Early Phase Of Severe Acute Pancreatitis Research Articles

Prediction of acute lung injury in severe acute pancreatitis by routine clinical data.

Acute lung injury (ALI) is a common complication of severe acute pancreatitis (SAP) with a high mortality. Early prediction of patients at risk in initial stage can improve the long-term survival. A total of 91 patients with SAP out of 1647 acute pancreatitis patients from January 2015 to December 2020 were considered. A predictive model for SAP-associated ALI was constructed based on the valuable risk factors identified from routine clinical characteristics and plasma biomarkers. The value of the model was evaluated and compared with Lung Injury Prediction Score (LIPS). A nomogram was built to visualize the model. Diabetes, oxygen supplementation, neutrophil count and D-dimer were found to be associated with ALI in SAP. The predictive model based on these factors had an area under the receiver operating characteristic curve [AUC: 0.88, 95% confidence interval (CI): 0.81-0.95], which was superior to LIPS (AUC: 0.71, 95% CI: 0.60-0.83), also with the higher sensitivity (65%) and specificity (96%) than LIPS (62%, 74%, respectively). Decision curve analysis of the model showed a higher net benefit than LIPS. Visualization by a nomogram facilitated the application of the model. Diabetes, oxygen supplementation, neutrophil count and D-dimer were risk factors for SAP-associated ALI. The combination of these routine clinical data and the model visualization by a nomogram provided a simple and effective way in predicting ALI in the early phase of SAP.

Management of abdominal compartment syndrome in acute pancreatitis.

Abdominal compartment syndrome (ACS), defined by the presence of increased intra-abdominal pressure>20mmHg in association with failure of at least one organ system, is a common and feared complication that may occur in the early phase of severe acute pancreatitis (AP). This complication can lead to patient death in the very short term. The goal of this review is to provide the surgeon and intensivist with objective information to help them in their decision-making. In the early phase of severe AP, it is essential to monitor intra-vesical pressure (iVP) to allow early diagnosis of intra-abdominal hypertension or ACS. The treatment of ACS is both medical and surgical requiring close collaboration between the surgical and resuscitation teams. Medical treatment includes vascular volume repletion, prokinetic agents, effective curarization and percutaneous drainage of large-volume ascites. If uncontrolled respiratory or cardiac failure develops or if maximum medical treatment fails, most teams favor performing an emergency xipho-pubic decompression laparotomy with laparostomy. This procedure follows the principles of abbreviated laparotomy as described for abdominal trauma.

The impacts of acid suppression on duodenal microbiota during the early phase of severe acute pancreatitis

Duodenal dysbiosis may be potential infection risks in patients with severe acute pancreatitis (SAP). Acid-suppression drugs (ACDs) are widely used in SAP patients in Asian countries. However, the impact of ACDs on duodenal microbiota during the early phase of SAP is still unknown. This randomized controlled clinical trial evaluated the impacts of esomeprazole (Eso), one of ACDs on duodenal microbiota during the first week of SAP with duodenal aspirates culture and 16sRNA Illumina sequencing analysis. 66 patients were randomized as 1:1 ratio into Eso group (Eso 40 mg/day) and Eso-N group (no Eso). The occurrence of duodenal bacterial overgrowth (DBO) was significantly higher in Eso group (about 85%) than that in Eso-N group (about 42%). The duodenal microbiota of the SAP patients shifted away from that of the normal control. There were differences between the Eso-N and Eso groups including enriched abundances of the class Negativicutes, order Selenomonadales and genus Veillonella. Acid suppression significantly increased incidence of Candida oesophagitis (CE) by 8-folds but did not increase other infectious events. In conclusion, acid suppression greatly increased the occurrence of DBO, duodenal dysbiosis and CE during the first week of SAP. Restrictive use of acid-suppressing medications might be helpful to reduce CE and potential risk of pancreatic infection in SAP patients.Trial registration: Chictr.org, ChiCTR-IPR-16008301, Registered April 18 2016, http://www.chictr.org.cn/showproj.aspx?proj=14089.

