Consecutive Acute Pancreatitis Patients Research Articles

Neutrophil to lymphocyte ratio predicts persistent organ failure and in-hospital mortality in an Asian Chinese population of acute pancreatitis.

Neutrophil to lymphocyte ratio (NLR) has frequently been reported as a significant indicator of systemic inflammation in various medical conditions. The association underlying NLR and outcomes in patients with acute pancreatitis (AP) has not been evaluated after the publication of revised Atlanta classification.This was a single-center retrospective diagnostic accuracy study and a cohort outcome study. From 2009 to 2015, Asian Chinese patients with a diagnosis of AP presented within 72 hours from symptom onset and underwent neutrophil, lymphocyte assessment at presentation were included in this study. The outcomes were the occurrence of persistent organ failure (POF), intensive care unit (ICU) stay >7 days, and in-hospital mortality. The relationships of baseline neutrophil, lymphocyte count, and NLR with outcomes were assessed with multivariate Cox regression model.A total of 974 consecutive AP patients were clinically eligible. The mean neutrophils, lymphocytes, and NLR for the entire population were 10.23 ± 4.76 × 10/L, 1.05 ± 0.49 × 10/L, and 12.88 ± 11.25. Overall, 223 (22.9%) of the patients developed with POF, 202 (20.7%) spent more than 7 days in ICU, and 58 (6.0%) died during hospitalization. The NLR had a superior predictive performance than neutrophils and lymphocytes. Using an NLR cutoff of 11, the area under the curves (AUC) were 0.76 for POF, 0.74 for longer ICU stay, and 0.79 for death during hospitalization. After multivariate analysis, NLR ≥ 11 was further identified as an independent prognostic factor (hazard ratio [HR] 1.37, 95% confidence interval [CI] 1.00-1.89; HR 1.44, 95% CI 1.03-2.00; HR 2.75, 95% CI 1.12-6.76; all P value < 0.05). Following stratification according to quartiles of NLR, positive trends for the association across increasing NLR quartiles and the 3 outcomes were observed (P values for trends across quartiles were 0.007, 0.016, and 0.028, respectively). The adjusted HRs for highest NLR quartile versus the lowest were 2.80 (95% CI 1.42-5.51) (POF), 2.79 (95% CI 1.37-5.70) (ICU > 7 days), and 2.22 (95% CI 0.49-10.05) (mortality), respectively.Our data show for the first time that an increased NLR is an independent risk factor for POF, longer ICU stay, and in-hospital mortality in AP.

Obesity as a risk factor for severe acute pancreatitis patients

Obesity plays an important role in increasing the risks of cardiovascular diseases, metabolic diseases, and death. Controversy persists concerning the degrees to which obesity influences mortality and morbidity in severe acute pancreatitis. Between 2008 and 2012, the findings of 384 consecutive acute pancreatitis patients were analyzed in a prospective trial. Ranson's scores, Acute Physiology And Chronic Evaluation II scores, and computed tomography severity indexes were calculated. Patients were categorized by body mass index (BMI) and waist circumference for the analysis. The aim of this study was to investigate the influence of obesity on local and systemic complications as well as on mortality in severe acute pancreatitis patients. Severe acute pancreatitis was confirmed in 91 (23.7 %) patients. Local and systemic complications were recorded in 64 (16.7 %) and 51 (13.3 %) patients, respectively. Obesity calculated by BMI was identified as a significant risk factor for local and systemic complications (p < 0.02 and p < 0.03, respectively). Moreover, in this study, obesity was also categorized by waist circumference and was confirmed as a risk factor (p < 0.01). The overall mortality rate was 2.4 %, i.e., nine patients died. This study indicates that obesity can have a statistically significant influence on the mortality of severe acute pancreatitis patients. The presence of obesity has a negative impact on the survival rate of severe acute pancreatitis patients. Obese patients have higher incidence of local and systemic complications. Obesity seems to be a negative prognostic factor in severe acute pancreatitis patients.

