Mortality In Acute Pancreatitis Research Articles

Impact of nutritional support routes on mortality in acute pancreatitis: A network meta-analysis of randomized controlled trials.

Nutritional administration in acute pancreatitis (AP) management has sparked widespread discussion, yet contradictory mortality results across meta-analyses necessitate clarification. The optimal nutritional route in AP remains uncertain. Therefore, this study aimed to compare mortality among nutritional administration routes in patients with AP using consistency model. This study searched four major databases for relevant randomized controlled trials (RCTs). Two authors independently extracted and checked data and quality. Network meta-analysis was conducted for estimating risk ratios (RRs) with 95% confidence interval (CI) based on random-effects model. Subgroup analyses accounted for AP severity and nutrition support initiation. A meticulous search yielded 1185 references, with 30 records meeting inclusion criteria from 27 RCTs (n=1594). Pooled analyses showed the mortality risk reduction associated with nasogastric (NG) (RR=0.34; 95%CI: 0.16-0.73) and nasojejunal (NJ) feeding (RR=0.46; 95%CI: 0.25-0.84) in comparison to nil per os. Similarly, NG (RR=0.45; 95%CI: 0.24-0.83) and NJ (RR=0.60; 95%CI: 0.40-0.90) feeding also showed lower mortality risk than total parenteral nutrition. Subgroup analyses, stratified by severity, supported these findings. Notably, the timing of nutritional support initiation emerged as a significant factor, with NJ feeding demonstrating notable mortality reduction within 24 and 48h, particularly in severe cases. For severe AP, both NG and NJ feeding appear optimal, with variations in initiation timings. NG feeding does not appear to merit recommendation within the initial 24h, whereas NJ feeding is advisable within the corresponding timeframe following admission. These findings offer valuable insights for optimizing nutritional interventions in AP.

The Impact of Age Over 80 Years on Outcomes in Geriatric Patients with Acute Pancreatitis: A Single Center Experience

The aim of this study is to evaluate the prognosis and mortality of acute pancreatitis (AP) in older subjects and compare octogenarians (≥80 years) with nonoctogenarians (age <80 years). The medical records of elderly patients who were followed up with the diagnosis of AP at our clinic between January 2018 and December 2021 were retrospectively analyzed. The etiology of AP, comorbidities, laboratory parameters, intensive care unit (ICU) admission, and mortality were noted. Among survivors, one-year mortality status was also recorded. Disease severity, in-hospital mortality and one-year mortality were compared. A total of 206 older patients (60 octogenarian, 146 nonoctogenariean) were recruited to the study. Of them, 115 (56%) were female and the mean age was 76.1±7.3 years. Severity of AP didn’t differ between octogenarians and nonctogenarians (p>0.05). ICU admission was seen in 13% of octogenarians and 11% of nonoctogenarians (p>0.05). In-hospital mortality occurred in 8.3% of octogenarians and 6.8% of nonoctogenarians (p>0.05). After discharge, one-year mortality occurred in 20% of octogenarians and 6.6% of nonoctogenarians (p<0.01). In multivariate analysis severe AP (OR:24.940;%95CI:1.013–95.609; p=0.01), ICU admission (OR:10.244;%95CI:1.399–74.990; p=0.01) and chronic kidney disease(CKD) (OR:9.840;%95CI:1.013–95.609; p=0.04) were independent risk factors for in-hospital mortality, and ≥80 years (OR:2.984;%95 CI:1.116–7.980; p =0.03) and neurological disorders (OR:4.424;%95CI:1.480–13.226; p <0.01) were independent factors related to one-year mortality. Our results showed that advenced age has not a significant effect on the course of AP in elderly. Comorbidities play important role in short- and long-term outcomes in elderly. Larger prospective trials are needed to draw more definitive conclusions.

