Organ Failure In Acute Pancreatitis Research Articles

Development and validation of a nomogram combining pain score with laboratory indicators for predicting persistent organ failure in acute pancreatitis: a retrospective cohort study.

Acute pancreatitis is an inflammatory disease that can lead to persistent organ failure (POF), which is associated with increased morbidity and mortality. Early prediction of POF in AP can significantly improve patient outcomes. To develop and validate a nomogram that combines pain score with laboratory indicators for predicting POF in patients with AP. A retrospective cohort study was conducted, including patients diagnosed with AP. Pain score and laboratory indicators were collected within the first 24 h of admission. A nomogram was developed using logistic regression models and validated in a separate cohort. There were 807 patients in the training cohort and 375 patients in the internal validation cohort.Multivariate logistic regression demonstrated that pain score, serum creatinine, hematocrit, serum calcium, and serum albumin were independent risk factors for the incidence of POF in patients with AP. The area under the curve of the nomogram constructed from the above factors were 0.924, respectively. The model demonstrated good calibration and discrimination in both the development and validation cohorts. The nomogram had a good performance in predicting POF in patients with AP and can be used to guide clinical decision-making.

Intra-abdominal pressure: a predictor of severity in acute pancreatitis

Background: Acute pancreatitis is a multisystem disease which has an unpredictable course. The major consequence of severe acute pancreatitis is usually intra-abdominal hypertension. So, abdominal compartment syndrome occurs with serve increase in intra-abdominal pressure (IAP) with organ failure. If conservative measures fail, some early interventional procedures have to be performed to reduce mortality in those patients. Methods: The ethics committee clearance was obtained. The study included 50 patients who were admitted in our institution with acute pancreatitis (diagnosed based on clinical, radiological, biochemical parameters) from December 2022 to August 2023. Intravesical route was used to measure IAP and it was performed by bladder catheterization using a Foley's catheter which was then connected with a three-way stopcock, which further attached with a water manometer and on that same day APACHE scores was calculated, compared and analyzed. Results: IAP was >25 cm H2O in 48% of patients and 28% of patients developed MODS and they did not survive. The mean IAP among the survivors was 13.56 cm H2O and in non-survivors it was 24.94 cm H2O. Correlation studies between IAP & the clinical severity of acute pancreatitis was significant (p<0.05). Conclusions: IAP seems to be a simple, reliable and single mortality predictor and helps to assess organ failure in acute pancreatitis and it also well correlates with other pancreatic prognostic scores. It also serves as a selective prognostic marker in acute pancreatitis and found to have a direct correlation between IAP and clinical severity of acute pancreatitis.

Early Predictive Value of Different Indicators for Persistent Organ Failure in Acute Pancreatitis: A Systematic Review and Network Meta-Analysis.

In this study, we conducted this network meta-analysis (based on the ANOVA model) to evaluate the predictive efficacy of each early predictor. Persistent organ failure (POF) is one of the determining factors in patients with acute pancreatitis (AP); however, the diagnosis of POF has a long-time lag (>48h). It is of great clinical significance for the early noninvasive prediction of POF. We conducted a comprehensive and systematic search in PubMed, Cochrane library, Embase, and Web of Science to identify relevant clinical trials, case-control studies, or cohort studies, extracted the early indicators of POF in studies, and summarized the predictive efficacy of each indicator through network meta-analysis. The diagnostic odds ratio (DOR) was used to rank the prediction efficiency of each indicator. We identified 23 studies in this network meta-analysis, including 10,393 patients with AP, of which 2014 patients had POF. A total of 10 early prediction indicators were extracted. The mean and 95% CI lower limit of each predictive indicator were greater than 1.0. Albumin had the largest diagnostic odds ratio, followed by high-density lipoprotein-cholesterol (HDL-C), Ranson Score, beside index for severity in acute pancreatitis Score, acute physiology and chronic health evaluation II, C-reactive protein (CRP), Interleukin 6 (IL-6), Interleukin 8 (IL-8), Systemic Inflammatory Response Syndrome (SIRS) and blood urea nitrogen. Albumin, high-density lipoprotein-cholesterol, Ranson Score, and beside index for severity in acute pancreatitis Score are effective in the early prediction of POF in patients with AP, which can provide evidence for developing effective prediction systems. However, due to the limitations of the extraction method of predictive indicators in this study, some effective indicators may not be included in this meta-analysis.

Elevated venous lactate level as an early predictive marker of organ failure in acute pancreatitis: a retrospective study.

