Course Of Acute Pancreatitis Research Articles

Relationship of Crohn’s disease and acute pancreatitis in pediatric practice: literature review

Inflammatory bowel diseases (IBD) are a certain group of pathologic conditions of the gastrointestinal tract (GIT), including Crohn’s disease (CD) and ulcerative colitis (UC). In the modern world, vigilance for these diseases is growing, because their characteristic feature is the involvement of other organs in the pathological inflammatory process, as well as the development of local and systemic complications. As a rule, in children CCD occurs mainly at the age of 12-16 years. Recently, the attention of the medical world has been drawn to the issue of extraintestinal manifestations of CD. Pathological manifestations associated with lesions of the skin and mucous membranes, eyes, bone and joint system, pancreas, negatively affect both physical and psychological health of the child. Such pathology associated with pancreatic malfunction, such as acute pancreatitis (AP) often occurs in patients with inflammatory bowel disease and is one of the main causes of hospitalization for diseases of the digestive system. According to statistics, the incidence ranges from 15 to 40 cases per 100,000 per year in European countries. According to the Gastroenterological Society, there are different variations in the course of acute pancreatitis, whether occurring in patients with IBS due to the disease itself or as a side effect of drug therapy. However, IBD patients are at increased risk of developing both acute and chronic pancreatitis. In this review, we consider the relationship and mutual influence of these two pathologies.

Кислотно-основное равновесие слюны у больных с различной степенью тяжести течения острого панкреатита

The purpose of the work. To study the change in acid-base balance in the oral cavity in various variants of the course of acute pancreatitis. Materials and methods. On the basis of GUZ "City Clinical Hospital No. 1" and GUZ "Regional Clinical Hospital" Chita for the period 2021-2023, a single-stage study was performed, which included 95 patients (n=95) suffering from acute pancreatitis of varying severity aged 15 to 80 years. At admission, the pH of saliva was measured using litmus strips from EKROSCHEM LLC, St. Petersburg. Statistical processing of the obtained results was carried out using the SPSS Statistics 11.0 program in compliance with the principles of statistical analysis adopted for research in biology and medicine. In order to assess the correlation and determine the closeness and direction of the correlation between the two features, Spearman's criterion was used. When comparing the study groups and the clinical comparison group, the Student's criterion with the Bonferroni correction was used. Results. As a result of the study, it was found that in patients with acute pancreatitis, the pH of saliva is shifted to the acidic side of 4.2-6.2 with an average value of 5.4 ±0.4. At the same time, in patients with acute pancreatitis, a shift in the acid-base balance of saliva towards its acidification was revealed as inflammatory and destructive changes in the pancreatic parenchyma increase. This established fact is of particular interest for the timely diagnosis of the severity of acute pancreatitis.

Integrating metagenomics with metabolomics for gut microbiota and metabolites profiling in acute pancreatitis

Acute pancreatitis (AP) is an inflammatory disease of the pancreas. Despite of a steadily increasing in morbidity and mortality, there is still no effective therapy. Gut microbial dysbiosis and its derived-metabolites disorder have been shown to play an important role in the development of AP, however, little is known regarding the crosstalk between gut microbiota and metabolites. In this study, we assessed the alterations in gut microbiota and metabolites by constructing three AP mouse models by means of metagenomic and metabolomic sequencing, and further clarified their relationship by correlation analysis. The results revealed that each model exhibited unique flora and metabolite profiles. KEGG analysis showed that the differential flora and metabolite-enriched pathway functions were correlated with lipid metabolism and amino acid metabolism. Moreover, two core differential bacterial species on Burkholderiales bacterium YL45 and Bifidobacterium pseudolongum along with eleven differential metabolites appeared to exert certain effects during the course of AP. In conclusion, further exploration of the crosstalk between microbiota and derived metabolites may provide novel insights and strategies into the diagnosis and treatment of AP.

Very early and early nutrition in children with pancreatitis-A randomised trial.

