Severity Assessment Of Acute Pancreatitis Research Articles

CONTEMPORARY PERSPECTIVES ON DIAGNOSING ACUTE PANCREATITIS

Acute pancreatitis represents a significant challenge in urgent surgery. It holds a prominent position among urgent surgical diseases, with a rising incidence of severe, complicated forms. The increase in the negative outcomes of acute pancreatitis treatment is linked to delayed diagnosis of severe forms and their complications, owing to the absence of a highly effective severity assessment scale. This deficiency contributes to unjustified surgical interventions. Early severe pancreatitis manifests with a rapidly progressive course leading to organ failure, hypoxia, necrotic foci formation, abdominal sepsis, and abdominal compartment syndrome. Specific scales for early diagnosis include the criteria scale for primary assessment of acute pancreatitis severity, the Ranson scale, and the BISAP scale. The modern diagnosis of severe acute pancreatitis relies on two key international classifications: the Revised Atlanta Classification (2012) and the Determinant-based classification (2012). To assess the intensity of pancreatic inflammation by CT scan, the Balthazar scale is used, which is included in the Computer Tomography Severity Index and enables to determine the area of pancreatic necrosis.
 The purpose of this study is to improve the diagnosis of acute severe pancreatitis.
 The study was carried out by assessing the medical records of 20 patients diagnosed with acute pancreatitis who received treatment at the Surgical Inpatient Department of the 2nd City Hospital, Poltava, from 2021 to 2022.
 The analysis revealed that conducting a computer tomography within the 48-72 hours from the onset of the disease enables a comprehensive assessment of its severity. This assessment significantly influences the subsequent treatment approach, reducing the necessity for surgical intervention and lowering the risk of patient mortality.
 Hence, in alignment with contemporary classifications and diagnostic perspectives on acute pancreatitis, MSCT assumes a pivotal role, significantly influencing the selection of treatment strategies in all cases. This inclusion facilitates timely surgical interventions and allows for adjustments to conservative therapy based on the severity of pancreatic inflammation. It is advisable, however, to conduct computed tomography 48-72 hours after the onset of pain to adequately assess the pancreatic condition. Morphological changes in the pancreas typically do not manifest within the initial day of the disease, making early CT diagnostics potentially misleading regarding the true state and severity of acute pancreatitis.

Assessing the efficacy of modified Marshall scoring system in severity assessment of acute pancreatitis in comparison to Ranson score at tertiary centre

Background: Early determination of severity of acute pancreatitis is essential for prediction of prognosis and proper treatment selection. This study aims to evaluate the effectiveness of the Modified Marshall scoring system in evaluating severity in acute pancreatitis at admission. Methods: A hospital based prospective observational study was conducted at SMS medical college, Jaipur from May 2019 to September 2021 with a sample size of 60 patients. Modified Marshall Score and Ranson’s score were done at admission and 48 hours respectively for same patient. Results: Most patients (31.66%) were among age group 31-45 years (mean age 43.95±16.28 years) with slight female (51.55%) preponderance. The mean hospital stay was 4.883±3.405 days with maximum mortality in first week (6/8). All patients with mild pancreatitis under Modified Marshall score were discharged uneventfully while patients with severe pancreatitis, 8 (25%) died. Respiratory system failure (48.33%) was most commonly involved followed by renal (16.66%) and cardiovascular system (11.66%). Single organ failure (35%) had no mortality while 2/3 patients with all three-organ system failure died. The AUC value of ROC curve (0.863) (p<0.001) showed that Modified Marshall score is a significant predictor for severity of acute pancreatitis. The correlation coefficient was strongly positive and statistically significant (p<0.001) for the relationship between Ranson’s score, Modified Marshall score and hospital stay. Conclusions: Modified Marshall Score is simple and equally effective tool for predicting severity and prognosis early in the course of disease. Therefore, it prevents delay in aggressive treatment of critically ill patient and would contribute to decrease mortality.

