Elevated Pancreatic Enzyme Levels Research Articles

Patients with advanced cancer were treated with immune checkpoint inhibitors and injected with COVID-19 vaccine to improve their prognosis without increasing pancreatic related adverse events

ABSTRACT To investigate immune checkpoint inhibitors (ICIs) induced pancreatic injury (ICIPI), the prognostic effect of COVID-19 vaccine on cancer patients, and whether COVID-19 vaccine increases the incidence of ICIPI. We conducted a retrospective study of 256 stage IV cancer patients treated with ICIs at The First Affiliated Hospital of Anhui Medical University from January 2020 to November 2022. Data collected included pancreatic enzyme levels, treatment outcomes, and vaccination status. Statistical significance was determined using the χ2 test and Kaplan-Meier method (p < .05). Compared to the control group, the vaccinated group (p < .0001) and the group with elevated pancreatic enzyme levels (p = .044) demonstrated higher disease control rates, indicating a direct benefit of vaccination and enzyme monitoring on treatment outcomes. Additionally, vaccinated patients demonstrated longer overall survival versus unvaccinated patients (23.9 months [95% CI, 22.3–25.5] vs 23.6 months [95% CI, 21.1–26.2], HR = 0.45 [95% CI, 0.24–0.86], p = .015) and progression-free survival (17.2 months [95% CI, 14.3–20.1] vs 13.7 months [95% CI, 11.3–16.1], HR = 0.54 [95% CI, 0.36–0.82], p = .004). Importantly, the analysis revealed no significant association between vaccination and pancreatic injury (p = .46). Monitoring pancreatic enzymes can effectively evaluate the therapeutic impact in patients using ICIs. Patients vaccinated against COVID-19 experience better immunotherapy outcomes without an increased risk of ICIPI.

Understanding the influence of COVID-19 on pancreatic exocrine and endocrine function: сlinical and pathogenetic insights and their correlation with infection severity

The aim. This study aims to investigate the clinical and pathogenetic features of pancreatic involvement in patients diagnosed with COVID-19. Material and methods. We conducted an analysis of two hundred medical records belonging to patients hospitalized with COVID-19 at the gastroenterology department of the Central Clinical Hospital of Russian Federation Presidential Administration, from March 2020 to July 2021. Results. Among the comorbidities observed, type 2 diabetes mellitus and glucose intolerance (T2DM/GI) were present in 39 (19.5%) patients, while chronic pancreatitis was evident in 10 (5%) patients. Notably, a history of T2DM/GI correlated with prolonged hospital stays (p=0.0024). Elevated pancreatic enzyme levels were detected in 11.5% of patients, showing a significant association with the COVID-19 severity (p=0.0001) and prolonged hospitalization (p=0.0002). Furthermore, a statistically significant correlation was found between age and the risk of elevated pancreatic enzyme levels (p=0.0011). Conclusion. The involvement of the pancreas in COVID-19 patients poses a significant clinical challenge, exacerbating overall clinical outcomes. These findings underscore the critical importance of monitoring pancreatic enzymes and glycemic profiles within the evaluation protocols of COVID-19 patients to facilitate early diagnosis and ensure prompt treatment of complications.

Localized Pancreatitis in an Elderly Patient Without Suspected Etiology

Once pancreatic inflammation is triggered, it spreads throughout the pancreas. Here, we present a case of localized pancreatitis wherein the inflammation was confined to the pancreatic head. A 91-year-old woman was admitted with complaints of vomiting and epigastric pain. Blood tests showed elevated pancreatic enzyme levels, whereas imaging studies showed an enlarged pancreatic head and an area of increased density in the surrounding fatty tissue extending along the retroperitoneum below the subrenal pole. Atrophy of the pancreatic parenchyma in the pancreatic body and tail and dilatation of the main pancreatic duct were observed. The patient was diagnosed with acute pancreatitis, was kept nil by mouth, and was administered supplemental fluids. The symptoms resolved within two weeks. Age-related anatomical and histological changes in the pancreas may influence the development of pancreatitis, making it difficult to rule out the possibility of cancer. As age-related changes in the pancreas could lead to the development of pancreatitis, it is an important differential diagnosis of abdominal pain, even in older patients without suspected etiologies.