The aim of our study was to assess the impact of the very early introduction of refeeding on the course of acute pancreatitis (AP) in children. Additionally, we evaluated the effect of nutrition on inflammatory markers, including cytokines. This prospective randomised study was conducted in three university hospitals in Poland. Patients, aged 1-18 years with AP, were randomised into two groups: A-refeeding within 24 h of hospital admission (very early), and B-refeeding at least 24 h after admission (early nutrition). The severity of AP was assessed after 48 h. The serum concentrations of four cytokines (tumour necrosis factor α [TNFα], interleukin-1β [IL-1β], interleukin-6 [IL-6] and interleukin-8 [IL-8]) and C-reactive protein, as well as the activity of amylase, lipase and aminotransferases, were measured during the first 3 days of hospitalisation. A total of 94 children were recruited to participate in the study. The statistical analysis included 75 patients with mild pancreatitis: 42-group A and 33-group B. The two groups did not differ in the length of hospitalisation (p = 0.22), AP symptoms or results of laboratory tests. Analysis of cytokine levels was conducted for 64 children: 38-group A and 26-group B. We did not find a difference in concentrations of the measured cytokines, except for IL-1β on the third day of hospitalisation (p = 0.01). The time of initiation of oral nutrition within 24 h (very early) or after 24 h (early) from the beginning of hospitalisation had no impact on the length of hospitalisation, concentrations of TNF-α, IL-1β, IL-6 and IL-8, activity of amylase and lipase or occurrence of symptoms in children with mild AP.

Chronic liver disease is an important risk factor for worse outcomes in acute pancreatitis: a systematic review and meta-analysis

Chronic liver diseases (CLD) affect 1.5 billion patients worldwide, with dramatically increasing incidence in recent decades. It has been hypothesized that the chronic hyperinflammation associated with CLD may increase the risk of a more severe course of acute pancreatitis (AP). This study aims to investigate the underlying impact of CLD on the outcomes of AP. A systematic search was conducted in Embase, Medline, and Central databases until October 2022. Studies investigating patients with acute pancreatitis and CLD, were included in the meta-analysis. A total of 14,963 articles were screened, of which 36 were eligible to be included. CLD was a risk factor for increased mortality with an odds ratio (OR) of 2.53 (CI 1.30 to 4.93, p = 0.01). Furthermore, renal, cardiac, and respiratory failures were more common in the CLD group, with ORs of 1.92 (CI 1.3 to 2.83, p = 0.01), 2.11 (CI 0.93 to 4.77, p = 0.062) and 1.99 (CI 1.08 to 3.65, p = 0.033), respectively. Moreover, the likelihood of developing Systemic Inflammatory Response Syndrome (SIRS) was significantly higher, with an OR of 1.95 (CI 1.03 to 3.68, p = 0.042). CLD is an important risk factor for worse outcomes in AP pancreatitis, leading to higher mortality and increased rates of local and systemic complications.

Association between acute peripancreatic fluid collections and early readmission in acute pancreatitis: A propensity-matched analysis.

Patients with acute pancreatitis (AP) frequently experience hospital readmissions, posing a significant burden to healthcare systems. Acute peripancreatic fluid collection (APFC) may negatively impact the clinical course of AP. It could worsen symptoms and potentially lead to additional complications. However, clinical evidence regarding the specific association between APFC and early readmission in AP remains scarce. Understanding the link between APFC and readmission may help improve clinical care for AP patients and reduce healthcare costs. To evaluate the association between APFC and 30-day readmission in patients with AP. This retrospective cohort study is based on the Nationwide Readmission Database for 2016-2019. Patients with a primary diagnosis of AP were identified. Participants were categorized into those with and without APFC. A 1:1 propensity score matching for age, gender, and Elixhauser comorbidities was performed. The primary outcome was early readmission rates. Secondary outcomes included the incidence of inpatient complications and healthcare utilization. Unadjusted analyses used Mann-Whitney U and χ 2 tests, while Cox regression models assessed 30-day readmission risks and reported them as adjusted hazard ratios (aHR). Kaplan-Meier curves and log-rank tests verified readmission risks. A total of 673059 patients with the principal diagnosis of AP were included. Of these, 5.1% had APFC on initial admission. After propensity score matching, each cohort consisted of 33914 patients. Those with APFC showed a higher incidence of inpatient complications, including septic shock (3.1% vs 1.3%, P < 0.001), portal venous thrombosis (4.4% vs 0.8%, P < 0.001), and mechanical ventilation (1.8% vs 0.9%, P < 0.001). The length of stay (LOS) was longer for APFC patients [4 (3-7) vs 3 (2-5) days, P < 0.001], as were hospital charges ($29451 vs $24418, P < 0.001). For 30-day readmissions, APFC patients had a higher rate (15.7% vs 6.5%, P < 0.001) and a longer median readmission LOS (4 vs 3 days, P < 0.001). The APFC group also had higher readmission charges ($28282 vs $22865, P < 0.001). The presence of APFC increased the risk of readmission twofold (aHR 2.52, 95% confidence interval: 2.40-2.65, P < 0.001). The independent risk factors for 30-day readmission included female gender, Elixhauser Comorbidity Index ≥ 3, chronic pulmonary diseases, chronic renal disease, protein-calorie malnutrition, substance use disorder, depression, portal and splenic venous thrombosis, and certain endoscopic procedures. Developing APFC during index hospitalization for AP is linked to higher readmission rates, more inpatient complications, longer LOS, and increased healthcare costs. Knowing predictors of readmission can help target high-risk patients, reducing healthcare burdens.

