Clinical Diagnosis Of Acute Pancreatitis Research Articles

Evaluation of red blood cell distribution width, neutrophil-to-lymphocyte ratio, and other hematologic parameters in canine acute pancreatitis.

To determine if RBC distribution width (RDW), neutrophil-to-lymphocyte ratio (NLR), and other hematological parameters are associated with increased odds of in-hospital mortality, increased length of hospitalization (LOH), or disease severity as measured by the Canine Acute Pancreatitis Severity (CAPS) score in dogs with acute pancreatitis (AP). Retrospective, multicenter study from January 2016 to August 2020. Four private emergency and specialty referral centers. On initial case search, 118 client-owned dogs were identified with a clinical diagnosis of AP. Out of these cases, 114 dogs met inclusion criteria, defined as sudden onset of ≥2 compatible clinic signs (lethargy, anorexia, vomiting, or abdominal pain), a specific canine pancreatic lipase concentration >400μg/L, hospital admission, as well as CBC and serum biochemistry run within 48hours of initial hospitalization. Disease severity was calculated and measured using the CAPS score, in addition to LOH and in-hospital mortality. None. Clinical endpoints were in-hospital mortality, LOH, and disease severity, as evaluated by the CAPS score. Overall in-hospital mortality was 36.8%. NLR was significantly associated with survival, with a higher percentage being associated with an increased likelihood of nonsurvival (odds ratio: 1.1, 95% confidence interval: 1.0-1.2; P=0.006, adjusted P=0.04). Increased NLR was found to be significantly associated with a longer LOH based on the unadjusted P-value (P=0.02) but was not statistically significant based on a P-value adjusted for multiple comparisons (P=0.12). No significant associations were noted when RDW, platelet-to-lymphocyte ratio, WBC count, mean platelet volume, RDW-to-platelet ratio, or RDW-to-total serum calcium ratio was evaluated against outcome measures. This study retrospectively evaluated the prognostic utility of several readily available hematological parameters in dogs hospitalized for AP. Dogs with an increased NLR may have a higher risk of in-hospital mortality and increased LOH, although future prospective studies are necessary to confirm these findings.

COMPARITIVE STUDY OF PANC-3 AND BEDSIDE INDEX FOR SEVERITY IN ACUTE PANCREATITIS (BISAP) SCORING SYSTEM TO IDENTIFY SEVERITY OF PANCREATITIS

Background & Objectives: Objective of this study is to evaluate accuracy and predictability of PANC-3 over BISAP scoring system to predict severity in an attack of acute pancreatitis. Methods: A total of 160 cases were enrolled in the study and was conducted in Department of General Surgery, ESICMC & PGIMSR, Bangalore. All patients with clinical diagnosis of acute pancreatitis will be included in the study. It was a prospective study with study period of 18 months. Results: A total number of 160 patients were included in the study. Patients presenting with acute pancreatitis were maximum in age group of 31-40 years which included 60 patients (37.5). 153 (96%) patients were male and 4 percent (n=7) are female. Most common cause is alcohol- 124 (77.5%) patients. Next common cause is the gallstone 19 patients (11.9%). The most common chief complaint in our study was characteristic upper abdominal pain (100%) followed by vomiting (22.5%), fever (13.8%), jaundice (1.9%) and abdominal distension (1.3%). 91 patients were diagnosed to have mild acute pancreatitis, 37 patients with moderate acute pancreatitis and 32 patients with severe acute pancreatitis. All the 32 patients were correctly predicted by PANC-3 score. 11(6.9%) developed complications like pancreatic necrosis, pancreatic abscess, upper gastrointestinal bleeding, MODS, sepsis and death. 3 patients died due to complications associated with severe pancreatitis which accounts for 1.9%. Interpretation &Conclusion: Our study shows that PANC-3 can be used to predict the severity of pancreatitis as efficiently as BISAP scoring. It uses only 3 criteria which are easily done and available in even the basic health care setup. The interpretation of PANC-3 does not need expertise and can be applied at the time of admission which is an advantage when compared to classical scoring systems.

