Moderately Severe Acute Pancreatitis Patients Research Articles

Clinical Outcomes of Diabetes Mellitus on Moderately Severe Acute Pancreatitis and Severe Acute Pancreatitis.

To analyze the influence of diabetes mellitus on the clinical outcomes of moderately severe acute pancreatitis (MSAP) and severe acute pancreatitis (SAP). This retrospective study included patients diagnosed with MSAP and SAP at Shanxi Bethune Hospital from January 1, 2017, to December 31, 2021. Clinical data were collected, including patient demographics, 24-hour laboratory indicators, and inflammation indices. Propensity score matching (PSM) was used to compare outcomes before and after matching. Patients were randomized into training and validation sets (7:3) to develop and validate a clinical prediction model for infected pancreatic necrosis (IPN). Among 421 patients, 79had diabetes at admission. Before PSM, diabetic patients had higher incidences of peripancreatic fluid (71% vs 47%, p<0.001) and IPN (48% vs 10%, p<0.001), higher surgical intervention rates (24% vs 12%, p=0.008), and significant differences in abdominocentesis (22% vs 11%, p=0.014). After PSM, 174 patients were matched, and the diabetes group still showed higher incidences of peripancreatic fluid (69% vs 47%, p=0.008), IPN (48% vs 11%, p<0.001), and surgical intervention rates (27% vs 13%, p=0.037). Diabetes, modified CT severity index (MCTSI), serum calcium, and HDL-c were identified as independent risk factors for IPN. The prediction model demonstrated good predictive value. In MSAP and SAP patients, diabetes mellitus can exert an influence on their clinical outcome and is an independent risk factor for IPN. The alignment diagram and web calculator constructed on the basis of diabetes mellitus, modified CT severity index (MCTSI), serum calcium and high-density lipoprotein cholesterol (HDL-c) have good predictive value and clinical guidance for the occurrence of IPN in MSAP and SAP.

Serum soluble T cell immunoglobulin mucin domain-3 as an early predictive marker for severity of acute pancreatitis; a retrospective analysis

BackgroundEarly prediction of severe acute pancreatitis (SAP) plays an important role in timely treatment decisions. Soluble T cell immunoglobulin and mucin domain-3 (sTIM-3) has been applied as a potential biomarker for the prediction of many diseases, while its predictive ability for AP severity remains largely unexplored. In this study, we aimed to identify whether serum sTIM-3 could be used as an indicator of AP severity in the early stage of the disease.MethodsA retrospective study was conducted. The enrolled AP patients should meet the 2012 Atlanta guideline and have an onset to admission ≤ 48 h.ResultsA total of 94 AP patients were enrolled in the current analysis, including 42 (45%), 35 (37%), and 17 (18%) patients were diagnosed as mild AP (MAP), moderately SAP (MSAP), and SAP, respectively. SAP patients had significantly higher the white blood cells (WBCs) count, red blood cells (RBCs) count, C-reactive protein (CRP) level, direct bilirubin level, creatinine and procalcitonin levels compared with MAP and MSAP patients. Among SAP and MSAP patients, significantly higher APACHE II, BISAP, and MCTSI scores were observed compared with MAP patients, and there was significant difference in APACHE II and BISAP scores between SAP and MSAP patients. Stepwise multivariate linear regression analysis showed that the concentrations of serum sTIM-3, as well as the BISAP and MCTSI scores, were significantly associated with the severity of AP. The areas under the ROC curve were 0.914 (95% CI, 0.865-0.963), 0.855 (95%CI, 0.742-0.968) 0.853 (95%CI, 0.768-0.938), and 0.746 (95%CI, 0.633-0.860) for BISAP score, APACHE II score, sTIM-3 level, and MCTSI score, respectively.ConclusionsSerum sTIM-3 might be ultimately incorporated into a predictive system for assessing the severity of AP.

Prolonged Intermittent Renal Replacement Therapy Combined with Hemoperfusion Can Improve Early Recovery of Moderate and Severe Acute Pancreatitis, Especially in Patients with Acute Kidney Injury

