients with acute pancreatitis. Methods: The data of two hundred twenty-nine patients with AP were analyzed. All patients were divided into two groups: the group with a positive outcome and the group with a fatal outcome. NLR was counted on the 1st, 3rd and 5th day after admission in each group. The dynamics of NLR index by groups and days, as well as its correlation with other 18 simple laboratory parameters were evaluated. Results: The level of NLR rate itself was significantly higher on the 1st, 3rd and 5th day in the group with the fatal result compared with the group with the positive result (p < 0.05). In patients with AP with the positive result of treatment, there was a gradual decrease in the rate between the 1st and the 3rd day (-21.8%) (p < 0.05). The overall dynamics of the indicator between the 1st and the 5th day was -21.5%. In contrast to the group of patients with the fatal outcome, despite the infusion therapy, there was an increase in NLR rate between the 1st and 3rd day of +15.7%. The overall dynamics between the 1st and 5th day was -34.0%. A significant negative relationship of the Spearman's rank correlation coefficient between NLR on the 1st and 3rd day with the fatal outcome was revealed. The highest reliability of this indicator was found on the 3rd day after admission (p < 0.0001). In the group of patients with a positive result, a correlation between NLR on the 1st day and stabs on the 1st day, segmental forms on the 1st day, serum amylase on the 1st day was found. A very high correlation was found with the level of lymphocytes on the 1st day (rs = -0.98, p < 0001). In the group of patients with the fatal outcome, a statistically significant correlation (p < 0.05) of moderate strength was found between the value of NLR and the following indicators: glucose level on the 1st day, total protein on the 5th day, prothrombin index on the 5th day. A high correlation was found with the level of segmental forms on the 1st day (rs = 0.7) and a very high correlation with the level of lymphocytes on the 1st day (rs = -0.99). Conclusions: There was a significant increase in NLR on the 1st, 3rd, and 5th day in the group of patients with AP with the fatal outcome compared with the group of patients with AP with the positive result. Elevated NLR levels on the 1st and 3rd day seem to be associated with hospital mortality in patients with AP. No correlation was found between NLR rate and clinical data in the group with fatal outcome. The main indicators among simple laboratory parameters for determining the predictors of lethal outcome in AP in different periods after hospitalization were: the level of blood glucose, lymphocytes, total protein, serum amylase, prothrombin index.
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Knoph CS, Cook ME, Fjelsted CA, Novovic S, Mortensen MB, Nielsen LBJ, Hansen MB, Frøkjær JB, Olesen SS, Drewes AM. Effects of the peripherally acting μ-opioid receptor antagonist methylnaltrexone on acute pancreatitis severity: study protocol for a multicentre double-blind randomised placebo-controlled interventional trial, the PAMORA-AP trial. Trials 2021; 22:940. [PMID: 34924020 PMCID: PMC8686628 DOI: 10.1186/s13063-021-05885-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Accepted: 11/26/2021] [Indexed: 12/19/2022] Open
Abstract
Background Moderate to severe acute pancreatitis (AP) is associated with a high rate of complications and increased mortality, yet no targeted pharmacologic treatment currently exists. As pain is a dominant symptom in AP, patients are exposed to excess levels of both endo- and exogenous opioids, which may have harmful effects on the course of AP. This trial investigates the effects of the peripherally acting μ-opioid receptor antagonist (PAMORA) methylnaltrexone on disease severity and clinical outcomes in patients with moderate to severe AP. Methods PAMORA-AP is a multicentre, investigator-initiated, double-blind, randomised, placebo-controlled, interventional trial, which will be conducted at four referral centres for acute pancreatitis in Denmark. Ninety patients with early-onset AP (pain onset within 48 h) as well as predicted moderate to severe disease (two or more systemic inflammatory response syndrome criteria upon admission) will be prospectively included. Subsequently, participants will be randomised (1:1) to intravenous treatment with either methylnaltrexone or matching placebo (Ringer’s lactate) during 5 days of admission. The primary endpoint will be the group difference in disease severity as defined and measured by the Pancreatitis Activity Scoring System (PASS) score 48 h after randomisation. Secondary endpoints include daily PASS scores; disease severity according to the Atlanta classification; quantification of need for analgesics, nutritional support, intravenous fluid resuscitation and antibiotics; duration of hospital admissions, readmission rates and mortality. Pain intensity and gut function will be self-reported using validated questionnaires. Exploratory endpoints include circulating levels of pro-and anti-inflammatory markers, polyethylene glycol recovery from the urine, circulating levels of blood markers of intestinal permeability, the prevalence of pancreatic complications on computed tomography (CT) scans, and colon transit time assessed using a CT-based radiopaque marker method. Discussion This trial aims to evaluate the PAMORA methylnaltrexone as a novel targeted pharmacotherapy in patients with moderate to severe AP with the potential benefit of improved patient outcomes. Trial registration ClinicalTrials.govNCT04743570. Registered on 28 January 2021. EudraCT 2020-002313-18.