Thoracic epidural analgesia in intensive care unit patients with acute pancreatitis: the EPIPAN multicenter randomized controlled trial

BackgroundFindings from preclinical studies and one pilot clinical trial suggest potential benefits of epidural analgesia in acute pancreatitis. We aimed to assess the efficacy of thoracic epidural analgesia, in addition to usual care, in improving clinical outcomes of intensive care unit patients with acute pancreatitis.MethodsA multicenter, open-label, randomized, controlled trial including adult patients with a clinical diagnosis of acute pancreatitis upon admission to the intensive care unit. Participants were randomly assigned (1:1) to a strategy combining thoracic epidural analgesia and usual care (intervention group) or a strategy of usual care alone (control group). The primary outcome was the number of ventilator-free days from randomization until day 30.ResultsBetween June 2014 and January 2019, 148 patients were enrolled, and 135 patients were included in the intention-to-treat analysis, with 65 patients randomly assigned to the intervention group and 70 to the control group. The number of ventilator-free days did not differ significantly between the intervention and control groups (median [interquartile range], 30 days [15–30] and 30 days [18–30], respectively; median absolute difference of − 0.0 days, 95% CI − 3.3 to 3.3; p = 0.59). Epidural analgesia was significantly associated with longer duration of invasive ventilation (median [interquartile range], 14 days [5–28] versus 6 days [2–13], p = 0.02).ConclusionsIn a population of intensive care unit adults with acute pancreatitis and low requirement for intubation, this first multicenter randomized trial did not show the hypothesized benefit of epidural analgesia in addition to usual care. Safety of epidural analgesia in this setting requires further investigation.Trial registration: ClinicalTrials.gov registration number NCT02126332, April 30, 2014.

BISAP plus serum lactate dehydrogenase: a new scoring system for assessment of severity of acute pancreatitis

Background: Acute Pancreatitis is a process of acute inflammation of pancreas along with peripancreatic tissue and multi organ involvement. To reduce morbidity and mortality by predicting the course of the disease and do an early intervention several scoring systems have been proposed such as RANSON’S score, BISAP score, APACHE II etc. Methods: Patients are chosen with clinical diagnosis of acute pancreatitis over a period of 6 months, based on inclusion criteria, with consent. They underwent investigations base d on the scoring systems and institutional protocol. The different scoring systems were used and calculated. The effectiveness of all the scoring systems were calculated using Microsoft Excel indicating its sensitivity, specificity, accuracy, positive and negative predictive value. Results: BISAP with LDH (BISAP PLUS) shows the highest sensitivity (85.71%), Positive predictive value (70.59%), Negative predictive value (84.62%) and Accuracy (76.67%) among different scoring systems. The highest specificity was seen in APACHE II (75%) Conclusions: Use of BISAP plus serum LDH (BISAP plus) can help in daily assessment and quicker management of acute pancreatitis and should be studied further, as it is showing promise in helping in management of acute pancreatitis.

Comparative analysis of computed tomography severity indices in predicting the severity and clinical outcome in patients with acute pancreatitis

Background: Acute pancreatitis (AP) has unpredictable severity. Its management is based on initial assessment of disease severity. It ranges from mild interstitial to severe necrotic form; the latter is associated with poor prognosis. Contrast-enhanced computed tomography (CT) of the abdomen is the gold standard in early detection of pancreatic necrosis and in assessing the severity of AP. Two CT grading systems exist to assess severity of AP: CT severity Index (CSI) and modified CSI (MCSI). This study compares the usefulness of these two systems in predicting severity and clinical outcome in AP in comparison with Ranson’s criteria and clinical outcome parameters. Methods: This is a prospective hospital-based screening study of 80 patients aged >12 years with clinical diagnosis of AP who underwent contrast-enhanced CT study of the abdomen. Comparative analysis between MCSI and CSI with Ranson’s criteria and clinical outcome parameters was assessed by Chi-Squared test. Results: The accuracy of CSI and MSCI in predicting the requirement of critical care, superadded infection, multiple organ dysfunction syndrome (MODS) and requirement of intervention were 73.0%, 64.5%, 69.8% 60.9% and 77.2%, 76.0%, 74.4% & 56.6%, respectively. Area under the curve for MCSI score was significantly higher (AUC : 0.861; 95% CI: 0.736-0.986) than CSI score (AUC:0.815;95% CI:0.749-0.941). MCSI and CSI showed significant correlation with Ranson’s criteria; however, MCSI correlation was better (r:0.53; p<0.01) than CSI (r:0.35;p:0.04). Conclusion: CSI and MCSI are better predictors of severity, clinical outcome and mortality compared with Ranson’s criteria, with MCSI being more accurate and better predictor than CSI. The accuracy of MCSI is better than CSI for prediction of requirement of critical care, development of superadded infection and development of MODS in AP. However, CSI and MCSI have low accuracy in predicting intervention in AP.