Predictive value of immature granulocyte percentage and neutrophil lymphocyte ratio in terms of prognosis in the course of acute pancreatitis.

We aimed to investigate the role and importance of immature granulocyte percentage and neutrophil/lymphocyte ratio in the etiology, diagnosis and follow-up of acute pancreatitis (AP) in patients tentatively diagnosed with AP in the emergency department. We evaluated these factors alongside other established markers proven effective in the diagnosis and follow-up of AP. Atotal of 139 patients with atentative diagnosis of acute pancreatitis who were hospitalized and followed up in the gastroenterology clinic in 2021‒2022 were included in the study. In addition, acontrol group, consisting of 139 individuals admitted to the clinic for various other reasons, was established. The cases were also compared with the control group in terms of NLR, ICG and IG%. There was asignificant difference in the NLR, IGC and IG% measurements between the patients in the AP group and the control group. In all three markers, the average values of the patient group were higher than those of the control group. Furthermore, asignificant difference in IGC and IG% blood measurements was noted between sub-groups of patients categorized based on the severity of acute pancreatitis, particularly the patients with severe pancreatitis exhibited higher mean IGC and IG% blood measurements compared to those with mild or moderate pancreatitis. IGC and IG% values emerged as superior indicators to other acute-phase reactants for detecting inflammation, determining its severity, and establishing prognosis in acute pancreatitis. While the N/L ratio remains an important parameter in acute pancreatitis, our findings indicate that it was not significantly superior to other investigated markers in terms of prognosis (Tab. 5, Ref. 35).

Predictive value of immature granulocyte percentage and neutrophil lymphocyte ratio in terms of prognosis in the course of acute pancreatitis

Predictive value of immature granulocyte percentage and neutrophil lymphocyte ratio in terms of prognosis in the course of acute pancreatitis

Acute pancreatitis in children with inflammatory bowel disease: Risk factors, clinical course, and prognosis.

To characterize the clinical course of acute pancreatitis (AP) in pediatric inflammatory bowel disease (IBD) patients compared to children with AP without IBD and to identify risk factors associated with AP among IBD patients. This retrospective, single-center study compared clinical characteristics of children (<19 years) with AP with and without concomitant IBD who were hospitalized 2005-2019. We also conducted a risk factor analysis of AP development in pediatric IBD. Sixty-eight (54% males) patients with 120 episodes of AP were admitted at a median age of 15.3 years. Thirteen patients (14 episodes) had a co-diagnosis of IBD, representing 4% of our IBD patient population. The AP-IBD patients presented with lower amylase levels compared to the non-IBD patients (160 [interquartile range, IQR: 83-231] vs. 418 [IQR: 176-874] U/L, p > 0.01), all had a mild pancreatitis, and none required invasive intervention. The presumed etiology for AP in all IBD patients was IBD-related: IBD flare-up in five, side effects of medications in two, and undetermined in seven. The only risk factor for AP development among IBD patients was IBD-associated arthritis (23% vs. 3% for IBD-non-AP, p = 0.04), while extracolonic Crohn's disease and induction therapy with nutrition were negative risk factors (15% vs. 51%, p = 0.05, and 8% vs. 44%, p = 0.04, respectively). Other parameters, including disease type and medications, were nonsignificant. The clinical course of AP in pediatric IBD patients is mild. Only IBD-associated arthritis emerged as a risk factor for the development of AP, while, unexpectedly, IBD medication did not.

