Indicator In Acute Pancreatitis Research Articles

Decrease of Membrane B7-H5 on CD14+ Cells in Severe Acute Pancreatitis Is Related to RANSON Scores and APACHE II Scores.

B7-H5 is an important ligand which is deeply involved in the immune response in various diseases. However, its clinical usefulness as an early indicator in acute pancreatitis (AP) remains unclear. To determine the role of B7-H5 in severe acute pancreatitis (SAP). Whole blood samples from patients with SAP (n = 20) and healthy donors (n = 20) were collected. Expression of soluble B7-H5 (sB7-H5) in plasma was determined by ELISA and membrane B7-H5 (mB7-H5) on the peripheral CD14+ cells was determined by flow cytometry. Peripheral blood mononuclear cells (PBMCs) were isolated from healthy donors and stimulated with serum from SAP patients, lipopolysaccharide (LPS), TNF-α, or IFN-γ, then, sB7-H5 and mB7-H5 were measured. The relationship between expression levels of mB7-H5 and clinical features of SAP patients were analyzed. The expression levels of sB7-H5 in plasma were increased and the expression levels of mB7-H5 on the peripheral CD14+ cells were decreased in SAP patients. These changes of B7-H5 expression pattern in cultured PBMCs could be induced by stimulation with serum from SAP patients, LPS, TNF-α, or IFN-γ. Expression levels of mB7-H5 were negatively related to levels of hematocrit, urea nitrogen, creatinine, lactic acid, RANSON scores, and APACHE II scores. Changes of B7-H5 expression pattern were involved in immune response of SAP. Innate immunity activation-induced decrease of mB7-H5 might be related to poor prognosis of SAP patients.

Single Cell Transcriptomic Analysis Reveals Signature Cell Types and Gene Sets As Severity Prediction Indicators in Acute Pancreatitis

Single Cell Transcriptomic Analysis Reveals Signature Cell Types and Gene Sets As Severity Prediction Indicators in Acute Pancreatitis

Soluble B7-H5 Is a Novel Diagnostic, Severity, and Prognosis Marker in Acute Pancreatitis.

As an important ligand in T lymphocyte costimulatory pathways, B7-H5 is involved deeply in the immune response in various diseases. However, its clinical usefulness as an early indicator in acute pancreatitis (AP) remains unclear. In this study, the levels of sB7-H5 and cytokines in plasma samples of 75 AP patients, 20 abdominal pain patients without AP, and 20 healthy volunteers were determined. Then, the correlation of sB7-H5 and clinical features, cytokines, the Ranson score, APACHE II score, Marshall score, and BISAP score was analysed, and the value of sB7-H5 for diagnostic, severity, and prognosis of AP was evaluated. We found that the levels of sB7-H5 were specifically upregulated in AP patients. Receiver operating characteristic (ROC) analysis revealed that sB7-H5 can identify AP patients from healthy or abdominal pain patients with 78.9% or 86.4% sensitivity and 93.3% or 90.0% specificity. Further analysis showed that the levels of sB7-H5 were significantly correlated with WBC (p = 0.004), GLU (p = 0.008), LDH (p < 0.001), Ca2+ (p = 0.006), AST (p = 0.009), PLT (p = 0.041), IL-6 (p < 0.001), IL-10 (p < 0.001), and TNF-α (p < 0.001). And levels of sB7-H5 were gradually increased among patients with mildly acute pancreatitis (MAP), moderately severe acute pancreatitis (MSAP), and severe acute pancreatitis (SAP). It can distinguish the severity of AP with good sensitivity and specificity. Moreover, when dividing the patients into two groups according to the median level of sB7-H5, the local complication and length of stay of low levels of the sB7-H5 group were significantly less than those in high levels of the sB7-H5 group. And the levels of sB7-H5 in AP patients were significantly correlated with the Ranson score (p < 0.001), APACHE II score (p < 0.001), Marshall score (p < 0.001), and BISAP score (p < 0.001). The AUCs of assessing local complications of sB7-H5 at day 1 and day 3 were 0.704 (p = 0.0024) and 0.727 (p = 0.0373). These results showed the potential value of sB7-H5 as a diagnostic, severity, and prognosis marker of AP.