C-Reactive Protein as a Prognostic Indicator: Navigating the Challenge of Predicting Severity and Mortality in Acute Pancreatitis

Objective: The main goal was to evaluate the effectiveness of C-reactive protein (CRP) in assessing acute pancreatitis severity 48 hours after onset by contrasting its results with CT scans.
 Methodology: This cross-sectional study, which lasted six months from May to December 2019 at the Department of General Surgery, Pakistan Institute of Medical Sciences, comprised 150 suspected cases. CT scans and serum samples were taken 48 hours after the onset of symptoms. A postgraduate trainee created reports using a standard proforma to record CT scan results and CRP levels.
 Results: The average age of the patients was 45.03±10.86 years, with severe acute pancreatitis confirmed in 28.7% of cases by CT scans. CRP demonstrated notable diagnostic values: sensitivity 81.4%, specificity 92.52%, PPV 81.4%, NPV 92.52%, and an overall accuracy of 89.33%.
 Conclusion: C-reactive protein (CRP), a product of interleukin-1 and interleukin-6 responses by the liver, emerges as a valuable and cost-effective biomarker. Its consistent elevation in correlation with pancreatitis severity, especially within the critical 48-hour window, suggests its potential as a reliable predictor. This study underscores CRP's diagnostic utility and accessibility, emphasizing its role in assessing acute pancreatitis severity.
  
 Key Words: C-reactive protein, CT scan, Acute pancreatitis

Pancreatitis survey of clinicians in the surgical department.

Abstract Pancreatitis is a common emergency presentation with acute abdomen. A short 10 question snapshot survey about pancreatitis based on Nice guideline NG 104 and the (United Lincolnshire Hospitals NHS Trust) ULHT Trust guidelines was conducted among clinicians in the surgical department. Survey answers were collected anonymously via google forms and paper forms. Data was analysed with Excel. First cycle 17 responses. 2nd cycle 20 responses. Teaching sessions were conducted; wall posters, notice letters were installed to improve the clinicians knowledge. A second cycle was conducted with the same set of questions.1st Cycle2nd CycleDefinition (88%)Definition (95%)Cause (88%)Cause (85%)Common Presentation (88%)Common Presentation (80%)Fluid management (88%)Fluid management (95%)Mortality rate (40%)Mortality rate (55%)Confirmatory test (64%)Confirmatory test (50%)Intervention (64%)Intervention (60%)Complication (70%)Complication (60%)Pain management (70%)Pain management (55%) In conclusion, the basic idea about pancreatitis of the responders is already good which is found to be further improved even in a slightly larger sample size. The overall mortality of acute pancreatitis vs acute severe pancreatitis seems to be confused. More diverse opinions of the participants are obtained in the slightly controversial questions such as the pain management and the diagnosis. Why the varied response? It must be acknowledged, the set of responders were a different subset as clinicians rotate in various departments. It highlights the necessity to promote education and awareness in a constant manner to provide best patient care, despite the constraints of time and workload.

Anaemia predicts organ failure and mortality in acute pancreatitis

Anaemia predicts organ failure and mortality in acute pancreatitis

S152 Health Insurance Prevalence & Acute Pancreatitis Mortality: A Cross-Sectional Analysis

S152 Health Insurance Prevalence & Acute Pancreatitis Mortality: A Cross-Sectional Analysis

Role of Red Cell Distribution Width and Platelet Count Ratio to Predict the Severity and Outcome in Acute Pancreatitis

