Acute Pancreatitis Admissions Research Articles

S1749 Hypertriglyceridemia-Induced Pancreatitis in the Setting of Acute COVID-19 Infection

Introduction: Profound hypertriglyceridemia has been documented in cases of acute and prior COVID-19 infections. A common cause of acute pancreatitis is hypertriglyceridemia. In some cases, this can require intensive care unit (ICU) admission for management. Case Description/Methods: The patient is a 49-year-old male with a history of recent COVID-19 infection who initially presented for epigastric pain with intractable nausea and vomiting. He was found to have acute pancreatitis on imaging and lab work. Incidentally, he was found to be COVID-19 positive. He had no respiratory or infectious symptoms from this infection. The patient was initially admitted to ICU for his triglyceride level reading greater than 5680. He was managed with an insulin drip for resolution of his hypertriglyceridemia. The patient required an extended ICU stay as his triglyceride level remained difficult to decrease while on the insulin drip. Eventually, he was able to be downgraded to the hospital floor after a 6-day ICU stay requiring an insulin drip to decrease his profound hypertriglyceridemia. Discussion: Interestingly, the patient’s refractory hypertriglyceridemia remained difficult to treat. It has been previously documented that COVID-19 infections can lead to hypertriglyceridemia. This can lead to an increase of acute pancreatitis admissions secondary to COVID-19 infections. In conclusion, more research is warranted into the association between hypertriglyceride-induced pancreatitis and COVID-19 infection.

The Utility of Abdominal Ultrasound Following Negative Computed Tomography in Diagnosing Acute Pancreatitis.

AimAcute pancreatitis is a diagnosis established by fulfillment of at least two out of three clinical features, including epigastric pain, elevated lipase, and/or radiographic evidence of acute pancreatitis. Computed tomography of the abdomen and pelvis (CTAP) is the gold standard imaging modality for evaluating acute pancreatitis. Although abdominal ultrasound (AUS) is increasingly utilized given the widespread availability and high sensitivity and specificity for detecting gallstone-related complications, including gallstone pancreatitis, the leading cause of acute pancreatitis in the US. However, recent literature has concluded that performing AUS following a negative CTAP rarely led to changes in management and imparted an increased length of service (LOS) in the ED. Our study investigated whether a similar relationship was observed when managing acute pancreatitis in the inpatient setting. We aimed to quantify how performing AUS influenced inpatient LOS for patients admitted for acute pancreatitis without radiographic evidence of acute pancreatitis on CTAP. We also aimed to quantify how AUS influenced the likelihood of subsequent intervention via endoscopic retrograde cholangiopancreatography (ERCP) or cholecystectomy, including the relative impact of certain demographic or clinical features.MethodsA retrospective analysis was performed using a cohort of 6069 patient encounters extracted via the HCA Healthcare enterprise data warehouse (EDW) database. Inclusion criteria were all adult patients with an index admission for acute pancreatitis between January 1 and December 31, 2019, who underwent CTAP during admission. Patients younger than 18 years, with prior cholecystectomy, or without documentation of demographic or clinical data of interest were excluded. The primary outcome was to quantify how performing AUS within 48 hours impacted LOS for patients admitted for acute pancreatitis following negative CTAP. Secondary outcomes examined whether AUS changed management (i.e., per likelihood of subsequent ERCP or cholecystectomy). This included determining the influence of various demographic or clinical characteristics on the likelihood of intervention via ERCP or cholecystectomy. Linear regression was used to determine the effect of performing AUS on the duration of LOS. Logistic regression was used for covariate analysis based on demographic (BMI, sex, race, age) and clinical data (comorbid conditions, abnormal labs, and vital signs).ResultsPatients with acute pancreatitis who underwent AUS within 48 hours had a reduced LOS of 1.099 days. Patients who underwent AUS were 1.126 times more likely to undergo subsequent ERCP than those who received CTAP alone. Patients who received AUS following CTAP were also 2.711 times more likely to undergo subsequent cholecystectomy. Increasing age and BMI were correlated with an increased likelihood of ERCP and cholecystectomy. Males were less likely to undergo cholecystectomy (OR = 0.753) and ERCP (OR = 0.815) compared to females.ConclusionPerforming AUS within 48 hours following negative CTAP in this cohort of patients admitted for acute pancreatitis was associated with a decreased LOS. Furthermore, patients who underwent AUS were more likely to undergo ERCP and even more likely to undergo cholecystectomy. The likelihood of ERCP and cholecystectomy increased proportionally to both age and BMI. Females were more likely than males to undergo subsequent ERCP or cholecystectomy.