Serial estimation of serum myeloperoxidase in patients of acute pancreatitis: A pilot study

Acute pancreatitis (AP) is an inflammatory condition having varied presentation ranging from a mild self-limiting illness to a severe disease with multi organ failure. Excessive recruitment of leukocytosis is an important pathophysiological feature and Myelo-peroxidase (MPO) forms an important part of neutrophil induced inflammation. The current prognostic criteria are complex and cumbersome.: The present cross sectional pilot study serial estimation of plasma MPO levels were done at the time of admission and on 3, 7 and 14 days in patient of Acute Pancreatitis (n=64) patient with acute abdominal symptoms (n=15) otherthan acute pancreatitidand healthy volunteers (n=15). The values of serum MPO levels were correlated with Ransons`s score, Apache score, CT severity index and patient developing local and systemic complications due to acute pancreatitis. Serum MPO levels in (mU/ml) were measured by colorimetric Assay kit (bio Vision, USA). Statistical Analysis on SPSS (Windows version 21.0): The mean serum MPO levels were significantly high in patients of AP as compared to controls comprising of patients with acute abdominal conditions and healthy individuals (mean 12.73 vs 1.67 mU/ml. p&amp;#60; 0.001). The highest levels of serum MPO were observed on the first day of mild and severe AP. The mean MPO levels in mild diseases (n=21 patients) were 3-10 mU/ml and 10-20 mU/ml in severe AP (n=43 patients) who also experienced higher local complications and worse outcome in terms of mortality. MPO returned to normal levels within 7-10days in mild but were persistently raised in patients with severe diseases. The higher serum MPO levels correlated with more severe diseases, worse outcome and can be a simple and effective prognostic indicator in AP.

Serial Estimation of Serum Myeloperoxidase in Patients of Acute Pancreatitis: A Pilot Study

Introduction: Acute Pancreatitis (AP) is an inflammatory condition having varied presentation ranging from a mild self-limiting illness to a severe disease with multi organ failure. Excessive recruitment of leukocytosis is an important pathophysiological feature and Myelo-Peroxidase (MPO) forms an important part of neutrophil induced inflammation. The current prognostic criteria are complex and cumbersome. Materials and methods: The present cross sectional pilot study serial estimation of plasma MPO levels were done at the time of admission and on 3, 7 and 14 days in patient of Acute Pancreatitis (n=64) patient with acute abdominal symptoms (n=15) otherthan acute pancreatitidand healthy volunteers (n=15). The values of serum MPO levels were correlated with Ransons`s score, Apache score, CT severity index and patient developing local and systemic complications due to acute pancreatitis. Serum MPO levels in (mU/ml) were measured by colorimetric Assay kit (bio Vision, USA). Statistical Analysis on SPSS (Windows version 21.0) Results: The mean serum MPO levels were significantly high in patients of AP as compared to controls comprising of patients with acute for to abdominal conditions and healthy individuals (mean 12.73 vs. 1.67 mU/ml. p<0.001). The highest levels of serum MPO were observed on the first day of mild and severe AP. The mean MPO levels in mild diseases (n=21 patients) were 3-10 mU/ml and 10-20 mU/ml in severe AP (n=43 patients) who also experienced higher local complications and worse outcome in terms of mortality. MPO returned to normal levels within 7-10days in mild but were persistently raised in patients with severe diseases. Conclusion: The higher serum MPO levels correlated with more severe diseases, worse outcome and can be a simple and effective prognostic indicator in AP.