The aim of this study was to elucidate the relationship between venous lactate levels and the severity of acute pancreatitis (AP). Retrospective data analysis was conducted on patients diagnosed with acute pancreatitis. The comparative assessment encompassed baseline characteristics, laboratory data, illness severity, local consequences, and organ failure instances. This comparison was performed between patients exhibiting normal serum lactic acid levels (HL) and those displaying elevated HL levels. The association between serum HL levels and other pertinent clinical markers was investigated using linear regression. Logistic regression analysis was employed to evaluate the utility of elevated serum lactate levels in identifying high-risk groups. Significantly elevated serum HL levels were observed in patients with moderately severe acute pancreatitis (MSAP) and severe acute pancreatitis (SAP) in contrast to those with mild acute pancreatitis (MAP) (p<0.01). Multivariate logistic analysis demonstrated that higher lactate levels independently predicted organ failure (95% CI 0.738-0.902, p<0.05). Receiver operating characteristic (ROC) curve analysis indicated that the lactate (LAC) cut-off value of 2.45 mmol/L yielded sensitivity and specificity values of 76.5% and 79.1%, respectively, for predicting AP-associated organ failure. The corresponding area under the curve (AUC) was 0.820. In AP patients, elevated serum HL levels signify disease severity and hold predictive potential for assessing the risk of organ failure.

Peri-onset non-steroidal anti-inflammatory drugs use and organ failure in acute pancreatitis: A multicenter retrospective analysis

Organ failure (OF) of acute pancreatitis (AP) significantly contributes to AP-related mortality. Non-steroidal anti-inflammatory drugs (NSAIDs) have been associated with reduced complications of AP. We aimed to investigate whether NSAIDs ameliorates SIRS and OF in patients with AP. Eligible patients with AP were retrospectively identified in 4 hospitals between January 2015 and December 2018. Associations between peri-onset NSAIDs use (day -3 to day 3) and OF, persistent OF (POF), and SIRS within the first week were analyzed. Propensity score-matched (PSM) analysis and inverse probability of treatment-weighted (IPTW) analysis were used to estimate risk ratios. Among 1,528 patients with AP (97 [6.3%] with NSAIDs use), 242 (15.8%) developed organ failure, 89 (5.8%) progressed to POF, and 27 (1.8%) died within 3 months. PSM analysis showed no association between peri-onset NSAIDs and OF (risk ratio [RR], 1.00; 95% confidence interval [CI], 0.46 to 2.15) and POF (RR, 0.80; 95% CI, 0.21 to 2.98). IPTW analysis yielded similar results. Patients with and without peri-onset NSAIDs use were comparable with respect to OF, POF, and SIRS across subgroups defined by COX-2 selectivity and dose. Peri-onset NSAIDs use was not significantly associated with reduced OF.

Decreased HDL-C Levels as a Predictor of Organ Failure in Acute Pancreatitis in the Emergency Department.

High-density lipoprotein cholesterol (HDL-C) is reported as a biomarker of systemic inflammation and multi-organ failure (MOF), which has been rarely investigated in acute pancreatitis (AP), a frequent condition in the emergency department (ED). The objective was to study the predictive capacity of the decrease in HDL-C to the progression of MOF in AP in the ED; analyzing 114 patients with AP for one year in a longitudinal and prospective study, AP severity was obtained by the Atlanta classification, in relation to modified Marshall and Bedside Index for Severity in Acute Pancreatitis (BISAP) scores, and clinical and laboratory parameters in a 48 h hospital stay. The area under the receiver operating characteristic (ROC) curve was used to estimate the validity of the predictor and define optimal cut-off points. It was found that AP was classified as severe in 24.5%, mainly for biliary etiology (78.9%) and female sex (73.6%). As a biomarker, HDL-C decreased from 31.6 to 29.5 mg/dL in a 48 h stay (p < 0.001), correlating negatively with the increase in severity index > 2 and the modified Marshall (p < 0.032) and BISAP (p < 0.009) scores, finding an area under the ROC curve with a predictive capacity of 0.756 (95% CI, 0.614-0.898; p < 0.004) and a cut-off point of 28.5 mg/dL (sensitivity: 79%, specificity: 78%), demonstrating that the decrease in HDL-C levels serves as a useful indicator with a predictive capacity for MOF in mild to severe AP, during a 48 h hospital stay in the ED.

Relationship of circulating levels of long-chain fatty acids to persistent organ failure in acute pancreatitis.