Can Empirical Segmental Angioembolization of Splenic Artery Salvage Pancreatic Intraluminal Bleed?

Background Postpancreatectomy hemorrhage (PPH) and Hemosuccus Pancreaticus (HP) may present with slow but significant intraluminal bleed which may not be evident on imaging. We evaluated the efficacy of empirical segmental-angioembolization of splenic artery in intraluminal PPH and HP. Result This is a cross-sectional study done by analyzing all consecutive patients with PPH and HP who underwent empirical coil embolization of splenic artery. There were total of 137 pancreaticoduodenectomies (PD), 68 distal pancreatectomies (DP), 11 patients with median pancreatectomies (MP) and 134 admissions for acute pancreatitis and exacerbation of chronic pancreatitis during the study period. Eleven (5.1%) patients had PPH, of which two were managed surgically. Among nine patients, 4/9 (44.4%) with pseudoaneurysm on computed tomography angiography (CTA) were excluded. Among pancreatitis, 7 (5.2%) had HP, and 5/7 (71.4%) patients with pseudoaneurysm on CTA were excluded. Hence, seven patients, PPH—5 and HP—2, were included. Both HP patients were managed successfully with empirical segmental coil embolization of splenic artery. Among PPH, one patient required laparotomy for failed embolization. Overall, 6/7 (85.7%) had successful coil embolization. No reintervention, continued bleed, or blood transfusions were required postprocedure, and no splenic infarct or abscess was seen in any of the seven patients postembolization. The 72-hour rebleed rate was 1/7 (14.3%), which was managed surgically. Conclusion Empirical segmental coil embolization of splenic artery in intraluminal pancreatic bleed holds promise as a salvage life-saving procedure even when no blush or pseudoaneurysm is evident.

Assessing the impact of hypercalcemia of malignancy on clinical outcomes in cancer patients admitted with acute pancreatitis.

e24049 Background: Hypercalcemia of malignancy is a well-recognized complication in cancer. Hypercalcemia itself is one of the etiologies of acute pancreatitis. Empiric data on how presence of both these entities affect hospitalization outcomes in cancer patients is lacking. We studied 5 common cancers - Lung cancer, multiple myeloma, diffuse large B-cell lymphoma, renal cell cancer and head & neck cancers with known hypercalcemia of malignancy and studied the outcomes if they developed acute pancreatitis versus not. Methods: Healthcare Cost and Utilization Project National Inpatient Sample (HCUP-NIS) 2016 – 2018 was queried to identify adult patients with known hypercalcemia of malignancy and any of the 5 cancers stated above. From this cohort we identified patients admitted with a principal diagnosis of acute pancreatitis. The frequency of various etiologies of acute pancreatitis in the defined population was assessed. Primary outcomes assessed were mortality, length of stay (LOS), and total hospitalization charges (THC). Secondary outcomes included diagnosis of septic shock, acute kidney injury (AKI), and acute respiratory failure (ARF). Statistics were performed using multivariate linear and logistic regression. Results: There were a total of 44,030 adult patient hospitalizations with history of hypercalcemia of malignancy and one of the 5 cancers of which 4,195 hospitalizations were for acute pancreatitis. The most common etiology for acute pancreatitis was idiopathic (69.4%), followed by biliary pancreatitis (15.7%), alcohol-associated pancreatitis (7.75%) and drug-induced pancreatitis (7.15%). The incidence of acute pancreatitis was higher in the hypercalcemia of malignancy group than those without (0.36% vs 0.28%). Hypercalcemia of malignancy group had significantly increased odds of mortality during admission for acute pancreatitis (15.63% vs 3.48%, aOR: 3.48, p = 0.043) and significantly higher THC ($122,184 vs $49,223, adjusted difference of $69,974.59, p = 0.049). There was a trend towards an increased LOS among patients with hypercalcemia of malignancy (10.7 vs 5.5 days), but it was not statistically significant (p = 0.069). Hypercalcemia of malignancy was also associated with an increased odds of AKI, 53.13% vs 16.85% (aOR: 6.15, p < 0.001). Other outcomes of septic shock and ARF were similar between groups. Conclusions: Despite the high prevalence of hypercalcemia of malignancy in certain at-risk cancer groups, the most common etiology of acute pancreatitis is idiopathic. The history of hypercalcemia of malignancy in cancer patients with acute pancreatitis was associated with a 3-fold increased odds of death, higher odds of AKI and a significant increase in THC. Cancer patients with history of hypercalcemia presenting with acute pancreatitis may need more aggressive management to prevent worse outcomes than patients without history of hypercalcemia.

