Atlanta Classification Of Acute Pancreatitis Research Articles

COMPARATIVE CHARACTERISTICS OF THE INFORMATIVENESS OF THE LAL TEST AND PROCALCITONIN IN THE DIAGNOSIS OF INFECTIOUS COMPLICATIONS IN ACUTE ALCOHOLIC PANCREATITIS

Acute pancreatitis (AP) is an inflammatory condition of the pancreas, characterized by acute, intense abdominal pain. AP accounts for 20-30% of hospitalizations due to abdominal symptoms. The incidence of AP is increasing globally by 2-5% annually, ranging from 3.4 to 73.4 cases per 100,000 people. A critical concern in AAP is the potential development of infectious complications, which may require surgical intervention and increase mortality rates. Effective management and monitoring of these complications are essential. Research Justification. The diagnosis of AAP in clinical practice commonly relies on serum levels of α-amylase, lipase, C-reactive protein, and leukocyte counts. However, these markers have limitations and do not fully reflect the level of intoxication. The accuracy of C-reactive protein as a marker is not well established and is used mainly as a prognostic indicator. Serum α-amylase levels tend to decrease sharply after the fifth day of illness, regardless of the patient's condition. Lipase levels in diabetic patients can exceed reference values even without pathology, necessitating adjustments for AAP diagnosis. These criteria are most effective during the enzymatic phase of AAP (days 1-5). To predict the course of AAP and assess the adequacy of therapy, as well as to determine the need for surgical intervention, serum procalcitonin levels are commonly used. However, some studies question the diagnostic accuracy of procalcitonin, particularly regarding its correlation with organ failure, infectious complications, and patient mortality. Materials and Methods: This study involved 55 AAP patients, 51 men (92.7%) and 4 women (7.3%), with an average age of 49.49±9.87 years. Patients were categorized based on the severity of their condition: moderate (39 patients, 70.9%) and severe (16 patients, 29.1%). The control group consisted of 10 healthy individuals (9 men, 90.0%; 1 woman, 10.0%; average age 45.22±7.55 years). AAP was classified according to the Atlanta classification of acute pancreatitis. The study included patients with moderate to severe AAP who were hospitalized within 48 hours of symptom onset. All patients received treatment according to clinical guidelines, including intensive fluid therapy with Ringer's lactate. The Limulus Amebocyte Lysate (LAL) test and procalcitonin levels were measured on days 5, 8, 11, and 14 of hospitalization. For suspected infected necrosis, patients underwent contrast-enhanced computed tomography (CT) on day 14, with fine-needle aspiration biopsy or surgical intervention if necessary. Results. On day 5, LAL test values in the moderate and severe AAP groups were within reference ranges, and procalcitonin levels did not exceed 0.5 ng/ml. By day 14, a significant increase in LAL test values was noted in both groups, with a corresponding rise in procalcitonin levels. The ROC analysis for LAL test values on day 14 in the moderate AAP group showed an area under the curve (AUC) of 0.966, with 92.86% sensitivity and 96% specificity. For procalcitonin, the AUC was 0.723, with 71.43% sensitivity and 92% specificity. Conclusion. The LAL test is a sensitive and specific marker for detecting endotoxemia and monitoring the progression of AAP, particularly in predicting the development of infectious complications. The study demonstrates that LAL test values significantly correlate with the severity of AAP and may provide better diagnostic accuracy than procalcitonin, especially in the later stages of the disease.

Geriatrik Hasta Popülasyonunda Akut Pankreatit Şiddeti ile D Vitamini Düzeyi Arasındaki İlişki

Background: It is important to determine the severity of acute pancreatitis (AP) and its prognosis.The aim of this study is to research the efficiency of vitamin D level on the severity of acute pancreatitis in geriatric population.
 Methods: Files of 4108 patients were analyzed retrospectively. Serum vitamin D levels of total 404 patients (geriatric 160 (n:160); non-geriatric 244 (n:244)) were compared between mild, moderate and severe groups according to revised Atlanta classification for acute pancreatitis. Relationship between the severity of acute pancreatitis and vitamin D levels were analyzed.
 Results: No significant difference was observed in non-geriatric patients in terms of vitamin D levels according to the Atlanta classification for acute pancreatitis. However, there were significant differences both between mild and moderate groups and between moderate and severe groups in geriatric patients (p

Enteral Nutrition Versus Parenteral Nutrition on Outcomes in Acute Pancreatitis: Insights From the Nationwide Inpatient Sample.