Predisposing Factors and Neurologic Outcomes of Patients with Elevated Serum Amylase and/or Lipase after Out-of-Hospital Cardiac Arrest: A Retrospective Cohort Study.

This study investigated the patient outcomes, incidence, and predisposing factors of elevated pancreatic enzyme levels after OHCA. We conducted a retrospective cohort study of patients treated with targeted temperature management (TTM) after out-of-hospital cardiac arrest (OHCA). Elevation of pancreatic enzyme levels was defined as serum amylase or lipase levels that were at least three times the upper limit of normal. The factors associated with elevated pancreatic enzyme levels and their association with neurologic outcomes and mortality 28 days after OHCA were analyzed. Among the 355 patients, 166 (46.8%) patients developed elevated pancreatic enzyme levels. In the multivariable analysis (odds ratio, 95% confidence interval), initial shockable rhythm (0.62, 0.39–0.98, p = 0.04), time from collapse to return of spontaneous circulation (1.02, 1.01–1.04, p < 0.001), and history of coronary artery disease (1.7, 1.01–2.87, p = 0.046) were associated with elevated pancreatic enzyme levels. After adjusting for confounding factors, elevated pancreatic enzyme levels were associated with neurologic outcomes (5.44, 3.35–8.83, p < 0.001) and mortality (3.74, 2.39–5.86, p < 0.001). Increased pancreatic enzyme levels are common in patients treated with TTM after OHCA and are associated with unfavorable neurologic outcomes and mortality at 28 days after OHCA.

A Case of Acute Pancreatitis Following Computed-Tomography Scan

Introduction:&#x0D; Acute pancreatitis is a common cause of hospitalization among gastrointestinal disorders and its frequency has been rising in the past few years. The majority of cases are due to alcohol use, gallstones and hypertriglyceridemia. However, there still remain a significant number of cases in which no causative factor can be found and therefore called idiopathic. Contrast-induced pancreatitis is a rare cause pancreatitis and there are only a few cases reported so far. Here we present a case of mild acute pancreatitis following iodinated contrast exposure.&#x0D; &#x0D; Case Presentation:&#x0D; A 42-year-old female patient with a history of lymphoma was admitted to our clinic with severe abdominal pain and nausea. Her blood tests revealed elevated pancreatic enzyme levels and mildly elevated liver function tests. Upper abdomen magnetic resonance imaging revealed pancreatic inflammation without any sign of necrosis. Since her complaints began after a computed-tomography scan that she had earlier that day for the evaluation of lymphoma and no other cause could be found, iodinated contrast was thought to be the cause of acute pancreatitis in this patient.&#x0D; &#x0D; Conclusion:&#x0D; Contrast agents seem to be a rare cause of acute pancreatitis, however taking the increasing availability of procedures involving radiocontrast agents into consideration, it is important to keep in mind that clinicians may come across more cases of contrast-induced acute pancreatitis in the future.

Proposal of the term "gallstone cholangiopancreatitis" to specify gallstone pancreatitis that needs urgent endoscopic retrograde cholangiopancreatography.

Opie’s “pancreatic duct obstruction” and “common channel” theories are generally accepted as explanations of the mechanisms involved in gallstone acute pancreatitis (AP). Common channel elucidates the mechanism of necrotizing pancreatitis due to gallstones. For pancreatic duct obstruction, the clinical picture of most patients with ampullary stone impaction accompanied by biliopancreatic obstruction is dominated by life-threatening acute cholangitis rather than by AP, which clouds the understanding of the severity of gallstone AP. According to the revised Atlanta classification, it is difficult to consider these clinical features as indications of severe pancreatitis. Hence, the term “gallstone cholangiopancreatitis” is suggested to define severe disease complicated by acute cholangitis due to persistent ampullary stone impaction. It incorporates the terms “cholangitis” and “gallstone pancreatitis.” “Cholangitis” refers to acute cholangitis due to cholangiovenous reflux through the foci of extensive hepatocyte necrosis reflexed by marked elevation in transaminase levels caused by persistent ampullary obstruction. “Gallstone pancreatitis” refers to elevated pancreatic enzyme levels consequent to pancreatic duct obstruction. This pancreatic lesion is characterized by minimal or mild inflammation. Gallstone cholangiopancreatitis may be valuable in clinical practice for specifying gallstone AP that needs urgent endoscopic retrograde cholangiopancreatography with endoscopic sphincterotomy.