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Affiliation(s)
- Cecilie Siggaard Knoph
- Mech-Sense, Department of Gastroenterology & Hepatology, Aalborg University Hospital, Aalborg, Denmark.,Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Mathias Ellgaard Cook
- Mech-Sense, Department of Gastroenterology & Hepatology, Aalborg University Hospital, Aalborg, Denmark.,Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Camilla Ann Fjelsted
- Mech-Sense, Department of Gastroenterology & Hepatology, Aalborg University Hospital, Aalborg, Denmark.,Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Srdan Novovic
- Gastrounit, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark
| | - Michael Bau Mortensen
- Odense Pancreas Centre, HPB Section, Department of Surgery, Odense University Hospital, Odense, Denmark
| | - Liv Bjerre Juul Nielsen
- Digestive Disease Centre K, Bispebjerg Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Mark Berner Hansen
- Digestive Disease Centre K, Bispebjerg Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Jens Brøndum Frøkjær
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark.,Mech-Sense, Department of Radiology, Aalborg University Hospital, Aalborg, Denmark
| | - Søren Schou Olesen
- Mech-Sense, Department of Gastroenterology & Hepatology, Aalborg University Hospital, Aalborg, Denmark.,Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Asbjørn Mohr Drewes
- Mech-Sense, Department of Gastroenterology & Hepatology, Aalborg University Hospital, Aalborg, Denmark. .,Department of Clinical Medicine, Aalborg University, Aalborg, Denmark.
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Acharya R, Dahal P, Parajuli S. Harmless Acute Pancreatitis Negative among Cases of Acute Pancreatitis in a Tertiary Care Centre: A Descriptive Cross-sectional Study. JNMA J Nepal Med Assoc 2021; 59:1297-1301. [PMID: 35199790 PMCID: PMC9200029 DOI: 10.31729/jnma.6627] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Accepted: 12/04/2021] [Indexed: 11/29/2022] Open
Abstract
INTRODUCTION Acute Pancreatitis is a common disease, diagnosed in about 3% of cases presenting with abdominal pain. Severe disease with multiple systemic complications develops in 10-20% of the cases which require intensive care in specialized centres. Harmless acute pancreatitis score is a simple and economical score predicting the non-severe course of disease within 30 minutes of admission. The aim of our study was to find the prevalence of harmless (harmless acute pancreatitis) among cases of acute pancreatitis in a tertiary care centre. METHODS A descriptive cross-sectional study was conducted after obtaining the ethical approval (Reference no. 344/2076/77). The study was carried out from September 2019 to February 2020 taking 50 patients with the first attack of acute pancreatitis. Convenient sampling was done. Harmless acute pancreatitis score prediction of severe disease and final outcome as severe or non-severe was noted with predefined severity criteria. Data were entered in Microsoft Excel and Statistical Package for the Social Sciences and results represented in tables and charts. Point estimate at 95% was done and frequency and percentage were calculated. RESULTS Out of 50 patients with first attack of acute pancreatitis, using the harmless acute pancreatitis score, the prevalence of harmless acute pancreatitis was 22 (56%) (44.45-67.5 at 90% Confidence Interval). CONCLUSIONS The harmless acute pancreatitis score is an easy, less expensive, quick and promising early scoring system for prediction of non-severe courses of acute pancreatitis. The prevalence of harmless (harmless acute pancreatitis) among cases of acute pancreatitis was found to be similar to other studies.
