Acute Pancreatitis Research Articles

Determining the value of endoscopic retrograde cholangiopancreatography in the management of patients with acute pancreatitis and related complications.

Endoscopic retrograde cholangiopancreatography (ERCP) has evolved from a diagnostic to a therapeutic tool in acute pancreatitis management, largely due to the availability of less invasive diagnostic modalities such as endoscopic ultrasound (EUS) and magnetic resonance cholangiopancreatography (MRCP). This review explores the therapeutic applications of ERCP across various acute pancreatitis etiologies and its role in managing complications such as bile duct obstructions, pancreatic duct disruptions, and infected necrosis. The discussion highlights the procedure's expanding indications and its critical role in addressing complex cases. ERCP remains central to the management of acute pancreatitis complications. As endoscopic techniques and devices continue to advance, its therapeutic scope is likely to grow. Performing ERCP for appropriate indications and optimizing its use is essential for minimizing risks and improving outcomes.

New perspectives in the management of acute pancreatitis – focus on antibiotic prophylaxis, management of necrosis and COVID-19 implications

This review highlights the recent development in the management of acute pancreatitis in the area of antibiotic prophylaxis, management of necrosis and correlation with SARS-CoV-2 infection. The evidence from recent studies has not shown a significant benefit of administration of antibiotic prophylaxis in acute pancreatitis. Additionally, a few trials draw attention to the disadvantages of prophylactic use of antibiotics. However, in this area more trials have to be conducted. When it comes to management of necrosis, the recent data recommends a postponed drainage. Delayed procedure is considered now as preferential treatment. Furthermore, delayed drainage is associated with fewer interventions and necrosectomies compared to immediate drainage. There is still insufficient data to confirm the influence of SARS-CoV-2 infection on the development and course of pancreatitis. Special attention should be brought to all COVID-19 patients presenting with gastrointestinal symptoms. Measurement of amylase and/or lipase levels in the serum is recommended for preliminary diagnosis. If suspicion arises, full diagnosis of acute pancreatitis should be conducted for early implementation of supportive treatment.

Increased Early Post-Discharge Mortality in Patients With Acute Pancreatitis.

Emerging evidence suggests that individuals who recover from acute pancreatitis may face a significant risk of mortality during the early post-discharge period. Despite these concerns, comprehensive population-based studies on this issue are lacking. To study in-hospital and post-discharge mortality in patients with acute pancreatitis and how it has changed over time. In a Danish nationwide population-based cohort study, we included all adults discharged after an incident episode of acute pancreatitis between 2002 and 2017. For each patient, five individuals from the general population, matched by age and sex, were selected as controls. We used Cox regression analysis to assess all-cause mortality at 90days, 1, 2, and 5years post-discharge and to examine trends in in-hospital and post-discharge mortality over the study period. Models were adjusted for comorbidities, heavy smoking, alcohol abuse and sociodemographic factors. Of 28,759 adults with incident acute pancreatitis, 956 (3.3%) died in hospital. The 27,803 patients discharged from the hospital following an incident episode of acute pancreatitis were matched with 139,035 individuals (mean age 58.1years, 51.1% men). The cumulative post-discharge mortality at 90days was 5.0% for the acute pancreatitis cohort and 0.55% for controls. The mortality risk was significantly increased in acute pancreatitis patients at 90days post-discharge (adjusted hazard ratio [aHR] 7.62; 95% CI 6.86-8.45); the risk attenuated over time but remained elevated for up to five years (aHR 1.85; 95% CI 1.79-1.92). In-hospital mortality decreased over the study period (aHR 0.65; 95% CI 0.53-0.81) from 2002-2005 to 2014-2017, while post-discharge mortality risk remained stable (aHR 0.85; 95% CI 0.72-1.01). Gastrointestinal and cardiovascular diseases accounted for 59.4% of 90-day post-discharge deaths. In-hospital mortality for acute pancreatitis has improved in recent years. However, the risk of post-discharge mortality remains high, especially in the first 90days after discharge.