Dual Energy CT for determining the severity of acute pancreatitis

We aimed to quantitatively compare the iodine concentration measured by Dual Energy Computed Tomography （CT） between acute and mild pancreatitis cases and to evaluate the accuracy of the severity assessment of acute pancreatitis using Dual Energy CT. The contrast CT grade based on the guidelines in Japan and definitive diagnoses were evaluated. Iodine concentrations and C-reactive protein （CRP） levels were compared between mild and severe acute pancreatitis. The CECT grading diagnosed five false negative cases out of 41 patients. Only when the CRP reached the highest level, there was a significant difference between severe and mild cases. There were significant differences between the iodine concentration of severe and mild cases. Our results demonstrated measuring iodine concentration using Dual Energy CT is useful for severity assessment of acute pancreatitis.

ETIOLOGY, CLINICAL PROFILE, ASSESSMENT AND COMPARISON OF SCORING SYSTEMS IN PATIENTS DIAGNOSED WITH ACUTE PANCREATITIS IN A TERTIARY CARE CENTRE

Background:Acute pancreatitis is a sudden inammation of the pancreas with an incidence 13–45 /1,00,000. A Bedside Index for Severity in Acute Pancreatitis (BISAP) has recently been proposed as an accurate and simple method for early identication of persistent organ failure and mortality. CT, as used to aid the diagnosis and staging of acute pancreatitis, has greatly improved and has changed the clinical management of this condition. 50 patients who came Methods: with acute abdomen and diagnosed with acute pancreatitis were selected satisfying inclusion and exclusion criteria. BISAP score and CT severity index was calculated and compared. Results: Out of 50 patients mild, moderate and severe acute pancreatitis was identied in 35, 9 and 6 patients respectively based on CT severity score index(CTSI). Out of 50 cases,47 had BISAP score < 3 and 3 had >3.BISAP score as a predictor of prognosis has a signicant relation as evident by the data in our study (p value<0.05).BISAP score and CTSI are used for severity assessment of acute pancreatitis, both these scoring systems showed positive correlation in assessing the severity. Early evaluation of the Conclusion: severity of acute pancreatitis is essential to allow the clinician to predict the patient's clinical course, estimate prognosis, and determine the need for admission to the intensive care unit. BISAP score is relatively simple & accurate in predicting the clinical severity of Acute Pancreatitis with a prognostic accuracy of BISAP similar to CTSI.

Comparison of CT Severity Index and Modified CT Severity Index in the Clinical Severity Assessment of Acute Pancreatitis

Objective: To compare the computed tomography severity index (CTSI) and the modified computed tomography severity index (MCTSI) in the clinical severity assessment of acute pancreatitis.Material and Methods: This retrospective cohort study comprised acute pancreatitis patients who underwent contrastenhanced abdominal computed tomography (CT) scans within 4 weeks after clinical onset. Two experienced abdominal radiologists, blinded to the clinical outcome, independently reviewed the CT images and retrospectively scored them using CTSI and MCTSI. Any discrepancies were resolved by a consensus review. The clinical severity assessment of each participant was categorized by the determinant-based classification of acute pancreatitis severity. The correlations of CTSI and MCTSI with the clinical severity assessment were analyzed.Results: This cohort study consisted of 40 participants—28 of them were men (70.0%)—with a mean age of 59.3 years. They were clinically divided into mild, moderate, severe, and critical groups comprising 11 (27.5%), 16 (40.0%), 7 (17.5%), and 6 (15.0%) participants, respectively. Due to the small number of patients in the severe and critical groups, we combined these into a single severe category (13 patients, 32.5%). The CTSI and MCTSI scores showed moderate and fair agreement with the clinical severity assessment. A trend linking poor clinical outcome with high CTSI/MCTSI scores (moderate and severe groups) more commonly than low scores (mild group) was observed. There was a very strong agreement between CTSI and MCTSI (rs =0.97).Conclusion: CTSI and MCTSI showed a moderate and fair agreement, respectively, with the clinical severity assessment. Compared to low scores, a poor clinical outcome was more often associated with high CTSI/MCTSI scores.

Assessment of Acute Pancreatitis Severity and Prognosis with CT-Measured Body Composition.