A procalcitonin-based algorithm to guide antibiotic use in patients with acute pancreatitis (PROCAP): a single-centre, patient-blinded, randomised controlled trial

Differentiating inflammation from bacterial infection in patients with acute pancreatitis can be difficult. Procalcitonin can distinguish infection from inflammation, and algorithms based on procalcitonin measurement can differentiate bacterial sepsis from a systemic inflammatory response. We aimed to test the hypothesis that a procalcitonin-based algorithm to guide initiation, continuation, and discontinuation of antibiotics could lead to reduced antibiotic use without an adverse effect on outcome in acute pancreatitis. PROCAP was a single-centre, patient-blinded, randomised controlled trial done at the Manchester Royal Infirmary (Manchester, UK). Eligible participants were aged 18 years or older and had a clinical diagnosis of acute pancreatitis. Participants were randomly assigned (1:1) to procalcitonin-guided care or usual care using web-based randomisation software. The randomisation sequence was stratified by disease severity and admission pathway, using variable block sizes of 4, 6, or 8. Patients, but not clinicians, were masked to group assignment. In the procalcitonin-guided care group, procalcitonin testing was conducted on days 0, 4, 7, and weekly thereafter. Guidance was to stop or not start antibiotics following a test value of less than 1·0 ng/mL and to start or continue antibiotics following a test value of 1·0 ng/mL or more. In the intervention group, any empirical clinical decision to use antibiotics was preceded by measurement of procalcitonin. Otherwise, both groups received standard care. The primary outcome was use of antibiotics during the index admission to hospital. All analyses were done in the intention-to-treat population. This study was registered with the International Standard Randomised Controlled Trial registry, ISRCTN 50584992. Between July 29, 2018, and Nov 13, 2020, 369 patients were screened, of whom 260 were enrolled and randomly assigned to a treatment group (132 to procalcitonin-guided care and 128 to usual care). 59 (45%) of patients in the procalcitonin-guided care group were prescribed antibiotics compared with 79 (63%) in the usual care group (adjusted risk difference -15·6% [95% CI -27·0 to -4·2]; p=0·0071). The odds ratio for the treatment effect was 0·49 (95% CI 0·29 to 0·83; p=0·0077). There was no significant difference between groups in terms of the number of clinical infections or hospital-acquired infections per patient. Four (3%) patients in the procalcitonin-guided care group and three (2%) patients in the usual care group died; all deaths were related to underlying severe pancreatitis. There was no difference in adverse events between the groups. Our findings suggest that procalcitonin-guided care can reduce antibiotic use without increasing infection or harm in patients with acute pancreatitis. Procalcitonin-based algorithms to guide antibiotic use should be considered in the care of this group of patients and be incorporated into future guidelines on the management of acute pancreatitis. None.

Advances in the diagnosis of acute pancreatitis in dogs.

In the last 20 years, the diagnosis of pancreatitis has become more frequent as a result of improved diagnostic modalities such as abdominal ultrasound examination, advanced imaging, and immunoassays for the measurement of pancreatic lipase. Our aim is to provide a state‐of‐the‐art overview of the clinical diagnosis of acute pancreatitis (AP) in dogs with a particular focus on pancreatic lipase assay validation and clinical performance, in addition to advanced imaging modalities. We also discuss the potential indications for cytology and histopathology in dogs with suspected AP.