Ultrasound findings of acute pancreatitis in children.

Studies systematically documenting US findings in children with acute pancreatitis are limited. Pancreas duct dilation is described as the most reliable finding of acute pancreatitis but this has not been rigorously examined in children. To systematically document US findings in children with acute pancreatitis and to define interobserver agreement on those findings. In this cross-sectional study we retrospectively reviewed images for all pediatric patients <18years of age who had been prospectively enrolled in a registry of patients with index admissions for acute pancreatitis between March 2013 and July 2020. Two blinded observers (R1, R2) reviewed the first transabdominal US examination performed within 2weeks of the pancreatitis attackfor each patient. In 141 children, US was performed at a median of 1day (interquartile range [IQR]: 0, 1) following acute attack. Thirty-three (23%, R1) and 38 (27%, R2) children had no abnormal findings on US. Peripancreatic edema was the most frequent finding documented by both reviewers (63% R1, 54% R2). The pancreatic duct was visible in only 35% of the children and was dilated in only 12% (R1) and 14% (R2). There was substantial to almost-perfect agreement between reviewers on findings of acute pancreatitis (κ=0.62-1), including duct visibility. Peripancreatic edema was the most frequently identified finding in children with acute pancreatitis, present in up to 63%, with almost perfect interobserver agreement. Duct dilation, cited in the literature as a reliable finding of acute pancreatitis, was rarely identified in our sample.

Characteristics and clinical outcomes of patients over 80 years of age with acute pancreatitis.

In this study, we aimed to compare differences in disease course, etiology of acute pancreatitis admission to the intensive care unit, in-hospital mortality, disease severity, and local and systemic complications between patients aged ≥ 80years (octogenarians) and patients aged between 65 and 79years (non-octogenarians), all of whom were being followed with the diagnosis of acute pancreatitis. Patients aged 65years and older with a diagnosis of acute biliary pancreatitis were included in the study. Clinical findings, routine laboratory test results, and imaging findings of all patients were reviewed retrospectively via the hospital's records system. Of a total of 402 enrolled patients, 238 (59.2%) were female. Mean age was 77.1 ± 7.37years. Pancreatitis after endoscopic retrograde cholangiopancreatography was detected more frequently among octogenarians than non-octogenarians (12.9% versus 5.3%, respectively; p = 0.007). Levels of blood urea nitrogen, creatinine, and total bilirubin were higher among octogenarians, while lymphocyte, calcium, and albumin levels were lower. The frequency of patients without local complications was higher among octogenarians than non-octogenarians (75.5% versus 63.6%, respectively; p = 0.013). Necrosis was less frequent in the octogenarian group than the non-octogenarian group (2.6% versus 8.9%, respectively; p = 0.012). Mild acute pancreatitis was higher in the octogenarian group, while moderate acute pancreatitis was higher in the non-octogenarian group (p = 0.028 and p = 0.012, respectively). The frequencies of prolonged hospitalization, intensive care unit admission, and in-hospital mortality were similar in the octogenarian and non-octogenarian groups. In terms of disease severity, mild acute pancreatitis was higher in the octogenarian group, while moderate acute pancreatitis was higher in the non-octogenarian group.