Neutrophil Lymphocyte Ratio as a Prognostic Factor in Acute Pancreatitis

Background: Different scoring systems are currently in use to stratify the severity of the acute pancreatitis to guide clinicians in triaging patients with the aim of improving outcomes. The Neutrophil-Lymphocyte Ratio (NLR) provides a rapid indication of the extent of an inflammatory process. Its value to predict the severity of acute pancreatitis has not been well studied. The aim of this study was to investigate the prognostic value of the NLR in acute pancreatitis patients.&#x0D; Materials and methods: This hospital based observational study was conducted at Medicine ward of Chittagong Medical College Hospital (CMCH) for one year period from January 2015 to December 2015. One hundred and four adult patients with a diagnosis of acute pancreatitis who fulfilled the defined inclusion and exclusion criteria were selected for the study. After obtaining informed consent clinical interviewing and physical examination were done according to predesigned case record form. Then blood was collected within one hour of admission. After getting the result, final selection were done following exclusion criteria. The patients were arranged into three groups according to NLR tertiles. Main outcome measures were intensive Care Unit (ICU)/High Dependency Unit (HDU) admission, Length of Stay (LOS) in the hospital and in-hospital mortality. &#x0D; Results: According to NLR tertiles, patients in the 3 tertile (NLR³7.6) had significantly more ICU/HDU admissions (40.6% vs. 0%), longer average LOS (7.91 vs. 4.03 days) and more death (12.5% vs. 0%) compared with those in the 1rd tertile (NLR&lt; 3.6). The higher the NLR tertile, the Modified Early Warning Score (MEWS) also increased significantly. According to the ROC curve, NLR values were superior in predicting ICU/HDU admission and hospitalization for ³ 7 days compared to WBC and MEWS values. &#x0D; Conclusion: Elevation of the NLR during admission was significantly associated with severe acute pancreatitis and is a negative prognostic indicator in acute pancreatitis. It is superior to total WBC and modified MEWS in predicting adverse outcomes of acute pancreatitis.&#x0D; JCMCTA 2020 ; 31 (1) : 90-95

A reduced lymphocyte ratio as an early marker for predicting acute pancreatitis

The early diagnosis and severity grading for acute pancreatitis (AP) are difficult to determine because of the complexity and differences in disease process. To date, few studies have investigated the role of lymphocyte ratio (LR) in AP. Therefore, the objective of the present study was to investigate the prognostic value of LR as an indicator in AP, as well as determine an optimal cut-off value for the severity prediction. There were two hundred four patients involved in this study, ninety-two of whom had severe acute pancreatitis (SAP). The LR was analyzed on admission and correlated with severity, which was determined using the Atlanta classification. The optimal cut-off value for LR was generated using receiving operator characteristic (ROC) curves. The results showed that the LR in the SAP group decreased significantly compared to the mild acute pancreatitis (MAP) group (8.82 vs. 13.43). The optimal cut-off value obtained from ROC curves was 0.081, with a sensitivity of 80.4%, a specificity of 53.3%, a positive likelihood ratio of 1.722, and a negative likelihood ratio of 0.368. In conclusion, the LR is obviously related to the condition of AP patients and is valuable for the differential diagnosis of SAP in early stages of AP.

Mo1420 Parenteral Nutrition is Associated with Higher Mortality, Hospital Associated Complications and Patient Safety Indicators in Acute Pancreatitis: the Results from the Nationwide Inpatient Sample 2008-2012

Mo1420 Parenteral Nutrition is Associated with Higher Mortality, Hospital Associated Complications and Patient Safety Indicators in Acute Pancreatitis: the Results from the Nationwide Inpatient Sample 2008-2012

Remote effect of kidney ischemia-reperfusion injury on pancreas: role of oxidative stress and mitochondrial apoptosis.