Pancreatitis, Panniculitis, and Polyarthritis Syndrome Simulating Cellulitis and Gouty Arthritis

Pancreatitis, panniculitis, and polyarthritis (PPP) syndrome is a rare but critical disease with a high mortality rate. The diagnostic dilemma of PPP syndrome is the fact that symptoms occur unexpectedly. A 48-year-old man presented with fever and painful swelling of the left foot that was initially mistaken for cellulitis and gouty arthritis. The diagnosis of PPP syndrome was made based on the abdominal CT findings and elevated pancreatic enzyme levels, lobular panniculitis with ghost cells on a skin biopsy, and polyarthritis on a bone scan. The pancreatitis and panniculitis disappeared spontaneously over time, but the polyarthritis followed its own course despite the use of anti-inflammatory agents. In addition to this case, 30 cases of PPP syndrome in the English literature were reviewed. Most of the patients had initial symptoms other than abdominal pain, leading to misdiagnosis. About one-third of them were finally diagnosed with a pancreatic tumor, of which pancreatic acinar cell carcinoma was the most dominant. They showed a mortality rate of 32.3%, associated mainly with the pancreatic malignancy. Therefore, PPP syndrome should be considered when cutaneous or osteoarticular manifestations occur in patients with pancreatitis. Active investigation and continued observations are needed for patients suspected of PPP syndrome.

Successful diagnosis of acute pancreatitis caused by impacted gallstone at the ampulla of Vater using endoscopic ultrasonography: a case report

A 69-year-old woman with a history of chronic pancreatitis and gallbladder stone was emergently transported to our hospital for sudden epigastric pain after ingesting alcohol. Her blood test showed elevated pancreatic enzyme levels, including amylase at 3515U/L. Although jaundice was not observed, there was a mild increase in hepatobiliary enzyme levels. Abdominal ultrasonography and computed tomography showed no stone in the common bile duct; however, we observed a fat stranding around the pancreas and made a diagnosis of acute pancreatitis. Although alcoholic pancreatitis was strongly suspected, we performed endoscopic ultrasonography (EUS) to rule out gallstone pancreatitis. On EUS, a 6-mm hyperechoic lesion with acoustic shadow was observed at the papilla; the patient was diagnosed with an impacted stone at the ampulla of Vater. Emergency endoscopic sphincterotomy and removal of the impacted stone were performed. EUS is useful for evaluating biliary obstruction in cases with gallstone pancreatitis and can diagnose impacted stone at the papilla. We strongly recommend EUS in cases with pancreatitis for which an indication of endoscopic retrograde cholangiopancreatography is uncertain.

Toxic epidermal necrolysis in a child with lupus-associated pancreatitis

Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are life-threatening dermatological conditions that are characterized by mucosal erosions, epidermal detachments and erosions. The most common causes of SJS and TEN are drugs; other causes such as systemic lupus erythematosus (SLE), vaccinations and infections have been rarely implicated. We present the case of a 14-year-old female patient with acute pancreatitis as an initial manifestation of systemic lupus erythematosus, complicated by the toxic epidermal necrolysis with a fatal outcome. She initially presented with abdominal pain, fever, vomiting, and intolerance to oral intake and elevated pancreatic enzyme levels. Systemic lupus erythematosus was diagnosed secondary when her condition has been already complicated by the toxic epidermal necrolysis. The administration of corticosteroids and high doses of intravenous immunoglobulin did not lead to positive effects in the treatment of our patient.