A comparison of the BISAP score and serum procalcitonin for predicting the severity of acute pancreatitis

Background/AimsThe bedside index of severity in acute pancreatitis (BISAP) is a new, convenient, prognostic multifactorial scoring system. As more data are needed before clinical application, we compared BISAP, the serum procalcitonin (PCT), and other multifactorial scoring systems simultaneously.MethodsFifty consecutive acute pancreatitis patients were enrolled prospectively. Blood samples were obtained at admission and after 48 hours and imaging studies were performed within 48 hours of admission. The BISAP score was compared with the serum PCT, Ranson's score, and the acute physiology and chronic health examination (APACHE)-II, Glasgow, and Balthazar computed tomography severity index (BCTSI) scores. Acute pancreatitis was graded using the Atlanta criteria. The predictive accuracy of the scoring systems was measured using the area under the receiver-operating curve (AUC).ResultsThe accuracy of BISAP (≥ 2) at predicting severe acute pancreatitis was 84% and was superior to the serum PCT (≥ 3.29 ng/mL, 76%) which was similar to the APACHE-II score. The best cutoff value of BISAP was 2 (AUC, 0.873; 95% confidence interval, 0.770 to 0.976; p < 0.001). In logistic regression analysis, BISAP had greater statistical significance than serum PCT.ConclusionsBISAP is more accurate for predicting the severity of acute pancreatitis than the serum PCT, APACHE-II, Glasgow, and BCTSI scores.

Hepatocyte Growth Factor and E-Cadherin in Acute Pancreatitis. Time Course and Early Assessment of Disease Severity

Objectives To evaluate the hepatocyte growth factor (HGF) and E-cadherin (EC) time course in the early phases of acute pancreatitis and to explore the usefulness of these molecules in assessing the severity of the disease. Patients Sixteen consecutive acute pancreatitis patients (7 males, 9 females; mean age 62.8 years, range 30-79 years) admitted to the hospital within 6 hours after the onset of pain; 16 age- and sex-matched healthy subjects were also studied. Eleven patients had mild pancreatitis and 5 had a severe disease. The acute pancreatitis was of biliary origin in 7 patients (43.8%), due to ERCP in 4 (25.0%), due to alcohol abuse in 2 (12.5%) and idiopathic in the remaining 3 (18.8%). Methods HGF and EC were quantified on hospital admission and for the following 2 days by using commercially available kits (Human HGF Immunoassay and Human sE-Cadherin Immunoassay; RD P=0.015) and the second day (57.7±25.2 ng/mL; P=0.015) of the disease than in healthy subjects (mean±SD: 40.5±11.6 ng/mL). HGF and EC serum concentrations were not significantly different between patients with severe disease and those with mild disease (P>0.089). Conclusions HGF and EC reflect an inflammatory response in acute pancreatitis patients; however, serum levels of these two molecules are not related to the severity of acute pancreatitis.

Clinicoetiological and Demographic Profile of Acute Pancreatitis in Kashmir Valley

Background and objectives:The study has been done with the aim to identify the clinicoetiological profile of acute pancreatitis in Kashmir valley in view of the fact of low alcoholism and high biliary tract worm infestation in the region.Design and Setting:Prospective, in patients admitted with acute pancreatitis.Patients and Methods:The study included 150 consecutive patients of acute pancreatitis who reported to surgical department of this hospital over a period of five years. All these patients were subjected to detailed history and clinical examination and investigations. Data collected was tabulated and subjected to appropriate statistical analysis.Results:The majority of our patients were in the age range of 41-60 years. Females had a clearcut predominance over males. A larger proportion of our patients was from rural areas of Kashmir. Biliary tract pathology was the predominant etiology in our study patients. Most patients presented with history of pain abdomen and nausea, vomiting. Tenderness and guarding of upper abdomen were the main clinical findings.Conclusion: Acute pancreatitis is most commonly caused by billiary pathologies among which ascariasis is the second most common cause after the gallstones, which is preventable if transmission of ascariasis can be checked by sanitation barriers.

Scoring systems in acute pancreatitis: Which one to use in intensive care units?