ObjectiveThe aim of this study was to investigate the possible association of muscle and adipose parameters with the severity and prognosis of patients hospitalized with acute pancreatitis (AP).MethodsA total of 392 hospitalized patients and 309 controls were enrolled in the study analysis from April 1, 2016, to February 1, 2021. The computed tomography scans of each population were evaluated for muscle and adipose parameters. The effects of parameters on developing moderately severe acute pancreatitis (MSAP) or severe acute pancreatitis (SAP) were evaluated using univariate and multivariate logistic regression analyses. Associations with disease recurrence and death were analyzed through Cox regression analysis.ResultsThe AP patients had higher levels of visceral adipose tissue (144.25 vs 97.81 cm2, p < 0.001) and subcutaneous adipose tissue (135 vs 120 cm2, p < 0.001) but lower levels of adipose tissue attenuation (visceral and subcutaneous) and skeletal muscle attenuation (SMA) than the controls (p < 0.05, respectively). Visceral adipose tissue (VAT) and SMA differed significantly with p-values of 0.014 and 0.003 in the different severity groups of AP. In multivariate analysis, VAT and SMA were associated with MSAP or SAP, with odds ratios of 1.003 and 0.973, respectively (95% CI 1.000–1.006, p = 0.041; 95% CI 0.953–0.993, p = 0.010). Cox regression analysis showed that low SMA was strongly associated with an increased mortality in MSAP and SAP patients (HR 10.500, 95% CI 1.344–82.025, p = 0.025). Regression analysis also showed an association of VAT loss of more than 17% with reduced 1-year recurrence of acute pancreatitis (HR 0.427, 95% CI 0.189–0.967, p = 0.041).ConclusionVAT and SMA were influential factors for the severity and prognosis of patients with AP. Patients should proper diet and exercise after discharge to reduce VAT and strengthen muscle function to improve prognosis.

Assessment of acute pancreatitis severity via determination of serum levels of hsa-miR-126-5p and IL-6.

Early assessment of acute pancreatitis (AP) severity is key to its treatment. The present study aimed to explore the role of microRNAs (miRNAs/miRs) combined with inflammatory factors in determining AP severity. For this, serum pro-inflammatory cytokines [tumor necrosis factor (TNF)-α, interleukin (IL)-1, IL-6, IL-8 and IL-10)] and miRNAs [Homo sapiens (hsa)-miR-548d-5p, hsa-miR-126-5p and hsa-miR-130b-5p] were detected in patients with mild AP (MAP), severe AP (SAP) and recurrent AP (RAP). High expression of IL-10, TNF-α, hsa-miR-126-5p, hsa-miR-548d-5p and hsa-miR-130b-5p was able to distinguish SAP from MAP and RAP (P<0.05). Multifactorial binary logistic regression analysis indicated that IL-1/IL-6 combined with hsa-miR-126-5p/hsa-miR-548d-5p had a significant influence on AP and AP severity (P<0.05). Receiver operating characteristic analysis revealed that IL-1 combined with hsa-miR-126-5p [area under the curve (AUC), 0.926; sensitivity, 90.0%; specificity, 86.7%, P<0.001] and IL-6 combined with hsa-miR-126-5p (AUC, 0.952; sensitivity, 93.3%; specificity, 90.0%; P<0.001) were able to better distinguish MAP from SAP than IL-1/IL-6 combined with hsa-miR-548d-5p, lipase, and amylase. IL-1 or IL-6 combined with hsa-miR-548d-5p (AUC, 0.924; sensitivity, 83.3%; specificity, 93.3%; P<0.001) were able to better distinguish SAP from RAP than IL-1/IL-6 combined with hsa-miR-126-5p, lipase, and amylase. IL-1 combined with hsa-miR-126-5p (AUC, 0.926; sensitivity, 90.0%; specificity, 86.7%; P<0.001) and IL-6 combined with hsa-miR-126-5p (AUC, 0.952; sensitivity, 93.3%; specificity, 90.0%; P<0.001) were able to better differentiate between MAP and RAP than IL-1/IL-6 combined with hsa-miR-548d-5p, lipase, and amylase. These results demonstrated that the combined detection of serum IL-6 and hsa-miR-126-5p may be useful for the early prediction of AP classification.

Recent Advances in Diagnosis and Severity Assessment of Acute Pancreatitis.

The incidence and prevalence of acute pancreatitis (AP) is increasing over time. The diagnosis of acute pancreatitis is established by revised Atlanta criteria (2012). Multiple criteria and scoring systems have been used for assessment of severity of AP. Majority of acute pancreatitis cases (80%) are mild, the challenge remains in early diagnosis, severity assessment and treatment of severe AP and its complications. Assessment of severity of AP is important part of management because line of treatment depends on aetiology and severity of acute pancreatitis. In this article a comprehensive review of recent advances in diagnosis and severity assessment of acute pancreatitis has been described.