Healing Effects of Single-Dose Triptolide in Rats with Severe Acute Pancreatitis

Aim: Severe acute pancreatitis (SAP) carries high morbidity and mortality risk. If the proinflammatory response phase of SAP cannot be controlled, it may result in multiorgan failure (MOF). Nuclear factor-kappa B (NF-κB) activation plays an important role in the development of MOF. In this study, it was aimed to investigate the healing effects of triptolide, an anti-inflammatory and immunosuppressive agent in rats with SAP.Material and Methods: A total of 20 Wistar-Albino rats were divided into two groups as the SAP and triptolide treatment (TT) groups. SAP was induced by intraperitoneal injection of cerulean (50 mg/kg) in both groups. TT group was administered a single dose (0.2 mg/kg) triptolide 24 hour after the induction of SAP. Serum ALT, AST, GGT, Lipase, Glucose, ALP and amylase levels and pancreatic tissue samples were examined.Results: Serum glucose and amylase levels were found to be significantly lower in the TT group (p=0.011 and p=0.035, respectively). There was no significant difference between the groups in terms of other biochemical parameters. Pancreatic edema, acinar cell degeneration, fat necrosis, intrapancreatic&perivascular inflammation, inflammation in the peripancreatic fat tissue were common histopathological findings in both groups. There was no significant difference between the groups in terms of histopathologic changes.Conclusion: Cerulein-induced pancreatitis is a successful method for experimental SAP. The healing effects of single-dose triptolide treatment are not evident in the early phase of SAP. The therapeutic effects of triptolide on inflammatory and oxidative stress were not significantly approved by histopathological and biochemical parameters by the pancreatic tissue.

Hydroxyethyl starch resuscitation downregulate pro-inflammatory cytokines in the early phase of severe acute pancreatitis: A retrospective study.

In the present study, we investigated the effects of hydroxyethyl starch (HES) 130/0.4 on serum pro-inflammatory variables, immunologic variables, fluid balance (FB)-negative(−) rate and renal function in severe acute pancreatitis (SAP) patients. From October, 2007 to November, 2008, a total of 120 SAP patients were enrolled in this retrospective study. Fifty-nine patients in the HES group received 6% HES 130/0.4 combined with crystalloid solution for fluid resuscitation (HES group). In the control group, 61 patients received only crystalloid solution after admission. Interleukin (IL)-1, IL-6, IL-8 and tumor necrosis factor (TNF)-α levels in serum were measured on days 1, 2, 4 and 8. The peripheral blood CD4+CD8+ T lymphocyte rates, serum BUN and Cr values were also measured on days 1, 4 and 8. Patients with FB(−) rates were recorded from day 1 to 8. Interaction term analysis (hospital stay and fluid resuscitation methods) based on mixed-effects regression model revealed significantly lower levels of IL-1 and TNF-α in the HES group compared with the control group. The difference in curve's risk ratio was not significant for IL-6, CD4+CD8+ T lymphocyte rate, BUN and Cr values (P>0.05). In the HES group, we detected a significantly higher rate of patients with FB(−) from day 4 to 8 (P<0.05). Thus, HES 130/0.4 resuscitation could decrease the IL-1 and IL-8 levels, shorten the duration of positive FB, and preserve the patient's immune status as well as renal function during the early phase of SAP.

Effect of early CRRT on correlation kidney injury in patients with severe acute pancreatitis

Objective To investigate the effects of early continuous renal replacement thempy(CRRT) on correlation kidney injury and prognosis in patients with severe acute pancreatitis(SAP). Methods According to the digital table, 40 SAP patients were randomly divided into two groups: the control group(21 cases)and CRRT treatment group(19 cases). The levels of serum creatinine, urea nitrogen, IL-1,IL-6,TNF-α, the APACHE Ⅱ score, the incidence of mechanical ventilation were compared between the two groups. Results The levels of serum creatinine, urea nitrogen were significantly lower in the CRRT group than those in the control group in day 3(t=2.836,2.952,P=0.003,0.004); The levers of IL-1,IL-6,TNF-αwere significantly lower in the CRRT group than those in the control group in day 3(t=2.376,2.414,2.197,P=0.351,0.028,0.042);The APACHE II score,incidence of mechanical ventilation, the fatality rate in the CRRT group were significantly lower than those in the control group in day 3[(20.16±5.23)points vs.(13.83±4.48)points,14 cases (66.7%)vs.6 cases(31.6%),8 cases(38.1%)vs.2 cases(14.3%),t=4.572,χ2=4.912,4.043;P=0.0329,0.027,0.044]. Conclusion Early CRRT therapy can eliminate the IL-1,IL-6 and TNF-αin SAP patients, can reduce the incidences of AKI, which may provide more clinical benefits in the early phase of SAP. Key words: Pancreatitis, acute necrotizing; Renal replacement therapy; Interleukin-1β; Interleukin-6; Tumor necrosis factor-α