107 Retrospective Pilot Study in Preparation for Setting Up an Acute Pancreatitis MDT in a Medium Sized NHS Acute Trust in the UK

Abstract Aim Within the spectrum of pancreatitis, patients with severe disease require specialist multidisciplinary care including dietician and radiology input. Therefore, certain patients would benefit from an MDT approach to coordinate their management. This retrospective study analyses data on pancreatitis admissions within our Trust, to inform the set-up of a new specialist MDT. Method Patients were identified using admission coding data. Relevant patient data was extracted, including demographics, disease severity (using the Atlanta classification) and relevant outcomes. Both first-time and repeat admissions were included. Incorrectly coded patients were excluded. Statistical analysis was performed using SPSS (Version 23.0). Results Over a study period of 489 days, 246 patients were coded as having pancreatitis.186 patients were first time admissions, and 27 patients were repeat admissions. 33 patients were incorrectly coded and excluded. Hence, the annual acute pancreatitis admission rate was 139 patients/year, with an additional 20 readmissions. 149 (80%) admissions were mild cases, with the remaining 14 (8%) and 23 (12%) being moderate and severe respectively. 149 (80%) were acute cases, compared to 20 (11%) chronic and 17 (9%) acute-on-chronic. 52/186 cases had no cause of pancreatitis recorded; where cause was identified, gallstones were the most common aetiology. Conclusions Pancreatitis is a common reason for admission during a general surgery on-call in our Trust; while the majority of cases are mild, the remaining 20% of moderate–severe cases qualify for discussion at an Acute Pancreatitis MDT. This pilot has facilitated the allocation of resources in our Trust and the MDT goes live in September 2021.

Impact of COVID-19 pandemic on acute pancreatitis presentations, management, and in-hospital outcomes: a single-center, retrospective observational study from the northeast of China.

Since initially detected in late December 2019, the novel coronavirus disease 2019 (COVID-19) outbreak rapidly swept the world, which has profoundly affected healthcare system and clinical practice in the management of gastrointestinal diseases. We aimed to evaluate the impact of COVID-19 pandemic on the pattern of hospital admissions and healthcare services for acute pancreatitis (AP). We conducted a retrospective observational cohort study using the anonymized electronic medical records. This single-center, retrospective observational study from a regional medical center in the northeast of China included all consecutively admitted patients with AP from 23 January to 10 June 2020 (during the COVID-19 outbreak in Harbin), compared with the equivalent period of the previous year, in terms of demographics, clinical characteristics, and in-hospital outcomes. In this article, we observed a reduction in AP admissions after the beginning of COVID-19 outbreak. With the prolonged time from symptom onset to hospitalization [32.0 (22.0-72.0) versus 18.0 (12.0-24.0) h; p < 0.001], a higher proportion of AP patients developed acute renal failure (14.0% versus 7.4%, p = 0.004) and acute necrotic collection (16.5% versus 11.2%; p = 0.038) in the COVID-19 era. The percentage of alcohol etiology significantly decreased after the implementation of social restriction measures (11.5% versus 20.4%; p = 0.002), whereas biliary etiology was numerically more common amidst the COVID-19 era (41.6% versus 32.6%; p = 0.014). No significant differences were found in the rates of intensive care unit admission and mortality between the two groups. This study preliminarily demonstrated the descending trend and delay in hospital presentations for AP during the outbreak of COVID-19. Given that the pandemic may persist for several years, adjustments of medical services according to the varying degrees of local breakouts are imperative to provide appropriate care for AP patients and diminish the risk of viral transmission. ClincialTrials.gov number ChiCTR2100043350.