Study on severity assessment of acute pancreatitis using BISAP score in rural area of south India

Background: Acute Pancreatitis is one of the most common disease in all parts of INDIA. The morbidity and mortality of the disease can be reduced by early detection of complications. In rural health centres, authors need a simple and easily accessible and reproducible scoring system to access the severity. The main aim of the study is, using BISAP score authors can easily identify the severity and complications of acute pancreatitis as early as possible even in rural health centres.Methods: This is a prospective study conducted at Koppal District Hospital, Karnataka. Authors included 80 acute pancreatitis patients admitted in present hospital from July 2015 to July 2017. BISAP score is used within 24 hours of admission to access the severity and complications of the pancreatitis. Complications are accessed with respect to duration of hospital stay, organ failure and necrotising pancreatitis against BISAP score less than 3 and more than 3.Results: In present study male (83.75%) patients are more affected than females (16.25%). Alcohol (52.5%) being the main culprit then biliary (32.5%) and idiopathic (15%) as causes of acute pancreatitis. Middle age group between 30 to 50 years (66.25%) are more affected. Severe pancreatitis features like organ failure (66.67%) and necrotising pancreatitis (71.4%) are seen in patients with score more than 3. And also, the duration of inpatient hospital stay is longer (more than 5 day) in same patients.Conclusions: Acute pancreatitis is one of the most common causes for acute abdomen and alcohol consumption being the main culprit in rural areas of south India. Of the many scoring systems, BISAP score can be easily done at rural health centres to early detection of severity and complication of acute pancreatitis.

Severity assessment of acute pancreatitis using four prognostic factors - a nationwide multicenter study of 3682 cases in Japan.

Dear Sir, We read with great interest the article by Ikeura et al.1 assessing the efficacy of the prognostic factor score in the Japanese severity criteria for acute pancreatitis (AP). By analyzing 1159 patients with severe AP, they showed that the area under the curve (AUC) for the receiver-operating characteristic curve of the prognostic factor score for predicting AP-related mortality was 0.78, which was comparable to that for the well-known acute physiology and chronic health evaluation (APACHE) II score (AUC = 0.80). One weakness of their study is that mild AP cases were not included in the analysis due to the study design. In addition, severity assessment using the nine factors might be too complicated. In Japan, the Research Committee of Intractable Pancreatic Diseases, under the support of the Ministry of Health, Labor, and Welfare of Japan, has conducted nationwide epidemiological surveys of AP including both severe and mild cases every 4–5 years.2-4 We recently reported that four (base excess or shock, renal failure, systemic inflammatory response syndrome criteria and age) out of the nine prognostic factors were associated with AP-related death by multivariate analysis in the 2011 survey.5 Here, we validated the utility of the severity assessment system based on these four factors in 3682 AP cases collected for the 2003 (285 cases), 2007 (1146 cases), and 2011 (2251 cases) surveys. We performed receiver-operating characteristic curve analysis to evaluate the predictive accuracy of the prognostic factor scores for mortality. The AUC was 0.80 for the nine prognostic factors. If the cut-off point was set at score = 3 as adopted currently, the sensitivity was 0.47 with a specificity of 0.93. The AUC for predicting mortality was 0.78 for the four prognostic factors, suggesting the comparable utility of these four factors in the severity assessment. The sensitivity was 0.53 with a specificity of 0.92 if the cut-off point was set at score = 2. If we define the patients fulfilling at least two out of the four prognostic factors as severe, 342/3682 (9.3%) patients had severe AP. The mortality of severe AP cases was 17.3% (59/342), whereas that of mild AP cases was 1.6% (52/3340) (Figure 1 ). If we choose only two factors (renal failure and age) that showed a stronger association with AP-related mortality among the four factors,5 the AUC was decreased to 0.72. The sensitivity was 0.22 with a specificity of 0.98 if the cut-off point was set at score = 2. Mortality of the 3682 acute pancreatitis patients stratified by the four prognostic factor scores. Number of patients in each category is shown in the parentheses. Our results suggested that severity assessment using the four prognostic factors was equivalent to the current Japanese severity criteria employing nine factors. Accurate assessment of severity in patients with AP is still a challenge.6 Development of a more convenient and accurate severity assessment system would contribute to improving the outcomes of this intractable disease. None declared. This study was approved by the Ethics Committee of Tohoku University Graduate School of Medicine (article #: 2015-1-519). Supported by grants from the Smoking Research Foundation (to Atsushi Masamune). This study based on an anonymous questionnaire and does not require informed consent from patients.

