Clinical Outcomes In Acute Pancreatitis Research Articles

Meta-Analysis of Early Enteral Nutrition Provided Within 24 Hours of Admission on Clinical Outcomes in Acute Pancreatitis.

Enteral nutrition (EN) is more beneficial than parenteral nutrition (PN) in reducing organ failure, infectious complications, and mortality of acute pancreatitis (AP), but its timing is controversial. We attempted to evaluate the safety and clinical outcomes of early EN within 24 hours of admission in patients with AP, especially in predicted severe or severe acute pancreatitis (SAP). We searched PubMed, EMBASE Databases, Web of Science, and the Cochrane Library for relevant articles before June 2016 using RevMan 5.2 software. Eight studies containing 727 patients with AP were analyzed in the meta-analysis. Comparing early EN to late EN or total parental nutrition in AP, the odds ratios (OR) were 0.56 (95% CI 0.23 -1.34) for the risk of mortality, 0.40 (95% CI 0.20-0.79) for multiple organ failure, 0.57 (95% CI 0.23-1.42) for infectious complications, 0.45 (95% CI 0.17-1.21) for adverse events, and 0.83 (95% CI 0.59-1.18) for pancreatic-related infections. Furthermore, subgroup analysis for early EN in predicted severe or SAP showed a significant reduction in multiple organ failure (OR 0.30; 95% CI 0.09-0.96) and pancreatic-related infections (OR 0.51, 95% CI 0.29-0.88). Early EN provided no benefits for mild to moderate AP. Early EN within 24 hours of admission is safe and provides benefits for predicted severe or SAP, but not for mild to moderate pancreatitis.

Predictors of acute pancreatitis with low elevation of serum amylase.

Background and aimsSerum amylase is a traditional measure used to establish the diagnosis of acute pancreatitis (AP). The current study aimed to assess the predictors and clinical outcome of AP with low serum amylase.MethodsAll patients were divided into two groups, based on their serum amylase level within the first 2 days after hospital admission: group 1 (amylase ≥300 U/L) and group 2 (amylase <300 U/L). Clinical outcomes were compared between the two groups before and after 1:1 propensity score matching. Clinical and biochemical parameters were collected and evaluated as potential predictors of AP with low serum amylase.ResultsA total of 464 patients were enrolled. After propensity score matching according to age, gender, time interval before admission, hematocrit, blood urea nitrogen and creatinine, 108 matched pairs of patients were selected. There was no significant statistical difference between group 2 and group 1 with respect to severity of AP, median days of stay in hospital and death. Multivariate analysis indicated that biliary etiology (odds ratio [OR]: 0.499; 95% confidence interval [CI]: 0.265–0.942; P=0.003), low-density lipoprotein cholesterol (LDL-C) (OR: 1.009; 95% CI: 1.002–1.017; P=0.017) and triglyceride levels (OR: 1.001; 95% CI: 1.0001–1.001; P=0.015) were independently associated with development of AP along with low serum amylase.ConclusionSerum amylase level was not related to the severity of AP, median hospital stay (days) and death. Biliary etiology, LDL-C and triglyceride levels were independently associated with the development of AP with lower elevation of serum amylase.

Venous Thromboembolism Is Associated With Adverse Outcomes in Hospitalized Patients With Acute Pancreatitis: A Population-Based Cohort Study.