Introduction: The aim of this study was to investigate the efficacy of prolonged intermittent renal replacement therapy (PIRRT) plus hemoperfusion (HP) in treating moderately severe acute pancreatitis (MSAP) and severe acute pancreatitis (SAP). Methods: A total of 105 MSAP and SAP patients were enrolled. Sixty of them received routine internal medical therapy (control group), and 45 received PIRRT and HP in addition to routine internal medical therapy (PIRRT + HP group). The vital signs, laboratory results, and the Acute Physiology and Chronic Health Evaluation II (APACHE II) score were compared between the two groups before treatment and on the 3rd and 7th days of treatment. Results: No deaths or treatment-related serious adverse reactions occurred in both groups. After 3 and 7 days of treatment, the APACHE II score decreased more significantly in the PIRRT + HP group than in the control group (3 days: 5.47 [±3.30] vs. 7.53 [±3.89], p = 0.005. 7 days: 4.82 [±3.49] vs. 6.87 [±3.54], p = 0.004). After 3 days of treatment, the inflammatory combination parameters systemic immune-inflammation index (SII) and neutrophil-to-lymphocyte ratio (NLR) in the PIRRT + HP group decreased more significantly than those in the control group (SII: 1,239.00 [737.80–1,769.00] vs. 2,013.00 [1,260.00–3,167.00], p = 0.001. NLR: 8.78 [±4.52] vs. 11.88 [±7.30], p = 0.009). After 7 days of treatment, SII, NLR, and hypersensitive C-reactive protein decreased significantly compared with baseline, but no statistical differences between the two groups were observed. AST in both groups remained stable with treatment. There was no significant difference in baseline creatinine between the two groups of AKI patients, but after 3 and 7 days of treatment, the proportion of acute kidney injury (AKI) patients in the PIRRT + HP group whose creatinine decreased by 50% from baseline or fell to the normal range was significantly higher than that in the control group (p < 0.05). Conclusion: PIRRT + HP therapy could not only improve the general conditions, as measured by APACHE II score, but also reduce the inflammatory cascade of patients with acute pancreatitis. For MSAP and SAP patients complicated with AKI, this therapy may accelerate the recovery of renal function.

Assessment of Acute Pancreatitis Severity and Prognosis with CT-Measured Body Composition.

ObjectiveThe aim of this study was to investigate the possible association of muscle and adipose parameters with the severity and prognosis of patients hospitalized with acute pancreatitis (AP).MethodsA total of 392 hospitalized patients and 309 controls were enrolled in the study analysis from April 1, 2016, to February 1, 2021. The computed tomography scans of each population were evaluated for muscle and adipose parameters. The effects of parameters on developing moderately severe acute pancreatitis (MSAP) or severe acute pancreatitis (SAP) were evaluated using univariate and multivariate logistic regression analyses. Associations with disease recurrence and death were analyzed through Cox regression analysis.ResultsThe AP patients had higher levels of visceral adipose tissue (144.25 vs 97.81 cm2, p < 0.001) and subcutaneous adipose tissue (135 vs 120 cm2, p < 0.001) but lower levels of adipose tissue attenuation (visceral and subcutaneous) and skeletal muscle attenuation (SMA) than the controls (p < 0.05, respectively). Visceral adipose tissue (VAT) and SMA differed significantly with p-values of 0.014 and 0.003 in the different severity groups of AP. In multivariate analysis, VAT and SMA were associated with MSAP or SAP, with odds ratios of 1.003 and 0.973, respectively (95% CI 1.000–1.006, p = 0.041; 95% CI 0.953–0.993, p = 0.010). Cox regression analysis showed that low SMA was strongly associated with an increased mortality in MSAP and SAP patients (HR 10.500, 95% CI 1.344–82.025, p = 0.025). Regression analysis also showed an association of VAT loss of more than 17% with reduced 1-year recurrence of acute pancreatitis (HR 0.427, 95% CI 0.189–0.967, p = 0.041).ConclusionVAT and SMA were influential factors for the severity and prognosis of patients with AP. Patients should proper diet and exercise after discharge to reduce VAT and strengthen muscle function to improve prognosis.

Bloodstream Infection in Moderately Severe and Severe Acute Pancreatitis: Microbiological Features and a Prediction Model