Despite considerable research on the comparison of enteral and parenteral nutrition in patients with acute pancreatitis, there is an ongoing debate about the optimal timing of nutrition initiation, invasiveness of interventions, impact on outcomes, and patient tolerance. Given the gap that still exists in the literature, we investigated the relationship between the mode of nutrition and critical outcomes such as mortality rates, inpatient complications, length of hospitalization, and discharge disposition, using comprehensive national-level data. In addition, we investigated the impact of early enteral nutrition on outcomes in acute pancreatitis. All adult discharges for acute pancreatitis between 2016 and 2018 were analyzed from the National (Nationwide) Inpatient Sample (NIS). Discharges of minors and those involving mixed nutrition were excluded from the analysis. Enteral nutritionand parenteral nutrition subgroups were identified using the International Classification of Diseases, 10th revision (ICD-10)codes. Disease severity was defined using the 2013 revised Atlanta Classification of Acute Pancreatitis, along with the All Patient Refined Diagnosis Related Group (APR-DRG)'s severity of illness and likelihood of mortality variables. Complications were identified using ICD-10 codes from the secondary diagnoses variables within the NIS dataset. Multivariable logistic regression analyses were employed to assess associations between the mode of nutrition and the outcomes of interest. A total of 379,410 hospitalizations were studied. About 2,011 (0.53%) received enteral nutrition, while 4,174 (1.1%) received parenteral nutrition. The mean age of the study was 51.7 years (SD 0.1). About 2,280 mortalities were recorded in the study. After adjustments, enteral nutrition was associated with significantly lower odds of mortality (adjusted OR (aOR): 0.833; 95%CI: 0.497-0.933; P<0.001). Parenteral nutrition was linked with significantly greater odds of mortality(aOR: 6.957; 95%CI: 4.730-10.233; P<0.001). Both enteral nutrition and parenteral nutrition were associated with augmented odds of complications and prolonged hospitalization (P<0.001) compared to normal oral feeding. Initiation of enteral nutrition within 24 hours of admission did not improve the odds of mortality in this study (aOR: 5.619; 95%CI: 1.900-16.615; P=0.002). Enteral nutrition demonstrates better outcomes in mortality rates and systemic complications compared to parenteral nutrition in patients unable to maintain normal oral feeding.

Incidence and risk factors of postoperative hyperamylasemia and pancreatitis following total knee arthroplasty: a retrospective study

BackgroundPostoperative hyperamylasemia and pancreatitis are recognized complications after abdominal and spinal surgeries. The aim of this study is to investigate the incidence and identify risk factors for postoperative hyperamylasemia and pancreatitis following total knee arthroplasty.Methods170 patients undergoing total knee arthroplasty were retrospectively identified from our database from January 2017 to January 2021. Patients were divided into normal and hyperamylasemia groups based on the presence of serum amylase level within or greater than the normal range. The diagnosis of postoperative pancreatitis was based on the 2012 revised Atlanta Classification of Acute Pancreatitis. Patient demographics, perioperative parameters were investigated with student t test, chi square test and multivariate logistic regression analysis.Results43 patients (25.3%) exhibited postoperative hyperamylasemia while eight patients (4.7%) exhibited serum amylase < 5 times the normal upper limit. One patient (0.6%) was designated as having postoperative pancreatitis. More patients with Hypertriglyceridemia (HTG) were noted in hyperamylasemia group (P = 0.009) compared with normal group. Hyperamylasemia group showed higher preoperative serum amylase (74.95 vs. 55.62 IU/L, P < 0.001), higher intra-operative blood loss (IBL) (117.67 vs. 77.01 mL, P = 0.040) and longer surgical duration (132.98 vs. 107.01 min, P = 0.041). Multivariate logistic analysis revealed that HTG (OR = 0.189, P = 0.006), preoperative serum amylase (OR = 1.042, P < 0.001) and IBL (OR = 1.004, P = 0.022) were independent risk factors for postoperative hyperamylasemia.ConclusionsA significant percentage of patients developed hyperamylasemia after total knee arthroplasty. Patients with HTG, higher preoperative serum amylase and higher IBL had an increased risk of developing postoperative hyperamylasemia and pancreatitis.

Automated Machine Learning for the Early Prediction of the Severity of Acute Pancreatitis in Hospitals.