Splanchnic Vein Thrombosis in Acute Pancreatitis: Incidence, Risk Factors and Long Term Outcomes

Introduction: There is paucity of data on the incidence, risk factors and role of anticoagulation for splanchnic vein thrombosis (SVT) in acute pancreatitis (AP). Methods: A retrospective review of AP admissions between 2018-2021 across the North East of England was undertaken. Data on demographics, etiology, severity of AP and SVT was collected. In addition, a selective anticoagulation policy for portal vein thrombosis (PVT) and progressive splenic vein thrombosis was explored. Results: 401 patients were included with a mean age of 57.0 and M:F ratio of 1.6:1. 152 patients developed intestinal oedematous pancreatitis and 249 developed necrotising pancreatitis based on Revised Atlanta criteria (RAC). 109 patients (27.2%) developed SVT of which 27 developed a PVT and splenic vein thrombus, 36 PVT only and 46 splenic vein thrombus only. On univariate analysis, alcoholic aetiology, severe pancreatitis, necrotising pancreatitis with >50% necrosis and elevated CRP at 2 weeks were risk factors for developing SVT. On multivariable analysis, alcohol aetiology (OR 2.6, p = 0.002), and >50% pancreatic necrosis (OR 14.6,p = 0.048) increased the risk of developing SVT. 58 patients received anticoagulation for SVT, with a median duration of 90 days of anticoagulation. Recanalization rates were higher for PVT when compared to splenic vein thrombosis. 6 patients developing bleeding complications whilst on anticoagulation therapy. Conclusion: A third of patients with AP develop SVT, particularly those with severe AP secondary to alcohol and with extensive pancreatic necrosis. A selective anticoagulation policy was associated with improved recanalization rates and fewer bleeding complications.

P-P31 Splanchnic vein thrombosis in acute pancreatitis: Incidence, risk factors and long term outcomes

Abstract Background There is paucity of data on the incidence, risk factors and role of anticoagulation for splanchnic vein thrombosis (SVT) in acute pancreatitis (AP). Methods A retrospective review of AP admissions between 2018-2021 across North East England was undertaken. Data on demographics, etiology, severity of AP and SVT was collected. In addition, a selective anticoagulation policy for portal vein thrombosis (PVT) and progressive splenic vein thrombosis was explored. Results 401 patients were included with a mean age of 57.0 and M:F ratio of 1.6:1. 152 patients developed intestinal oedematous pancreatitis and 249 developed necrotising pancreatitis based on Revised Atlanta criteria (RAC). 109 patients (27.2%) developed SVT of which 27 developed a PVT and splenic vein thrombus, 36 PVT only and 46 splenic vein thrombus only. On univariate analysis, alcoholic aetiology, severe pancreatitis, necrotising pancreatitis with &amp;gt;50% necrosis and elevated CRP at 2 weeks were risk factors for developing SVT. On multivariable analysis, alcohol aetiology (OR 2.6, p = 0.002), and &amp;gt;50% pancreatic necrosis (OR 14.6,p = 0.048) increased the risk of developing SVT . 58 patients received anticoagulation for SVT, with a median duration of 90 days of anticoagulation. Recanalization rates were higher for PVT when compared to splenic vein thrombosis. 6 patients developing bleeding complications whilst on anticoagulation therapy. Conclusions A third of patients with AP develop SVT, particularly those with severe AP secondary to alcohol and with extensive pancreatic necrosis. A selective anticoagulation policy was associated with improved recanalization rates and fewer bleeding complications.

Sequential organ failure assessment score is superior to other prognostic indices in acute pancreatitis.