4-octyl Itaconate Attenuates Acute Pancreatitis and Associated Lung Injury by Suppressing Ferroptosis in Mice.

Acute pancreatitis (AP) is a common gastrointestinal emergency requiring hospitalization. In recent years, several studies have demonstrated a role for 4-octyl itaconate (4-OI) in anti-inflammatory and oxidative stress injury. However, the potential effects of 4-OI in AP have not been investigated. Caerulein and LPS were used to induce experimental AP models in mice and AR42J cells and then studied by histopathology, biochemical, and molecular analysis. Ferroptosis inhibitor ferrostatin-1 effectively improves pancreatic injury and reduces lipid peroxidation products in experimental AP mice. 4-OI treatment significantly alleviated pancreatic and AP-associated lung injury and inflammation in experimental AP mice by inhibiting ferroptosis. The ferroptosisactivator Erastin blocked the protective effect of 4-OI against pancreatic injury in AP, validating that 4-OI alleviates pancreatitis injury through ferroptosis. In vitro experiments further confirmed that 4-OI treatment ameliorated AP-induced pancreatic injury by inhibiting ferroptosis. Our study, for the first time, found that 4-OI ameliorates AP and AP-related lung injury by inhibiting ferroptosis in experimental AP mice, providing a new therapeutic target for alleviating AP.

Macrophage Activation Syndrome Complicated with Acute Pancreatitis as the First Presentation of Systemic Lupus Erythematosus

Macrophage Activation Syndrome Complicated with Acute Pancreatitis as the First Presentation of Systemic Lupus Erythematosus

Construction and validation of a nomogram for predicting survival in diabetic patients with severe acute pancreatitis: A retrospective study from a tertiary center.

There is currently a lack of nomograms specifically designed for predicting the risk of death in diabetic patients with severe acute pancreatitis (SAP). The objective of this study was to develop a nomogram tailored to diabetic patients with SAP to predict overall survival. Diabetic patients diagnosed with SAP between January 1, 2018 and December 31, 2023 were included in the study. Risk factors were identified through least absolute shrinkage and selection operator regression analysis. Subsequently, a novel nomogram model was developed through multivariable logistic regression analysis. The predictive performance of the nomogram was evaluated using metrics such as the receiver operating characteristic curve, calibration curve, and decision curve analysis (DCA). A total of 206 patients were included in the analysis, with 171 in the survival group and 35 in the deceased group. Multivariate logistic regression indicated that age, platelet, total bilirubin, and potassium were independent prognostic factors for the survival of diabetic patients with SAP. The nomogram demonstrated a performance comparable to sequential organ failure assessment (P = 0.570). Additionally, the calibration curve showed satisfactory predictive accuracy, and the DCA highlighted the clinical application value of the nomogram. We have identified key demographic and laboratory parameters that are associated with the survival of diabetic patients with SAP. These parameters have been utilized to create a precise and user-friendly nomogram, which could be an effective and valuable clinical tool for clinicians.

Clinical risk factors for sarcopenia in acute and chronic pancreatitis

BackgroundSarcopenia is common in chronic pancreatitis (CP) and has been associated with unfavorable outcomes; however, it is not well studied in acute pancreatitis (AP).AimsTo evaluate risk factors for sarcopenia among individuals with AP or CP.MethodsA cross sectional analysis was performed among subjects with AP or CP seen in a tertiary care Pancreas Clinic. TeraRecon software was used to calculate the cross-sectional area of skeletal muscle, visceral fat, and subcutaneous fat at the level of the L3 vertebrae. Sarcopenia was classified using sex-specific skeletal muscle index. Univariate and multivariate logistic regressions were performed to assess differences between groups and associations with sarcopenia.ResultsA total of 49 subjects with AP and 54 subjects with CP were included. Sarcopenia was more frequently observed in CP compared to AP (83.3% vs. 46.9%, p < 0.001). The multivariate logistic regression demonstrated CP, male sex, increased age, and decreased subcutaneous fat were independently associated with sarcopenia.ConclusionSarcopenia is observed in both CP and AP. In addition to traditional risk factors (including male sex, older age, and decreased subcutaneous fat), CP is independently associated with sarcopenia. Further investigations are necessary to gain deeper insights into sarcopenia pathogenesis, which could inform potential intervention strategies.