Clinical course of acute pancreatitis (AP) varies widely, its clinical features exhibit very low sensitivity for the prediction of severity of disease which is associated with high morbidity and mortality. Several single or multi parameter scoring systems have been described to evaluate the severity of AP. But sometimes, it is not clinically practicable to use these scoring systems for evaluation. This study aimed to find out the Role of Red Cell Distribution Width and Platelet Count Ratio (RPR) to predict the Severity and Outcome in AP. This prospective longitudinal study was carried out from July 2019 to July 2020, at the in-patient department of Gastrointestinal, Hepatobiliary and Pancreatic Disorders, BIRDEM General Hospital, Dhaka. Total 100 patients with AP were included for this study according to selection criteria. An informed written consent was taken from all the participants. Detail history was taken and thorough physical examination was done along with relevant laboratory investigations. Ranson's score, Modified Glasgow score, Bedside index of severity in acute pancreatitis (BISAP), red cell distribution width and platelet count ratio (RPR) were calculated. All data were recorded and analyzed by Statistical package for social sciences (SPSS) 23. In this study 44% patients were more than 60 years with a mean age of 51.34 (±15.45) year. More than two thirds patients were (67%) male. In mild acute pancreatitis  mean value of Ranson's score, BISAP score and modified Glasgow score was 0.79 (±0.14), 0.90 (±0.1) and 0.80 (±0.14) and 3.29 (±1.16), 1.77 (±0.46) ,2.74 (±0.69) in moderate to severe pancreatitis respectively with statistically difference were found in both severities (p<.05). The patients with mild pancreatitis and the patients with moderate to severe pancreatitis had significant difference (p<.05) between mean RDW (14.68±1.59% versus 15.51±3.27%), mean RPR (0.043±0.06 versus .062±.002) and platelet count (340.9±841.6 cells/mm3 Versus 236.4±825.4 cells/mm3). The ROC analysis of RPR in predicting severity of pancreatitis showed a cut-off value of ≥ 0.056 and diagnostic accuracy test showed sensitivity, specificity, PPV, NPV and accuracy as 63.6%, 82.2%, 81.4%, 64.9% and 72% respectively. Mean Ranson's score, BISAP score and Modified Glasgow score was 2.09 (±1.45), 1.34 (±0.39) and 1.83 (±1.08) in survived patients and 5.50 (±0.70), 4 and 3.50 (±0.70) in dead patients with significant difference between both groups (p<.05). Mean RDW (15.08±2.67% Vs 17.85±0.21%), mean platelet count (284.43±143×109/L Vs 236.4± 825.4×109/L) and mean RPR (0.053±0.02 Vs 0.094± 0.005) was also significant between survived and dead patients (p<.05). The ROC analysis of RPR in predicting outcome showed cut-off value of ≥ 0.06 and diagnostic accuracy test showed sensitivity, specificity, PPV, NPV and accuracy as 100%, 63.27%, 5.26%, 100% and 64% respectively. Red cell distribution width and platelet count ratio (RPR) can be used as a novel biomarker to predict the severity and mortality of acute pancreatitis in very early stage. Bangladesh Med J. 2021 Sept; 51(1): 18-24

The association between phosphate level at admission and early mortality in acute pancreatitis.

Abnormal phosphate levels are associated with adverse outcomes in critical illness. However, there is scarce evidence on phosphate's impact on acute pancreatitis outcomes, and the few studies examining this subject are relatively small and show conflicting data. We sought to determine the association between phosphate level at admission and the clinical course and outcomes of acute pancreatitis. In this retrospective single-center observational study, we included all adult patients admitted with a primary diagnosis of acute pancreatitis between January 2008 and June 2021. Phosphate levels at admission were classified as normal (2.8-4.5mg/dl), low (below 2.8mg/dl), or high (above 4.5mg/dl). Out of 2308 cases, 1868 patients had documented phosphate levels at admission and were thus included in our final analysis. 1096 (59%) had normal phosphate levels, 686 (37%) had hypophosphatemia, and 86 (4.6%) had hyperphosphatemia on admission. 30-day mortality rates were 3.4%, 3.8%, and 19% in normal, low, and high phosphate levels, respectively. In univariate analysis, hyperphosphatemia was significantly associated with 30-day mortality, with an OR of 6.54 (95% CI 3.39-12.2, p < 0.001; AUC = 0.58). In a multivariate analysis adjusting for age, MAP, GFR, BUN, and pH, hyperphosphatemia remained a statistically significant independent predictor of early mortality (OR-2.93, 95% CI 1.28-6.51, p = 0.009). Hypophosphatemia was not significantly associated with 30-day mortality in univariate analysis, OR of 1.13 (95% CI 0.67-1.87, p = 0.6). Hyperphosphatemia at admission was independently associated with increased 30-day mortality in patients with acute pancreatitis. Hypophosphatemia at admission was not significantly associated with 30-day mortality.

Kynurenine pathway alteration in acute pancreatitis and its role as a biomarker of infected necrosis

