Independent Risk Factor For Severity Research Articles

Acute pancreatitis

To review advances over the last year in the prevention, diagnosis and management of acute pancreatitis. Obesity is an independent risk factor for severity in acute pancreatitis, and heavy alcohol consumption for the development of necrosis in severe acute pancreatitis. Biochemical markers have been further tested, including carbohydrate-deficient transferrin for the diagnosis of alcohol-induced acute pancreatitis, urinary trypsinogen-2 as a diagnostic marker for acute pancreatitis, and interleukin-6 and procalcitonin as markers of disease severity. A new, simple stratification system, the 'panc 3 score', has been described. There are conflicting data on the use of antibiotic prophylaxis in acute necrotizing pancreatitis, and on the chemoprevention of postendoscopic retrograde cholangiopancreatography pancreatitis. Enteral feeding is established as standard practice early in the management of acute pancreatitis of all aetiologies; probiotics and other compounds may also play a role. Over the last year, there have been further innovations in the risk stratification and management of acute pancreatitis. Unresolved issues include chemoprevention of endoscopic retrograde cholangiopancreatography-induced acute pancreatitis, the indications for antibiotic prophylaxis in severe acute pancreatitis and nutritional supplementation with probiotics and synbiotics.

Etiology, Severity and Recurrence of Acute Pancreatitis in Southern Taiwan

Changes in lifestyle have led to variation in the etiologies of acute pancreatitis indifferent areas of Taiwan. This study investigated the etiologies and factors associated with severity and recurrence of acute pancreatitis in southern Taiwan. Eighty acute pancreatitis patients (M/F: 64/16), including 53 (66.2%) with alcohol abuse, 16 (20%) with biliary disease, five (6.3%) with hyperlipidemia, and six (7.5%) with other risk factors, etiologies or idiopathic disease, were included. The mean follow-up period was 20 months. Contrast-enhanced computed tomography (CT) was used to assess the severity of acute pancreatitis. Biliary pancreatitis was significantly associated with females while alcoholic pancreatitis occurred predominantly in males. Univariate analysis showed that male gender, alcoholic pancreatitis, and elevated serum triglyceride (>170 mg/dL) were significantly associated with severe acute pancreatitis. Multivariate logistic regression analysis revealed that male gender and abnormal serum triglyceride were independent risk factors for severity. Alcohol abuse was an independent risk factor for recurrent pancreatitis. Alcoholic pancreatitis was the major etiology of acute pancreatitis in southern Taiwan, exhibiting a strong male predominance and higher risk of severe CT grading. Abnormal serum triglyceride was independently associated with the severity of acute pancreatitis. Alcoholic pancreatitis had a higher risk of recurrence than other etiologies.

Envenoming by Bothrops jararaca in Brazil: association between venom antigenaemia and severity at admission to hospital

The association between the clinical severity of Bothrops jararaca envenoming at admission and serum venom and plasma fibrinogen concentrations before antivenom administration is reported in 137 patients admitted to Hospital Vital Brazil, Instituto Butantan, São Paulo, Brazil, between 1989 and 1990. Other variables such as age, gender, site of the bite, use of tourniquet and the time interval between the bite and start of antivenom therapy, spontaneous systemic bleeding, and the 20 minute whole blood clotting test (20WBCT) at admission showed no association with either severity or serum venom antigen concentration (SVAC). Mean SVAC in patients with mild envenoming was significantly lower than in the group with moderate envenoming ( P = 0.0007). Patients with plasma fibrinogen concentrations > 1.5 g/L had a lower mean SVAC than patients with plasma fibrinogen concentrations ⪕ 1.5 g/L ( P = 0.02). Those admitted with a tourniquet in place had significantly higher plasma fibrinogen concentrations than those without a tourniquet ( P = 0.002). A multiple logistic regression model showed independent risk factors for severity: bites at sites other than legs or forearms, SVACs ⪕ 400 ng/mL, and the use of a tourniquet. Rapid quantification of SVAC before antivenom therapy might improve initial evaluation of severity in B. jararaca bites.

Acute pancreatitis: does gender matter?

In a number of gastrointestinal and nongastrointestinal diseases, gender has been proven to be an independent risk factor for severity. To determine whether this holds true for severity in acute pancreatitis is the aim of our study. This paper derives from a prospective study on the epidemiology of acute pancreatitis, which included 274 patients (172 male and 102 female) with a first attack of the disease. Severity parameters were: Atlanta criteria (arterial Po2 < or = 60 mm Hg, and serum creatinine on admission >2 mg/dl after rehydration); Ranson's and Imrie's prognostic factors; APACHE II score; Balthazar-scored contrast-enhanced computed tomography (CT) results obtained within 72 hr of admission; days spent in the intensive care unit and total hospital stay; the necessity for artificial ventilation, dialysis, or surgery; and mortality. As already known, there is a significant association between gender and etiology of pancreatitis in general. Not surprisingly, the men in our study had alcohol-induced acute pancreatitis more frequently than women, whereas biliary pancreatitis predominated among the women. As for severity, there was no significant association between gender and any of the severity parameters with a few minor exceptions: longer hospital stays, higher Imrie scores and more pseudocysts for women, and more necroses in women with idiopathic pancreatitis. Thus, gender is no independent risk factor for the severity and outcome of acute pancreatitis.