Purpose The aim of the study was to assess and compare the efficacy of various scoring systems in predicting the severity and outcome of patients with acute pancreatitis (AP) admitted in intensive care unit (ICU). Methods Prospective, single institution review of 55 consecutive AP patients admitted in ICU during a 2-year period. Disease severity scores and mortality predictions were calculated using the collected data in the first 48 hours of ICU admission for Ranson and Glasgow scores and in the first 24 hours for other scores. Results Forty-two patients (76.4%) developed severe pancreatitis. Intensive care unit and 30-day mortality was 18.2% and 27.3%, respectively. Use of mechanical ventilation (MV) was an independent predictor of outcome on multivariate analysis with lack of MV being protective (adjusted odds ratio, 0.003; 95% confidence interval [CI], 0.00001-0.67; P = .04). All scoring systems had comparable accuracy in predicting severity and 30-day mortality, but sequential organ failure assessment (SOFA) score had greater efficacy with its area under curve for predicting severity and 30-day mortality being 0.81 (95% CI, 0.69-0.92) and 0.93 (95% CI, 0.85-0.99), respectively. Sensitivity and specificity (SOFA score, >4) was 76.2% and 69.2%, respectively, for predicting severity, and sensitivity and specificity (SOFA score, >8) was 86.7% and 90%, respectively, for predicting 30-day mortality. Conclusions Use of MV is an independent predictor of outcome in AP patients admitted to ICU. Although all scoring systems had reliable accuracy in predicting severity and outcome, SOFA score performed better with additional advantages of easy applicability and timely assessment.

Blood Urea Nitrogen (BUN) for the Early Prediction of Mortality in Acute Pancreatitis

Purpose: We previously identified BUN as the most accurate routine laboratory test for prediction of mortality in acute pancreatitis (AP) in a large multi-center retrospective cohort study. The purpose of this study was to: 1) confirm accuracy of BUN during first 24 hours for prediction of mortality in a rigorously defined prospective AP cohort and; 2) identify factors associated with increased BUN. Methods: Prospective cohort study of consecutive AP patients treated in a tertiary care hospital from June 2005-May 2007. AP was defined as 2 or more of the following: characteristic abdominal pain, amylase/lipase elevation >3 times upper limit normal and/or confirmatory imaging findings. Routine laboratory tests were monitored throughout hospitalization. Accuracy of BUN for prediction of in-hospital mortality was evaluated using logistic regression including admission BUN and change in BUN at 24 hours as discreet variables. Logistic regression was also used to determine the extent to which hydration (cc/kg first 24 hours), renal insufficiency (serum creatinine) or systemic inflammation (SIRS) contributed to increases in BUN. Results: We enrolled a total of 397 AP cases during the study period. Among these, 17% were hospital transfers. There were 15 (3.7%) deaths. A logistic regression model incorporating admission BUN and change in BUN at 24 hours produced an AUC of 0.91 for mortality. Both admission BUN and change in BUN were independent predictors of mortality (p<0.0001) after adjusting for age, gender, Charlson comorbidity score and hospital transfer status. Reduced fluid resuscitation (p=0.03), worsened renal insufficiency (p<0.0001) and SIRS (p=0.03) were independently associated with rise in BUN. Conclusion: We have prospectively confirmed the accuracy of early rise in BUN for prediction of mortality in AP. Rise in BUN is multi-factorial, reflecting intravascular volume depletion, renal insufficiency and systemic inflammation.

Serum Adhesion Molecules in Acute Pancreatitis

To evaluate the adhesion molecule time course in the early phases of acute pancreatitis and to explore the usefulness of these proteins in assessing the severity of the disease. Fifteen consecutive acute pancreatitis patients (10 patients with the mild and 5 with the severe disease) admitted to the hospital within 6 hours after the onset of pain and 15 age- and sex-matched healthy subjects. Vascular cell adhesion molecule 1, intercellular adhesion molecule 1, E-selectin, P-selectin, and L-selectin were quantified on hospital admission and for the following 2 days. Acute pancreatitis patients had vascular cell adhesion molecule 1 and P-selectin concentrations significantly lower and L-selectin concentrations significantly higher than the healthy subjects. Only E-selectin was significantly higher in severe than in mild disease (P = 0.029); a value of E-selectin ranging from 3.83 to 3.92 ng/mL was the best cutoff value for differentiating severe from mild acute pancreatitis (sensitivity: 60.0%, specificity: 90.0%, cases correctly classified: 80%). E-selectin and P-selectin entered the multivariate logistic regression analysis, and a score was calculated showing a sensitivity of 93.3% and a specificity of 86.7% in identifying the patients with severe pancreatitis. This score seems to be useful for the early assessment of the severity of acute pancreatitis.