A novel “BISSHOAP” score for predicting severe and moderately severe acute pancreatitis in emergency room

<br><b>Background</b>: The existing scores for predicting severity of acute pancreatitis (AP) underperform in sensitivity. The existing scores do not predict moderately severe pancreatitis. <b>Methods:</b> We performed a prospective observational study from August 2014 to April 2016 on patients hospitalized at Apollo Hospitals, Chennai, with a clinical diagnosis of AP (as per Atlanta 2012 classification). Three established scoring systems – Complete Ranson's (at 48 h), Acute Physiology and Chronic Health Evaluation (APACHE-II), Bedside Index of Severity in AP (BISAP) and new score BISAP + saturation of oxygen, hematocrit (BISAP + SHO) (packed cell volume [PCV]) and overweight by body mass index [BMI]) were calculated at admission. In BISAP + SHO score 5 points were given as in BISAP and 3 points were added 1 each for low oxygen saturation ≤92%, PCV ≥47% and BMI of ≥23 making BISAP + SHO an 8-point score. The prediction by scores was validated against the actual clinical outcome of severity. <b>Results:</b> Of 102 patients with AP, 34 (33%) patients had organ failure (OF) and in 17 patients (16.5%) it lasted >48 h, classified as severe AP. Remaining 17 were moderately severe AP as OF resolved within <48 h. Cut-off values to predict severe pancreatitis were - Ranson's score - ≥3, APACHE-II - ≥8, BISAP - ≥3, and BISAP + SHO - ≥5. Area under receiver operator curve (AUC) for Ranson's, APACHE-II, BISAP and BISAP + SHO were 0.958, 0.953, 0.899 and 0.989, respectively. With a score 3 or 4, BISAP + SHO predicted moderately severe AP with a sensitivity of 94.12%, specificity 97.6%. <b>Conclusions:</b> The BISAP + SHO (rephrased as BISSHOAP) stratifies AP with better AUC than existing scores and is also able to predict moderately severe pancreatitis in the ER.<br>

Evaluation of patients who are clinically suspected for the case of acute pancreatitis by MCTSI

AP can be diagnosed either by clinical, laboratory, or image findings. For an appropriate diagnosis of AP, at least two of the following criteria to be fulfilled. In majority of cases, the disease is self-limiting and presents with response to supportive treatment alone. The assessment of the severity of AP has a significant role in management. All male and female patients with complaints of abdominal pain (epigastric pain), vomiting with raised serum amylase & lipase levels and who underwent contrast enhanced MDCT during study period were study subjects. MDCT being a useful, non-invasive, accurate investigative tool in confirming the clinical diagnosis of acute pancreatitis and grading of AP as mild (grade 2 and grade 4), moderate (grade 6) and severe (grade 8 and 10) contrary to other previous studies which classified it into mild (grade 2), moderate (grade 4 and grade 6) and severe (grade 8 and 10) on the basis of MCTSI scoring index.

Hyperlipasemia in critically ill dogs with and without acute pancreatitis: Prevalence, underlying diseases, predictors, and outcome.