BackgroundMachine learning (ML) algorithms are widely applied in building models of medicine due to their powerful studying and generalizing ability. This study aims to explore different ML models for early identification of severe acute pancreatitis (SAP) among patients hospitalized for acute pancreatitis.MethodsThis retrospective study enrolled patients with acute pancreatitis (AP) from multiple centers. Data from the First Affiliated Hospital and Changshu No. 1 Hospital of Soochow University were adopted for training and internal validation, and data from the Second Affiliated Hospital of Soochow University were adopted for external validation from January 2017 to December 2021. The diagnosis of AP and SAP was based on the 2012 revised Atlanta classification of acute pancreatitis. Models were built using traditional logistic regression (LR) and automated machine learning (AutoML) analysis with five types of algorithms. The performance of models was evaluated by the receiver operating characteristic (ROC) curve, the calibration curve, and the decision curve analysis (DCA) based on LR and feature importance, SHapley Additive exPlanation (SHAP) Plot, and Local Interpretable Model Agnostic Explanation (LIME) based on AutoML.ResultsA total of 1,012 patients were included in this study to develop the AutoML models in the training/validation dataset. An independent dataset of 212 patients was used to test the models. The model developed by the gradient boost machine (GBM) outperformed other models with an area under the ROC curve (AUC) of 0.937 in the validation set and an AUC of 0.945 in the test set. Furthermore, the GBM model achieved the highest sensitivity value of 0.583 among these AutoML models. The model developed by eXtreme Gradient Boosting (XGBoost) achieved the highest specificity value of 0.980 and the highest accuracy of 0.958 in the test set.ConclusionsThe AutoML model based on the GBM algorithm for early prediction of SAP showed evident clinical practicability.

Atlanta Classification for Acute Pancreatitis- A Study Protocol

Background: Acute pancreatitis is one of the most common abdominal pathologies having variable outcome ranging from self limiting abdominal pain to high mortality and morbidity due to organ failure, over the past five decades, various classification systems have emerged to classify pancreatitis according to its severity , and the associated complications have emerged to classify acute pancreatitis and its various complications, such as Apache Scoring , Ct Severity , Modified Ct Severity ,Ransen and Atlanta Classification.&#x0D; Objectives: We in our study will be classifying patients suffering from acute pancreatitis according to the revised Atlanta classification to divide them into interstitial edematous pancreatitis and necrotizing pancreatitis. The local complications will be classified according to CT imaging findings into acute necrotic collection, psuedocyst, acute necrotic collection and walled of necrosis. Organ failure will be assessed according to modified marshal scoring system into transient or persistent organ failure.&#x0D; Methodology: We will be carrying forward our study on Siemens 16 slice computer tomography machine over a sample of 140 patients coming to the outpatient department of our hospital which will be followed by a routine clinical follow up of the patient to find out their prognosis.&#x0D; Results: Will be tabulated at the end of the study using SPSS version 26 software.&#x0D; Conclusion: The revised Atlanta classification for acute pancreatitis, in conjunction with the Modified Marshall Scoring System for organ failure, if found useful, in our series in improving the prognosis of the patients, then it can be incorporated in management.

Magnetic resonance imaging glossary of findings of pediatric pancreatitis and the revised Atlanta classification.

While still uncommon, the incidence of acute pancreatitis in children has been increasing over the last two decades. The Atlanta classification for acute pancreatitis, developed for adults, stratifies cases of acute pancreatitis based on imaging and clinical criteria. This classification scheme allows for standardized use of terminology to facilitate treatment and prognostication. Although US and CT should be used in critical or unstable patients, MRI is an ideal imaging modality in pediatric patients with acute pancreatitis because of its ability to characterize tissue without ionizing radiation. We review MRI examples specific to Atlanta classification terminology in pediatric patients. Chronic pancreatitis has also been increasingly diagnosed in children, and imaging plays a key role in the diagnosis and management of this insidious disease. MRI with magnetic resonance cholangiopancreatography is the optimal modality for assessing the pancreas in a child with known or suspected chronic pancreatitis because it provides tissue characterization and high-contrast imaging of the pancreatic duct without the use of invasive instrumentation or ionizing radiation. We also review and demonstrate accepted MRI findings of chronic pancreatitis.