IntroductionInfected pancreatic necrosis (IPN) is a major cause of mortality in acute pancreatitis (AP). Currently, no specific strategies are available to predict the development of IPN. Earlier we reported that persistent down-regulation of HLA-DR increases risk of developing IPN. Altered kynurenine pathway (KP) metabolites showed poor prognosis in sepsis. Here we evaluated the role of HLA-DR and KP in IPN. MethodsPatients with ANP and healthy controls were enrolled. Demographic and clinical parameters were recorded. Circulating interleukin (IL)-8, 6, 1β, 10, Tumor necrosis factor-α were quantified using flowcytometry. Plasma procalcitonin, endotoxin, and KP (tryptophan, kynurenine) concentrations were estimated using ELISA. qRT-PCR was conducted to evaluate mRNA expression of HLA-DR, IL-10, Toll like receptor-4 (TLR-4), and kynurenine-3-monooxygenase (KMO) genes on peripheral blood mononuclear cells. Plasma metabolites were quantified using gas chromatography mass spectrometry (GC-MS/MS). Standard statistical methods were used to compare study groups. Metaboanalyst was used to analyse/visualize the metabolomics data. ResultsWe recruited 56 patients in Cohort-1 (IPN:26,Non-IPN:30), 78 in Cohort-2 (IPN:57,Non-IPN:21), 26 healthy controls. Increased cytokines, endotoxin, and procalcitonin were observed in patients with IPN compared to Non-IPN. HLA-DR and KMO gene expressions were significantly down-regulated in IPN groups, showed positive correlation with one another but negatively correlated with IL-6 and endotoxin concentrations. Increased IDO and decreased plasma tryptophan were observed in IPN patients. Metabolome analysis showed significant reduction in several essential amino acids including tryptophan in IPN patients. Tryptophan, at a concentration of 9 mg/ml showed an AUC of 91.9 (95%CI 86.5–97.4) in discriminating IPN. ConclusionHLA-DR downregulation and KP alteration are related to IPN. The KP metabolite plasma tryptophan can act as a potential biomarker for IPN.

The utility of the bedside index of severity in acute pancreatitis at prognosticating adverse outcomes.

Identification of at-risk patients with acute pancreatitis (AP) early on in the course of hospital admission remains a challenge. Early identification of these patients can facilitate early referral to tertiary hospitals with skilled multidisciplinary teams (MDTs) and high-dependency health care facilities. This study retrospectively reviewed the ability of the bedside index of severity in acute pancreatitis (BISAP) score and other biochemical markers to predict organ failure and mortality in acute pancreatitis. All patients presenting to Grey's Hospital with AP between 2012 and 2020 were included in the study. The BISAP score and other biomarkers were evaluated at presentation in predicting organ failure (≥ 48 hours duration) and mortality. A total of 235 patients were included in the study. A total of 144 (61%) were male and 91 (39%) were female. Alcohol (81%) and gallstones (69%) were the commonest aetiological factors amongst males and females respectively. A total of 42 (29%) males and 10 (11%) females developed organ failure during their hospital stay. The mortality rate was 11.8% for males, 6.59% for females, with an overall mortality of 9.8%. A BISAP score of 2 had a sensitivity of 87.98% and specificity of 59.62% at predicting organ failure (positive predictive value [PPV] = 88.46%, negative predictive value [NPV] = 58.49%, 95% confidence interval [CI], p = 0.001). A BISAP score of 3 and above had a sensitivity of 98.11% and specificity of 69.57% at predicting mortality (PPV = 96.74%, NPV = 80%, 95% CI, p = 0.001). A multivariate analysis of biomarkers bicarbonate, base excess, lactate, urea and creatinine either failed to reach statistical significance or had specificity that is too low to prognosticate organ failure and mortality. The BISAP score has limitations at predicting organ failure, but it is a reliable tool for predicting mortality in AP. Due to its simplicity of use, it should be used in resource-constrained settings to triage at-risk patients in smaller hospitals, for early referral to tertiary hospitals.

The relationship of biochemical parameters and radiological parameters in the evaluation of the clinical severity of acute pancreatitis in the emergency department – a retrospective analysis

Introduction and aim. Computed tomography severity index (CTSI) and Balthazar score are among the most frequently used scorings in the determination of severe acute pancreatitis. The primary purpose of this study is evaluation of the effects of biochemical parameters, Balthazar score and CTSI on mortality in acute pancreatitis. At the same time, correlations with biochemical parameters, CTSI and Balthazar score were evaluated in patients with AP. Material and methods. In this study, the amylase, lipase, CRP, and procalcitonin values of ​​ patients diagnosed with acute pancreatitis were retrospectively recorded. Contrast-enhanced computed tomography (CECT) images obtained at the time of presentation to the emergency department or within seven days of admission were re-evaluated by two radiologists. The CTSI scores and Balthazar scores of the patients were calculated. Results. The study included 240 patients. The amylase level of the patients was positively correlated with the Balthazar score at a statistically significant level (R=0.189, p=0.003). In addition,, the relationship between pancreatic scoring systems and mortality, the AUC value for CTSI was 0.9 (95% CI: 0.826-0.973) and was higher than other scoring systems. Conclusion. CTSI had better performance in the prediction of mortality in patients with acute pancreatitis.