Elevated Amylase and Lipase Levels in the Neurosurgery Intensive Care Unit

Multiple factors may affect pancreatic enzyme levels even in the absence of pancreatitis. In the general intensive care unit (ICU), we examined the incidence, various clinical factors, and sequelae associated with elevated pancreatic enzymes in the neurosurgery ICU. Eighty-nine patients who were admitted to the neurosurgery ICU with gastrointestinal symptoms and signs from January to October 2007 were classified into 2 groups according to their pancreatic enzymes as follows: normal pancreatic enzyme levels (n = 46) and elevated levels (n = 43). We analyzed the general data, including sex, age, indications for admission, types of surgery, initial Glasgow coma scale (GCS) score, neurosurgery ICU-stay days, and mechanical ventilator- use days. We also collected data on vital signs, serum markers, and drug prescriptions. Radiological examinations, including sonography and computed tomography (CT) scans of the abdomen were performed. Nearly half of the patients who were admitted to the neurosurgical ICU with gastrointestinal symptoms and signs had elevated serum pancreatic enzymes. Elevated pancreatic enzyme levels were significantly associated with anemia (p = 0.048) and renal failure (p = 0.026), and were not associated with sex, age, indications for admission, types of surgery, initial GCS, neurosurgery ICU-stay days, mechanical ventilator-use days, hypotension, fever, usual ICU drugs, and other serum hepatic markers. High pancreatic enzyme levels were associated with a high mortality (p = 0.02). Abdominal CT had a high positive-predictive rate for the diagnosis of pancreatitis (63%). Various neurosurgery events and diagnoses may lead to different degrees of serum pancreatic enzyme elevation. Patients with elevated pancreatic enzyme levels have a higher mortality rate than those with normal enzyme levels. We believe that abdominal CT should be indicated for patients if their amylase levels are more than 3-fold the upper normal limit and lipase levels are more than 5-fold.

ISCHEMIC ACUTE PANCREATITIS

Background: Acute pancreatitis (AP) can be caused by various triggers. Besides alcohol excess and gallstones, pancreatic ischemia can cause AP. Although this is poorly defined clinically or radiologically as an independent entity, it should be considered when anamnestic risk factors are present and no other obvious reasons can be defined. Aim of this study was to define ischemic AP in terms of pathophysiological, radiological and clinical conditions regarding the history of 7 consecutive patients. Methods: Seven patients suffered from acute pancreatitis caused by mesenteric hypoperfusion of different origin. Course, severity and outcome of the disease as well as diagnostic and therapeutic measures were evaluated with a special focus on the differentiation between acute pancreatitis and elevated pancreatic enzyme levels, which can often be observed in ICU patients without further clinical complications. Results: Three causes of acute ischemia-induced pancreatitis were observed: hemorrhage or hypotension (3 patients), mesenteric macrovessel occlusion (3 patients) and posttransplantation pancreatitis (1 patient). Therapy of the patients was conservative in 2 patients, operative with surgical hemostasis and drainage (4 patients) and explantation of a transplanted pancreas (1 patient), respectively. Four of the patients died within 18 days after the onset of AP, indicating a severe course of AP with major systemic complications; 2 patients recovered completely, the transplant patient lost the pancreas graft after 5 days without further complications. Conclusions: Ischemia is an important etiology of acute pancreatitis. Different causes of ischemia can lead to a hypoperfusion of the pancreas with a consecutive induction of an inflammatory response. Diagnostic and therapeutic procedures are similar to those performed in acute pancreatitis of other etiology, causal therapy includes restoration of pancreatic perfusion, if possible. Severity of the disease can range from moderate edematous affections up to severe courses with lethal outcome. However, in the reported patients mortality was high, indicating that ischemia of the pancreas, when present at the onset of the disease, tends to lead to a severe, often irreversible organ damage with early and fatal systemic complications.

Acute pancreatitis as an initial symptom of systemic lupus erythematosus: A case report and review of the literature

Acute pancreatitis as an initial symptom of systemic lupus erythematosus (SLE) is rare. We present a report of a 46-year-old female patient who had fever, abdominal pain and vomiting, elevated pancreatic enzyme levels, hypocalcemia, hypoxemia, and various other laboratory abnormalities. She was first diagnosed with acute severe pancreatitis and then with SLE after further investigations. After a 2-mo treatment with somatostatin, the patient recovered.

Clinically silent elevated pancreatic enzyme levels: what needs to be done diagnostically and therapeutically?

Clinically silent elevated pancreatic enzyme levels: what needs to be done diagnostically and therapeutically?