IntroductionRecent studies have demonstrated remote effects of renal ischemia/reperfusion (IR) injury on some organs such as brain, liver, and lungs. Oxidative stress is reported to be the cornerstone in such ischemic conditions. Associated apoptosis is also reported in remote lung, liver and myocardial injury after acute kidney injury. So, we postulated that renal IR may affect the pancreas by its remote effect. Oxidative stress and mitochondrial mediated apoptosis may play a crucial role in this injury. We investigated the effects of kidney IR on pancreatic exocrine and endocrine functions, antioxidant enzyme activity, and apoptosis.Material and methodsThe protective effect of vitamin C was also investigated. The animals were submitted to non-traumatic bilateral renal IR, sham operation or treatment with vitamin C after IR. Rats were sacrificed on the 1st, 3rd, and 7th days of the experiment to evaluate the parameters of oxidative stress (catalase, lipid peroxidase, reduced glutathione and superoxide dismutase), pancreatic endocrine and exocrine function (amylase, insulin and fasting blood glucose), renal functions (serum creatinine and blood urea nitrogen), cellular injury and apoptotic markers (Bcl-2, Bax and caspase-3).ResultsKidney I/R significantly increased the renal and pancreatic functions at 1, 3 and 7 days, while fasting insulin was significantly increased at day 3 after ischemia. Moreover, I/R significantly increased the studied oxidative stress markers and decreased the antioxidant capacity in pancreatic tissues. In addition, renal I/R induced numerous histopatological lesions in pancreatic tissues and increased the apoptosis-related genes. Treating the rats with vitamin C (100 mg/kg) significantly restored the renal and pancreatic functions, improved the pancreatic antioxidant capacity and protected the pancreatic tissues from apoptotic necrosis.ConclusionsThe results suggested that bilateral renal ischemia for 45 min caused significant impairment of pancreatic function and structure as indicators of acute pancreatitis. While IR enhances oxidative stress and apoptosis, vitamin C appears to play a cytoprotective role.

Prognostic indicators in acute pancreatitis: Comparison of interleukin 6 and some selected severity scoring systems in acute pancreatitis

Background: It is important to predict the severity of acute pancreatitis as early as possible in order to optimize the therapy and to prevent organ dysfunction and local complications. Several scores of severity have been proposed. New biochemical markers are now available besides physiological and radiological markers. Our study was done to know the relation between interleukin 6 (IL-6) concentrations, Acute Physiology and Chronic Health Evaluation II (APACHE-II) scores and computed tomography (CT) severity index in acute pancreatitis. Patients and Methods: The study was done in Jawaharlal Nehru Medical College, Aligarh Muslim University from December 2011 to November 2013. Blood sample was taken between 24 and 48 h from the onset of symptoms and IL-6 was assessed using ELISA method and compared with physiological APACHE-II and CT Severity scores. Results: Mean IL-6 levels were found to be higher in higher APACHE-II score categories and the difference was significant statistically (P 0.7). However, the IL levels did not correlate with the modified CT severity index. Conclusion: APACHE-II scores show a strong correlation with IL-6 levels within the limitation of having patients of only lower order of APACHE-II scores. Nonsignificant correlation with CT severity index was found. This should encourage us to use biochemical parameters to determine the severity of acute pancreatitis instead of CT standards.

Procalcitonin Strip Test as an Independent Predictor in Acute Pancreatitis.

Plasma procalcitonin (PCT) is a highly specific marker for the diagnosis of bacterial infection and sepsis. Studies have demonstrated its role in the setting of sepsis and acute pancreatitis. This study aims to analyze and compare the prognostic efficacy of plasma procalcitonin strip test in acute pancreatitis. A prospective study was conducted in the department of general surgery from June 2012 to June 2013. Plasma procalcitonin was estimated by the semiquantitative strip test. The study included a total of 50 patients diagnosed to have acute pancreatitis. Data was collected and statistically analyzed using SPSS version 17. Thirty-nine out of the 50 patients (78%) were males with a mean age of 46.8years (range, 25-78years) and 25 patients (50%) had ethanol-induced pancreatitis, while 13 patients (26%) had gall stone pancreatitis. Plasma PCT values were found to correlate better than CRP levels and total leukocyte count with the total duration of hospitalization, ITU, and ICU stay, as well as with the progression to severe acute pancreatitis. A cut off for plasma PCT of >2ng/mL was found to be 100% sensitive and 100% specific and a cut off for CRP of >19mg/dL was 70% sensitive and 65% specific for predicting the progression to severe acute pancreatitis. Plasma PCT also correlated well with antibiotic requirement. A cut off value of >0.5ng/mL for plasma PCT was 100% sensitive and 80% specific and a cut off value of >18mg/dL for CRP was 86% sensitive and 63% specific for predicting antibiotic requirement. Plasma procalcitonin is an early and reliable prognostic indicator in acute pancreatitis. The procalcitonin strip test is a rapid test which is useful in analyzing prognosis in patients with acute pancreatitis.