O82: SCORPION: SCOPING OUTCOMES FOR ACUTE PANCREATITIS: A NATIONWIDE STUDY

O82: SCORPION: SCOPING OUTCOMES FOR ACUTE PANCREATITIS: A NATIONWIDE STUDY

German Terminology of the Revised Atlanta Classification of AcutePancreatitis: Glossary Based on the New German S3 Guideline on Acute, Chronic, and Autoimmune Pancreatitis

The Atlanta classification published in 1992 was supposed to classify the severity and complications in acute pancreatitis with the goal of providing uniform terminology for clinicians and researchers. After continuous evolution, the revised Atlanta classification was published in 2012. In this updated classification, imaging aspects were better integrated and unclear terms were better defined. To date, this terminology for disease grading, severity, and local complications has been solely available in English. This prevented wide acceptance of the classification by the German-speaking medical community. Therefore, an expert team of the German Radiological Society translated the terms based on German medical literature. This translation was approved by consensus in the new S3 guideline meeting in February 2020 with an approval rate of 97.3 %. This manuscript explains the translated and approved German terminology of the revised Atlanta classification and offers additional imaging examples. KEY POINTS:: · The revised Atlanta classification allows correct definition of the grading and complication assessment of acute pancreatitis.. · An expert group translated the terms into the German language. The translation was approved by the S3 guideline committee for pancreatitis.. · Based on the new German S3 guideline for pancreatitis, the translated terms should be employed consistently.. CITATION FORMAT: · Schreyer AG, Seidensticker M, Mayerle J et al. German Terminology of the Revised Atlanta Classification of Acute Pancreatitis: Glossary Based on the New German S3 Guideline on Acute, Chronic, and Autoimmune Pancreatitis. Fortschr Röntgenstr 2021; 193: 909 - 918.

S0043 Real World Practices of Same-admission Cholecystectomy in Gallstone Pancreatitis

INTRODUCTION: Cholecystectomy performed during an admission for gallstone pancreatitis (GP) has been reported to reduce both length of stay (LOS) and future encounters without causing an increase in complications. Despite this, rates of cholecystectomy remain low. To understand real-world trends of patients who underwent cholecystectomy after diagnosis of GP, we characterized their rates, risks, benefits, comorbid conditions, location of care and contrasted them across a nine-hospital system. METHODS: ICD-10 codes were used to retrieve charts of patients presenting to the MedStar Health between March 2015 and June 2019. These included emergency department visits and inpatient admissions. Charts meeting Revised Atlanta Classification for acute pancreatitis (AP) were reviewed. Charts that carried a diagnosis of GP were put into two groups, 1) those that underwent same-admission cholecystectomy (SAC) and 2) those who did not. These groups were then compared for the following variables: LOS, future encounter and complication rates, location of care, history of cholelithiasis or choledocholithiasis and presence of hypertension, coronary artery disease, congestive heart failure, asthma/chronic obstructive pulmonary disease, smoking status, chronic kidney disease or cirrhosis. Statistical analysis was performed using GraphPad PRISM. RESULTS: 1722 of 2541 charts met criteria for AP; 366 of which carried a diagnosis of GP. LOS was observed to be greater in those who underwent SAC when compared to those who did not (5.5 vs 4.2 days, 95% Cl 0.26–2.26, P = 0.0138.) Patients at tertiary centers were observed to have been less likely to undergo SAC (31.4% vs 44.5%, OR 0.570, P = 0.0151.) There was no significant difference in rates of future encounters or complications, presence of comorbidities or history of either cholelithiasis (50.0% vs 48.4%, P = 0.831) or choledocholithiasis (7.64% vs 8.60%, P = 0.847) between the two groups. CONCLUSION: In patients with GP, SAC was associated with increased LOS. Despite the association between choledocholithiasis or cholelithiasis and GP, there was no correlation between SAC and history of these prior conditions. This lower rate of SAC at tertiary centers could reflect a lack of penetrance of guideline adherence. Given these findings, the balance between benefit and risk remains to be one that warrants careful consideration and further investigation.Figure 1.: Length of stay compared between same-admission cholecystectomy and no cholecystectomy groupsFigure 2.: Prevalence of cholelithiasis history in same-admission cholecystectomy and no cholecystectomy groups.Figure 3.: Prevalence of choledocholithiasis history in same-admission cholecystectomy and no cholecystectomy groups.

S3070 Severity of Biliary Pancreatitis in Hispanics vs Non-Hispanics: Are There Any Differences?