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Affiliation(s)
- Ravi Acharya
- Department of General Surgery, Rapti Academy of Health Sciences, Dang, Nepal,Correspondence: Dr. Ravi Acharya, Department of General Surgery, Rapti Academy of Health Sciences (RAHS), Dang, Nepal. , Phone: +977-9851167637
| | - Peeyush Dahal
- Burn And Plastic Unit, Bir Hospital, Kathmandu, Nepal
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Teng TZJ, Tan JKT, Baey S, Gunasekaran SK, Junnarkar SP, Low JK, Huey CWT, Shelat VG. Sequential organ failure assessment score is superior to other prognostic indices in acute pancreatitis. World J Crit Care Med 2021; 10:355-368. [PMID: 34888161 PMCID: PMC8613719 DOI: 10.5492/wjccm.v10.i6.355] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Revised: 08/10/2021] [Accepted: 10/11/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Acute pancreatitis (AP) is a common surgical condition, with severe AP (SAP) potentially lethal. Many prognostic indices, including; acute physiology and chronic health evaluation II score (APACHE II), bedside index of severity in acute pancreatitis (BISAP), Glasgow score, harmless acute pancreatitis score (HAPS), Ranson's score, and sequential organ failure assessment (SOFA) evaluate AP severity and predict mortality. AIM To evaluate these indices' utility in predicting severity, intensive care unit (ICU) admission, and mortality. METHODS A retrospective analysis of 653 patients with AP from July 2009 to September 2016 was performed. The demographic, clinical profile, and patient outcomes were collected. SAP was defined as per the revised Atlanta classification. Values for APACHE II score, BISAP, HAPS, and SOFA within 24 h of admission were retrospectively obtained based on laboratory results and patient evaluation recorded on a secure hospital-based online electronic platform. Data with < 10% missing data was imputed via mean substitution. Other patient information such as demographics, disease etiology, and patient outcomes were also derived from electronic medical records. RESULTS The mean age was 58.7 ± 17.5 years, with 58.7% males. Gallstones (n = 404, 61.9%), alcohol (n = 38, 5.8%), and hypertriglyceridemia (n = 19, 2.9%) were more common aetiologies. 81 (12.4%) patients developed SAP, 20 (3.1%) required ICU admission, and 12 (1.8%) deaths were attributed to SAP. Ranson's score and APACHE-II demonstrated the highest sensitivity in predicting SAP (92.6%, 80.2% respectively), ICU admission (100%), and mortality (100%). While SOFA and BISAP demonstrated lowest sensitivity in predicting SAP (13.6%, 24.7% respectively), ICU admission (40.0%, 25.0% respectively) and mortality (50.0%, 25.5% respectively). However, SOFA demonstrated the highest specificity in predicting SAP (99.7%), ICU admission (99.2%), and mortality (98.9%). SOFA demonstrated the highest positive predictive value, positive likelihood ratio, diagnostic odds ratio, and overall accuracy in predicting SAP, ICU admission, and mortality. SOFA and Ranson's score demonstrated the highest area under receiver-operator curves at 48 h in predicting SAP (0.966, 0.857 respectively), ICU admission (0.943, 0.946 respectively), and mortality (0.968, 0.917 respectively). CONCLUSION The SOFA and 48-h Ranson's scores accurately predict severity, ICU admission, and mortality in AP, with more favorable statistics for the SOFA score.
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Affiliation(s)
- Thomas Zheng Jie Teng
- Department of General Surgery, Tan Tock Seng Hospital, Singapore 308433, Singapore
- Undergraduate Medicine, Lee Kong Chian School of Medicine, Singapore 308232, Singapore
| | | | - Samantha Baey
- Undergraduate Medicine, Yong Loo Lin School of Medicine, Singapore 119077, Singapore
| | | | - Sameer P Junnarkar
- Department of General Surgery, Tan Tock Seng Hospital, Singapore 308433, Singapore
| | - Jee Keem Low
- Department of General Surgery, Tan Tock Seng Hospital, Singapore 308433, Singapore
| | | | - Vishal G Shelat
- Department of General Surgery, Tan Tock Seng Hospital, Singapore 308433, Singapore
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Abstract
Purpose of Review Sepsis is a leading cause of death worldwide. Groundbreaking international collaborative efforts have culminated in the widely accepted surviving sepsis guidelines, with iterative improvements in management strategies and definitions providing important advances in care for patients. Key to the diagnosis of sepsis is identification of infection, and whilst the diagnostic criteria for sepsis is now clear, the diagnosis of infection remains a challenge and there is often discordance between clinician assessments for infection. Recent Findings We review the utility of common biochemical, microbiological and radiological tools employed by clinicians to diagnose infection and explore the difficulty of making a diagnosis of infection in severe inflammatory states through illustrative case reports. Finally, we discuss some of the novel and emerging approaches in diagnosis of infection and sepsis. Summary While prompt diagnosis and treatment of sepsis is essential to improve outcomes in sepsis, there remains no single tool to reliably identify or exclude infection. This contributes to unnecessary antimicrobial use that is harmful to individuals and populations. There is therefore a pressing need for novel solutions. Machine learning approaches using multiple diagnostic and clinical inputs may offer a potential solution but as yet these approaches remain experimental.
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