BackgroundHyperlipasemia is frequent in critically ill people without evidence of acute pancreatitis (AP), and has been associated with increased morbidity and mortality.ObjectiveTo evaluate the prevalence of hyperlipasemia at admission and development of hyperlipasemia during hospitalization in critically ill dogs, explore factors associated with hyperlipasemia, and evaluate association with outcome.AnimalsCritically ill, client owned dogs (n = 1360), presented on emergency and admitted to the intensive care unit, that had 1,2‐o‐dilauryl‐rac‐glycero‐3‐glutaric acid‐(6′‐methylresorufin) ester (DGGR) lipase activity measured within 24 hours of admission.MethodsRetrospective cross‐sectional study of clinical and laboratory records.ResultsThe DGGR lipase activity was increased >3× the upper reference limit at admission in 216/1360 (16%) dogs, of which 70/216 (32%) had a clinical diagnosis of AP. Other primary conditions associated with hyperlipasemia were renal, endocrine, and immune‐mediated diseases, and upper airway obstruction. Predictors of hyperlipasemia at admission were prior glucocorticoid administration, vomiting and abdominal pain, increased age, plasma bilirubin and creatinine concentrations, and decreased hematocrit. Of dogs with repeat measurements, 78/345 (23%) had significantly increased lipase during hospitalization, of which 13/78 (17%) had a clinical diagnosis of AP. Other primary conditions associated with in‐hospital hyperlipasemia were renal and immune‐mediated disorders. Predictors of developing hyperlipasemia during hospitalization were hemodialysis events, increased plasma bilirubin and creatinine concentrations, and decreased hematocrit. Hyperlipasemia both at admission and during hospitalization was associated with longer hospitalization and higher mortality.Conclusions and Clinical ImportanceSignificant DGGR‐hyperlipasemia is frequent in critically ill dogs and associated with a variety of nonpancreatic conditions and negative outcome.

Extra Pancreatic Necrotic Volume: Can It Prognosticate Acute Necrotising Pancreatitis— A Prospective Study

Abstract Background Acute necrotizing pancreatitis (ANP) is associated with higher mortality and morbidity. We need a method which is accurate in predicting the prognosis, and when applied early in the disease process, can help in closer monitoring and early initiation of treatment for at-risk patients. Objectives The aim of this prospective study was to assess the extra pancreatic necrosis (EPN) volume in patients with ANP and compare it with outcome variables such as organ failure, death and need for intervention as well as to compare the predictive power of EPN volume with modified CT severity index (CTSI). Materials and Methods The study had 48 patients with clinical diagnosis of acute pancreatitis, who underwent Contrast enhanced CT (CECT) between 3–6 days of onset. In all these patients, EPN volume (in cubic centimetre) and modified CTSI score were calculated and compared with the patient outcome parameters such as duration of hospital/ICU stay, need for percutaneous/surgical intervention, evidence of infection and organ failure. The results were compared with assess the predictive power of EPN volume. Statistical analysis The analysis was done in SPSS version 16.0 for windows. Pearson Correlation was used to assess the significant relationship between selected objective variables. Results EPN volume (&gt;/= to 360 cc) had a statistically significant correlation with outcome parameters as well as in predicting overall organ failure. In our study, Modified CTSI had no significant correlation with the above mentioned factors. Conclusions The volume of EPN calculated between 3rd and 6th day of onset of symptoms showed a significant correlation with the outcome in patients with ANP.

Role of total calcium and corrected calcium in comparisons with computed tomography to predict severity of acute pancreatitis

Background: The objective of the study was to evaluate corrected calcium levels in patient of acute pancreatitis and to evaluate role of corrected calcium as predictor of severity in acute pancreatitis in comparison to computed tomography (CT) scan.Methods: The study was conducted in Department of Biochemistry of G.G.S Medical College in collaboration with the Department of Surgery and Department of Radio diagnosis. 50 patients, with clinical diagnosis of acute pancreatitis, attending the Inpatient Department of Department of Surgery, were taken. 50 patients, of either sex of 18 to 70 age groups suffering from acute pancreatitis were enrolled for the study.Results: On exploring the data, highly significant negative correlation found between CT severity index (CTSI) and serum calcium (p≤0.001; r value=-0.520) whereas the non-significant correlation found between CTSI and amylase (p=0.778; r value=-0.041). The corrected calcium and CTSI shows highly negative significant correlation (p≤0.001; r value=-0.654). Serum albumin with CTSI also shows significant correlation (p=0.006; r value=0.385). But no significant association with lipase (p≥0.05).Conclusions: We observed that corrected calcium and calcium is better and alternative marker for predicating the severity of disease because corrected calcium and calcium is having good positive predictive value to indicate progression of damage and also a highly significant negative predictive value to rule out severity of acute pancreatitis.