Detailed Characteristics of Post-discharge Mortality in Acute Pancreatitis

The in-hospital survival of patients suffering from acute pancreatitis (AP) is 95% to 98%. However, there is growing evidence that patients discharged after AP may be at risk of serious morbidity and mortality. Here, we aimed to investigate the risk, causes, and predictors of the most severe consequence of the post-AP period: mortality. A total of 2613 well-characterized patients from 25 centers were collected and followed by the Hungarian Pancreatic Study Group between 2012 and 2021. A general and a hospital-based population was used as the control group. After an AP episode, patients have an approximately threefold higher incidence rate of mortality than the general population (0.0404 vs 0.0130 person-years). First-year mortality after discharge was almost double that of in-hospital mortality (5.5% vs 3.5%), with 3.0% occurring in the first 90-day period. Age, comorbidities, and severity were the most significant independent risk factors for death following AP. Furthermore, multivariate analysis identified creatinine, glucose, and pleural fluid on admission as independent risk factors associated with post-discharge mortality. In the first 90-day period, cardiac failure and AP-related sepsis were among the main causes of death following discharge, and cancer-related cachexia and non-AP-related infection were the key causes in the later phase. Almost as many patients in our cohort died in the first 90-day period after discharge as during their hospital stay. Evaluation of cardiovascular status, follow-up of local complications, and cachexia-preventing oncological care should be an essential part of post-AP patient care. Future study protocols in AP must include at least a 90-day follow-up period after discharge.

Comparing Prognostic Scores and Inflammatory Markers in Predicting the Severity and Mortality of Acute Pancreatitis.

Acute pancreatitis is an emergency gastrointestinal condition for which severity prediction is crucial during hospitalization. This study aimed to compare the diagnostic accuracy of inflammatory markers with gold standard scoring systems in predicting pancreatitis severity. A prospective, hospital-based, cohort study was conducted, including 249 patients diagnosed with acute pancreatitis via clinical examination. Laboratory investigations and radiological investigations were conducted. The diagnostic accuracy of the inflammatory markers neutrophil/lymphocyte ratio (NLR), lymphocyte/monocyte ratio (LMR), red cell distribution width (RDW), and prognostic nutritional index (PNI) was compared with gold standard prognostic scores, namely, the Acute Physiology and Chronic Health Evaluation II (APACHE II), Simplified Acute Physiology Score II (SAPS II), Bedside Index of Severity in Acute Pancreatitis (BISAP), and Systemic Inflammatory Response Syndrome (SIRS), in predicting primary and secondary outcomes. All values were analyzed using mean and standard deviation (SD). Sensitivity, specificity, positive predictive value, negative predictive value, and area under the receiver operating characteristic curve for mortality prediction were calculated for NLR, LMR, RDW, and PNI. Of 249 patients with acute pancreatitis (mean age: 39-43 years), 94 were classified as mild acute, 74 as moderately severe acute, and 81 as severe acute. The most common etiology was alcohol use (40.2%), followed by gallstones (29.7%), hypertriglyceridemia (6.4%), steroid use (4%), diabetic ketoacidosis (2.8%), hypercalcemia (2.8%), and complication of endoscopic retrograde cholangiopancreatography (2%). On day 1, mean values of NLR, LMR, RDW, and PNI were 8.23±5.11, 2.63±1.76, 15.93±3.64, and 32.84±8.13, respectively. Compared to APACHE II, SAPS II, BISAP, and SIRS on day 1, day 3, day 7, and day 14, the cutoff values for NLR were 4.06, 10.75, 8.75, and 13.75, respectively. Similarly, on day 1, the cutoff value of LMR was 1.95, and on day 1 and day 3, the cutoff values of RDW were 14.75% and 15%, respectively. The results indicate that inflammatory biomarkers NLR, LMR, RDW, and PNI are comparable with gold standard scoring systems for predicting the severity and mortality of acute pancreatitis. NLR on day 7 was significantly associated with higher severity of illness. NLR on days 3, 7, and 14, LMR on day 1, and RDW on days 1 and 3 were significantly associated with mortality.