Studies Related to the Involvement of EsA in Improving Intestinal Inflammation in Acute Pancreatitis via the NF-κB Pathway.

Acute pancreatitis (AP) is a clinically frequent acute abdominal condition, which refers to an inflammatory response syndrome of edema, bleeding, and even necrosis caused by abnormal activation of the pancreas's own digestive enzymes. Intestinal damage can occur early in the course of AP and is manifested by impaired intestinal mucosal barrier function, and inflammatory reactions of the intestinal mucosa, among other factors. It can cause translocation of intestinal bacteria and endotoxins, further aggravating the condition of AP. Therefore, actively protecting the intestinal mucosal barrier, controlling the progression of intestinal inflammation, and improving intestinal dynamics in the early stages of AP play an important role in enhancing the prognosis of AP. The viability and apoptosis of RAW264.7 cells treated with Esculentoside A (EsA) and/or lipopolysaccharide were detected using 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT) and flow cytometry, respectively. The expression of apoptosis-related proteins and NF-κB signaling pathway-related proteins were detected by western blot (WB). An enzyme-linked immunosorbent assay was used to measure TNF-α and IL-6 secretion. In vitro experiments demonstrated that EsA not only promoted the apoptosis of inflammatory cells but also reduced the secretion of TNF-α and IL-6 in a dose-dependent manner. Additionally, it inhibited the activation of the NF-κB signaling pathway by decreasing the expression of phosphorylated-p65(p-p65) and elevating the expression of IκBα. Similarly, in vivo experiments using a rat AP model showed that EsA inhibited the expression of p-p65 elevating the expression of IκBα in the intestinal tissues of the rat AP model and promoting the apoptosis of inflammatory cells in the intestinal mucosa in vivo experiments, while improving the pathological outcome of the pancreatic and intestinal tissues. Our results suggest that EsA can reduce intestinal inflammation in the rat AP model and that EsA may be a candidate for treating intestinal inflammation in AP and further arresting AP progression.

FEATURES OF ANTIBIOTIC THERAPY IN PATIENTS WITH A COMPLICATED COURSE OF ACUTE PANCREATITIS

Background. The most common cause of death among patients with acute pancreatitis in the late period of the disease is purulent-septic complications, which occur in 30-50% of cases.&#x0D; Aim: To study of the spectrum of microorganisms in the complicated course of acute pancreatitis and justification of the appointment of antibiotic therapy, taking into account the role of Helicobacter pylori as a pathogenetic factor of the disease.&#x0D; Materials and methods: 280 patients with acute pancreatitis participated in the study, who were divided depending on the treatment tactics into the main (n=140) and comparison group (n=139). To assess the effectiveness of surgical tactics in the studied groups, a comparative analysis of the frequency of development of purulent-septic complications and the species composition of microorganisms based on the results of bacteriological examination of biological fluids was carried out.&#x0D; Results. The species composition of microorganisms in case of purulent-septic complications in patients with severe acute pancreatitis is represented mainly by gram-negative flora (Escherichia coli, Pseudomonas aeruginosa, Acinetobacter spp., Klebsiella pneumoniae) with low sensitivity to most antibiotics, with the exception of protected semi-synthetic broad-spectrum antibiotics from the group penicillins and imipenem-cilastatin. When analyzing the studied indicators in the main group, an increase in the content of immunoglobulin M to Helicobacter pylori was detected in 41.1% (39/95) of patients with a severe course of the disease within 3 weeks from the moment of hospitalization. The use of generally accepted schemes of antibacterial therapy in combination with proton pump inhibitors for the treatment of purulent-septic complications of acute pancreatitis, taking into account the sensitivity of Helicobacter pylori to them, is not inferior to standard anti-Helicobacter treatment in terms of eradication effect (eradication was achieved in 94.9% of patients).&#x0D; Conclusions. The use of improved methods of diagnosis and treatment, including the justified appointment of antibiotic therapy taking into account Helicobacter pylori infection, made it possible to significantly reduce the frequency of development of purulent-septic complications by 18.1% (χ2=7.67, 95% CI 5.30 -30.20, p=0.005) and the number of microbial associations in the studied biological fluids by 51.3% (χ2=37.62, 95% CI 37.15-61.44, p&lt;0.0001).