PROCalcitonin-based algorithm for antibiotic use in Acute Pancreatitis (PROCAP): study protocol for a randomised controlled trial

BackgroundDifferentiating infection from inflammation in acute pancreatitis is difficult, leading to overuse of antibiotics. Procalcitonin (PCT) measurement is a means of distinguishing infection from inflammation as levels rise rapidly in response to a pro-inflammatory stimulus of bacterial origin and normally fall after successful treatment. Algorithms based on PCT measurement can differentiate bacterial sepsis from a systemic inflammatory response. The PROCalcitonin-based algorithm for antibiotic use in Acute Pancreatitis (PROCAP) trial tests the hypothesis that a PCT-based algorithm to guide initiation, continuation and discontinuation of antibiotics will lead to reduced antibiotic use in patients with acute pancreatitis and without an adverse effect on outcome.MethodsThis is a single-centre, randomised, controlled, single-blind, two-arm pragmatic clinical and cost-effectiveness trial. Patients with a clinical diagnosis of acute pancreatitis will be allocated on a 1:1 basis to intervention or standard care. Intervention will involve the use of a PCT-based algorithm to guide antibiotic use. The primary outcome measure will be the binary outcome of antibiotic use during index admission. Secondary outcome measures include: safety non-inferiority endpoint all-cause mortality; days of antibiotic use; clinical infections; new isolates of multiresistant bacteria; duration of inpatient stay; episode-related mortality and cause; quality of life (EuroQol EQ-5D); and cost analysis. A 20% absolute change in antibiotic use would be a clinically important difference. A study with 80% power and 5% significance (two-sided) would require 97 patients in each arm (194 patients in total): the study will aim to recruit 200 patients. Analysis will follow intention-to-treat principles.DiscussionWhen complete, PROCAP will be the largest randomised trial of the use of a PCT algorithm to guide initiation, continuation and cessation of antibiotics in acute pancreatitis. PROCAP is the only randomised trial to date to compare standard care of acute pancreatitis as defined by the International Association of Pancreatology/American Pancreatic Association guidelines to patients having standard care but with all antibiotic prescribing decisions based on PCT measurement.Trial registrationInternational Standard Randomised Controlled Trial Number, ISRCTN50584992. Registered on 7 February 2018.

Ultrasonographic features of presumed gastric wall edema in 14 dogs with pancreatitis.

BackgroundGastric wall edema has not been reported as a complication of acute pancreatitis in dogs.ObjectiveTo describe the ultrasonographic features of gastric wall thickening in dogs with acute pancreatitis.AnimalsFourteen dogs with ultrasonographic evidence and clinical diagnosis of acute pancreatitis, with ultrasonographic evidence of increased gastric wall thickness (>5 mm).MethodsA retrospective search in the medical records from 2014 to 2016 was performed to identify dogs that had ultrasonographic evidence of acute pancreatitis, that had increased thickness of the gastric wall and that were diagnosed with acute pancreatitis clinically. The gastric wall changes such as thickness, layering appearance, echogenicity, distribution of lesions, and perigastric changes were recorded. Serial ultrasonographic examination and histopathological findings were recorded if available.ResultsMean gastric wall thickness was 9.9 ± 4.0 mm (SD). A complete loss of wall layering was observed in 2 dogs. Thickening of the submucosal layer was observed in 12 dogs, and 5 of them had concurrent muscularis layer thickening. The echogenicity of thickened submucosal layer was intermediate hyperechoic. Lacy appearances were present within the thickened submucosal layer in 7 dogs and in the muscularis layer of 1 dog. Thickening was focal in 12 dogs and adjacent to the diseased pancreas. Subsequent resolution of gastric wall thickening was observed in 3 dogs (range 3‐28 days) via follow‐up ultrasound. One dog underwent necropsy, and gastric wall edema was confirmed histopathologically.Conclusions and Clinical ImportanceFindings indicated that gastric wall thickening presumably because of edema could be a complication of acute pancreatitis.