The systemic inflammatory cascade and vascular stasis in hospitalized patients with acute pancreatitis (AP) serve as a milieu for development of venous thromboembolism (VTE). Our aim was to estimate the prevalence and risk factors of VTE in AP and to evaluate its impact on clinical outcomes of AP. The Nationwide Inpatient Sample (2002-2011) was reviewed to identify all patients hospitalized with AP. Patients with a concomitant diagnosis of VTE were compared with those without. The primary clinical outcome (inpatient mortality) and secondary resources outcomes (length of stay and total hospital charges) were analyzed using univariate and multivariate comparisons. Among 2,382,426 patients with AP, 22,205 (0.93%) had VTE. Multivariate analysis showed patients with greater comorbidity (odds ratio [OR], 1.47), white race (OR, 1.11), acute kidney injury (OR, 1.08), acute respiratory failure (OR, 1.40), pseudocyst (OR, 1.41), total parenteral nutrition (OR, 1.28), and central venous catheter placement (OR, 3.01) were associated with a diagnosis of VTE. Venous thromboembolism was also independently associated with increased mortality (OR, 1.31) and prolonged duration of hospitalization by 6.5 days (P < 0.001) and contributed to an excess $44,882 (P < 0.001) in hospitalization costs. Venous thromboembolism is adversely associated with mortality and health care resource utilization in AP.

Effect of Serum Triglycerides on Clinical Outcomes in Acute Pancreatitis: Findings From a Regional Integrated Health Care System.

The aim of this study was to evaluate the effect of serum triglycerides on the development of multiple or persistent organ failure in patients with acute pancreatitis. A retrospective cohort study was conducted among patients hospitalized for acute pancreatitis between 2006 and 2013. Triglyceride levels measured before and within 72 hours of admission were compared. In addition, the effect of triglyceride levels on the development of multiple or persistent organ failure during hospitalization for acute pancreatitis was assessed. Among 2519 patients, 267 patients (10.6%) developed organ failure, of which 75 patients developed multiple system organ failure and 82 patients developed persistent organ failure. Triglyceride levels in patients who developed organ failure were initially much higher than in patients who did not develop organ failure, but by 72 hours into admission, approached levels of patients who did not develop organ failure. Approximately 8% of patients had triglyceride levels greater than 500 mg/dL, the majority of which had similarly high levels before admission. Increased triglyceride levels were associated with the development of multiple or persistent organ failure among patients hospitalized with acute pancreatitis. Patients with high triglyceride levels at the time of admission were likely to have high triglyceride levels before admission.

Su1249 - Impact of Early Fluid Therapy on Clinical Outcomes in Acute Pancreatitis

Su1249 - Impact of Early Fluid Therapy on Clinical Outcomes in Acute Pancreatitis

Impact of Serum Triglycerides on Clinical Outcomes in Acute Pancreatitis: Findings from a Regional Integrated Healthcare System

Introduction: Hypertriglyceridemia is an established risk factor for acute pancreatitis. This study seeks to evaluate the effect of serum triglycerides on the development of persistent or multiple organ failure in patients with acute pancreatitis. Methods: A retrospective cohort study was conducted using data from an integrated healthcare system. Patients hospitalized for acute pancreatitis between January 1, 2006 and December 31, 2013 were included in the study. Triglyceride levels measured prior to and within 72 hours of admission were compared. In addition, the impact of serum triglycerides on the development of persistent or multiple organ failure during hospitalization for acute pancreatitis was assessed using Poisson regression models adjusting for age and sex. Results: Among 2,519 patients, 267 patients (10.6%) developed organ failure, of which 75 patients (28.1%) developed multiple system organ failure and 82 patients (30.7%) developed persistent organ failure. Serum triglyceride levels in patients who developed organ failure were initially much higher than in patients who did not develop organ failure, but by 72 hours into the admission, approached levels of the patients who did not develop organ failure. Approximately 7% of patients had very high serum triglyceride levels (>500 mg/dL), which correlated with similarly high triglycerides levels prior to admission. Conclusion: Increased TG levels were associated with the development of multiple or persistent organ failure in this study of patients hospitalized with acute pancreatitis. Patients with high triglyceride levels at the time of admission for acute pancreatitis were likely to have high triglyceride levels prior to admission.