The Impact of Age Over 80 Years on Outcomes in Geriatric Patients with Acute Pancreatitis: A Single Center Experience

The aim of this study is to evaluate the prognosis and mortality of acute pancreatitis (AP) in older subjects and compare octogenarians (≥80 years) with nonoctogenarians (age &amp;lt;80 years). The medical records of elderly patients who were followed up with the diagnosis of AP at our clinic between January 2018 and December 2021 were retrospectively analyzed. The etiology of AP, comorbidities, laboratory parameters, intensive care unit (ICU) admission, and mortality were noted. Among survivors, one-year mortality status was also recorded. Disease severity, in-hospital mortality and one-year mortality were compared. A total of 206 older patients (60 octogenarian, 146 nonoctogenariean) were recruited to the study. Of them, 115 (56%) were female and the mean age was 76.1±7.3 years. Severity of AP didn’t differ between octogenarians and nonctogenarians (p&amp;gt;0.05). ICU admission was seen in 13% of octogenarians and 11% of nonoctogenarians (p&amp;gt;0.05). In-hospital mortality occurred in 8.3% of octogenarians and 6.8% of nonoctogenarians (p&amp;gt;0.05). After discharge, one-year mortality occurred in 20% of octogenarians and 6.6% of nonoctogenarians (p&amp;lt;0.01). In multivariate analysis severe AP (OR:24.940;%95CI:1.013–95.609; p=0.01), ICU admission (OR:10.244;%95CI:1.399–74.990; p=0.01) and chronic kidney disease(CKD) (OR:9.840;%95CI:1.013–95.609; p=0.04) were independent risk factors for in-hospital mortality, and ≥80 years (OR:2.984;%95 CI:1.116–7.980; p =0.03) and neurological disorders (OR:4.424;%95CI:1.480–13.226; p &amp;lt;0.01) were independent factors related to one-year mortality. Our results showed that advenced age has not a significant effect on the course of AP in elderly. Comorbidities play important role in short- and long-term outcomes in elderly. Larger prospective trials are needed to draw more definitive conclusions.

Can neutrophil gelatinase-associated lipocalin be a novel and efficient marker to predict the clinical course of acute pancreatitis?

This study aimed to determine the value of serum Neutrophil Gelatinase-Associated Lipocalin (NGAL) levels to predict the severity of the disease and to identify its correlation with White Blood Cell (WBC), C-reactive protein (CRP), and high-sensitivity C-reactive protein (hs-CRP) levels in acute pancreatitis (AP). The study sample included 86 AP-diagnosed patients in the study group and 77 age- and gender-matched healthy volunteers with no comorbidity in the control group. The WBC, CRP, hs-CRP, and NGAL levels were examined at the time and 24 hours after diagnosis. Between the control group and the study group, a significant difference with and without necrosis in terms of NGAL averages (p=0.003) at the time of admission was observed. The mean level of the 24th-hour NGAL in the study group with necrosis (132.7±11.7 ng/ml) was found to be higher than the mean of the 24th-hour NGAL (117.5±22.6 ng/ml) in the study group without necrosis (p=0.032). Additionally, a significant difference was observed between the control group and the study group with and without necrosis in terms of CRP averages evaluated at admission. When the correlation of NGAL levels with WBC, CRP, and hs-CRP levels at the admission (r=0.224, p=0.038) and at the 24th h (r=0.389, p<0.001) are evaluated, weak correlations between NGAL and WBC levels were identified, but no correlation between NGAL and CRP and hs-CRP levels were observed. The usability of serum NGAL levels to predict the development of necrotizing pancreatitis in the early period was evaluated. Serum NGAL levels were found to be higher in the study group than in the control group, but there was no statistically significant difference between the mean values of 0th and 24th h NGAL values in any of the groups with/without pancreatic necrosis and the total study group was observed. More research is needed on the subject, with larger sampling sizes.