During acute pancreatitis (AP), free fatty acids (FFAs) are liberated from circulating triglycerides (TG) and injured adipocytes by pancreatic lipase. Circulating FFAs have been suspected as a source of systemic lipotoxicity in AP. However, assessment of FFAs is difficult and time-consuming, and little is known about relative levels of FFAs between patients with different severities of AP and controls. This study's aims were to assess early circulating levels of FFAs, (both saturated and unsaturated) in patients with AP vs. controls, and associations between FFA levels and AP severity. Serum samples from patients with AP were collected at enrollment (day 1 of hospital stay); serum samples were also collected from controls. FFAs including palmitic, palmitoleic, stearic, oleic, and linoleic acid were extracted and quantitated using gas chromatography separation. Severity of AP was determined by Revised Atlanta Classification. Differences in FFA levels and percentages of total FFAs were assessed between patients with AP and controls and patients with AP of different severity grades. A total of 93 patients with AP (48 female, 52%) and 29 controls (20 female, 69%) were enrolled. Of the patients with AP, 74 had mild/moderate and 19 had severe AP. Serum levels of all FFAs except stearic acid were significantly higher in patients with AP compared with controls. A strong and independent association between elevated palmitoleic acid levels and severe AP was found. Serum unsaturated FFA levels, specifically palmitoleic acid, appear to correlate with severe AP. These findings have potential clinical implications for targeted AP therapies.NEW & NOTEWORTHY Drivers of the inflammatory response in acute pancreatitis remain incompletely understood. Unsaturated fatty acids, specifically palmitoleic, appear to have an association with more severe acute pancreatitis. This finding presents a new clinical understanding of fatty acid toxicity and highlights a potential future target for treatment in severe acute pancreatitis.

C-reactive protein and Procalcitonin Levels in Acute Pancreatitis: A Study in A Tertiary Care Hospital in Bangladesh

Background: Acute pancreatitis is an inflammatory disease of highly variable severity, ranging from mild cases with low mortality to severe cases with high mortality. Numerous biomarkers have been studied as potential early predictors of the severity of this disease so that treatment can be optimally tailored to prevent complications. C-reactive protein and procalcitonin are the most promising single markers for assessment of major complications and prognosis. Aim of the Study: The aim of this study was to evaluate C-reactive protein and procalcitonin levels in acute pancreatitis. Methods: This was a prospective observational study. The study was conducted on 35 admitted patients with diagnosis of acute pancreatitis at BIRDEM General Hospital, Dhaka, Bangladesh from October 2016 to April 2017. Complete blood count, serum amylase, serum lipase, C-reactive protein and serum procalcitonin values were observed. Data were collected from history, clinical findings and investigations. Proper written consents were taken from all the participants before data collection. A predesigned questioner was used in data collection. All data were processed, analyzed and disseminated by using MS Excel and SPSS version 23 program as per necessity. Results: Among the parameters of the patients, P values of CRP were 0.047 and procalcitonin (PCT) was 0.032, less than 0.05 which were statistically significant. These studies have shown that, serum procalcitonin (PCT) is a good marker for predicting severity and development of organ failure in acute pancreatitis and it is superior to serum C reactive protein. The negative predictive values and positive predictive value for the procalcitonin were higher (90% and 53% respectively) than the respective values for CRP (89% and 47% respectively). The values of PCT showed high sensitivity of 91% and specificity of 81% in predicting severe acute pancreatitis. The negative predictive value was high (90%) indicating that with a negative test result ...

Altered gut microbiota in the early stage of acute pancreatitis were related to the occurrence of acute respiratory distress syndrome.

Acute respiratory distress syndrome (ARDS) is the most common cause of organ failure in acute pancreatitis (AP) patients, which associated with high mortality. Specific changes in the gut microbiota have been shown to influence progression of acute pancreatitis. We aimed to determine whether early alterations in the gut microbiota is related to and could predict ARDS occurrence in AP patients. In this study, we performed 16S rRNA sequencing analysis in 65 AP patients and 20 healthy volunteers. The AP patients were further divided into two groups: 26 AP-ARDS patients and 39 AP-nonARDS patients based on ARDS occurrence during hospitalization. Our results showed that the AP-ARDS patients exhibited specific changes in gut microbiota composition and function as compared to subjects of AP-nonARDS group. Higher abundances of Proteobacteria phylum, Enterobacteriaceae family, Escherichia-Shigella genus, and Klebsiella pneumoniae, but lower abundances of Bifidobacterium genus were found in AP-ARDS group compared with AP-nonARDS groups. Random forest modelling analysis revealed that the Escherichia-shigella genus was effective to distinguish AP-ARDS from AP-nonARDS, which could predict ARDS occurrence in AP patients. Our study revealed that alterations of gut microbiota in AP patients on admission were associated with ARDS occurrence after hospitalization, indicating a potential predictive and pathogenic role of gut microbiota in the development of ARDS in AP patients.

Anemia can predict organ failure in acute pancreatitis.

Acute pancreatitis (AP) is the leading hospital admission in Gastroenterology and has a variable clinical course. Identifying severity of AP patients in its early stages is of foremost importance to improve prognosis. The revised Atlanta Classification grades AP severity by the presence of organ failure and local complications.

Circulating monocytes in acute pancreatitis.