Octreotide attenuates experimental severe acute pancreatitis through inhibiting pyroptosis and modulating intestinal homeostasis.

Severe acute pancreatitis (SAP) is a common clinical condition characterized by acute abdominal symptoms. Octreotide (OCT) is a commonly prescribed treatment for acute pancreatitis (AP). Recent research shows that pyroptosis and intestinal homeostasis significantly contribute to the progression of AP. However, it remains unclear whether OCT treats SAP through modulating pyroptosis and intestinal microbiota. Our study aimed to investigate and validate the potential therapeutic effects of OCT on SAP and underlying mechanisms. The inhibition of pyroptosis in mice using disulfiram was investigated to elucidate the role of pyroptosis in AP. Molecular biology experiments confirmed that OCT effectively inhibited the expression of pyroptosis-related markers. Additionally, the composition, abundance, and functionality of the intestinal microbiota were analyzed using 16S rRNA sequencing, while short-chain fatty acids (SCFAs) were quantified by targeted metabolomics. Our study demonstrated that the administration of OCT significantly mitigated the severity of SAP in a dose-dependent manner. Furthermore, the inhibition of pyroptosis in mice attenuated SAP, thereby highlighting the critical role of pyroptosis in this condition. OCT administration was observed to suppress the expression of key pyroptosis markers. Additionally, there was a notable reduction in intestinal permeability and bacterial translocation. OCT reverses gut dysbiosis caused by SAP, increasing beneficial bacteria while inhibiting pathogenic strains. Furthermore, OCT administration enhanced the levels of SCFAs, including propanoic acid, acetic acid, and butyric acid. Our findings indicate OCT has the potential to alleviate SAP by suppressing pyroptosis and restoring intestinal homeostasis.

Association between the triglyceride–glucose index and the risk of acute kidney injury in critically ill patients with acute pancreatitis: a retrospective study

BackgroundThe triglyceride–glucose (TyG) index is increasingly recognized for its ability to predict cardiovascular and metabolic risks. This study investigated the correlation between the TyG index and the risk of acute kidney injury(AKI) in critical ill patients with acute pancreatitis(AP).MethodsThe Medical Information Mart for Intensive Care IV database was retrospectively searched to identify AP patients hospitalized in the intensive care unit. The primary outcome measure was the incidence of AKI. The secondary endpoint was in-hospital mortality and the rate of renal replacement therapy(RRT) use. Cox regression analysis and restricted cubic spline were used to analyze TyG index association with AKI risk. Kaplan–Meier survival analysis was performed to assess the incidence of endpoints in the different groups.ResultsA total of 848 patients were enrolled. The incidence of AKI was 61.56%.The in-hospital mortality was 11.69%. Kaplan–Meier analysis showed that the TyG index ≥ 8.78 group has a high incidence of AKI and high risk of requiring RRT (P < 0.001). Multivariable Cox regression analysis showed whether TyG index was a continuous variable (HR, 1.65 [95% CI 1.10–2.48], P = 0.015) or a categorical variable (HR, 1.72 [95% CI 1.09–2.79], P = 0.028), and the TyG index was independently associated with the risk of AKI in AP patients. The restricted cubic splines model illustrated the linear relationship between higher TyG index and increased risk of AKI in this specific patient population.ConclusionsHigh TyG index is an independent risk factor for AKI in critical ill patients with AP. Assessing the TyG index may be beneficial for early stratification and interventions to improve prognosis.