Severity assessment of acute pancreatitis using CT severity index and modified CT severity index: Correlation with clinical outcomes and severity grading as per the Revised Atlanta Classification.

Aims:To assess the severity of acute pancreatitis (AP) using computed tomography (CT) severity index (CTSI) and modified CT severity index (MCTSI), to correlate with clinical outcome measures, and to assess concordance with severity grading, as per the revised Atlanta classification (RAC).Materials and Methods:In this prospective study approved by the Institutional Review Board (November 2014 to March 2016), sixty patients with AP (as per the RAC definition) underwent contrast-enhanced computed tomography (CECT) 5–11 days (median 6 days) after symptom onset. Two radiologists, blinded to clinical parameters, independently assessed CTSI and MCTSI (differences were resolved by consensus). Clinical outcome parameters included duration of stay in the hospital and intensive care unit (ICU), presence of persistent organ failure (OF), evidence of infection, need for intervention, and mortality.Results:We included 60 cases [36 males, age range 19–65 (mean 37) years]. As per the RAC, 26 patients had mild AP, 12 moderately severe, and 22 severe AP. According to CTSI and MCTSI, mild, moderate, and severe cases were 27 (45%), 19 (31.7%), 14 (23.3%) and 24 (40%), 10 (16.7%), 26 (43.3%), respectively. MCTSI was concordant with the RAC grading in 54 (90.0%), CTSI was concordant in 47 (78.3%), and both were concordant in 43 (71.7%) cases. Area under the receiver-operating characteristic (ROC) curves (AUROC) was compared by the Hanley and McNeil method. Both CTSI and MCTSI were significantly associated with outcome parameters (P < 0.001), except duration of ICU stay. Sensitivity, specificity, positive predictive value (PPV), and accuracy of CTSI for detecting moderate/severe disease were 97.1%, 100%, 100%, and 98.3% respectively, and of MCTSI were 100%, 92.3%, 94.4%, and 96.7% respectively.Conclusion:Both CTSI and MCTSI showed significant correlation with clinical outcome parameters, and good concordance with RAC grading of severity. MCTSI showed a higher sensitivity but lower specificity than CTSI in differentiating mild from moderate/severe AP.

The clinical value of adipokines in predicting the severity and outcome of acute pancreatitis.

BackgroundRecent data shows that patients with severe acute pancreatic might benefit from early intensive therapy, enteral nutrition and timely transfer to specialized centers. The early prophylactic use of antibiotics in AP remains controversial. The role and need for new markers in stratification of acute pancreatitis is also uncertain. This study aims to evaluate the prognostic usefulness of adipokines in prediction of the severity and outcome of acute pancreatitis (AP).MethodsProspective study was conducted in four clinical centers. The diagnosis and severity assessment of AP was established according to the revised 2012 Atlanta classification. Adipokines, IL-6 and CRP levels were measured at admission and on 3rd day of hospital stay and compared with the control group. The predictive accuracy of each marker was measured by area under the receiver operating curve.ResultsForty healthy controls and 102 patients were enrolled in to the study. Twenty seven (26.5 %) patients had mild, 55 (53.9 %) - moderate and 20 (19.6 %) - severe AP. Only resistin (cut-off value 13.7 ng/ml) and IL-6 (cut-off value 473.4 pg/ml) were reliable early markers of SAP. IL-6 with cut-off value of 157.0 pg/ml was a predictor of necrosis. The peripancreatic necrosis volume of 112.5 ml was a marker of SAP and 433.0 ml cut-off value could be used to predict the need of interventions.ConclusionsThe prognostic value of adipokines in AP is limited. Only admission resistin levels could serve as an early predictor for SAP.The Lithuanian Regional Ethics Committee approved the study protocol (permission No. L-12-02/1/2/3/4) and all the patients and the control group provided written informed consent.

Severity assessment of acute pancreatitis: applying Marshall scoring system.