Association of estimated glomerular filtration rate and all-cause mortality in acute pancreatitis: a retrospective analysis

BackgroundOur primary objective was to explore the association between estimated glomerular filtration rate (eGFR) and all-cause mortality in acute pancreatitis (AP) admission to intensive care units.MethodsThis study is a retrospective cohort analysis based on the Medical Information Mart for Intensive Care III database. The eGFR was calculated based on Chronic Kidney Disease Epidemiology Collaboration equation. Cox models with restricted cubic spline functions were used to evaluated the association of eGFR with all-cause mortality.ResultsThe mean eGFR was 65.93 ± 38.56 ml/min/1.73 m2 in 493 eligible patients. 28-day mortality was 11.97% (59/ 493), which decreased by 15% with every 10 ml/min/1.73 m2 increase in eGFR. The adjusted hazard ratio (95% confidence interval) was 0.85 (0.76–0.96). A non-linear association was proved between eGFR and all-cause mortality. When eGFR < 57 ml/min/1.73 m2, there was a negative correlation between eGFR and 28-day mortality, hazard ratio (95% CI) was 0.97 (0.95, 0.99). The eGFR was also negatively correlated with in-hospital and in-ICU mortality. Subgroup analysis confirmed that the association between eGFR and 28-day mortality in different characteristics was stable.ConclusionsThe eGFR was negatively correlated with all-cause mortality in AP when eGFR is less than the threshold inflection point.

Pancreatic Necrosis Infection as a Determinant of Multiple Organ Failure and Mortality in Acute Pancreatitis.

Several recommendations and data on the treatment of acute necrotizing pancreatitis (ANP) are conflicting and different surgical approaches continue to exist. We conducted a study on 148 patients with ANP, who were divided into two groups: the main group (n = 95) when the tactics of the step-up approach were applied with the principles of the concept of Enhanced Recovery After Surgery (ERAS) in order to determine this approach on effectiveness in reducing complications and 30-day mortality (2017-2022); the comparison group (n = 53) when the same tactic of the treatment was used without ERAS principles (2015-2016). Treatment time for the main group in the intensive care unit was minimized (p ≤ 0.004); it has been shown to reduce the frequency of complications in these patients (p < 0.001) requiring conservative or surgical treatment without general anaesthesia (Clavien-Dindo I-IIIa); no statistically significant differences were observed for the total incidence of Clavien-Dindo IIIb-IVb complications (p > 0.05); the median duration of treatment for patients in the primary group was 23 days, and in the reference group-34 days (p ≤ 0.003). Pancreatic infections have been observed in 92 (62.2%) patients and gram-negative bacteria predominated in the overall pathogen structure with 222 (70.7%) strains. The only evidence of multiple organ failure before (AUC = 0.814) and after surgery (AUC = 0.931) was found to be predictive of mortality. Antibiotic sensitivity of all isolated bacteria better understood local epidemiology and identified the most effective antibiotics when treating patients.

Association between early vasopressor administration and in-hospital mortality in critically ill patients with acute pancreatitis: A cohort study from the MIMIC-IV database.