Role of Magnetic Resonance Imaging in Evaluation of Acute Pancreatitis

AbstractBackground: To investigate the role of dynamic Magnetic Resonance Imaging (MRI) in diagnosing and assessing the severity of Acute Pancreatitis (AP) patients and role out pancreatic necrosis.Aim of Study: The aim of the study was to determine the effectiveness of dynamic MRI in the diagnosis of AP and assessing the severity of AP by detection and delineation of extension of pancreatic necrosis in comparison to clinical scoring systems.Material and Methods: Thirty four patients with clinical diagnosis of acute pancreatitis underwent magnetic resonance imaging using 1.5T machine include T1, T2 weighted imaging, SPAIR and dynamic contrast. Magnetic Resonance Severity Index (MRSI) was used to assess the severity and correlated with clinical scoring based on revised Atlanta classification and Acute Physiology and Chronic Health Evaluation II (APACHE II) score.Results: T2-SPAIR is the best sequence to diagnose AP. The MRSI significantly correlates with both revised Atlanta and APACHE II scores in differentiating mild cases of AP from moderate edematous and severe necrotizing cases (p <0.001 for revised Atlanta and 0.004 for APACHE II.Conclusion: Dynamic MRI help to diagnose mild forms of AP and differentiate it from other causes of abdominal pain.MRI can be used in combination with clinical scoring for diagnosis of AP and accurate assessment of disease severity.

Acute pancreatitis, its diagnosis with special reference to contrast enhanced CT scan (CECT) and serum enzyme studies: a comparative study in tertiary referral hospital of Odisha, India

Background: Acute pancreatitis is sudden swelling and inflammation of the pancreas. It can be diagnosed on the basis of clinical and laboratory data. At times, it may be difficult to differentiate it from other acute abdominal conditions. In these patients, serum enzymes (amylase and lipase) study, imaging by ultrasonography (USG) and/or computed tomography (CT) is of immense value in arriving at a diagnosis. In this study, we have compared the role of serum enzymes (amylase and lipase) levels, with the imaging studies (US/CECT scan) in relation to early diagnosis of acute pancreatitis and to find out the most specific and sensitive diagnostic modality.Methods: 300 patients (220 males, 80 females) in age group of 21 to 62 years with a clinical diagnosis of acute pancreatitis, which were admitted to surgical ward of S.C.B. Medical College Hospital, Cuttack during a period from November 2013 to October 2015, were included in the study. All selected cases (clinically diagnosed as acute pancreatitis) were serially subjected to tests of serum amylase and lipase estimation, USG and CECT scan of abdomen.Results: In our study the most common cause found was gall stone disease followed by chronic alcoholism. Serum amylase test showed diagnostic accuracy of 46.66% whereas serum lipase it was 70 %. Further USG of abdomen diagnostic accuracy was 83.33%, finally CECT scan had a diagnostic accuracy of 93.33%.Conclusions: Comparing all the diagnostic modalities described above it was found that contrast enhanced CT scan has highest accuracy rate (i.e. about 93% in our study) in detecting acute pancreatitis. This study proved that CECT scan was very important in the following up of the patients in order to detecting regression of disease appearance and complication in relation to acute pancreatitis.

Elevated Serum Midkine in Patients With Acute Pancreatitis

BackgroundMidkine (MK) is reported to be involved in the pathogenesis of numerous pathologies, but the expression of MK in acute pancreatitis (AP) has not been well studied and documented. MethodsIn this study, the temporal changes of serum MK were assessed in 97 patients with AP by enzyme-linked immunosorbent assay. ResultsThe concentration of serum MK increased along with the severity of AP. Serum MK level increased more significantly in patients with organ failure than in those without organ failure. A more obvious elevation of serum MK level was also observed in patients with pancreatic necrosis. ConclusionSerum MK might be a useful marker in the clinical diagnosis of AP.