Portal Vein Thrombosis (PVT) Is Associated with Poor Clinical Outcomes in Acute Pancreatitis: Results from a Propensity-Matched Study on a Nationwide Cohort

Introduction: In acute pancreatitis (AP), the inflammatory process may involve the portal vein, this together with action of proteolytic enzymes, weakens the vessel wall and causes stasis of blood flow, which serves as a milieu for the development of portal vein thrombosis (PVT). PVT may adversely influence the clinical course of AP; however there are no inpatient, population-based studies assessing the impact of PVT in AP. We evaluated the prevalence and clinical outcomes of PVT in AP patients in a propensity matched analysis. Methods: The national inpatient sample (1998-2012) was reviewed to identify all patients hospitalized with AP with a concomitant diagnosis of PVT. The primary clinical outcome (mortality, renal failure, respiratory failure and pseudocyst) and secondary resources outcomes (length of stay and total hospital cost) were analyzed using univariate and multivariate comparisons. Propensity score-matched analysis (matched for patient demographics, hospital characteristics, etiology, and AHRQ-Elixhauser comorbidities) was performed to compare the outcomes in patients with and without PVT. Results: PVT is associated with 0.2% (5681/ 3454400) of all AP admissions. There is trend for increased PVT during the study period (47.5/100,000 in 1998 to 347.8/100,000; Cochran Armitage Trend test p < 0.001). Multivariate analysis showed PVT is associated with increased mortality [odds ratio (OR): 1.3, 95% confidence interval (CI) 1.0, 1.7; p=0.023], renal failure (OR 1.5, 95% CI 1.3, 1.6; p < 0.001), respiratory failure (OR: 3.1, 95% CI 2.7, 3.5; p < 0.001), severe AP (OR: 2.5, 95% CI 2.3, 2.8; p < 0.001), prolonged stay (median 5.4 days, p < 0.001) and higher hospital cost (median: $36,509, p < 0.001). Propensity matched analysis confirmed PVT is associated with increased renal failure (OR 1.8; p=0.002), respiratory failure (OR: 2.9; p=0.002), respiratory failure (OR: 2.9; p < 0.001), pseudocyst complication (OR: 4.5; p < 0.001) prolonged stay (median: 5.5 days, p < 0.001) and higher hospital cost (median: $38,123, p < 0.001). Conclusion: PVT is associated with adverse clinical outcomes like organ failure, severe AP, prolonged hospital stay and increased hospital charges which negatively impacts inpatients healthcare utilization. Further studies are needed to determine the optimal strategy for its detection and to reduce disease burden on AP patients.

Mo1402 Portal Vein Thrombosis (PVT) Is Associated With Poor Clinical Outcomes in Acute Pancreatitis (AP) - A Nationwide Study of Hospitalized Patients in United States

Mo1402 Portal Vein Thrombosis (PVT) Is Associated With Poor Clinical Outcomes in Acute Pancreatitis (AP) - A Nationwide Study of Hospitalized Patients in United States

Effect of immunonutrition on clinical outcome of acute pancreatitis: a meta-analysis

Objective To systematically evaluate the effect of immunonutrition for patients with acute pancreatitis. Methods PubMed, EMBASE, Cochrane Library, China National Knowledge Infrastructure (CNKI), VIP, Wan fang, and Chinese Science Citation Database (CSCD) were searched for literature up to October 2014. Data were extracted by two researchers independently based on predetermined inclusion criteria. RevMan 5.3 software was used for meta-analysis. Categorical data were expressed as the risk ratio (RR), continuous data as weighted mean difference (WMD), or standard mean difference (SMD) when measuring methods or units are different, with 95% confidence intervals (CI) and significance level of 0.05. Results 16 randomized controlled trials (RCTs) were included, involving 740 patients, but most of them were low qualities. Meta-analysis showed that immunonutrition may reduce the incidence rate of infectious complications during hospitalization (RR=0.71, 95% CI: 0.57-0.89, P=0.003), mortality of acute pancreatitis (RR=0.52, 95% CI: 0.32-0.86, P=0.010), length of hospital stay (WMD=-2.38, 95% CI: -4.04--0.73, P=0.005), and C-reactive protein level (SMD=-0.28, 95% CI: -0.55--0.01, P=0.04) for patients with acute pancreatitis. Conclusions Compared with the regular nutrition, immunonutrition seems to reduce the incidence of infectious complications and mortality during hospitalization for patients with acute pancreatitis, as well as shorten the length of hospital stay. However, due to the low quality in study design, lack of database control and methodology of most of the included studies, further high-quality clinical trials are needed to provide reliable evidence to establish the clinical effectiveness of immunonutrition. Key words: Immunonutrition; Speed recovery; Acute pancreatitis; Meta-analysis