Natural Antioxidants: New Possibilities For The Treatment and Prevention of Acute Pancreatitis

Abstract Acute pancreatitis is one of the serious diseases of the gastrointestinal tract with possible systemic complications. The goal of AP therapy is thorough supportive treatment after obtaining hemodynamic status, prevention of necrosis, infection of the pancreas and organ failure. At present, however, there is no suitable pharmacological treatment that would act in the basic process of the pathology of acute pancreatitis. According to available scientific information, suitable candidates could be natural antioxidants that act on processes affecting oxidative stress in pancreatic acinar cells and thus have anti-inflammatory, antioxidant and anti-tumour effects.

Selenium Mitigates Caerulein and LPS-induced Severe Acute Pancreatitis by Inhibiting MAPK, NF-κB, and STAT3 Signaling via the Nrf2/HO-1 Pathway.

Severe acute pancreatitis (SAP) leads to systemic inflammation, resulting in multiorgan damage. Acute lung injury and acute respiratory distress syndrome develop in one-third of SAP patients, with a high mortality rate of 60% due to secondary complications. Patients with pancreatitis often have selenium deficiency, and selenium supplements may provide beneficial effects. This study examined the protective role of selenium in a model of SAP induced by caerulein + lipopolysaccharide (cae + LPS). Mice were administered selenium (1mg/kg) before being challenged with caerulein (6 injections of 50μg/kg) and LPS (10mg/kg). At 3h after the last caerulein injection, blood was collected for estimating pancreatic enzymes and cytokine levels, and the mice were euthanized. We performed morphological and histological studies, measured levels of protease and oxidative stress markers and conducted western blot, ELISA, and RT-qPCR analyses. We examined lung tissue histologically and estimated myeloperoxidase levels. Selenium pretreatment significantly reduced pancreatic enzyme levels such as amylase, lipase, and proteases (specifically MMPs) and reversed tissue injury in the pancreas and lungs caused by cae + LPS. In addition, selenium-treated mice showed decreased levels of inflammatory markers and chemokines. Examination of the downstream inflammatory pathways confirmed the protective effect of selenium, which mediates its anti-inflammatory and antioxidant action by inhibiting the major inflammatory signaling pathways (MAPKs, NF-κB, and STAT3) and activating the phosphorylation of Nrf2 via Nrf2/HO-1 pathways. These findings suggest that selenium may be a potential therapeutic option for treating SAP-associated secondary complications.

Iron and ferroptosis in kidney disease: molecular and metabolic mechanisms

Maintaining iron homeostasis is necessary for kidney functioning. There is more and more research indicating that kidney disease is often caused by iron imbalance. Over the past decade, ferroptosis’ role in mediating the development and progression of renal disorders, such as acute kidney injury (renal ischemia-reperfusion injury, drug-induced acute kidney injury, severe acute pancreatitis induced acute kidney injury and sepsis-associated acute kidney injury), chronic kidney disease (diabetic nephropathy, renal fibrosis, autosomal dominant polycystic kidney disease) and renal cell carcinoma, has come into focus. Thus, knowing kidney iron metabolism and ferroptosis regulation may enhance disease therapy. In this review, we discuss the metabolic and molecular mechanisms of iron signaling and ferroptosis in kidney disease. We also explore the possible targets of ferroptosis in the therapy of renal illness, as well as their existing limitations and future strategies.

Annular Pancreas and Superior Mesenteric Artery Syndrome: Rare Etiologies and an Exceptional Association – A Case Report

Annular pancreas and superior mesenteric artery syndrome are rare anatomical abnormalities, even more unusual when they coexist. This case report presents a 21-year-old patient suffering from recurrent acute pancreatitis and postprandial vomiting. Imaging revealed an annular pancreas encircling the duodenum, causing partial stenosis, and duodenal compression by the superior mesenteric artery (with an aorto-mesenteric angle reduced to 18°), characteristic of superior mesenteric artery syndrome [1, 2]. This association created a vicious cycle: duodenal obstruction and stasis promoted pancreatitis, while weight loss exacerbated mesenteric compression [3]. Initial treatment was medical (rehydration and parenteral nutrition), with surgical intervention (duodenojejunostomy) undertaken after failure of conservative measures. This case underscores the importance of a multidisciplinary approach to diagnose and manage these complex anomalies [4].