To analyze the effectiveness of the Marshall scoring system to evaluate the severity of acute pancreatitis (AP). We performed a prospective, observational study in 39 patients with AP evaluated by the Marshall scoring system and the Ranson criteria (admission and 48 hours). We assessed the progression of the disease for seven days and compared the data of the two criteria. Seven patients died during the observation period and one died afterwards. All deaths had shown failure of at least one system by the Marshall method. The Marshall scoring system may be used as an effective and simplified application method to assess the severity of acute pancreatitis.

The role of CD19+ CD24hiCD27hi regulatory B cells in the severity assessment of acute pancreatitis

Objective To investigate the prognostic value of regulatory B cells (Bregs) in patients with acute pancreatitis. Methods Flow cytometry analysis was performed to detected the percentages of CD19+ IL-10+ and CD19+ CD24hiCD27hi Bregs in peripheral blood samples collected from patients with acute pancreatitis (36 cases with mild acute pancreatitis and 15 cases with severe acute pancreatitis) as well as the surface costimulatory molecules including CD80 and CD86 on CD19+ CD24hiCD27hi Bregs. Their correlations with lymphocytes and C-reactive protein (CRP) were further analyzed. Results The numbers of lymphocytes, CD19+ lymphocytes, CD19+ IL-10+ and CD19+ CD24hiCD27hi Bregs in peripheral blood samples collected from patients with severe and mild acute pancreatitis as well as the mean fluorescence intensities (MFI) of CD80 and CD86 were significantly lower than those from healthy subjects. Compared with patients with mild acute pancreatitis, the numbers of lymphocytes and CD19+ lymphocytes, the absolute numbers of CD19+ IL-10+ and CD19+ CD24hiCD27hi Bregs as well as the mean fluorescence intensities (MFI) of CD80 and CD86 in patients with severe acute pancreatitis were significantly decreased. The percentages of CD19+ IL-10+ and CD19+ CD24hiCD27hi Bregs in patients with mild acute pancreatitis were significantly increased after an initial drop, but in patients with severe acute pancreatitis those values were continuously decreased along with the disease progression. The percentage of CD19+ IL-10+ Bregs was positively correlated with the percentage of CD19+ CD24hiCD27hi Bregs and the absolute number of CD19+ lymphocytes, but was negatively correlated with CRP. Conclusion The abnormal number and function of CD19+ IL-10+ and CD19+ CD24hiCD27hi Bregs might be one of the important reasons causing immune dysfunction in patients with acute pancreatitis. Key words: Acute pancreatitis; Regulatory B cell; Flow cytometry; Interleukin-10; Costimulatory molecule

A sytematic review of protease related markers in the severity assessment of acute pancreatitis

A sytematic review of protease related markers in the severity assessment of acute pancreatitis

Acute pancreatitis in pregnancy—Up to date

Acute pancreatitis during pregnancy is a rare event with wide variation in the incidence, ranging from 1:1000 to 1:10000. Pancreatitis in pregnancy presents the same etiological causes as in general population. However, differences are observed in the underlying mechanisms and the prevalence of each cause in the pregnant population. Acute pancreatitis is a complicated in diagnosis and treatment disease with various complications and severe prognosis in general population as well as pregnant women. The severity of acute pancreatitis is probably the most important issue that must be elucidated as early as possible since pancreatitis is an evolving disease. Clinical characteristics of acute pancreatitis in pregnancy do not differ from the non-pregnancy state. The most important disease during the first trimester which should be differentiated from acute pancreatitis is hyperemesis gravidarum. Complications of acute pancreatitis affect differently the mother and the fetus during pregnancy. Management of acute pancreatitis in pregnancy is a controversial issue since the initial treatment is similar to the non-pregnant patient but the subsequent management might differ due to the risk of fetal disturbances or teratogenesis. The initial management of acute pancreatitis is restricted in aggressive intravenous hydration. The interventional treatment of acute pancreatitis in pregnancy can be divided into three subcategories; the operational intervention for the disease itself, the operational intervention for biliary tract cormobidities and the endoscopic intervention. In conclusion, the initial assessment of acute pancreatitis severity and the initial management of the patient are of great importance in order to support the function and avoid failure of main organs.