CT Evaluation of Acute Pancreatitis and its Prognostic Correlation with CT Severity Index.

Pancreatitis is one of most complex and clinically challenging of all abdominal disorders. USG and abdominal CT are the most commonly used diagnostic imaging modalities for the evaluation of pancreas. Computed Tomography (CT) is highly accurate and sensitive than USG in both diagnosing as well as demonstrating the extent. Early assessment of the cause and severity of acute pancreatitis is of utmost importance for prompt treatment and close monitoring of patient with severe disease. CT is the imaging method of choice for assessing the extent of acute pancreatitis and for evaluating complications. To assess prognostic correlation and clinical outcome of acute pancreatitis on the basis of CT severity index. A prospective study of 50 cases was carried out in the Department of Radio Diagnosis, with complaint suggestive of acute pancreatitis on the basis of clinical/laboratory/ultrasonography findings were evaluated in Siemens somatom 40 slice CT. The severity of pancreatitis was scored using CT severity index, modified severity index and revised Atlanta classification and classified into mild, moderate, severe categories. Clinical follow-up of the patients was done in terms of the following parameters: Length of hospital stay, Need for surgery or percutaneous intervention, Evidence of infection in any organ system, Occurrence of organ failure- respiratory, cardiovascular, renal, hepatic and haematological system, death. The clinical outcome was compared with the currently accepted Balthazar's CTSI and Modified Mortele's CTSI and revised Atlanta classification in all the cases. Gall stone disease was most common aetiological factor seen in 40% cases, it was more common in females than males. Alcohol was second most common aetiological factor seen in 38% cases and was noted only in males. Pleural effusion was the most common extra-pancreatic complication seen in 46% cases. Balthazar grade C was the most common (40%) followed by grade D and E (25% each). Acute peri-pancreatic collection was the most common findings seen in 72% cases. Majority of the cases (42%) were categorized as mild pancreatitis according Balthazar CTSI score. Majority of the cases (44%) were categorized as severe pancreatitis according modified CTSI. Majority of the cases were categorized as mild pancreatitis according revised Atlanta classification. Organ system failure, death were more seen in severe grade in modified CTSI and revised Atlanta classification. Modified CT severity index makes the score easier to calculate and reduces the inter-observer variation. Scores obtained with the modified Mortele index, show a stronger statistical correlation for all clinical outcome parameters in all the patients better than the Balthazar index.

Ghrelin and gastroparesis as early predictors of clinical outcomes inacute pancreatitis.

Impaired motor and hormonal gastrointestinal functions have been implicated in the pathogenesis of acute pancreatitis. The aim of the present study was to investigate the predictive value of the Gastroparesis Cardinal Symptom Index and serum ghrelin in the development of clinically meaningful outcomes in patients with acute pancreatitis. This was a prospective clinical study. The Gastroparesis Cardinal Symptom Index and serum ghrelin were measured for 48h after hospitalization. Univariate and multivariate logistic regression analyses were conducted. The Gastroparesis Cardinal Symptom Index total score alone on day 2 was a significant predictor of oral feeding intolerance in both unadjusted (odds ratio 1.21 (1.01-1.46), P=0.04) and adjusted (odds ratio 1.30 (1.01-1.69), P=0.05) analyses. Adding ghrelin to Gastroparesis Cardinal Symptom Index further improved prediction in both unadjusted (odds ratio 1.26 (1.02-1.56), P=0.03) and adjusted (odds ratio 1.53 (1.00-2.35), P=0.05) analyses. This pilot study demonstrates that the Gastroparesis Cardinal Symptom Index has a potential to be used as a predictor of oral feeding intolerance. Ghrelin, when combined with the Gastroparesis Cardinal Symptom Index, may further improve the predictive accuracy. These findings need to be confirmed in larger studies.