Construction and validation of risk prediction models for renal replacement therapy in patients with acute pancreatitis.

Renal replacement therapy (RRT) plays a crucial role in managing acute pancreatitis (AP). This study aimed to develop and evaluate predictive models for determining the need for RRT among patients with AP in the intensive care unit (ICU). A retrospective selection of patients with AP was made from the Medical Information Mart for Intensive Care IV (MIMIC-IV, version V2.0). The cohort was randomly divided into a training set (447 patients) and a validation set (150 patients). The least absolute shrinkage and selection operator (LASSO) regression cross-validation method was utilized to identify key features for model construction. Using these features, four machine learning (ML) algorithms were developed. The optimal model was visualized and clarified using SHapley Additive exPlanations (SHAP) and presented as a nomogram. The mean age of the cohort was 59.17years, with an average Acute Physiology and Chronic Health Evaluation II (APACHE II) score of 17.55. Acute kidney injury (AKI) was observed in 52.43% of patients with AP, and 9.05% required RRT. After feature selection, four of 41 clinical factors were ultimately chosen for use in model construction. The Lasso-Logistic Regression (Lasso-LR) model showed a high discriminative ability to predict RRT risk in patients with AP, with an area under the receiver operating characteristic (AUROC) of 0.955 (95% CI 0.924-0.987) in the training set. In the validation set, it maintained its discriminative performance, achieving an AUROC of 0.985 (95% CI 0.970-1.000). Calibration curves indicated an excellent fit in both sets (Brier scores: 0.039 and 0.032, respectively), suggesting high consistency. Decision curve analysis (DCA) highlighted the Lasso-LR model's significant clinical utility in predicting RRT likelihood in patients with AP. Developed via the LASSO regression cross-validation method, the Lasso-LR model significantly excels in predicting the requirement for RRT in patients with AP, demonstrating its potential for clinical application.

Volume Matters: Examining The Management Of Necrotizing Pancreatitis In The United States.

To examine the impact of hospital volume on mortality and healthcare utilization in patients admitted with necrotizing pancreatitis (NP). Over 20% of patients with acute pancreatitis develop NP, which has been associated with higher rates of procedural intervention, morbidity, and mortality. Adult patients admitted with NP were identified in the 2016-2019 Nationwide Readmissions Database 2016-2019. Hospital volume cutoffs were defined by tertiles of total NP admissions per year (low-volume [<9 admissions/year]; medium-volume [9-25 admissions/year]; high-volume [≥26 admissions/year]). Subgroup analyses were performed for NP patients undergoing procedural intervention. The primary outcome was in-hospital mortality. Multivariable logistic regression models determined the association between clinical outcomes and hospital volume. A total of 25,483 patients were identified, 14.3% of whom underwent procedural intervention, with the highest rate of intervention occurring in high-volume hospitals. The most common interventions offered at low- and medium-volume hospitals were open necrosectomy and percutaneous drainage. In contrast, high-volume hospitals had increased rates of minimally invasive surgery and endoscopic management. High-volume centers had the highest mortality rate among all patients (7.3% vs. 6.6% vs. 5.5%, P<0.001) but the lowest among the intervention-only cohort (7.5% vs. 10.4% vs. 12.0%, P<0.001). After adjusting for confounders, high-volume centers had lower odds of mortality in all patients (odds ratio (OR) 0.78, 95% confidence interval (CI) 0.65-0.93) and in the intervention-only cohort (OR 0.64, 95% CI 0.42-0.96). High-volume hospitals were also associated with a shorter hospital stay and lower healthcare costs. Management of NP at high-volume hospitals was associated with improved survival and decreased healthcare utilization. As interventional techniques advance, following evidence-based guidelines and implementing clear referral pathways will optimize outcomes for both patients and hospital systems.