Background: Prediction of BSI would contribute to the management of MSAP and SAP. This study aimed to investigate pathogens distribution of bloodstream infection (BSI) in moderately severe acute pancreatitis (MSAP) and severe acute pancreatitis (SAP) patients and develop a prediction model for BSI development. Methods: MSAP and SAP patients admit to West China Hospital from January 2012 to December 2018 were collected. Include patients were divided into BSI group and non-bloodstream infection (NBSI) group. Isolated pathogens and antibiotic resistance were recorded. The least absolute shrinkage and selection operator (LASSO) regression was used to select the risk factors for BSI. Logistic regression was used to develop a nomogram. Random forest was used to validate the stable ability of prediction factors. The areas under receiver operating characteristic (AUC) and calibration curves were plotted to evaluate the prediction performance. Findings: 399 BSI patients and 1155 NBSI patients were enrolled in this study. Of the 408 isolated pathogens, 226 (55.39%) were gram-negative bacteria. Seven predictors (intensive care unit stay, cardiovascular failure, percentage of neutrophil, percentage of lymphocyte, triglyceride, low-density lipoprotein, and albumin) were identified for BSI. The nomogram prediction model has 0.913 and 0.888 AUCs in training and validation sets. The calibration curves show the nomogram has a good consistency. Interpretation: Gram-negative bacteria were the major BSI pathogens. A new nomogram with a high predictive value based on selected factors was built. It can be conveniently used to predict BSI development and help clinicians rationally use antibiotics in MSAP and SAP patients. Funding: This work was supported by the 1.3.5 project for disciplines of excellence, West China Hospital, Sichuan University (ZYJC18027); Sichuan Science and Technology Program (2020YFS0263); and Sichuan Science and Technology Program (2021YFS0234). Declaration of Interest: The authors declare no potential conflicts of interest. Ethical Approval: The Ethics Committee of West China Hospital approved the study (No. 2021-675)

Coloclyster of Red Peony Root Granules Alleviates Moderately Severe Acute Pancreatitis: A Double-Blinded, Placebo-Controlled, Randomized Clinical Trial.

The red peony root derived from Paeonia lactiflora has been applied to treat human inflammatory diseases. To investigate its therapeutic potential in treating moderately severe acute pancreatitis (MSAP), which has been rarely studied, this study was designed as a double-blinded, placebo-controlled, randomized clinical trial. A total of 60 MSAP patients were enrolled and randomly divided into an experimental (n = 30) group and a control group (n = 30), who received a coloclyster of 15 g of red peony root or placebo granules dissolved in 150 mL of water, respectively. The patients' demographic and clinical characteristics were recorded. The results showed that the experimental group had a shorter remission time of fever (p < 0.05) and abdominal pain (p < 0.01) and faster resumption of self-defecation (p < 0.01) than did the control group. In addition, the coloclyster of red peony root decreased the modified Balthazar CT score as well as the serum interleukin-6 and tumor necrosis factor-alpha levels to a greater extent than did the placebo coloclyster (p < 0.05). The remission times for the normalization of white blood cells and percentage of neutrophils and lymphocytes in the experimental group were also significantly shorter than those in the control group (p < 0.05). In conclusion, a coloclyster of red peony root could help alleviate the clinical symptoms and shorten the course of MSAP by possibly attenuating systematic inflammation. This trial is registered with 14004664.

Plasma D-Dimer Level Is an Early Predictor of Severity of Acute Pancreatitis Based on 2012 Atlanta Classification.

BackgroundAcute pancreatitis (AP) is a common digestive disorder. Its management depends on the severity; therefore, it is essential to stratify AP patients early. D-dimer, a coagulation indicator, appears to be associated with the pathogenesis of AP. The aim of this study was to evaluate D-dimer as an early predictor of the severity of AP.Material/MethodsThis was a single-center retrospective study of 1260 patients diagnosed based on the revised Atlanta classification. Only patients hospitalized within 24 h of onset were included, and 334 patients were enrolled. Blood was collected at admission and 3 times within 48 h of admission. Values at admission and average of the 3 blood samples were evaluated by univariate and multivariate analyses. Furthermore, the area under the receiver-operating characteristic curve (AUC) was used to estimate the validity of the predictor and to define optimal cut-off points for prediction.ResultsWe found that 53.3% of the patients had mild AP (MAP), 24.3% had moderately severe AP (MSAP), and 22.4% had severe AP (SAP). D-dimer at admission and the average D-dimer could distinguish MAP patients from MSAP and SAP patients, with cut-off values of 3.355 mg/L and 4.868 mg/L, respectively. No difference in the parameters at admission was observed in multivariate analysis in distinguishing SAP from MSAP, but the average D-dimer level was significantly different with a cut-off value of 7.268 mg/L by comparing Ranson score, APACHE II score, and D-dimer level.ConclusionsThe average value of D-dimer levels could be used as a predictor of severity of AP. In general, patients with an average D-dimer level <4.868 could be diagnosed with MAP, >7.268 would develop into SAP, and between 4.868 and 7.268 would be MSAP.

Fecal microbiota transplantation as an effective initial therapy for pancreatitis complicated with severe Clostridium difficile infection: A case report.