BACKGROUNDAcute 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. AIMTo evaluate these indices' utility in predicting severity, intensive care unit (ICU) admission, and mortality.METHODSA 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.RESULTSThe 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). CONCLUSIONThe SOFA and 48-h Ranson’s scores accurately predict severity, ICU admission, and mortality in AP, with more favorable statistics for the SOFA score.

The Predictors of In-hospital Mortality in Non-elderly Adult Patients Requiring Emergency Admission for Acute Pancreatitis: Analysis by Generalized Additive Model of 344,120 Patients

The Predictors of In-hospital Mortality in Non-elderly Adult Patients Requiring Emergency Admission for Acute Pancreatitis: Analysis by Generalized Additive Model of 344,120 Patients

The relationship between pre-existing diabetes mellitus and the severity of acute pancreatitis: Report from a large international registry

Background/ObjectivesThe relationship between pre-existing diabetes mellitus (DM) and acute pancreatitis (AP) severity has not been established. We assessed the impact of pre-existing DM on AP severity in an international, prospectively ascertained registry. MethodsAPPRENTICE registry prospectively enrolled 1543 AP patients from 22 centers across 4 continents (8 US, 6 Europe, 5 Latin America, 3 India) between 2015 and 2018, and collected detailed clinical information. Pre-existing DM was defined a diagnosis of DM prior to AP admission. The primary outcome was AP severity defined by the Revised Atlanta Classification (RAC). Secondary outcomes were development of systemic inflammatory response syndrome (SIRS) or intensive care unit (ICU) admission. ResultsPre-existing DM was present in 270 (17.5%) AP patients, of whom 252 (93.3%) had type 2 DM. Patients with pre-existing DM were significantly (p < 0.05) older (55.8 ± 16 vs. 48.3 ± 18.7 years), more likely to be overweight (BMI 29.5 ± 7 vs. 27.2 ± 6.2), have hypertriglyceridemia as the etiology (15% vs. 2%) and prior AP (33 vs. 24%). Mild, moderate, and severe AP were noted in 66%, 23%, and 11% of patients, respectively. On multivariable analysis, pre-existing DM did not significantly impact AP severity assessed by the RAC (moderate-severe vs. mild AP, OR = 0.86, 95% CI 0.63–1.18; severe vs. mild-moderate AP, OR = 1.05, 95% CI, 0.67–1.63), development of SIRS, or the need for ICU admission. No interaction was noted between DM status and continent. ConclusionAbout one in 5 patients with AP have pre-existing DM. Once confounding risk factors are considered, pre-existing DM per se is not a risk factor for severe AP.

S19 Patient Factors Associated With Oral Feeding Within 1 Day of Admission for Acute Pancreatitis in a Large Multihospital Health System

S19 Patient Factors Associated With Oral Feeding Within 1 Day of Admission for Acute Pancreatitis in a Large Multihospital Health System

Epidemiology of acute pancreatitis in Australia from 2007-2019.

There is a paucity of information on the epidemiology of acute pancreatitis (AP) in Australia. Data on hospital admissions for a principal diagnosis of AP were obtained from the Australian Institute of Health and Welfare; population data were extracted from the Australian Bureau of Statistics. Age-adjusted, and age and sex-specific rates for all subtypes of AP were compared. There were 208 390 admissions for a principal diagnosis of AP in Australia between 2006/07 and 2018/19, corresponding to an average admission rate of 46.03/105 /year. Over the study, there was a 38.7% increase in the age-adjusted rate of AP admissions [37.56 to 52.09/105 /year (P< 0.00001)], corresponding to an average increase of 3.0%/year. Unspecified AP comprised approximately 50% of admissions in each year. An increase in admission rates was observed for all categories of AP. Biliary AP admission rates increased from 8.28 to 13.90 /105 /year (P< 0.00001), increasing in both sexes and all age groups. Alcohol associated AP admissions increased from 8.23 to 9.98/105 /year (P< 0.00001), a phenomenon which was seen in older people and in females particularly, but there was a reduction alcohol related AP admission rates in the 20-29-year age group. AP admission rates increased significantly over the period 2006/07 to 2018/19 in both male and female populations, in most subtypes of AP, particularly 'unspecified AP', and among all age groups.