The Prognostic Value of the Neutrophil–Lymphocyte Ratio (NLR) in Acute Pancreatitis: Identification of an Optimal NLR

IntroductionThe neutrophil–lymphocyte ratio (NLR), calculated from the white cell differential count, provides a rapid indication of the extent of an inflammatory process. The aim of this study was to investigate the prognostic value of the NLR in acute pancreatitis (AP) and determine an optimal ratio for severity prediction. Materials and MethodsNLRs were calculated on days 0, 1, and 2, and correlated with severity. Severity was defined using the Atlanta classification. ResultsOne hundred forty-six consecutive patients managed were included, 22 with severe acute pancreatitis (SAP). NLR in SAP was significantly higher than in the favorable prognosis group on all 3 days (day 0, 15.5 vs. 10.5; day 1, 13.3 vs. 9.8; day 2, 10.8 vs. 7.6). The optimal cut-offs from ROC curves were 10.6 (day 0), 8.1 (day 1), and 4.8 (day 2) giving sensitivities of 63–90 %, specificities of 50–57 %, negative predictive value of 89.5–96.4 %, positive predictive values of 21.2–31.1 %, and accuracies of 57.7–60 %. ConclusionsElevation of the NLR during the first 48 h of admission is significantly associated with severe acute pancreatitis and is an independent negative prognostic indicator in AP.

The Effect of Intestinal Permeability and Endotoxemia on the Prognosis of Acute Pancreatitis

Background/AimsEarly intestinal mucosal damage plays an important role in severe acute pancreatitis (AP). Previous studies have shown that intestinal permeability (IP), serum endotoxin and cytokines contribute to the early intestinal barrier dysfunction in AP. This study explored the predictive capacity of IP, endotoxemia and cytokines as prognostic indicators in AP patients.MethodsEighty-seven AP patients were included in the study. The patients were classified into three groups according to the Balthazar computed tomography severity index (CTSI). We compared the biochemical parameters, including IP, serum endotoxin level and cytokine level among the three groups. The associations of IP with serum endotoxin, cytokines, CTSI, and other widely used biochemical parameters and scoring systems were also examined.ResultsIP, serum endotoxin, interleukin (IL-6) and tumor necrosis factor (TNF)-α had a positive correlation with the CTSI of AP. Endotoxin, IL-6, TNF-α, CTSI, the Ranson/APACHE II score, the duration of hospital stay, complications and death significantly affect IP in the AP patients.ConclusionsWe believe that IP with subsidiary measurements of serum endotoxin, IL-6 and TNF-α may be reliable markers for predicting the prognosis of AP. Further studies that can restore and preserve gut barrier function in AP patients are warranted.

IL-6 is Valuable Prognostic Indicator in Acute Pancreatitis.

Pismo uredniku u kojem se pridodaju statisticki podaci izraženi kao vrijednost povrsine pod krivuljom (Area under the curve ili AUC)za vrijednosti IL-6, IL-8 i IL-10, te Ranson, APACHE II i Glasgow sustava bodovanja kao prognostickih faktora za akutni pankreatitis. Dodatno se ukazuje na znacajniju prognosticku vrijednost IL-6.

Value of CT and clinical criteria in assessment of patients with acute pancreatitis

Objective To re-assess the value of CT and clinical criteria as prognostic and severity indicators in acute pancreatitis and the correlation between them. Methods Sixty-five cases with acute pancreatitis (AP) were included in the study. The hospitalization days, fevering days and overall complications were regarded as clinical endpoints for the patient group. CT criteria used for AP evaluation included Balthazar's plain CT scan score, CT severity index (CTSI) and London's pancreatic size index (PSI) score. Clinical criteria was Ranson score. The correlations between each criterion and the clinical endpoints, and the relation between CT and clinical criteria were analyzed. The power of each criterion and combination of CT and clinical criteria in predicting overall complications of AP were assessed and compared by using a receiver operative characteristic curve (ROC) analysis. Results The mean scores of PSI, Ranson among the three groups classified according to overall complications were significantly different. Except Balthazar's plain CT scan criterion, each criterion's mean score in-groups with local complications was significantly higher than that in-group without. The overall complications were significantly more in severe group than that in mild group classified according to each criterion except plain CT scan criterion. Mean days of hospital stay and fevering were significantly longer in severe group with Ranson score than that in mild group. PSI and Ranson score had a linear correlation with fevering days, and Ranson score had a linear correlation with hospitalization days. In CT criteria, only PSI had a linear correlation with Ranson score. The findings of plain CT scan was found to be some laggard compared with that of clinic. ROC analysis showed the largest A Z of Ranson score, and there was no A Z increase when CT criteria were added to clinical criteria. Conclusion The predictive values of Ranson and PSI score in AP patients are superior to that of other criteria. CT criteria are superior to clinical criterion in predicting local complications, and short-term CT follow-up examination is important in the evaluation of AP.