BACKGROUNDModerately severe acute pancreatitis (MSAP) is a critical form of acute pancreatitis that is related with high morbidity and mortality. Severe Clostridium difficile infection (sCDI) is a serious and rare nosocomial diarrheal complication, especially in MSAP patients. Fecal microbiota transplantation (FMT) is a highly effective treatment for refractory and recurrent CDI (rCDI). However, knowledge regarding the initial use of FMT in patients suffering from sCDI is limited.CASE SUMMARYHere, we report an MSAP patient complicated with sCDI who was treated by FMT as a first-line therapy. The patient was a 51-year-old man who suffered from diarrhea in his course of acute pancreatitis. An enzyme immunoassay was performed to detect toxins, and the result was positive for toxin-producing C. difficile and toxin B and negative for C. difficile ribotype 027. The colonoscopy revealed pseudomembranous colitis. Due to these findings, sCDI was our primary consideration. Because the patient provided informed consent for FMT treatment, we initially treated the patient by FMT rather than metronidazole. Diarrhea resolved within 5 d after FMT. The patient remained asymptomatic, and the follow-up colonoscopy performed 40 d after discharge showed a complete recovery. Our case is the first reported in China.CONCLUSIONThis case explores the possibilities of initially using FMT to treat severe CDI. Moreover, FMT may become a critical component of the treatment for severe CDI in MSAP patients.

Value of red blood cell distribution width in assessing the severity of acute pancreatitis

To explore the value of red blood cell distribution width (RDW) in assessment of the severity of acute pancreatitis (AP). This retrospective analysis was conducted among 527 patients with AP treated in our department from May, 2013 to May, 2016. According to the severity of the condition, the patients were classified into mild acute pancreatitis (MAP) group, moderately severe acute pancreatitis (MSAP) group and severe acute pancreatitis (SAP) group, with 105 subjects without AP as the control group. The demographic data and data of RDW were collected from all cases to evaluate the value of RDW in assessing the severity of AP in comparison with classic evaluation indicators glucose (Glu) and calcium (Ca). The patients with AP and the control subjects showed significant differences in RDW, Glu and Ca (P<0.05). RDW and Glu was significantly higher but Ca was significantly lower in SAP patients than in MAP and MSAP patients (P<0.05). Binary classification logistic regression analysis showed that Glu (P<0.05, OR=2.343), Ca (P<0.05, OR=2.182) and RDW (P<0.05, OR=3.374) were all independent risk factors for AP. The area under the ROC curve for predicting SAP decreased in the order of RDW (0.801), Glu (0.658), and Ca (0.227). RDW is a useful indicator for evaluation of the severity of AP.

Serum levels of thyroid hormones and thyroid stimulating hormone in patients with biliogenic and hyperlipidaemic acute pancreatitis: Difference and value in predicting disease severity.

ObjectivesTo compare retrospectively serum levels of thyroid hormones (THs) and thyroid stimulating hormone (TSH) between patients with biliogenic acute pancreatitis (BAP) and those with hyperlipidaemic acute pancreatitis (HLAP), in order to assess their value for predicting the severity of acute pancreatitis (AP).MethodsPatients with AP were divided into BAP and HLAP groups, then further divided into either a mild AP (MAP) group or a moderately severe AP (MSAP) group. Routine blood parameters were measured. Free tri-iodothyronine (FT3), free thyroxine (FT4) and TSH levels were measured.ResultsSeventy-six patients with AP were enrolled in the study. FT3 and TSH levels were significantly higher in patients with MAP than in patients with MSAP. FT4 and TSH levels were significantly lower in the HLAP group than in the BAP group. TSH levels in both MAP and MSAP patients were significantly lower in the HLAP group than in the BAP group. TSH was inversely correlated with triglyceride levels in patients with HLAP. FT3 was a risk factor for MSAP in patients with AP and also demonstrated moderate accuracy in predicting AP severity.ConclusionsTHs and TSH decrease with the severity of AP, especially in patients with HLAP. FT3 may be a useful biomarker for the early assessment of the severity of AP.