A nationwide survey of acute pancreatitis:a report from 126 hospitals in China

Objective: To investigate the current status of acute pancreatitis(AP) diagnosis and treatment in hospitals of different levels in China. Methods: A cross-sectional survey was conducted. The Acute Pancreatitis Diagnosis and Treatment Practice Questionnaire was designed and sent to the members of the Group of Pancreatic Surgery Chinese Society of Chinese Medical Association Branch and some other hospitals online from 8th to 24th December, 2020. Observation indicators included general information, AP diagnosis and assessment, treatment strategies, follow-up information, and comparisons of clinical practice between 3A-level and non-3A-level hospitals were performed. Counting data was used χ 2 test or Fisher exact test. Results: A total of 126 valid questionnaires were collected in final analysis, of which 75.4% (95/126) were from 3A-level hospitals, 15.9%(20/126) and 8.7%(11/126)were from other third-level and second-level hospitals,respectively. Of all participants, 88.1% (111/126)used classic AP diagnostic criteria, and 88.1% (111/126)conducted severity assessment. The revised Atlanta classification and determinant-based classification were commonly used, accounting for 72.1%(80/111) and 22.5%(25/111), respectively. 70.6%(89/126)used predictive models, including APACHE Ⅱ score, imaging models(modified CT severity index or Balthazar scoring) and Ranson criteria. For patients with early pancreatic or peripancreatic infection, 75.4%(95/126) preferred antibiotic therapy, and for those with infected walled-off necrosis, 61.1% (77/126) preferred percutaneous catheter drainage.When surgical intervention required,preferred methods were laparoscopic transabdominal surgery(37.3%, 47/126) and open surgery(25.4%,32/126). 61.1%(77/126) accepted "delayed surgery" notion. 32.5%(41/126) routinely used the step-up approach. For mild biliary acute pancreatitis, 44.4%(56/126) underwent cholecystectomy during the same hospital admission. Regarding follow-up, ideal overall follow-up periods were 6 months(46.0%,57/124) and 12 months(33.1%, 41/124), and follow-up interval was 3 months(50.8%,63/124) and 1 month(23.4%, 29/124). Comparing clinical practice of AP between 3A-level hospitals and non-3A-level hospitals, we found that the former had a significantly higher proportion of annual AP admission number of over 100(34.7%(33/95) vs.12.9%(4/31), χ 2=5.372, P=0.020), and higher proportion of routine severity assessment(68.4%(65/95) vs. 35.5%(11/31), χ²=11.107, P=0.004), higher proportion of routine severity prediction(45.3%(43/95) vs. 12.9%(4/31), χ²=13.549, P=0.001). When surgical intervention required, the proportion of step-up approach was significantly higher(37.9%(36/95) vs.16.1%(5/31), χ 2=8.512, P=0.017). Significantly more participants preferred that follow-up should be completed by full-time staff(35.8%(34/95) vs. 22.6%(7/31), χ²=8.154, P=0.043) in 3-A level hospitals. Conclusions: The standardization of AP diagnosis is relatively high in China. However, standardized assessment of severity and prediction need to be further prompted, especially in non-3A-level hospitals. Regarding AP treatment, especially the minimally invasive intervention strategy would be the focus of the promotion of standardized AP practice in the future.