Fas/FasL Play a Central Role in Pancreatitis-Induced Hepatocyte Apoptosis

Liver injury is a clinical prognostic indicator in acute pancreatitis (AP). We have demonstrated that Kupffer cell-derived FasL mediates liver injury during AP and sought to determine its role in AP-induced hepatocyte apoptosis. AP was induced in National Institutes of Health (NIH) Swiss mice, C57/C57, and Fas-/-, FasL-/- mice by a choline-deficient ethionine-supplement diet. Liver Fas, FasL, p38-mitogen activated phosphokinase (p38-MAPK), poly-ADP ribose polymerase (PARP), and cytochrome C were measured by immunoblotting. Apoptosis was assessed by terminal deoxynucleotidyl transferase biotin-dUTP nick end labeling (TUNEL) and DNA fragmentation (ELISA). AP upregulated liver FasL (4280 +/- 580 vs. 733 +/- 336), Fas (2866 +/- 595 vs. 649 +/- 111), cytochrome C (6980 +/- 237 vs. 903 +/- 156), and PARP (6393 +/- 591 vs. 466 +/- 261) as well as increased TUNEL staining (40 +/- 2 vs. 14 +/- 1) and DNA fragmentation (all P < 0.03 vs. control). In FasL-/- and Fas-/- mice, AP-induced upregulation of p38-MAPK, PARP, and cytochrome C was significantly attenuated (all P < 0.01 compared to C57/C57 control). In addition, AP-induced DNA fragmentation was reduced 60% in Fas-/- and FasL-/- mice (P < 0.01 vs. C57/C57). AP induces apoptosis by transcriptional activation of Fas/FasL. AP-induced apoptosis was significantly reduced in Fas and FasL knockout mice along with downregulation of p38-MAPK, PARP, and cytochrome C, thereby suggesting a central role for Fas/FasL in hepatocyte apoptosis. The manipulation of interactions between Kupffer cell-derived FasL and hepatocytes may have important therapeutic implications.

Acute pancreatitis induces FasL gene expression and apoptosis in the liver 1,2

Liver injury is an important prognostic indicator in acute pancreatitis. We previously demonstrated that Kupffer cell-derived cytokines mediate liver injury. In this work, we sought to characterize the role of Fas Ligand (FasL) in liver injury during acute pancreatitis. Acute pancreatitis was induced in mice using cerulein; serum FasL, AST, ALT, liver FasL, p38-MAPK, and caspase-3 were measured. FasL mRNA and protein and its receptor (Fas) were determined in rat Kupffer cells treated with elastase (1 U/ml) to mimic acute pancreatitis. Apoptosis was measured by flow cytometry. Cerulein-induced pancreatitis increased serum AST, ALT, and FasL and up-regulated liver FasL (1315 +/- 111 versus 310 +/- 164 pg/ml, P = 0.002 versus sham), while inducing p38-MAPK phosphorylation (P < 0.01 versus sham) and cleavage of caspase-3 (P < 0.04 versus sham); all were attenuated by pretreatment with the Kupffer cell inhibitor, gadolinium (all P < 0.003). In vitro, elastase induced a time-dependent increase in Kupffer cell FasL protein (FasL = 404 +/- 94 versus 170 +/- 40, P = 0.02, versus control), a 100-fold increase in FasL mRNA, and up-regulated Fas (FasL receptor). Gadolinium significantly attenuated the elastase-induced increase in FasL and FasL mRNA (FasL = 230 +/- 20 versus 404 +/- 94, P = 0.01, versus elastase) but had little effect on Fas. Additionally, elastase-primed Kupffer cell media induced apoptosis in hepatocytes (29 +/- 1 versus 16% +/- 1%; versus control, P < 0.001). Acute pancreatitis induces liver injury and hepatocyte death while up-regulating FasL, p38-MAPK, and caspase-3. Fas is up-regulated within Kupffer cells, suggesting that FasL may autoregulate its production by inducing its originator-cell death. The ability to manipulate interactions between Kupffer cells and hepatocytes may have important therapeutic implications.