INTRODUCTION: Biliary pancreatitis manifests as pancreatic inflammation due to ductal obstruction by a stone at the sphincter of Oddi. Often presenting as acute-onset abdominal pain with elevated biochemical markers, it can be a life-threatening disease requiring urgent evaluation. Contrast-enhanced computed tomography (CT) identifies the presence and extent of pancreatitis necrosis, and the CT Severity Index (CTSI) is a reliable predictor of severity and mortality of acute biliary pancreatitis. Mortality due to biliary pancreatitis ranges from 3% in patients with interstitial edematous pancreatitis to 17% in those who develop pancreatic necrosis, demonstrating the need for early identification and intervention. This study compared the severity of disease in Hispanic and non-Hispanic patients based on the CTSI as well as the Revised Atlanta Classification for Acute Pancreatitis. METHODS: A retrospective analysis of 303 biliary pancreatitis cases in patients aged 18-80 years from 2012 to 2019 were reviewed. Initial CT findings were standardized by a single reader. Patients were excluded if they did not have a diagnosis of biliary pancreatitis or an initial CT scan on admission. Data was analyzed with R, using univariate and multivariable logistic regression and Fisher’s exact test. RESULTS: 185 patients (average age 53.5 years) were Hispanic, and 118 (average age 49 years) were non-Hispanic. 21/185 (11.4%) patients in the Hispanic group presented with a fluid collection on initial CT versus 19/118 (16.1%) non-Hispanic patients (P = 0.309). 9/185 (4.9%) Hispanics had an acute necrotic collection (ANC), compared to 6/118 (5.1%) non-Hispanics (P = 0.44). 8/185 (4.3%) Hispanics had an acute peripancreatic fluid collection (APFC) associated with interstitial edematous pancreatitis, compared to 10/118 (8.5%) non-Hispanics. 5 total patients presented with a pancreatic pseudocyst, of which 4 were Hispanic. The average CTSI score was 2.14 +/- 1.96 for non-Hispanics and 1.82 +/- 1.76 (P = 0.132) for Hispanics. CONCLUSION: No statistical differences were noted in severity of biliary pancreatitis based on imaging evaluation among the two groups. The absolute difference of patients with pancreatic pseudocyst suggests that Hispanics may have stayed home longer between the onset of symptoms and hospital admission. This is the first study to classify ethnic differences in severity based on CT imaging. Larger cohort population studies are necessary to determine if statistically significant differences are present or not.Table 1.: Patient DemographicsTable 2.: Presence/Type of Fluid Collection on CT Scan and CTSI in Hispanics versus Non-Hispanics

Classification, Severity Assessment, and Prevention of Recurrences in Acute Pancreatitis.

Acute pancreatitis is a common disease, the incidence of which is 75-100/100,000/year in Finland. The worldwide incidence of acute pancreatitis is increasing. The identified mildcases usually show rapid recovery with conservative treatment allowing early discharge. Severe cases need early intensive care to reduce the risk of serious complications such as multi-organ failure. The revised Atlanta classification of acute pancreatitis was introduced in 2012-2013. A recurrent acute pancreatitis is defined as two or more well-documented separate attacks of acute pancreatitis with complete resolution in between. Alcoholic pancreatitis is the most common recurrent acute pancreatitis type. In this review current severity classifications and literature on the prevention of recurrent acute pancreatitis are analyzed. The severity of the disease is classified as mild, moderately severe, and severe acute pancreatitis. Novel entities include acute peripancreatic fluid collections in mild acute pancreatitis and acute necrotic collections in necrotizing acute pancreatitis lesser than 4 weeks after the onset and pancreatic pseudocyst in mild acute pancreatitis and walled-off necrosis in necrotizing acute pancreatitis more than 4 weeks after the onset of the disease. After the first attack of alcohol-induced acute pancreatitis, 46% of the patients develop at least one recurrence within 10- to 20-year follow-up. With repeated intervention against alcohol consumption, it is possible to reduce the recurrences. Removing the gall bladder after biliary pancreatitis is the key preventing recurrences. In mild cases, even during the index admission; in severe cases, it is recommended to wait until the inflammatory changes have resolved. Of total, 59% of the idiopathic pancreatitis had sludge of stones in the gall bladder. In other etiologies, addressing the etiological factor may prevent recurrent acute pancreatitis. This review describes current use of novel severity classifications and also different possibilities to prevent recurrent acute pancreatitis with different etiologies including idiopathic.