Personalized prediction of acute pancreatitis after endoscopic transpapillary interventions

To develop the personalized model for predicting the risk of acute pancreatitis after endoscopic transpapillary interventions. A retrospective analysis of treatment outcomes included 366 patients with benign and malignant pancreaticobiliary diseases who underwent endoscopic transpapillary interventions. Risk factors associated with patients, underlying diseases and interventions were analyzed. Logistic regression analysis was used to present the personalized model for predicting the risk of acute pancreatitis. Female gender (p=0.028), age <40 years (p=0.001-0.018), calculous cholecystitis (p=0.010) and stenosis of the major duodenal papilla (p=0.008) are patient-associated risk factors of acute postoperative pancreatitis. Stenting of the main pancreatic duct and thoracic epidural analgesia reduced this risk by 6.5 and 4.6 times, respectively. We developed significant (p<0.001) regression model to determine the likelihood of acute post-manipulation pancreatitis. Original prediction model is valuable to determine the risk of acute pancreatitis after endoscopic transpapillary interventions. This model justifies various methods to prevent this complication.

Overexpression of miR-155 Modulates Interferon Response and Inhibits Viral Replication of IHNV and IPNV in EPC Cells.

Infections caused by RNA viruses, including infectious haematopoietic necrosis virus (IHNV) and infectious pancreatic necrosis virus (IPNV), result in substantial economic losses in the aquaculture industry. MicroRNAs (miRNAs), particularly miR-155, play crucial roles in regulating host immune responses and viral infections. In this study, we investigated the overexpression effect of miR-155 in Epithelioma papulosum cyprini (EPC) cells infected with IHNV and IPNV and analysed the mechanisms underlying these antiviral activities. EPC cells were transfected with miR-155 at 40 pmol and then infected with IHNV or IPNV at an MOI of 0.01. The cytopathogenic effect (CPE) was observed for 5 days post-infection. The cells transfected with miR-155 did not show any signs of CPE or exhibit any viral growth over time after infection with both viruses. Additionally, real-time qPCR of type I interferon-related immune genes (ISG15 and Mx1) showed upregulation at 0, 24, and 48 h.p.i in cells transfected with miR-155. At 48 h post-infection, the cells transfected with miR-155 did not show any bands of viral protein by western blot. Furthermore, the overexpression of miR-155 in EPC cells significantly enhanced the expression of interferon response genes by targeting BCL2 and CYLD and suppressed the viral replication through directly targeting viral genes, including the L gene of IHNV and the VP2 gene of IPNV. These findings elucidate the dual mechanism of miR-155's antiviral effect through immune modulation and direct viral gene targeting, offering insights for developing novel antiviral strategies in aquaculture.

Ultrasonography in the diagnosis of acute pancreatitis keeping computed tomography as a gold standard: Multi-center study.

Acute pancreatitis is considered as a major risk towards the health of the patient as the sudden incidence of the inflammation in the pancreas develops sufficient impacts on the physiological functionality of the adjacent tissues or the organs. Study Design: Cross-sectional study. Setting: PAF Hospital Islamabad. Period: November 2021 to February 2022. Methods: This study, conducted at PAF Hospital Islamabad, evaluated the diagnostic efficacy of ultrasound and CT imaging in 150 patients with acute pancreatitis. Following ethical approval and informed consent, patients aged 15-70 years with serum amylase levels above 400 U/L were included. Ultrasounds and CT scans were performed by experienced radiologists, and data were analyzed using MS Excel and SPSS. The study assessed sensitivity, specificity, predictive values, and diagnostic accuracy of both imaging modalities. Results were stratified by age, gender, BMI, and disease duration, with true positives and negatives identified based on consistent imaging results, ensuring a thorough evaluation of imaging effectiveness for acute pancreatitis diagnosis. Results: Patients were predominantly aged 36-55 (127 patients) and male (115 patients). USG showed limited diagnostic accuracy (37.6%) with a sensitivity of 41% and specificity of 35.1%. The study evaluated the diagnostic accuracy of ultrasound (USG) compared to CT scans in identifying acute pancreatitis. The positive predictive value (PPV) was 35%, and the negative predictive value (NPV) was 41%. With an overall diagnostic accuracy of 37.6%, the findings highlight USG’s limited reliability for diagnosing acute pancreatitis when compared to CT. The significance value was 0.072, influenced by a high rate of false positives. The results underscore the varying reliability of USG across different demographics. Conclusion: Ultrasonography (USG) shows limited reliability in diagnosing acute pancreatitis compared to CT, with a sensitivity of 41%, specificity of 35.1%, and overall accuracy of 37.6%. The high rate of false positives highlights that while USG can be a preliminary tool, CT remains essential for accurate diagnosis and effective clinical management.