Japanese severity score for acute pancreatitis well predicts in-hospital mortality: a nationwide survey of 17,901 cases

Early identification of severe cases of acute pancreatitis is necessary to reduce mortality. The Japanese severity score, which consists of nine prognostic factors, is reported to be useful for assessment of acute pancreatitis severity, but has not been validated by large-scale data. Data on adult patients with acute pancreatitis were collected between July 1, 2010, and September 30, 2011, from a national administrative database covering 1,032 Japanese hospitals. In-hospital mortality was analyzed to evaluate the predictive value of the Japanese severity score. A total of 17,901 patients were included. Total in-hospital mortality was 2.6%, and mortality rates of non-severe and severe acute pancreatitis were 1.1 and 7.0%, respectively (P < 0.001). In multivariate analysis with adjustment for other baseline characteristics, the odds ratio for mortality significantly increased according to an increase in prognostic factor score. The odds ratio for mortality of computed tomography grade 3 was significantly higher than that of grade 1 (P < 0.001), but that of grade 2 was not (P = 0.149). In receiver operating characteristic curve analysis of the prognostic factor score for prediction of in-hospital mortality, the area under the curve was 0.798 (95% confidence interval 0.775-0.821), and the optimum cutoff level of the prognostic factors was 2, in accordance with the definition of the current scoring system. The prognostic factor score has good predictive value for in-hospital mortality of acute pancreatitis, and thus is useful for severity assessment of acute pancreatitis at the early stage of hospital admission.

Severity Assessment of Acute Pancreatitis

급성 췌장염의 중증에 대한 위험인자들로는 고령, 비만, 그리고 장기부전이다. 입원 당시 경미한 경우와 중증 급성췌장염과 감별하는 데 도움을 주는 검사들에는 APACHE-II 점수가 8점 이상, 혈청 헤마토크리트(< 44는 경미한 췌장염을 의미)가 있다. APACHE-II 점수가 입원 후 첫 48시간 이내에 계속 증가하는 것은 중증급성 췌장염으로의 발전을 의미한다. 첫 72시간 이내에 CRP가 150 mg/dL 이상인 것은 췌장괴사가 존재함을 의미한다. 중증급성 췌장염에 대한 중요한 지표는 장기부전(특히 다기관 장기부전)과 췌장괴사이다. 조영증강 CT는 간질성 췌장염과 괴사성 췌장염을 구분하는데 가장 유용한 검사로서 특이 발병 후 2-3일 뒤 가장 유용하다. 괴사성 췌장염과 동반된 지속성 다기관 장기 부전의 사망률은 36% 이상으로 높다. 그러므로 지속되는 장기부전이 있거나 심한췌장염을 의미하는 징후 즉, 소변감소, 지속성빈맥, 그리고 힘든 호흡증 등이 있다면 중환자실로 전원하여 집중적 치료가 필요하다. 이와 같이 급성 췌장염 환자에서의 중증도 파악 및 평가는 매우 중요하다.

New Insights into Pathogenesis, Diagnosis, and Treatment of Pancreatic Disorders

New Insights into Pathogenesis, Diagnosis, and Treatment of Pancreatic Disorders

Early Detection of Low Enhanced Pancreatic Parenchyma by Contrast-Enhanced Computed Tomography Predicts Poor Prognosis of Patients With Acute Pancreatitis

The usefulness of early severity assessment of acute pancreatitis (AP) by contrast-enhanced computed tomography (CECT) was investigated. Data were obtained from a 2007 nationwide survey in Japan. Clinical data of 983 patients with AP were analyzed. All were examined by CECT on the day of admission. Early findings of CECT demonstrated that low enhanced pancreatic parenchyma (LEPP) was associated with the incidence of organ failure (OF), multiple OF, and infectious complications as well as mortality (P < 0.0001). Next, patients were further divided into 4 groups according to the CECT findings, which focused on the LEPP and peripancreatic collections (PPCs). The LEPP/PPC (+/+) group was characterized as high morbidity and high mortality. The incidence of OF (28.2%), multiple OF (15.5%), and mortality (11.4%) in patients assigned to the (+/+) group was significantly higher than in those assigned to the other groups. The incidence of infectious complications was significantly higher in patients assigned to the (+/+) group (16.7%), the (+/-) group (9.0%), and the (-/+) group (7.0%) than those assigned to the (-/-) group (1.8%). The detection of LEPP and PPC was a useful CECT finding for the early assessment of the severity of AP.