Continuing Medical Education Questions: November 2015

If you wish to receive credit for this activity, please refer to the Web site:http://acgjournalcme.gi.org/ Article Title: Morbid Obesity Is Associated With Adverse Clinical Outcomes in Acute Pancreatitis: A Propensity-Matched Study

Morbid Obesity Is Associated With Adverse Clinical Outcomes in Acute Pancreatitis: A Propensity-Matched Study.

Morbid obesity may adversely affect the clinical course of acute pancreatitis (AP); however, there are no inpatient, population-based studies assessing the impact of morbid obesity on AP-related outcomes. We sought to evaluate the impact of morbid obesity on AP-related clinical outcomes and health-care utilization. The Nationwide Inpatient Sample (2007-2011) was reviewed to identify all adult inpatients (≥18 years) with a principal diagnosis of AP. The primary clinical outcomes (mortality, renal failure, and respiratory failure) and secondary resource outcomes (length of stay and hospital charges) were analyzed using univariate and multivariate comparisons. Propensity score-matched analysis was performed to compare the outcomes in patients with and without morbid obesity. Morbid obesity was associated with 3.9% (52,297/1,330,302) of all AP admissions. Whereas the mortality rate decreased overall (0.97%→0.83%, P<0.001), it remained unchanged in those with morbid obesity (1.02%→1.07%, P=1.0). Multivariate analysis revealed that morbid obesity was associated with increased mortality (odds ratio (OR) 1.6; 95% confidence interval (CI) 1.3, 1.9), prolonged hospitalization (0.4 days; P<0.001), and higher hospitalization charges ($5,067; P<0.001). A propensity score-matched cohort analysis demonstrated that the primary outcomes, acute kidney failure (10.8 vs. 8.2%; P<0.001), respiratory failure (7.9 vs. 6.4%; P<0.001), and mortality (OR 1.6, 95% CI 1.2, 2.1) were more frequent in morbid obesity. Morbid obesity negatively influences inpatient hospitalization and is associated with adverse clinical outcomes, including mortality, organ failure, and health-care resource utilization. These observations and the increasing global prevalence of obesity justify ongoing efforts to understand the role of obesity-induced inflammation in the pathogenesis and management of AP.

Early Enteral Nutrition and Aggressive Fluid Resuscitation are Associated with Improved Clinical Outcomes in Acute Pancreatitis

To determine whether recommendations for treatment of acute pancreatitis (AP) in adults impact the outcomes of pediatric AP. Adult guidelines regarding early management of AP were implemented through an admission order set at Cincinnati Children's Hospital Medical Center at the beginning of the year 2014. Recommendations included administering high rates of intravenous fluid (IVF) within 24 hours of admission and enteral nutrition within 48 hours of admission. A retrospective chart review of AP admissions before and after the implementation of the recommendations was undertaken. Outcomes studied were: hospital length of stay, intensive care unit transfer rates, development of severe AP, pulmonary complications, and readmission rates post discharge from the hospital. The study included 201 patients. Children who received feeds within the first 48 hours and received greater than maintenance IVF within 24 hours had a shorter length of stay, less intensive care unit admissions and severe AP rates compared with the patients who remained nil per os during the first 48 hours and received lower rates of IVF. Our data support that early enteral nutrition and early aggressive IVF improve outcomes of pediatric AP.

Retrocrural space involvement on computed tomography as a predictor of mortality and disease severity in acute pancreatitis.

