Definition Of Acute Pancreatitis Research Articles

Diagnosis and Treatment of Acute Pancreatitis Due to Hypertriglyceridemia in Italy: A Survey among Physicians of the Italian Association for the Study of the Pancreas: A Brief Report

Introduction: The Italian Association for the Study of the Pancreas promoted a survey on exploring the point of view of Italian pancreatologists regarding the diagnosis and the treatment of acute pancreatitis (AP) due to hypertriglyceridemia (HAP). Method: A questionnaire was administered, and it contained four sections regarding epidemiological characteristics of the participants, how the participants arrived at a diagnosis of the disease, how they treated familial hypertriglyceridemia, and whether they knew of the new drugs developed for the treatment of this disease. Definition of AP and HAP: In this survey, all participants followed this definition of AP: The diagnosis of AP requires two of the following three features: abdominal pain consistent with acute pancreatitis (acute onset of a persistent and severe epigastric pain, often radiating to the back); serum pancreatic enzymes at least three times greater than the upper limit of normal; and characteristic findings of acute pancreatitis using imaging techniques. On the other hand, HAP is characterized by serum triglyceride concentration of >1000 mg/dL as the diagnostic cut-off, even though a value of >500 mg/dL has been used for a more inclusive definition, since moderately elevated triglyceride levels have also been suggested as a risk factor for AP. Results. Nine percent of all managed patients with AP had HAP; 5.0 ± 7.7 patients per year had a recurrence of HAP, and the number of recurrences was about one. A diagnosis of hypertriglyceridemia was made by the majority of Italian physicians due to the presence of elevated serum triglycerides at a level of ≥880 mg/dL. Twenty-five physicians treated their patients with fibrates, 23 with statins, 11 with omega-3, one with medium-chain triglycerides, and six with plasmapheresis. Finally, fewer than 50% of the physicians knew of the new drugs to treat dyslipidemia. Conclusions: The results of this survey show that an educational program is important, and we also need an Italian National Registry both for improving knowledge regarding this disease and for identifying the causal factors in our country.

Body mass index as a predictor of acute kidney injury in critically ill patients

Revised JPN guidelines for the management of acute pancreatitis: JPN guidelines 2015 Toshihiko Mayumi, Tadahiro Takada, Masamichi Yokoe, Masahiro Yoshida University of Occupational and Environmental Health, Japan Teikyo University School of Medicine, Japan Japanese Red Cross Nagoya Daini Hospital, Japan Clinical Research Center Kaken Hospital, International University of Health and Welfare, Japan Background/Purpose: JPN guidelines for the management of acute pancreatitis were published in 2003 and revised in 2007 and 2009 that the severity assessment score has been highly regarded all over the world. Since the classification and the definition of acute pancreatitis had been changed significantly in the New Atlanta classification of acute pancreatitis 2012, the working group of JPN guidelines revised JPN guidelines with making new meta-analysis and using the GRADE system. Methods: The working group of revising JPN guidelines consists of 28 specialists, surgeons, gastroenterologists, endoscopists, radiologists, and epidemiologists. Results: JPNguidelines 2015 containmajor topics as described below: (1) epidemiology and etiology, (2) diagnostic criteria, (3) severity scoring system, (4) fundamental and intensive care with flowcharts, (5) therapeutic intervention and surgery, (6) post-ERCP pancreatitis, (7) treatment strategy, (8) clinical indicator andpancreatitis bundles, and (9) imaging. JPN guidelines also released mobile applications for the management of acute pancreatitis. Meta-analyses were performed on prophylactic antibiotic use for the prevention of necrotizing pancreatitis and reduction of mortality and on prophylactic pancreatic stent placement for the prevention of post-ERCP pancreatitis. These metaanalysis data have the results that significant effects are expected to each setting. JPN guidelines 2015 take advantage of this brand-new evidence for the new idea for the treatment of acute pancreatitis. Conclusions: Revised JPN guidelines 2015 achieve further evolution with new meta-analysis data and contain a lot of recommendations using the GRADE system for clinical use.