DEVELOPMENT OF A STRATIFICATION SYSTEM FOR SEVERE ACUTE PANCREATITIS IN THE FIRST DAY OF ITS ONSET

Introduction. Acute pancreatitis stands as one of the prevalent acute inflammatory diseases of the abdominal cavity, marked by a diverse range of clinical presentations and the risk of developing persistent organ failure is too high even in its early stages. At present, the widely adopted framework for assessing acute pancreatitis is the 2012 revised Atlanta classification. However, distinguishing between moderately severe and severe acute pancreatitis within this classification necessitates a minimum of 48 hours to determine the persistence of organ failure. Consequently, the primary challenge in contemporary acute pancreatitis diagnosis and treatment lies in the imperative task of early-stage prognosis and effective stratification of disease severity.&#x0D; Objective of this investigation is to determine the availability of optimal parameters of clinical and instrumental examination methods in order to predict the course of acute pancreatitis in the first day of its onset by conducting a statistical analysis of the studies performed.&#x0D; Materials and methods. The assessment the state of microcirculation in patients by the method of laser Doppler flowmetry was carried out using the LAKK-02 device according to the specified methodology. Patients were also subjected to general clinical and instrumental examination. In order to study the influence of indicators on the severity of the disease, the paired correlation coefficients of each of them were calculated, after which, for the parameters with the closest connection, a multiple linear correlation-regression model was built and the multiple correlation coefficient with the severity of the disease was calculated.&#x0D; Results. The following parameters have the most significant influence on the severity of the disease on the first day: findings of laser Doppler flowmetry C (A/M), systemic inflammatory response syndrome criteria, hematocrit, hydrothorax/peritonitis. In the complex analysis, the multiple correlation coefficient is 0.803, which indicates a significant relationship between the factors included in the model and the degree of severity. The coefficient of determination points out that the degree of severity is 64.5% dependent on the indicators included in the model.&#x0D; Conclusions. The obtained results of the study indicate the presence of a complex influence of the criteria of laser Doppler flowmetry C (A/M), criteria of the systemic inflammatory response syndrome, hematocrit, hydrothorax/peritonitis on the severity of the disease in patients with acute pancreatitis within the first day of the disease onset that underscores the potential for early-stage preliminary stratification of acute pancreatitis severity based on these criteria.

Acute post-manipulation pancreatitis after interventions on the major duodenal papilla (experimental study)

Objective. To study the morphological consequences of severe acute post-manipulation pancreatitis (APP), the morphological features of its course and the result of the compound "L-17" exposure.&#x0D; Materials and methods. Rats weighing 250–300 g were used. Forty operations were performed to create a model of APP on rats. The control group included 20 rats with APP without medication, the experimental group – 20 rats with AKI against the background of "L-17" introduced in the dose of 40 mg/kg once per day.&#x0D; Results. In all cases of application of this APP model in rats, the development of acute pancreatitis was noted. The conducted morphological studies showed that APP in rats in the experiment met the criteria for a severe course of acute pancreatitis with the development of purulent peritonitis and necrotizing parapancreatitis with morphological manifestations of systemic inflammation in all the organs studied (with a lethality of 70 %). The use of a new "L-17" in APP in experimental rats showed a decrease in the risk for developing both purulent peritonitis and purulent-necrotic parapancreatitis as well as a 2-fold decrease in mortality (from 70 % to 30 %). A new effect of "L-17" was revealed, i.e. prevention of necrosis of Langerhans islets. The study of the cellular composition of the inflammatory infiltrate showed a decrease in the activity of inflammatory process.&#x0D; Conclusions. The efficacy of a new rat model of APP, ranked by severity, was shown. "L-17" alleviates the severity of APP, reducing the risk for developing various purulent complications and systemic inflammation.

Organ dysfunctions and inflammatory reaction in acute post-manipulation pancreatitis in experiment

Objective: to prove the possibility of reducing the severity of the course of organ dysfunctions and inflammatory response with the compound L-17 in the model of acute post-manipulation pancreatitis (APMP). Material and methods. The APMP model was made on 40 rats. Animals were divided into control (without treatment) and experimental (with the introduction of the compound L-17) groups of 20 rats. The daily dose of the compound is 40 mg/kg. Results. APMP developed in all animals. In the control group, persistent organ dysfunction and inflammatory response corresponded to a severe course of acute pancreatitis with a mortality rate of 70%. In the experimental group, there was a decrease in the severity of organ dysfunction and inflammatory response, with a decrease in mortality up to 30%. Conclusion. The use of the compound L-17 reduces the severity of organ dysfunction and inflammatory response during APMP in the experiment.