Case‐Matched Comparison of the Retroperitoneal Approach With Laparotomy for Necrotizing Pancreatitis

Minimally invasive necrosectomy through a retroperitoneal approach is gaining popularity for the treatment of necrotizing pancreatitis. There is, however, no substantial evidence from comparative studies in favor of this technique over laparotomy. The aim of this case-matched study was to perform the first head-to-head comparison of necrosectomy by the retroperitoneal approach with laparotomy in patients with necrotizing pancreatitis. Between 2001 and 2005, there were 15 of 841 consecutive acute pancreatitis patients who underwent necrosectomy by the retroperitoneal approach using a small flank incision. These patients were matched for the presence of preoperative organ failure, status of infection, timing of surgery, age, and computed tomography severity index score with 15 of 46 patients treated with necrosectomy by laparotomy and continuous postoperative lavage (CPL). In addition to all matched preoperative characteristics, there were no significant differences in sex, preoperative intensive care unit (ICU) admission, preoperative ICU stay, preoperative APACHE-II scores, and preoperative multiple organ failure (MOF). Postoperative complications requiring reintervention occurred in six patients in each group (p = 1.000). Postoperative new-onset MOF occurred in 10 patients in the laparotomy/CPL group versus 2 patients in the retroperitoneal approach group (p = 0.008). Six patients died in the laparotomy/CPL group versus 1 patient in the retroperitoneal approach group (p = 0.080). The less postoperative organ failure and the trend toward lower mortality may point to a benefit of the retroperitoneal approach over laparotomy. A randomized controlled design is, however, still required to answer definitively the question of which operative technique is preferably for patients with (infected) necrotizing pancreatitis.

Disialotransferrin, Determined by Capillary Electrophoresis, Is an Accurate Biomarker for Alcoholic Cause of Acute Pancreatitis

Serum disialotransferrin is a specific marker of heavy alcohol consumption. We tested its accuracy and probability in detecting alcoholic cause of acute pancreatitis (AP). Blood samples from 271 consecutive AP patients, admitted to the Helsinki University Central Hospital emergency unit, were analyzed. The median (range) disialotransferrin value was significantly higher (P = 0.001) in AP patients with alcoholic (n = 172) 1.6% (0.3%-14.4) than with biliary (n = 60) 0.7% (0.3%-1.3%) or other causes (n = 39) 0.8% (0.3%-4.1%). In receiver operating curve analysis, disialotransferrin, as a single analyte, was significantly (P = 0.001-0.0001) more accurate (area under the curve [AUC], 0.88; 95% confidence interval [CI], 0.84-0.92) in detecting alcoholic AP as compared with glutamyl transferase (AUC, 0.51; 95% CI, 0.45-0.57), aspartate aminotransferase (AUC, 0.57; 95% CI, 0.51-0.63), alanine aminotransferase (AUC, 0.63; 95% CI, 0.57-0.69), erythrocyte mean cell volume (AUC, 0.72; 95% CI, 0.67-0.78), amylase (AUC, 0.74; 95% CI, 0.67-0.78), C-reactive protein (AUC, 0.65; 95% CI, 0.59-0.71), and bilirubin (AUC, 0.55; 95% CI, 0.49-0.62). At a disialotransferrin cutoff of 1.2%, giving an 8% false-positive rate, the positive likelihood ratio was 8.47. Thus, a positive disialotransferrin test result, performed within 24 hours of admission, increased the probability of alcoholic AP from pretest 64% to posttest 94%. Disialotransferrin, determined by capillary electrophoresis, is accurate, simple, and a rapid single biomarker of the alcoholic cause of AP.