Inverted U-Shaped Relationship between Central Venous Pressure and Intra-Abdominal Pressure in the Early Phase of Severe Acute Pancreatitis: A Retrospective Study.

ObjectiveMany studies have indicated that intra-abdominal pressure (IAP) is positively correlated with central venous pressure (CVP) in severe cases. However, although elevated IAP is common in patients with severe acute pancreatitis (SAP), its relationship with CVP remains unclear. Our study aimed to investigate the association of IAP with CVP in early-phase SAP patients.MethodsIn total, 116 SAP patients were included in this retrospective study. On the first day of hospitalization, blood samples were collected for biochemical examination and cytokine concentration monitoring. Additionally, a urinary catheter and right subclavian vein catheter were inserted for IAP and CVP measurement, respectively. Other routine clinical data were also recorded.ResultsWithin 24 hours after hospitalization, CVP fluctuated and increased with increasing IAP up to 15.7 mmHg (P = 0.054) but decreased with increasing IAP when the IAP was > 15.7 mmHg (P < 0.001). After adjusting for abdominal perfusion pressure (APP) and mean arterial pressure (MAP), a similar distribution was observed. An inverted U-shaped trend between IAP and CVP was also present in the groups classified according to the patient’s sex, local complications, ascites, and serum amylase levels.ConclusionsCVP and IAP have an inverted U-shaped relationship, with a peak at an IAP of 15.7 mmHg in the early phase of SAP. After this peak, CVP decreases as IAP increases. These results have crucial implications for clinical fluid resuscitation in SAP patients. In particular, because one CVP value might be correlated with different IAP values in patients with the same CVP, the volume of fluid needed might be different.

CRRT at early stageon in patients with severe acute pancreatitis applied to preventing acute lung injury in patients with severe acute pancreatitis

Objective To investigate the effects of early continuous renal replacement thempy(CRRT) on acute lung injury and prognosis in severe acute pancreatitis(SAP) patients. Methods 46 SAP patients were divided into the two groups randomly:the control group and CRRT treatment group. The levels of IL- 1β,IL-6,TNF-α,the APACHE Ⅱ score, oxygenation index, the incidence of acute lung injury(ALI)/acute respiratory distress syndrome(ARDS), ICU stay were compared between the two groups. Results The level of interleukin - 6(IL- 6)in the control group was significantly higher than that in CRRT group in day 1(t= 2.265,P 0.05). Conclusion Early CRRT therapy can eliminate the IL- 1β,IL- 6 and TNF-αin SAP patients, which can improve the oxygenation index and reduce the incidences of ALI/ARDS, may provide more clinical benefits in the early phase of SAP. Key words: Pancreatitis; Interleukin; Tumor necrosis factor-α; Continuous renal replacement therapy; Oxygenation index; Acute lung injury/acute respiratory distress syndrome

Treatment of early phase severe acute pancreatitis in intensive care units: a retrospective multicenter study