Characteristics and outcomes of critically ill cancer patients admitted to Korean intensive units: Multicenter study

Revised JPN guidelines for the management of acute pancreatitis: JPN guidelines 2015 Toshihiko Mayumi, Tadahiro Takada, Masamichi Yokoe, Masahiro Yoshida University of Occupational and Environmental Health, Japan Teikyo University School of Medicine, Japan Japanese Red Cross Nagoya Daini Hospital, Japan Clinical Research Center Kaken Hospital, International University of Health and Welfare, Japan Background/Purpose: JPN guidelines for the management of acute pancreatitis were published in 2003 and revised in 2007 and 2009 that the severity assessment score has been highly regarded all over the world. Since the classification and the definition of acute pancreatitis had been changed significantly in the New Atlanta classification of acute pancreatitis 2012, the working group of JPN guidelines revised JPN guidelines with making new meta-analysis and using the GRADE system. Methods: The working group of revising JPN guidelines consists of 28 specialists, surgeons, gastroenterologists, endoscopists, radiologists, and epidemiologists. Results: JPNguidelines 2015 containmajor topics as described below: (1) epidemiology and etiology, (2) diagnostic criteria, (3) severity scoring system, (4) fundamental and intensive care with flowcharts, (5) therapeutic intervention and surgery, (6) post-ERCP pancreatitis, (7) treatment strategy, (8) clinical indicator andpancreatitis bundles, and (9) imaging. JPN guidelines also released mobile applications for the management of acute pancreatitis. Meta-analyses were performed on prophylactic antibiotic use for the prevention of necrotizing pancreatitis and reduction of mortality and on prophylactic pancreatic stent placement for the prevention of post-ERCP pancreatitis. These metaanalysis data have the results that significant effects are expected to each setting. JPN guidelines 2015 take advantage of this brand-new evidence for the new idea for the treatment of acute pancreatitis. Conclusions: Revised JPN guidelines 2015 achieve further evolution with new meta-analysis data and contain a lot of recommendations using the GRADE system for clinical use.

Revised JPN guidelines for the management of acute pancreatitis: JPN guidelines 2015

Revised JPN guidelines for the management of acute pancreatitis: JPN guidelines 2015 Toshihiko Mayumi, Tadahiro Takada, Masamichi Yokoe, Masahiro Yoshida University of Occupational and Environmental Health, Japan Teikyo University School of Medicine, Japan Japanese Red Cross Nagoya Daini Hospital, Japan Clinical Research Center Kaken Hospital, International University of Health and Welfare, Japan Background/Purpose: JPN guidelines for the management of acute pancreatitis were published in 2003 and revised in 2007 and 2009 that the severity assessment score has been highly regarded all over the world. Since the classification and the definition of acute pancreatitis had been changed significantly in the New Atlanta classification of acute pancreatitis 2012, the working group of JPN guidelines revised JPN guidelines with making new meta-analysis and using the GRADE system. Methods: The working group of revising JPN guidelines consists of 28 specialists, surgeons, gastroenterologists, endoscopists, radiologists, and epidemiologists. Results: JPNguidelines 2015 containmajor topics as described below: (1) epidemiology and etiology, (2) diagnostic criteria, (3) severity scoring system, (4) fundamental and intensive care with flowcharts, (5) therapeutic intervention and surgery, (6) post-ERCP pancreatitis, (7) treatment strategy, (8) clinical indicator andpancreatitis bundles, and (9) imaging. JPN guidelines also released mobile applications for the management of acute pancreatitis. Meta-analyses were performed on prophylactic antibiotic use for the prevention of necrotizing pancreatitis and reduction of mortality and on prophylactic pancreatic stent placement for the prevention of post-ERCP pancreatitis. These metaanalysis data have the results that significant effects are expected to each setting. JPN guidelines 2015 take advantage of this brand-new evidence for the new idea for the treatment of acute pancreatitis. Conclusions: Revised JPN guidelines 2015 achieve further evolution with new meta-analysis data and contain a lot of recommendations using the GRADE system for clinical use.

Mo1355 Factors Affecting Cholecystectomy in Acute Gallstone Pancreatitis in a Nationwide Inpatient Sample

Background: Age Adjusted Charlson Comorbidity Index (AACCI) has been studied in the past to predict morbidity and mortality in various clinical conditions. At the same time there has been various markers and scores developed to predict morbidity and mortality in acute pancreatitis. Most of the tools used in acute pancreatitis, were unable to reach adequate sensitivity and specificity. However AACCI was never studied in the setting of acute pancreatitis. We hypothesized that AACCI which reflects the influence of burden of comorbid conditions, may predict outcomes in acute pancreatitis. We studied correlation between AACCI and length of hospital stay in individuals admitted with acute pancreatitis.Methods: We conducted retrospective observational study between January 1, 2009 and June 30, 2011 including all individuals admitted to our institutionwith acute pancreatitis.We collected demographic, laboratory, and radiological data. We used Length of Stay (LOS) as a measure of inpatient morbidity and extracted LOS days from medical records. We calculated AACCI based on comorbid conditions noted in electronic medical records. We divided study population into 3 groups based on AACCI score, Group A (scores 0 to 2), Group B (scores 3 to 5) and Group C (score 6 and above). We analyzed data using standard statistical methods and JMP11 software. Results: There were 209 individuals who met the inclusion criteria as per current definition of acute pancreatitis. Men and women were represented equally. There were 51% Hispanics and 49% non-Hispanics of which 80% were African Americans. There were no significant differences in LOS between women and men (10.25 vs. 10.42 days, p 0.91), between Hispanics and non-Hispanics (9.23 vs. 10.82, p 0.28). Also we did not notice any difference in length of stay based on etiology of acute pancreatitis. However we found significant increase in length of stay parallel to increase in AACCI (Table 1). (Group A 8.31, Group B 11.09 and Group C 15.44 days, p 0.002) Conclusion: Increase in Age Adjusted Charlson Comorbidity Index predicted prolonged Length of Stay, in patients hospitalized with acute pancreatitis. Our study is unique in studying relation between AACCI and LOS in acute pancreatitis especially in minority populations. Further studies are needed to relate AACCI with various local and systemic complications in acute pancreatitis, which may give single tool to predict outcomes without elaborative laboratory or radiological work up. Table 1