20 Comparison and Outcomes of Cannabis Users With Acute Pancreatitis According to Severity Using the Revised Atlanta Classification of Acute Pancreatitis

INTRODUCTION: Cannabis remains the most widely and commonly used substance in the world. There is conflicting data regarding its effects on Acute Pancreatitis. Aim with this study is to investigate the clinical effects of cannabis use and to compare outcomes in cannabis users (CU) vs. non-cannabis users according to acute pancreatitis severity. METHODS: Retrospective design study was conducted on a cohort of patients admitted with acute pancreatitis between January 2012 to April 2018 at a large tertiary hospital in Chicago, IL. Cannabis users were identified via recorded history, urine toxicology or both. Patients who were over 18 years of age at the time of the study and had an episode of acute pancreatitis were included, patients who were pregnant were excluded. Severity of acute pancreatitis was assessed using the revised Atlanta Classification for acute pancreatitis. Multivariate logistic regression model was constructed using STAT software version 13 (STATA Corp LLC, College Station, Texas, USA). RESULTS: Five hundred nineteen patients were included, from which 107 (21%) were CU. 65 (61%) had mild acute pancreatitis and 42 (39%) had moderate or severe pancreatitis. Mild acute pancreatitis outcomes: CU were more likely to have AKI (aOR 5.7, P &lt; 0.001), to come back to the ED for recurrent acute pancreatitis after discharge (aOR 2.77, P = 0.004), more likely to require re-hospitalization (aOR 2.43, P = 0.006). Moderate or Severe acute pancreatitis outcomes: CU were more likely to have AKI (aOR 1.8, P = 0.017) and less likely to have necrosis or any pancreatic fluid collection (aOR 0.15, P = 0.018), to require debridement (aOR 0.45, P = 0.037), to have bacteremia (aOR 0.27, P = 0.066). CONCLUSION: This is one of the largest studies investigating the clinical effects of cannabis in patients with AP. We found significant difference in AP outcomes according to the severity. CU had higher incidence of AKI either during a mild or moderate/severe pancreatitis attack and were more likely to have recurrent pancreatitis that requires ED visit or re-hospitalization. Interestingly, CU were less likely to have pancreatic necrosis, fluid collection, and bacteremia. Further prospective studies are needed to investigate the acute and long-term factors of cannabis consumption and its impact on AP course and outcomes.

Predictive values of neutrophil-lymphocyte ratio as an early indicator for severe acute pancreatitis in the emergency department patients.

CONTEXT:Acute pancreatitis is an acute inflammatory disease presenting with a wide range of severity.AIMS:We investigated the predictive values of the neutrophil-lymphocyte ratio (NLR) as an indicator for severe acute pancreatitis in the emergency department patients.SETTINGS AND DESIGN:This retrospective study was conducted on patients with acute pancreatitis who were diagnosed in the emergency department, from January 2008 to December 2017.SUBJECTS AND METHODS:Patients were classified into either mild-to-moderate severe group or severe group according to the Revised Atlanta Classification for Acute Pancreatitis. Clinical features and laboratory blood test parameters were considered as independent variables.STATISTICAL ANALYSIS USED:Independent variables were analyzed using the Chi-square test and Mann–Whitney U-test to determine statistically significant differences between the two groups. Logistic regression analysis and receiver operating characteristic analysis were performed to evaluate the predictive values of significantly different variables.RESULTS:Of the 672 patients, 52 (7.7%) were classified into the severe group. Tachycardia, fever, prevalence of liver cirrhosis and chronic alcoholism, white blood cell count, NLR, C-reactive protein (CRP), blood urea nitrogen (BUN), creatinine, aspartate transaminase, and total bilirubin were significantly higher in the severe group. Among them, NLR (adjusted odds ratio [aOR]: 1.13; 95% confidence interval [CI]: 1.081–1.181), CRP (aOR: 1.011; 95% CI: 1.004–1.017), BUN (aOR: 1.036; 95% CI: 1.004–1.069), and creatinine (aOR: 1.703; 95% CI: 1.008–2.877) were significant in the logistic regression analysis. NLR showed relatively high sensitivity (82.7%) and specificity (70%) and showed the highest area under the curve (0.821).CONCLUSIONS:The increase in NLR was associated with severe acute pancreatitis. NLR is expected to be useful as a prognostic factor in patients with acute pancreatitis who are visiting the emergency department.

MR imaging for acute pancreatitis: the current status of clinical applications.