Clinical Characteristics of Patients with Acute Pancreatitis Coexisting with Organ Failure: A Retrospective Cohort Study

Purpose: Acute pancreatitis is a systemic disease, and is usually closely associated with organ failures. This study was to investigate the pattern of organ failure in the course of acute pancreatitis. Recent Findings: A total of 783 severe acute pancreatitis (SAP) and moderately severe acute pancreatitis (MSAP) patients who were sequentially treated in Department of Surgery, Ruijin Hospital from January 2001 to December 2008 were retrospectively analyzed. All the patients were divided according to their outcomes into two groups: deceased group and survival group. The relationship between the happening of organ failure and outcome of the patients were observed. Then peripheral blood level of endotoxin core antibody and TNF-α between SAP and MSAP groups were compared. Among the 783 patients, the numbers of MSAP patients and SAP patients were 573 and 210 respectively. Overall, 698 patients were survived, which represents 89.1% of the total patients. Furthermore, 273 patients or 34.9% of the total were diagnosed with organ failure. There were 109 patients with single organ failure, 2 of which died; 81 and 60 patients with 2 organs failure and 3 organs failure respectively. In each group 30 patients died. Finally there were 23 patients with 4 or more organs failure and none of them survived. The rate is 15.3% (107/698) of the patients with single organ failure in survival group, while the corresponding number is only 2.4% (2/85) in deceased group. On the contrary, only 11.6% (81/698) patients in the survival group had multiple organ failure, while the number is 97.6% (83/85) in the deceased group. Respiratory, renal, cardiovascular, neurological, hematologic and hepatic failure occurred in 206, 80, 103, 92, 41, and 27 patients, with the incidence of 26.3%, 10.2%, 13.2%, 11.7%, 5.2%, and 3.4%; and the mortality rates were 38.8%, 63.8%, 49.5%, 37.0%, 53.7%, and 44.4% respectively. Peripheral blood levels of TNF-α and endotoxin core antibody in patients with SAP were significantly different with that of MSAP. Summary: In the course of acute pancreatitis, respiratory and cardiovascular failure has the highest incidence, and renal, hematologic failure is associated with poorest prognosis.

Coagulopathy and the prognostic potential of D-dimer in hyperlipidemia-induced acute pancreatitis

Coagulopathy and its association with disease severity in hyperlipidemia (HL)- and non-hyperlipidemia (NHL)-induced acute pancreatitis (AP) are not clear. The present study was to evaluate the relationship between coagulation homeostasis and AP. This study included 106 AP patients admitted to our hospital between October 2011 and January 2013. Stratified by disease severity, the patients were divided into two groups: a mild AP (MAP) group (n=69); and a moderately severe AP (MSAP) group (n=37). Based on disease etiology, there were 31 HL-induced AP (HLP) cases and 75 NHL-induced AP (NHLP) cases. The HLP and NHLP groups were compared for parameters of coagulation homeostasis, lipid metabolism, and disease severity. Correlations between disease severity and levels of D-dimer and protein C were investigated, and the prognostic potential of D-dimer was evaluated. Compared with MAP patients, MSAP patients showed higher levels of D-dimer and lower levels of protein C. HLP patients had higher protein C levels than NHLP patients. Both D-dimer and protein C levels were significantly associated with the disease severity, not the disease etiology. D-dimer levels correlated positively with low density lipoprotein cholesterol levels and performed well as a sensitive and specific predictor of disease severity in AP patients, especially in HLP patients. The coagulation homeostasis is different between HLP and NHLP patients, and HL may be a contributing factor for thrombosis and fibrinolysis in HLP. D-dimer may be a robust marker of disease severity in HLP.

Moderately Severe Acute Pancreatitis

We described the entity moderately severe acute pancreatitis (MSAP), characterized by local complications (LCs) without organ failure (OF). The aim of this study was to validate MSAP. We classified a prospectively collected cohort of 137 acute pancreatitis patients admitted to Mayo Clinic Hospitals into (a) severe acute pancreatitis (SAP; n = 15), presence of OF with/without LCs; (b) MSAP (n = 27), presence of LCs without OF; and (c) mild acute pancreatitis (MAP; n = 95), no OF and LCs. Primary outcomes were need for intensive care unit (ICU) care, total ICU days, total hospital stay, need for interventions, and death. Scores in the Acute Physiology and Chronic Health Evaluation II during admission were significantly different among the 3 groups (MAP vs MSAP, P = 0.02; MSAP vs SAP, P = 0.001); scores in the systemic inflammatory response syndrome during admission were similar between MAP and MSAP. Compared with patients with MAP, patients with MSAP had a significantly longer hospital stay (4 [3.0-7.0] vs 6 [4.0-18.0] days). Compared with those with SAP, a significantly smaller proportion of patients with MSAP required ICU care (12% vs 80%); total hospital stay and need for interventions were similar (6 [4.0-18.0] vs 21 [11.8-27] days and 44% vs 33%, respectively). None of the MSAP patients died compared with 40% from the SAP group. We have validated MSAP as an exclusive entity.