BackgroundBecause computed tomography (CT) has advantages for visualizing the manifestation of necrosis and local complications, a series of scoring systems based on CT manifestations have been developed for assessing the clinical outcomes of acute pancreatitis (AP), including the CT severity index (CTSI), modified CTSI, etc. Despite the internationally accepted CTSI having been successfully used to predict the overall mortality and disease severity of AP, recent literature has revealed the limitations of the CTSI. Using the Delphi method, we establish a new scoring system based on retrocrural space involvement (RCSI), and compared its effectiveness at evaluating the mortality and severity of AP with that of the CTSI.MethodsWe reviewed CT images of 257 patients with AP taken within 3–5 days of admission in 2012. The RCSI scoring system, which includes assessment of infectious conditions involving the retrocrural space and the adjacent pleural cavity, was established using the Delphi method. Two radiologists independently assessed the RCSI and CTSI scores. The predictive points of the RCSI and CTSI scoring systems in evaluating the mortality and severity of AP were estimated using receiver operating characteristic (ROC) curves.Principal FindingsThe RCSI score can accurately predict the mortality and disease severity. The area under the ROC curve for the RCSI versus CTSI score was 0.962±0.011 versus 0.900±0.021 for predicting the mortality, and 0.888±0.025 versus 0.904±0.020 for predicting the severity of AP. Applying ROC analysis to our data showed that a RCSI score of 4 was the best cutoff value, above which mortality could be identified.ConclusionThe Delphi method was innovatively adopted to establish a scoring system to predict the clinical outcome of AP. The RCSI scoring system can predict the mortality of AP better than the CTSI system, and the severity of AP equally as well.

Does higher hospital volume improve the patient outcome in acute pancreatitis?

Over the past decade, many studies have shown a significant association between the volume of hospital services and patient outcomes for a wide variety of medical conditions [1–3]. As regards acute pancreatitis, several population-based studies have shown higher hospital volume to be associated with better outcomes [4–6]. Especially, a lower mortality rate, shorter length of hospital stay and lower total costs had been shown with higher hospital volume. However, acute pancreatitis has a wide range of severity and mortality; especially severe acute pancreatitis has a high mortality rate and longer length of hospital stay. In clinical situations, several severity scoring systems have been used for judging the severity grading and making decisions for how to treat patients depending on the grading all over the world. Furthermore, various potentially effective treatments for acute pancreatitis, e.g. enteral nutrition, continuous hemofiltration, continuous regional arterial infusion, and endoscopic treatments, etc. are performed for severe acute pancreatitis. However, effectiveness and cost-performance analyses of those techniques have not been proven at this time. In addition, the mortality rate of each institution was not described, even for high volume centers. That is to say, a lot of clinicians have a great deal of concern about the volume–outcome relationship in order to perform effective treatments and decide referral patterns to improve mortality rates. In the current context, Professor Hamada et al. [7] are to be congratulated for performing the extremely large-scale study about clinical outcomes of acute pancreatitis based on the Japanese administrative database associated with the diagnostic procedure combination system (DPC). This is the first study to have successfully adjusted for baseline disease severity using an established scoring system to evaluate the volume–outcome relationship in acute pancreatitis. Unlike other analyses, this study focused on the hospital–volume relationship and severity of acute pancreatitis based on the Japanese Severity Scoring system [8]. Additionally, the researchers include adjustments for severity grading and assessment of the potential non-linear relationship between hospital volume and outcomes by means of restricted cubic spline (RCS) functions. As a result, the median length of hospital stay was 14 days (range 10–22 days) in Japan. Their analysis demonstrated that the median hospital volume was 22.4 (range 1–82 case/year), and higher hospital volume was associated with shorter length of stay (overall relationship p 0.001), however not evident in in-hospital mortality and total costs. Using the same Japanese DPC system database, Murata et al. [8] showed that increased hospital volume, which was categorized into tertiles, was significantly associated with decreased relative risk of in-hospital mortality in both patients with mild and severe acute pancreatitis. Meanwhile Professor Hamada et al. used the annual number of cases, not categorized, admitted to each individual hospital and mentioned that the correlation between the patients in the same hospital can be taken into account with using generalized estimating equations (GEE). Exactly this groundbreaking method was performed. So what is the key to have a better outcome and an effective utilization of medical resources? The clinical This comment refers to the article available at doi:10.1007/s00535013-0888-9.