Role of Red Cell Distribution Width and Platelet Count Ratio to Predict the Severity and Outcome in Acute Pancreatitis

Clinical course of acute pancreatitis (AP) varies widely, its clinical features exhibit very low sensitivity for the prediction of severity of disease which is associated with high morbidity and mortality. Several single or multi parameter scoring systems have been described to evaluate the severity of AP. But sometimes, it is not clinically practicable to use these scoring systems for evaluation. This study aimed to find out the Role of Red Cell Distribution Width and Platelet Count Ratio (RPR) to predict the Severity and Outcome in AP. This prospective longitudinal study was carried out from July 2019 to July 2020, at the in-patient department of Gastrointestinal, Hepatobiliary and Pancreatic Disorders, BIRDEM General Hospital, Dhaka. Total 100 patients with AP were included for this study according to selection criteria. An informed written consent was taken from all the participants. Detail history was taken and thorough physical examination was done along with relevant laboratory investigations. Ranson's score, Modified Glasgow score, Bedside index of severity in acute pancreatitis (BISAP), red cell distribution width and platelet count ratio (RPR) were calculated. All data were recorded and analyzed by Statistical package for social sciences (SPSS) 23. In this study 44% patients were more than 60 years with a mean age of 51.34 (±15.45) year. More than two thirds patients were (67%) male. In mild acute pancreatitis mean value of Ranson's score, BISAP score and modified Glasgow score was 0.79 (±0.14), 0.90 (±0.1) and 0.80 (±0.14) and 3.29 (±1.16), 1.77 (±0.46) ,2.74 (±0.69) in moderate to severe pancreatitis respectively with statistically difference were found in both severities (p&lt;.05). The patients with mild pancreatitis and the patients with moderate to severe pancreatitis had significant difference (p&lt;.05) between mean RDW (14.68±1.59% versus 15.51±3.27%), mean RPR (0.043±0.06 versus .062±.002) and platelet count (340.9±841.6 cells/mm3 Versus 236.4±825.4 cells/mm3). The ROC analysis of RPR in predicting severity of pancreatitis showed a cut-off value of ≥ 0.056 and diagnostic accuracy test showed sensitivity, specificity, PPV, NPV and accuracy as 63.6%, 82.2%, 81.4%, 64.9% and 72% respectively. Mean Ranson's score, BISAP score and Modified Glasgow score was 2.09 (±1.45), 1.34 (±0.39) and 1.83 (±1.08) in survived patients and 5.50 (±0.70), 4 and 3.50 (±0.70) in dead patients with significant difference between both groups (p&lt;.05). Mean RDW (15.08±2.67% Vs 17.85±0.21%), mean platelet count (284.43±143×109/L Vs 236.4± 825.4×109/L) and mean RPR (0.053±0.02 Vs 0.094± 0.005) was also significant between survived and dead patients (p&lt;.05). The ROC analysis of RPR in predicting outcome showed cut-off value of ≥ 0.06 and diagnostic accuracy test showed sensitivity, specificity, PPV, NPV and accuracy as 100%, 63.27%, 5.26%, 100% and 64% respectively. Red cell distribution width and platelet count ratio (RPR) can be used as a novel biomarker to predict the severity and mortality of acute pancreatitis in very early stage. Bangladesh Med J. 2021 Sept; 51(1): 18-24

Atomic force microscopy of erythrocytes of patients with different severity of pancreatitis

Aim of the study was to prove the possibility of using red blood cell probe microscopy as a predictor of the development of pancreonecrosis.Material and methods. Atomic force microscopy was performed in 143 people (82 were male and 61 were female). The study was performed on an Integra Aura probe microscope (ZAO NT-MDT, Russia). Each erythrocyte was scanned for cell membrane and cell as a whole. A total of 940 red blood cells were examined. According to the severity of acute pancreatitis, patients are distributed in three groups. As a control group, 37 people without somatic pathology were examined. Diagnosis and treatment of patients was carried out in the public health institution “Design Bureau” Russian Railways-Medicine “Krasnoyarsk” from 2015–2019.Results. The study showed that the shape of erythrocyte does not depend on the severity of pancreatitis and does not change, however, structural changes of the membrane occur in the form of the formation of multiple erosions on its surface. The membrane is deformed, and its adhesion increases. These changes reduce the transport capacity of the blood, which, in our opinion, leads to an increase in the general intoxication of the body and to a deterioration in the condition of the patient.Conclusions. Apparently, pancreatic enzymes entering the free bloodstream in the first phase of pancreatitis cause not only oxidative stress, but also the reorganization and destruction of the erythrocyte membrane. The increase in membrane rigidity and deformation of the erythrocyte surface cytoskeleton against the background of increased adhesion seems to disrupt the gas transmission function of erythrocyte and microrheological properties of blood, which in turn disrupts the exchange of amino acids, lipids and detoxification capabilities of blood. The appearance of erythrocytes in the free bloodstream with the presence of erosion on the surface of the erythrocyte membrane can serve as a prediction of a non-favorable course of acute pancreatitis and a predictor of a possible transition of edema pancreatitis to pancreonecrosis.