Prognostic indicators in acute pancreatitis.

Several approaches have been used in an attempt to predict the severity and prognosis of attacks of acute pancreatitis. The Ranson and Glasgow criteria include a variety of simple laboratory parameters that are measured on admission and again within 48 h. They are the most widely used indices in clinical practice. The Acute Physiological and Chronic Health Evaluation II system is more complicated, but can be applied to a wide variety of conditions, especially in intensive care settings. The usefulness of this system depends on the threshold score for defining severe pancreatitis; a score of eight appears to be the most appropriate. The finding of nonperfused areas in the pancreas at contrast-enhanced computed tomography is indicative of pancreatic necrosis and portends an unfavourable prognosis. Other clinical and laboratory indices have been proposed, but the most important predictive factor of early mortality seems to be the presence and persistence of a Marshall organ failure score of two or more. This is especially true if organ dysfunction persists beyond 36 h. Radiological findings do not always correlate well with the presence of organ dysfunction, and more investigations are required.

Shock, acute renal failure and MODS as mortality indicator in acute pancreatitis

It has been described some scores to establish the prognosis in patients with acute pancreatitis. The Balthasar CT classification (1) allows to establish with a lot of certainty the mortality according to the gland compromise that its seen in the CT, however the certainty of the prognosis is improved if these combine with other severity criteria as the Ramson criteria. These associations could show that the degree of SIRS has a more closer direct relation with the prognosis then the lesion seen in the CT.

Prognostic indicators in acute pancreatitis: CT vs APACHE II

Purpose: To investigate the correlation between established contrast-enhanced computed tomography (CECT) criteria of disease severity in acute pancreatitis and the APACHE (Acute Physiology and Chronic Health Evaluation) II score and to assess the utility of each as prognostic indicators in acute pancreatitis. Materials and Methods: Over a 1-year period, prospective, consensus interpretation of the CECTs of 35 consecutive inpatients was performed with determination of the CECT grade, degree of necrosis, and severity index. The APACHE II score was calculated within 24 h of CECT. Multiple clinical endpoints were recorded: local complications (pseudocyst, abscess, or acute fluid collections requiring urgent surgical or radiological intervention), systemic disease (intensive care unit admission), and duration of hospitalization. Statistical analysis was performed to determine correlations. Results: No statistically significant correlation existed between the APACHE II score and CECT grade, the degree of necrosis, or the CECT severity index. Only the CECT grade and severity index correlated significantly with the occurrence of local complications ( P = 0.0035 and 0.0048, respectively). The APACHE II score was superior to the CECT grade as a predictor of the need for ICU admission ( P = 0.022 vs P = 0.035), and no other CECT criteria was a significant predictor of ICU admission. Conclusion: The preferred clinical and imaging prognostic measures in acute pancreatitis, the APACHE II score and CECT criteria, do not correlate with one another in the commonly encountered, mixed primary and tertiary care population. The mathematical integration of CECT criteria and the APACHE II score fails to yield a predictor of outcome superior to the use of any one measure alone. CECT criteria best define local anatomic abnormality, and are superior to the APACHE II score as predictors of local complications. The APACHE II score is superior to all CECT criteria as an indicator of systemic disease severity (reflected in the need for ICU admission). The most effective initial triage would be immediate APACHE II calculation. Further use of imaging vs clinical assessment can then be individualized.