This study aims to explore the association between early administration of vasopressors and in-hospital mortality in acute pancreatitis (AP) patients admitted to the ICU. The MIMIC-IV database was used to identify AP patients who had and had not received vasopressors. Univariate and multivariate logistic regression, propensity score matching (PSM), and inverse probability of treatment weighting (IPTW) were used for statistical analysis. A total of 894 AP patients admitted to the ICU were included in the study. Among them, AP patients who received vasopressors were associated with an increased risk of in-hospital mortality in the unadjusted model (OR: 7.77, 95% CI 4.92-12.61, p<0.001), multivariable-adjusted model (OR: 2.51,95% CI 1.1-5.76, p<0.05), PSM model (OR: 2.58, 95% CI 1.03-6.85, p<0.05) and IPTW model (OR: 1.82, 95% CI 1.06-3.15, p<0.05) compared with patients who did not receive vasopressors. In the subgroup analysis, age (≥ 65 years old: OR: 2.5, 95% CI 0.82-7.91; <65 years old: OR: 4.63, 95% CI 0.84-26.41), male (OR: 1.19, 95% CI 0.35-4.03), ethnicity (white: OR: 2.49, 95% CI 0.81-7.62; non-white: OR: 4.28, 95% CI 0.85-23.7), usage of norepinephrine (OR: 2.29, 95% CI 0.91-5.78), and single-use of vasopressor (OR: 1.48, 95% CI 0.43-4.95) were not associated with in-hospital mortality in patients with AP, whereas vasopressin (OR: 4.27, 95% CI 1.24-15.13; p<0.05) and phenylephrine usage (OR: 4.75, 95% CI 1.66-13.95; p<0.05), combined vasopressor usage (OR: 4.41, 95% CI 1.55-12.96; p<0.01), and female usage (OR: 7.89, 95% CI 2.03-34.2; p<0.01) were associated with in-hospital mortality. Early vasopressor use is significantly associated with increased in-hospital mortality among critically ill AP patients. This association might be greater in females, vasopressin, phenylephrine, and combined vasopressor users. Our results may benefit clinicians as they can guide the rational use of vasopressors in critically ill AP patients admitted to the ICU.

ОБЩАЯ ХАРАКТЕРИСТИКА КЛИНИЧЕСКИХ НАБЛЮДЕНИЙ ОСТРОГО ПАНКРЕАТИТА БИЛИАРНОЙ ЭТИОЛОГИИ

The dynamics of hospital morbidity and lethality rate in acute biliary pancrea-titis are analyzed; demographic regularities of acute biliary pancreatitis morbidity are determined; general characteristics of clinical observations are presented. The increase in the absolute number of patients with acute pancreatitis of bili-ary etiology and necrotic pancreatitis of biliary etiology in many respects deter-mines the growth of acute pancreatitis morbidity in general. The morbidity of acute pancreatitis of biliary etiology is almost evenly distrib-uted between men and women with the ratio 1,4:1. The peak of morbidity (36,1 %) falls on elderly age. In the age structure of acute biliary pancreatitis the share of elderly and senile age was 62,6 %. Every third patient sought medical help during the first 12 hours, 64,4 % – during the first 24 hours, 78,1 % – dur-ing the first 48 hours of the disease onset. The category of patients with the high-est proportion (14,2 %) were elderly men, who came for treatment in the first 24 hours after the onset of the disease. In 82,7 % of patients with acute biliary pancreatitis the premorbid status was aggravated by two or more concomitant diseases, every 5th patient had CHD manifested by angina pectoris, postinfarction cardiosclerosis or rhythm disturb-ances. Premorbid status has a significant influence on the overall mortality in acute pancreatitis of biliary etiology. The relapses of acute pancreatitis of biliary etiology make up 9,6 % of all the attacks of the disease and 25,3 % of all relapses of acute pancreatitis, and in 47,6 % of cases of recurrent acute pancreatitis of biliary etiology the disease has an equally or more severe course with possible lethal outcome.

JUSTIFICATION OF LYMPHOTROPIC ANTIBACTERIAL THERAPY BENEFITS BASED ON THE CHANGES IN SPECIFIC IMMUNITY PARAMETERS IN ACUTE PANCREATITIS

Introduction. The incidence and features of acute pancreatitis stimulate the scientific community and clinicians to look for new antibiotics and new algorithms for their use in treating this disease, which is the world's third most frequent acute surgical disease. Despite this, acute pancreatitis mortality indicates the need for better approaches, especially in conditions of microbial resistance to antibiotics, which determines the urgency of the problem. The objective of the paper was to justify lymphotropic antibacterial therapy as an alternative method of treatment of acute pancreatitis based on the changes in specific immunity parameters, which will make it possible to increase the effectiveness of treatment of the disease and potential complications. Materials and methods were based on the study of the leukocyte index of intoxication, the hematological index of intoxication, and some other parameters of immunity on lymphotropic and standard antibacterial therapy. With this in mind, patients were divided into two groups. Results. It was established that under the influence of lymphotropic antibacterial therapy, the leukocyte index of intoxication decreased by 0.3392 units on early admission and by 0.4128 units on late admission compared to standard antibacterial therapy. LAT appeared to be more effective in terms of the effect on HII – by 1.1214 units on early admission and by 1.0537 units on late admission. The effect on cellular immunity with LAT was more pronounced than that with standard antibacterial therapy. Discussion. Purulent-infectious foci in acute pancreatitis lead to profound disturbances in the immune system as they develop intensively and quickly, and already after 24 hours of manifestation, they significantly exceed those that develop within 24 hours. Lymphotropic antibacterial therapy adjusts these changes bringing them closer to the control ones, while standard antibacterial therapy fails to do so. Conclusions. Changes in the immune system parameters, which tend towards the control ones, suggest that lymphotropic antibacterial therapy is an alternative to standard therapy.