Healing effect of warfarin in the course of cerulein-induced acute pancreatitis in rats.

Acute pancreatitis (AP) is the most common gastrointestinal disease leading to hospitalizations and unexpected deaths. The development of AP leads to damage of the pancreatic microcirculation with a cascade of subsequent events resulting, among others, in coagulopathy. Previous research showed that anticoagulants can be important therapeutic agents. Heparin and acenocoumarol can alleviate the course of AP, as well as accelerate healing and post-inflammatory regeneration of the pancreas. The aim of this study was to determine whether warfarin, a drug with more stable effects than acenocoumarol, affects the healing and regeneration of the pancreas in the cerulein-induced AP. AP was evoked in Wistar male rats by intraperitoneal administration of cerulein. The first dose of warfarin (45, 90 or 180 μg/kg) was administered 24 hours after the first dose of cerulein and the doses of warfarin were repeated once a day in subsequent 10 days. The severity of AP was assessed immediately after the last dose of cerulein, as well as at days 1, 2, 3, 5, and 10 after AP induction. Treatment with warfarin dose-dependently increased international normalized ratio (INR) and attenuated the severity of pancreatitis in histological examination and accelerated pancreatic recovery. These effects were accompanied with a faster reduction in the AP-evoked increase in serum activity of amylase and lipase, the serum concentration of pro-inflammatory interleukin-1β, and the plasma level of D-Dimer. In addition, treatment with warfarin decreased pancreatic weight (an index of pancreatic edema) and improved pancreatic blood flow in rats with AP. The therapeutic effect was particularly pronounced after the administration of warfarin at a dose of 90 μg/kg. We conclude that treatment with warfarin accelerated regeneration of the pancreas and recovery in the course of cerulein-induced mild-edematous acute pancreatitis.

IRAK3-mediated suppression of pro-inflammatory MyD88/IRAK signaling affects disease severity in acute pancreatitis

Acute pancreatitis (AP), which is characterized by self-digestion of the pancreas by its own prematurely activated digestive proteases, is a major reason for hospitalization. The autodigestive process causes necrotic cell death of pancreatic acinar cells and the release of damage associated molecular pattern which activate macrophages and drive the secretion of pro-inflammatory cytokines. The MYD88/IRAK signaling pathway plays an important role for the induction of inflammatory responses. Interleukin-1 receptor associated kinase-3 (IRAK3) is a counter-regulator of this pathway. In this study, we investigated the role of MYD88/IRAK using Irak3−/− mice in two experimental animal models of mild and severe AP. IRAK3 is expressed in macrophages as well as pancreatic acinar cells where it restrains NFκB activation. Deletion of IRAK3 enhanced the migration of CCR2+ monocytes into the pancreas and triggered a pro-inflammatory type 1 immune response characterized by significantly increased serum levels of TNFα, IL-6, and IL-12p70. Unexpectedly, in a mild AP model this enhanced pro-inflammatory response resulted in decreased pancreatic damage, whereas in a severe AP model, induced by partial pancreatic duct ligation, the increased pro-inflammatory response drives a severe systemic inflammatory response syndrome (SIRS) and is associated with an increased local and systemic damage. Our results indicate that complex immune regulation mechanism control the course of AP, where moderate pro-inflammation not necessarily associates with increased disease severity but also drives tissue regenerative processes through a more effective clearance of necrotic acinar cells. Only when the pro-inflammation exceeds a certain systemic level, it fuels SIRS and increases disease severity.