Mo1354 Age Adjusted Charlson Comorbidity Index: A Prognostic Tool to Measure Disease Burden: Can We Use It in Acute Pancreatitis? A Retrospective Observational Study in Minority Populations

Background: Age Adjusted Charlson Comorbidity Index (AACCI) has been studied in the past to predict morbidity and mortality in various clinical conditions. At the same time there has been various markers and scores developed to predict morbidity and mortality in acute pancreatitis. Most of the tools used in acute pancreatitis, were unable to reach adequate sensitivity and specificity. However AACCI was never studied in the setting of acute pancreatitis. We hypothesized that AACCI which reflects the influence of burden of comorbid conditions, may predict outcomes in acute pancreatitis. We studied correlation between AACCI and length of hospital stay in individuals admitted with acute pancreatitis.Methods: We conducted retrospective observational study between January 1, 2009 and June 30, 2011 including all individuals admitted to our institutionwith acute pancreatitis.We collected demographic, laboratory, and radiological data. We used Length of Stay (LOS) as a measure of inpatient morbidity and extracted LOS days from medical records. We calculated AACCI based on comorbid conditions noted in electronic medical records. We divided study population into 3 groups based on AACCI score, Group A (scores 0 to 2), Group B (scores 3 to 5) and Group C (score 6 and above). We analyzed data using standard statistical methods and JMP11 software. Results: There were 209 individuals who met the inclusion criteria as per current definition of acute pancreatitis. Men and women were represented equally. There were 51% Hispanics and 49% non-Hispanics of which 80% were African Americans. There were no significant differences in LOS between women and men (10.25 vs. 10.42 days, p 0.91), between Hispanics and non-Hispanics (9.23 vs. 10.82, p 0.28). Also we did not notice any difference in length of stay based on etiology of acute pancreatitis. However we found significant increase in length of stay parallel to increase in AACCI (Table 1). (Group A 8.31, Group B 11.09 and Group C 15.44 days, p 0.002) Conclusion: Increase in Age Adjusted Charlson Comorbidity Index predicted prolonged Length of Stay, in patients hospitalized with acute pancreatitis. Our study is unique in studying relation between AACCI and LOS in acute pancreatitis especially in minority populations. Further studies are needed to relate AACCI with various local and systemic complications in acute pancreatitis, which may give single tool to predict outcomes without elaborative laboratory or radiological work up. Table 1

Classification of acute pancreatitis

Increased knowledge of the natural history, etiology, morphology, complications and systemic response of the patient to acute pancreatitis has led to a rapid evolution in the classification of acute pancreatitis. It is recommended that the following elements be included in a classification system of acute pancreatitis: 1. A definition of acute pancreatitis and its complications based on CT scan, ultrasound, ERCP, and angiographic and histologic findings. 2. A statement regarding the etiology of the patient's pancreatitis. 3. An assessment of the patient's systemic response to his or her pancreatitis by means of APACHE II and/or Ranson's signs of severity. This system, through the use of ultrasound, CT scan with vascular enhancement, and clinical and laboratory tests, can be utilized to classify patients initially, on the day of hospital admission, with regard to etiology, morphology, and physiologic severity. Later in their hospital course, the complications of pancreatitis, e.g., fluid collections, necrosis, pseudocysts, infected necrosis, abscesses, fistulas, pancreatic, enteric, and cutaneous, pseudoaneurysm, and splenic vein thrombosis, can be added to the classification as modifiers when and if they occur. The process of the development and confirmation of theories of the origin and nature of the cosmos and evolution of concepts regarding the classification of pancreatitis have something in common. Theory generally stimulates experimental observation whose purpose is to test the theory's validity. New theories are generated when experimental observations demonstrate inconsistencies in previously held beliefs. Just as our understanding of the cosmos is undergoing constant change based on new data and new theories, so are our concepts regarding the classification of pancreatitis.