Effect of ambient temperature on daily hospital admissions for acute pancreatitis in Nanchang, China: A time-series analysis

ABSTRACT The aim of this study was to evaluate the short-term effect of temperature on the risk of acute pancreatitis (AP) in southern China. We performed a time-series study of 2822 patients admitted with a first episode of AP in Nanchang between May 2014 and June 2017. A generalized additive model combined with a distributed lag non-linear model was applied to assess the association of temperature and AP. In subgroup analysis, according to different etiologies of pancreatitis, significant associations were found between daily average temperature and non-biliary pancreatitis hospitalization at lags of 0–7 days, but not for biliary pancreatitis or total AP. Higher daily average temperature tended to increase the occurrence of non-biliary pancreatitis at lags of 0–7 days. These findings suggest that high temperature is associated with higher non-biliary pancreatitis risk in Nanchang, China. In the context of global warming, the morbidity of non-biliary pancreatitis may increase.

Early Prediction of Organ Failures in Patients with Acute Pancreatitis Using Text Mining

It is of great significance to establish an assessment model for organ failures in the early stage of admission in acute pancreatitis (AP). And the clinical notes are underutilized. To predict organ failures for AP patients using early clinical notes in hospital, early text features obtained from the pretrained Chinese Bidirectional Encoder Representations from Transformers model and attention-based LSTM were combined with early structured features (laboratory tests, vital signs, and demographic characteristics) to predict organ failures (respiratory, cardiovascular, and renal) in 12,748 AP inpatients in West China Hospital, Sichuan University, from 2008 to 2018. The text plus structured features fusion model was used to predict organ failures, compared to the baseline model with only structured features. The performance of the model with text features added is superior to the model that only includes structured features.

An Unusual Cause of Acute Pancreatitis in a Liver Transplant Recipient.

Posttransplant lymphoproliferative disorder (PTLD) in liver transplant recipients is relatively uncommon, with an estimated incidence of 1%–3%. Retrospective reviews of liver transplant recipients have mainly reported posttransplant lymphoproliferative disorder affecting the liver, gastrointestinal tract, or lymph nodes. In this case report, we describe a 45-y-old female with a history of deceased donor liver transplantation for autoimmune hepatitis who had recurrent hospital admissions for acute pancreatitis. Ultimately, imaging revealed numerous complex pancreatic and peripancreatic masses, appearing to originate from pancreatic lymphoid tissue. Tissue biopsy later confirmed monomorphic Epstein-Barr virus-negative large B-cell lymphoma. Overall, PTLD involving the pancreas after liver transplantation is incredibly rare. The patient’s cumulative immunosuppression drug dose and time posttransplant were suspected to be her main risk factors, given that she had been exposed to several years of treatment with tacrolimus, azathioprine, mycophenolate mofetil, and prednisone. She was treated with rituximab monotherapy and later escalated to chemoimmunotherapy due to lack of response. PTLD involving the pancreas is an unusual cause of pancreatitis and should be considered in cases of recurrent pancreatitis in transplant recipients.

Purtscher-Like Retinopathy Secondary to Medication Induced Calcium-Alkali Syndrome and Acute Pancreatitis in a Pregnant Female

ABSTRACT Purpose: To report a case of Purtscher-like retinopathy secondary to acute pancreatitis caused by medication-induced calcium-alkali syndrome in a pregnant woman. Methods: Case report Results: A 39-year-old 23-week pregnant patient complained of visual disturbances during admission for acute pancreatitis precipitated by calcium-alkali syndrome. History revealed the acute ingestion of over 2,400 mg of elemental calcium from over the counter medication in the background of longstanding use. Visual acuity was counting fingers at 1 foot bilaterally. Posterior segment exam revealed Purtscher-flecken in the posterior pole with scattered dot hemorrhages. Optical coherence tomography (OCT) revealed inner retinal thickening and increased hyper-reflectivity. OCT angiography demonstrated loss of flow primarily in the superficial capillary plexuses. The patient was diagnosed with Purtscher-like retinopathy and observed. Two months follow up revealed resolution of the funduscopic findings and visual acuity improved minimally to 20/200 in the right eye and counting fingers in the left eye. Conclusion: Common over the counter medication can potentiate a calcium-alkali syndrome capable of causing a Purtscher-like retinopathy.