Acute pancreatitis is a common clinical acute abdomen. Imaging examinations play an important role in the management of acute pancreatitis. MR imaging is a noninvasive examination with high tissue contrast and a variety of acquisition sequences that can help determine the diagnosis, complications and severity of acute pancreatitis. The acute pancreatitis classification working group modified the Atlanta classification in 2012 to improve clinical evaluations and standardize the radiologic nomenclature for acute pancreatitis. In particular, the redefinition of necrotizing pancreatitis offers a new understanding of this disease. In clinical practice, there is still a lack of unifying standards between radiologists and physicians, such as for the imaging features of pseudocysts, walled-off necrosis, peripancreatic necrosis and especially for the MR imaging features of acute pancreatitis. In this article, we review the 2012 revised Atlanta classification of acute pancreatitis and recent advances in the clinical applications of MR imaging (MRI) in acute pancreatitis by showing how MRI can provide more optimized information for clinical diagnosis and treatment plan.

Evolution of Transluminal Necrosectomy for Acute Pancreatitis to Stent in Stent Therapy: Step-Up Approach Leads to Low Mortality and Morbidity Rates in 302 Consecutive Cases of Acute Pancreatitis.

Background: The step-up approach, using either flexible endoscopy or a minimal invasive retroperitoneal access, has reduced mortality and morbidity in patients with acute pancreatitis. The use of fully covered self-expanding metal stents (FCSEMS) or lumen apposing metal stents (LAMS) facilitates endoscopic necrosectomy and drainage of walled-off necrosis (WON). The aim of our analysis was to investigate the 30/90/365-day mortality and morbidity rates of the subtypes of the revised Atlanta classification for acute pancreatitis. Materials and Methods: We conducted a retrospective analysis of all patients (n = 302) treated with acute pancreatitis in our institution from January 2014 to July 2017. Mortality, morbidity, management of fluid collections, interventions, complications, and new onset of diabetes were recorded. Results: In 30.8% (n = 93/302) of patients, pancreatic fluid collection developed. Out of these, 58.1% (54/93) required intervention, consisting of endoscopic treatment in 63% (34/54) or multidisciplinary approach in 37% (20/54). Overall, 90-day mortality rate according to Kaplan-Meier Estimator was 3.7%. Overall, 1-year mortality rate was 6.2%. One-year mortality for uncomplicated acute pancreatic fluid collection, pseudocyst, and WON were 5.4%, 2.6%, and 13.5%, respectively. Hemorrhage in case of metal stent treatment (FCSEMS/LAMS) occurred in 14.3%. If LAMS was combined with double pigtail stent-in-stent, bleeding was seen in 5.3%. No transperitoneal necrosectomy was needed. Conclusions: Treating acute pancreatitis with a step-up approach, including stent-in-stent procedures, leads to low mortality rates and few stent-associated bleeding complications and minimizes necessity for open transperitoneal surgical necrosectomy.

Elderly persons with acute pancreatitis - specifics of the clinical course of the disease.

BackgroundAs may readily be inferred from clinical observations, there is an increasing prevalence of severe acute pancreatitis (SAP) in the elderly, even though the precise nature of the relationship between a patient’s age and severity of the disease has not been unequivocally determined to date. This study aimed therefore to investigate the incidence, clinical course, and mortality rate among the elderly patients suffering from acute pancreatitis (AP), as compared to younger ones.MethodsA prospective study, lasting a single calendar year, covered patients with AP successively admitted to hospitals. The final assessment comprised 963 patients. The patients were subsequently divided into three groups corresponding to the three grades of disease severity, based on the Revised Atlanta Classification for Acute Pancreatitis. The actual cause of the disease, its clinical course, results of radiological ultrasonography, computed tomography, and laboratory tests, as well as the duration of hospital stay were assessed in due consideration of patients’ age (groups aged 65–79 years and ≥80 years vs <65 years).ResultsCholelithiasis was determined as the main cause of AP among the older patients (54.08% and 58.12% vs 22.46%; P<0.000). Among the oldest patients (≥80 years), its course was often significantly more severe, in comparison with the ones under 65 years of age: 14.53% vs 6.31% (P<0.00); a phenomenon not observed in the age range 65–79 years, nor among the younger patients (7.69% vs 6.31%; P>0.05). Moderate AP occurred significantly more often in the younger patients compared to those aged ≥80 years (16% vs 8.55%; P<0.00), although without any significant differences observed between the group aged 65–79 years and the younger patients (13.27% vs 8.55%). SAP more frequently ended in death among the oldest patients – 11.97% vs 2.31% (P<0.000) than in the group aged 65–79 years (4.59%), as compared to the younger groups (P>0.05).ConclusionAn appreciably higher susceptibility of older patients aged ≥80 years to AP, with cholelithiasis being the main cause that results in high mortality rate, is presently acknowledged a serious diagnostic and therapeutic management challenge to a national healthcare system.