Has COVID-19 Modified the Weight of Known Systemic Inflammation Indexes and the New Ones (MCVL and IIC) in the Assessment as Predictive Factors of Complications and Mortality in Acute Pancreatitis?

We aimed at evaluating the prognostic capacity of the inflammatory indices derived from routine complete blood cell counts in two groups of patients with acute pancreatitis from two different time periods, before and during the COVID-19 pandemic, when a high incidence of complications with surgical risk and mortality was found. Two new markers were introduced: the mean corpuscular volume to lymphocyte ratio (MCVL) and the cumulative inflammatory index (IIC), which were calculated at a baseline in the two groups of patients. Of the already established markers, none of them managed to effectively predict the complications with surgical risk and mortality, with a decrease of less than 50% in specificity in the peri-COVID group. The MCVL had the best prediction of complications with surgical risk in both the pre-COVID and peri-COVID groups, validated it as an independent factor by multivariate analysis. The IIC had the best prediction of mortality in both periods and was proven to be an independent factor by multivariate analysis. As the IIC predicted death best, we tested the occurrence of death and found that patients with PA who had an IIC &gt; 12.12 presented a risk of death 4.08 times higher in the pre-COVID group and 3.33 times higher in the peri-COVID group. The new MCVL and IIC independent markers had a superior sensitivity and specificity in predicting surgical risk complications and, respectively, mortality in the group of patients with acute pancreatitis during the COVID-19 pandemic, which makes them widely applicable in populations with modified immune and inflammatory status. Conclusions: In patients with acute pancreatitis, MCVL has a significant predictive value regarding complications with surgical risk (abscess, necrosis, and pseudocyst), and the IIC has a significant predictive value for mortality.

A prediction model with measured sentiment scores for the risk of in-hospital mortality in acute pancreatitis: a retrospective cohort study.

BackgroundAccurate and prompt clinical assessment of the severity and prognosis of patients with acute pancreatitis (AP) is critical, particularly during hospitalization. Natural language processing algorithms gain an opportunity from the growing number of free-text notes in electronic health records to mine this unstructured data, e.g., nursing notes, to detect and predict adverse outcomes. However, the predictive value of nursing notes for AP prognosis is unclear. In this study, a predictive model for in-hospital mortality in AP was developed using measured sentiment scores in nursing notes.MethodsThe data of AP patients in the retrospective cohort study were collected from the Medical Information Mart for Intensive Care III (MIMIC-III) database. Sentiments in nursing notes were assessed by sentiment analysis. For each individual clinical note, sentiment polarity and sentiment subjectivity scores were assigned. The in-hospital mortality of AP patients was the outcome. A predictive model was built based on clinical information and sentiment scores, and its performance and clinical value were evaluated using the area under curves (AUCs) and decision-making curves, respectively.ResultsOf the 631 AP patients included, 88 cases (13.9%) cases were dead in hospital. When various confounding factors were adjusted, the mean sentiment polarity was associated with a reduced risk of in-hospital mortality in AP [odds ratio (OR): 0.448; 95% confidence interval (CI): 0.233–0.833; P=0.014]. A predictive model was established in the training group via multivariate logistic regression analysis, including 12 independent variables. In the testing group, the model showed an AUC of 0.812, which was significantly greater than the sequential organ failure assessment (SOFA) of 0.732 and the simplified acute physiology score-II (SAPS-II) of 0.792 (P<0.05). When the same level of risk was considered, the clinical benefits of the predictive model were found to be the highest compared with SOFA and SAPS-II scores.ConclusionsThe model combined sentiment scores in nursing notes showed well predictive performance and clinical value in in-hospital mortality of AP patients.