Advances in acute pancreatitis management: From guidelines to clinical practice

Objectives: This study aimed to evaluate current management strategies and early outcomes in patients with acute pancreatitis (AP) to provide insights into effective practices and contribute to the discourse on optimizing AP care. Methods: A retrospective observational study was conducted on 350 AP patients admitted to Kanuni Sultan Süleyman Training and Research Hospital between January 2015 and December 2022. Data were extracted from electronic medical records, including demographics, clinical presentation, laboratory findings, imaging results, treatment strategies, and outcomes. Patients were assessed for severity using the Revised Atlanta Classification and Bedside Index for Severity in Acute Pancreatitis (BISAP) scores, and management protocols included controlled fluid resuscitation, pain management, nutritional support, selective antibiotic use, and endoscopic interventions. Results: Of 350 patients (male: 54%, mean age: 50 years), 79.7% had mild AP, 14.9% moderately severe AP, and 5.4% severe AP. Goal-directed fluid resuscitation and early nutritional support were implemented, with early oral feeding initiated in 81.4% of cases. Antibiotics were used in 20% of patients with confirmed or suspected infections, and Endoscopic retrograde cholangiopancreatography (ERCP) was performed in 24.6% of patients with biliary pancreatitis. The mean hospital stay was 7, 14, and 21 days for mild, moderately severe, and severe AP, respectively. Intensive care unit (ICU) admission was required for 8.6%, and in-hospital mortality was 2%. Recurrence within six months occurred in 9.1% of cases. Conclusions: management strategies adhering to current guidelines led to favorable early outcomes, including reduced complications and a high six-month survival rate (98%). Future multicenter studies are recommended to confirm these findings and assess long-term outcomes.

Evaluating the effectiveness of BISAP score in predicting severity of acute pancreatitis.

Objective: To assess the efficacy of the BISAP score in predicting the severity of acute pancreatitis. Study Design: Cross Sectional, Retrospective. Setting: Surgical Unit, Mardan Medical Complex, KPK. Period: June 2022 to October 2024. Methods: A sample size of 192 was determined. The study included patients aged 18-60 years, of both genders, diagnosed with acute pancreatitis based on the American Pancreatic Association criteria. Data was collected using a standardized form and analyzed with SPSS version 22. Results: Among the 192 patients, males and females’ ratio was 1.4: 1. with mean age of 35.89 ± 13.39 years. 31.2% had severe acute pancreatitis (score &gt;3), while 68.75% had mild pancreatitis (p value &lt; 0.001). The area under curve was 0.98, indicating strong diagnostic power. The study had a sensitivity 96.67%, specificity 93.2%, positive likelihood ratio (PPV) 86.6%, and true negative rate (NPV) of 98.43%. Overall diagnostic effectiveness for severity and mortality was 94.3% and 80.7%, respectively. Conclusion: The BISAP score is reliable, rapid, and cost-effective means for assessing severity, enabling effective patient stratification and prompt initiation of intensive management of severe patients to reduce mortality and morbidity.