Enteral Nutrition by Percutaneous Endoscopic Gastrojejunostomy Tube (PEG-J) Tube in Pancreatitis: A Retrospective Study

Introduction: Severe acute pancreatitis (SAP) and necrotizing pancreatitis (NP) or localized complications with infections account for > 40 % mortality in pancreatitis. Most studies evaluating enteral nutrition have utilized nasogastric, nasojejuneal or gastrostomy routes. We aimed to study the influence of enteral nutrition by PEG-J in mortality of patients with pancreatitis (SAP, NP and sterile/infected localized complications). Methods: Subjects with SAP and NP were collected retrospectively from a single tertiary care center by utilizing ICD-9 & ICD-10 codes. Each case was confirmed by manual review of the medical record. SAP and NP were defined per Revised Atlanta classification of acute pancreatitis 2012. Descriptive analysis was done by Excel & SPSS version 20. Results: All patients (79; 100%) with SAP or NP underwent PEG-J placement & were started on tube feeding immediately. Male 63%; Caucasians 96%, African American 4%, Age 56 ± 15 years & obesity (BMI ≥30) 38%. Etiologies were: Alcohol 30%, Biliary 38%, Idiopathic 23%. Distribution of subjects based on severity and morphological classification were as follows: SAP 43%, moderately-SAP 33% and mild AP were 24%. Interstitial pancreatitis or its local complications of acute peripancreatic fluid collection (APFC) or pseudocyst (PP) were present in 46%. Necrotizing pancreatitis or its local complications of acute necrotic collection (ANC) or walled-off necrosis (WON) were present in 37%. There were 11% of subjects with infected PP & 18% with infected WON/ANC. All patients but 2 achieved >75% of nutritional target. Gastrointestinal intolerance characterized by diarrhea, abdominal pain or both were present in 24% subjects, though the symptoms were transient & resolved spontaneously or with change of feeding formula. Standard tube feeding formulas were used. PEG-J malfunction was encountered in <0.5%. All-cause mortality was 12 (15%) and among this group 7 (9%) were related to pancreatitis related complications whereas 4 (5 %) patients opted for palliative care and 1 patient died of pancreatic cancer. Average ICU stay was 8 days & median hospital stay was 12 days. Subjects accounting for longer stay (≥ 30 days) in ICU or hospital were 9% & 25% respectively. Conclusion: Enteral nutrition by PEG-J decreases all cause and pancreatitis related mortality in patients with pancreatitis including SAP, NP or sterile/infected local complications (APFC, PP, ANC or WON).94 Figure 1. Comorbidities & Lab

Impact of revised atlanta classification of acute pancreatitis on generation of a score employing modified CT severity index.

Impact of revised atlanta classification of acute pancreatitis on generation of a score employing modified CT severity index.

Acute pancreatitis is a very rare comorbidity of acute ischemic stroke.

Background: Although acute pancreatitis is listed among the exclusion criteria for the administration of recombinant tissue plasminogen activator according to the Japanese Guideline for the Management of Stroke, the co-occurrence of acute pancreatitis and acute ischemic stroke has not been investigated. The present study aimed to assess the incidence rate of acute pancreatitis in patients with acute ischemic stroke.Methods: This study consecutively enrolled all patients with ischemic stroke admitted to the Department of Neurology, JA Toride Medical Center between April 2014 and March 2016. Diagnosis of acute pancreatitis was made according to the revised Atlanta Classification of Acute Pancreatitis. We retrospectively analyzed serum amylase activity and the frequency of acute pancreatitis as a comorbidity of ischemic stroke.Results: A total of 411 ischemic stroke patients were included. Serum amylase activity was measured for 364 patients, 27 of whom presented with amylase activity exceeding the upper limit of normal. In two patients with serum amylase activity greater than three times-fold the upper limit of normal, computed tomography or transabdominal ultrasonography showed no characteristic findings of acute pancreatitis. No patient in the cohort met the diagnostic criteria for acute pancreatitis.Conclusions: Acute pancreatitis is a very rare comorbidity of acute ischemic stroke.