Identification of potential diagnostic biomarkers of acute pancreatitis by serum metabolomic profiles

Acute pancreatitis (AP) is defined as an acute inflammation of pancreas that may cause damage to other tissues and organs depending upon the severity of symptoms. The diagnosis of AP is usually made by detection of raised circulating pancreatic enzyme levels, but there are occasional false positive and false negative diagnoses and such tests are often normal in delayed presentations. More accurate biomarkers would help in such situations. In this study, the global metabolites' changes of AP patients (APP) were profiled by using gas chromatography-mass spectrometry (GC-MS). Multivariate pattern recognition techniques were used to establish the classification models to distinguish APP from healthy participants (HP). Some significant metabolites including 3-hydroxybutyric acid, phosphoric acid, glycerol, citric acid, d-galactose, d-mannose, d-glucose, hexadecanoic acid and serotonin were selected as potential biomarkers for helping clinical diagnosis of AP. Furthermore, the metabolite changes in APP with severe and mild symptoms were also analyzed. Based on the selected biomarkers, some relevant pathways were also identified. Our results suggested that GC-MS based serum metabolomics method can be used in the clinical diagnosis of AP by profiling potential biomarkers.

Serum Lipase as Clinical Laboratory Index for Chronic Renal Failure Diagnosis.

Measuring the level of serum lipase has been used for the clinical diagnosis of acute pancreatitis. Reports showed that the serum lipase level increased in patients of clinical renal failure. In this study, we aimed to measure the change of serum lipase levels in chronic kidney diseases and determine whether it could serve as a clinical laboratory index for clinical renal failure diagnosis. Materials: The OLYMPUS AU5400 automatic biochemical analyzer was used to determine the serum levels of lipase and creatinine. The study included 120 cases in the clinical renal failure group, 76 cases in the nephrotic syndrome group, 81 cases in the chronic nephritis group, and 80 healthy controls from our hospital volunteers in the same period. We then compared the lipase levels and conducted statistical analyses among these groups. The serum lipase levels were 15.3 U/L, 79.8 U/L, 45.1 U/L, and 51.0 U/L in the normal control, clinical renal failure, nephrotic syndrome, and chronic nephritis groups, respectively. The lipase levels in the groups with diseases were significantly different compared with that of the normal control group (p < 0.01). The lipase level of the clinical renal failure group was significantly higher than that of the nephrotic syndrome group and chronic nephritis group (p < 0.01). However, no statistically significant difference between the nephrotic syndrome and chronic nephritis group (p > 0.05) was observed. Moreover, an association of the serum lipase with disease progression was observed in the study. Serum lipase is an effective serological index which can reflect the clinical changes in the clinical renal failure and tends to increase through the progression of renal dysfunction.

Soluble B7-H2 as a novel marker in early evaluation of the severity of acute pancreatitis.

The clinical usefulness of soluble B7-H2 (sB7-H2) as an early indicator of acute pancreatitis (AP) remains unclear, so we performed the present study to investigate this issue. For our cohort, we recruited 75 patients with AP, 70 patients with other abdominal sepsis, and 20 healthy control individuals. The sB7-H2 levels of AP patients or healthy control individuals were measured by enzyme-linked immunosorbent assay (ELISA). The sB7-H2 levels in patients with AP rather than other patients with abdominal sepsis were significantly higher than those in healthy controls. Hence, we selected AP to study the clinical significance of sB7-H2 in inflammatory conditions. The sB7-H2 level was positively correlated with the white blood cell (WBC) count and the lactate dehydrogenase (LDH), high-sensitivity C-reactive protein (hs-CRP), and lipopolysaccharide LPS levels (P <.05 for each). Receiver operating characteristic (ROC) analysis revealed that sB7-H2 can distinguish moderately severe acute pancreatitis (MSAP) and severe acute pancreatitis (SAP) from mildly acute pancreatitis (MAP) with 77.8% sensitivity and 80.0% specificity; and that the levels of sB7-H2 also can distinguish SAP from MSAP and MAP with 92.0% sensitivity and 86.0% specificity. The present results indicate that sB7-H2 might be a useful marker in the clinical diagnosis of AP.