Enteral nutrition within 48 hours of admission improves clinical outcomes of acute pancreatitis by reducing complications: a meta-analysis.

BackgroundEnteral nutrition is increasingly advocated in the treatment of acute pancreatitis, but its timing is still controversial. The aim of this meta-analysis was to find out the feasibility of early enteral nutrition within 48 hours of admission and its possible advantages.Methods and FindingsWe searched PubMed, EMBASE Databases, Web of Science, the Cochrane library, and scholar.google.com for all the relevant articles about the effect of enteral nutrition initiated within 48 hours of admission on the clinical outcomes of acute pancreatitis from inception to December 2012. Eleven studies containing 775 patients with acute pancreatitis were analyzed. Results from a pooled analysis of all the studies demonstrated that early enteral nutrition was associated with significant reductions in all the infections as a whole (OR 0.38; 95%CI 0.21–0.68, P<0.05), in catheter-related septic complications (OR 0.26; 95%CI 0.11–0.58, P<0.05), in pancreatic infection (OR 0.49; 95%CI 0.31–0.78, P<0.05), in hyperglycemia (OR 0.24; 95%CI 0.11–0.52, P<0.05), in the length of hospitalization (mean difference −2.18; 95%CI −3.48−(−0.87); P<0.05), and in mortality (OR 0.31; 95%CI 0.14–0.71, P<0.05), but no difference was found in pulmonary complications (P>0.05). The stratified analysis based on the severity of disease revealed that, even in predicted severe or severe acute pancreatitis patients, early enteral nutrition still showed a protective power against all the infection complications as a whole, catheter-related septic complications, pancreatic infection complications, and organ failure that was only reported in the severe attack of the disease (all P<0.05).ConclusionEnteral nutrition within 48 hours of admission is feasible and improves the clinical outcomes in acute pancreatitis as well as in predicted severe or severe acute pancreatitis by reducing complications.

Influence of Obesity on the Severity and Clinical Outcome of Acute Pancreatitis

Background/AimsObesity tends to be associated with increased mortality and morbidity in acute pancreatitis. However, in Asian populations, higher morbidity and mortality have been reported in patients with low body mass indexes (BMIs). This study was undertaken to evaluate the relation between obesity and outcome, and to investigate the occurrence of complications by overweightedness in acute pancreatitis.MethodsThe medical records of 403 patients with acute pancreatitis were reviewed retrospectively, and Ranson's scores, modified Glasgow scores, Acute Physiology and Chronic Health Evaluation (APACHE) II scores and computed tomography severity indexes were calculated. Patients were categorized by BMI for the analysis.ResultsWhen compared with normal patients (BMI 18.5 to 22.9), all categories with a BMI ≥23 had an increased risk of developing a severe form of acute pancreatitis (p=0.003) and all categories with a BMI ≥25 significantly predicted severity (p<0.001). Patients with class 1 obesity (BMI 25 to 29.9) developed significantly more systemic and metabolic complications.ConclusionsOverweightedness and obesity were found to be associated with a higher risk of developing severe pancreatitis. Further studies are needed to establish the precise prognostic value of obesity in members of the population with low BMIs.

T1491: Endoscopic Ultrasound Evaluation in Hospitalized Patients With Acute Pancreatitis

There are few data pertaining to the role of endoscopic ultrasound (EUS) in patients hospitalized with acute pancreatitis (AP). Our aims were to evaluate the indications for EUS during AP, EUS findings, and their potential correlation with clinical outcomes in AP and impact on management.

W1042 Clinical Outcomes of Acute Pancreatitis During Pregnancy

W1042 Clinical Outcomes of Acute Pancreatitis During Pregnancy