Objective To analyse the experience and treatment of early phase severe acute pancreatitis (SAP) in intensive care units (ICU).Methods A multicenter retrospective study was done on patients with SAP treated in three major teaching hospitals (Beijing Hospital,Peking University First Hospital and Peking University Shenzhen Hospital) in China from Jan.2001 to Dec.2011.Results There were 188 patients who were enrolled in the study,including 121 males and 67 females.The age ranged from 19 to 104 (51.0±18.2) years.The mean APACHE Ⅱ score was (22.2±4.6).84.0％ of patients survived,the mortality was 10.1％ in the early phase and 5.9％ in the late phase.The most common systemic complications were acute renal injury (46.3 ％),acute respiratory distress syndrome (35.6％),and septic shock (17.6％).The local complication rate was 47.3％,which included acute peripancreatic fluid collections (32.8％),acute necrotic collection and walled-off necrosis (48.4 ％) and pseudocyst (18.8 ％).The conservative treatments included intensive care,fluid resuscitation,mechanical ventilation,continuous renal replacement therapy,antibiotics,glucose control,inhibition of pancreatic enzyme activity and secretion,and nutritional support.Surgical intervention included endoscopic retrospective cholangio-pancreatography and endoscopic sphincterectomy,B ultrasound or CT guided puncture and drainage,and surgical drainage and debridement of necrosis.Conclusions The early phase of SAP was characterized by systemic inflammatory response syndrome and multiple organ dysfunction syndrome which accounted for the first peak in mortality.Intensive care therapy and multi disciplinary comprehensive combined strategy were very important for these patients with systemic and local complications.ICU treatment in the early phase was preferred for patients with SAP. Key words: Pancreatitis, acute necrotizing; Intensive care therapy; Retrospective studies

Clinical analysis of severe acute pancreatitis complicated with mental disorders.

Objective To investigate the causes, characteristics, diagnosis and treatment of severe acute pancreatitis (SAP) complicated with mental disorders. Methods The clinical data of 86 patients with SAP complicated with mental disorders who had been admitted to Union Hospital of Tongji Medical College from 2000 to 2007 were retrospectively analyzed. The causes, clinical manifestations, treatment and prognosis were analyzed. Results Of the 86 patients, 38 were caused by internal milieu disorder, 9 by pancreatic encephalopathy, 23 by infectious-toxic encephalopathy, and 16 by Wernicke encephalopathy. The manifestation of the patients with SAP complicated with mental disorders was complex, varied and nonspecific. Individualized treatment was applied to all patients after the analysis of the causes, and most patients recovered except 14 who died of hemorrhage or multiple organ dysfunction syndrome. Conclusions Internal milieu disorder should be first considered when patients have mental disorders which occurred at the early phase of SAP, then pancreatic encephalopathy should be considered. The infectious-toxic encephalopathy and Wernicke encephalopathy should beware of when the mental disorders occur in the late phase of SAP. Individualized treatment according to the causation and comprehensive treatment are effective in preventing and treating mental disorders which occurred in the course of SAP. Key words: Severe acute pancreatitis; Mental disorders

Effects of ω-3 fish oil emulsion on systemic inflammatory response syndrome in the early phase of severe acute pancreatitis:randomized clinical trial for 60 patients

Objective To evaluation the effects of parenteral supplementation with ω-3 fish oil emulsion on the systemic inflammatory response syndrome(SIRS)in the early phase of severe acute pancreatitis(SAP).Methods Sixty patients with SAP were randomized either to treat with fish oil emulsion 0.2 g/(ks·d)(FO group,n=30)or conventional therapy(Con group,n=30),and the change of SIRS state were observed by acute physiology and chronic health evaluation Ⅱ(APACHE-Ⅱ)scores,SIRS scores,and inflammatory cytokines.Results During observation,APACHE-Ⅱ scores in FO group were significantly lower,and the gap increased even larger after Day 4(P＜0.05).The negative fluid equilibrium time significantly decreased in FO group[(5.1±2.2)days]compared with Con group[(8.4±2.3)days](P＜0.05),while SIRS scores significantly decreased and firstly went out the SIRS state on Day 4 after treatment.Compared with Con group,the plasma level of tumor necrosis factor-α(TNF-α)continuously significantly decreased,interleukin-10(IL-10)significantly increased,and the ratio of IL-10/TNF-α significantly increased,which was most remarkable between Day 4 and Day 7 aftertreatment in FO group(P＜0.05).Conclusions Early parenteral supplementation with ω-3 fish oil emulsion can effectively reduced the magnitude and persistence of the SIRS,retrieve the unbalance of the pro-/anti-inflammatory,and improve the severe disease conditions.Therefore,it provides a new and feasible way to reglate SIRS in the early phase of SAP. Key words: Severe acute pancreatitis; Systemic inflammatory response syndrome; ω-3 fish oil emulsion