Acute pancreatitis is a common gastrointestinal disease characterized by inflammation of the exocrine pancreas and manifesting itself through acute onset of abdominal pain. It is frequently associated with organ failure, pancreatic necrosis, and death. Mounting evidence describes monocytes - phagocytic, antigen presenting, and regulatory cells of the innate immune system - as key contributors and regulators of the inflammatory response and subsequent organ failure in acute pancreatitis. This review highlights the recent advances of dynamic change of numbers, phenotypes, and functions of circulating monocytes as well as their underling regulatory mechanisms with a special focus on the role of lipid modulation during acute pancreatitis.

Development an Inflammation-Related Factor-Based Model for Predicting Organ Failure in Acute Pancreatitis: A Retrospective Cohort Study.

Several inflammation-related factors (IRFs) have been reported to predict organ failure of acute pancreatitis (AP) in previous clinical studies. However, there are a few shortcomings in these models. The aim of this study was to develop a new prediction model based on IRFs that could accurately identify the risk for organ failure in AP. Methods. 100 patients with their clinical information and IRF data (levels of 10 cytokines, percentages of different immune cells, and data obtained from white blood cell count) were retrospectively enrolled in this study, and 94 patients were finally selected for further analysis. Univariate and multivariate analysis were applied to evaluate the potential risk factors for the organ failure of AP. The area under the ROC curve (AUCs), sensitivity, and specificity of the relevant model were assessed to evaluate the prediction ability of IRFs. A new scoring system to predict the organ failure of AP was created based on the regression coefficient of a multivariate logistic regression model. Results. The incidence of OF in AP patients was nearly 16% (15/94) in our derivation cohort. Univariate analytic data revealed that IL6, IL8, IL10, MCP1, CD3+ CD4+ T lymphocytes, CD19+ B lymphocytes, PCT, APACHE II score, and RANSON score were potential predictors for AP organ failure, and IL6 (P = 0.038), IL8 (P = 0.043), and CD19+B lymphocytes (P = 0.045) were independent predictors according to further multivariate analysis. In addition, a preoperative scoring system (0-11 points) was constructed to predict the organ failure of AP using these three factors. The AUC of the new score system was 0.86. The optimal cut-off value of the new scoring system was 6 points. Conclusions. Our prediction model (based on IL6, IL8, and CD19+ B Lymphocyte) has satisfactory working efficiency to identify AP patients with high risk of organ failure.

Pathophysiological aspects as the object of the treatment tactics in acute pancreatitis (review)

The review presents a modern view on the features of the course and treatment of acute pancreatitis, based on a cascade of pathophysiological mechanisms of this disease. A number of concepts of development and course of acute pancreatitis on the basis of randomized prospective and retrospective researches devoted to this problem are considered. Attention is paid to the mechanisms of development of organ failure in acute pancreatitis. In accordance with the above, the main positions of treatment measures for acute pancreatitis, which are based on the principles of tactics "step-up approach" were highlighted. Among them, attention is focused on the features of the conservative treatment program, minimally invasive surgical interventions, as well as the management of the postoperative period of patients. Minimally invasive surgical interventions perform the main tasks of surgical treatment in acute pancreatitis, but significantly reduce surgical trauma compared to "open" methods. Adequate management of the postoperative period of patients is carried out through the implementation of protocols "fast-track surgery".

Stress Hyperglycemia Is Independently Associated with Persistent Organ Failure in Acute Pancreatitis

Background/AimsStress hyperglycemia is common in critical illness but it has not been clearly studied in patients with acute pancreatitis (AP). This study aimed to investigate the specific blood glucose (BG) level that defines stress hyperglycemia and to determine the impact of stress hyperglycemia on clinical outcomes in AP patients.MethodsAP patients admitted ≤ 48 h after abdominal pain onset were retrospectively analyzed. Patients were stratified by pre-existing diabetes and stress hyperglycemia was defined using stratified BG levels for non-diabetes and diabetes with clinical outcomes compared.ResultsThere were 967 non-diabetic and 114 diabetic (10.5%) patients met the inclusion criteria and the clinical outcomes between these two groups were not significantly different. In non-diabetes, the cut-off BG level of ≥ 180 mg/dl was selected to define stress hyperglycemia with an 8.8-fold higher odds ratio for persistent organ failure (POF) (95% CI 5.4–14.3; P < 0.001). For diabetes, ≥ 300 mg/dl was selected with a 7.5-fold higher odds ratio for POF (95% CI 1.7–34.3; P = 0.009). In multivariable logistic regression, stress hyperglycemia was independently associated with POF, acute necrotic collection, major infection and mortality. The combination of BG and systemic inflammatory response syndrome (SIRS) score in predicting POF was better than SIRS or Glasgow score alone.ConclusionsThis study identifies a cut-off BG level of ≥ 180 mg/dl and ≥ 300 mg/dl was optimal to define stress hyperglycemia for non-diabetic and diabetic AP patients, respectively. There was a significant relationship between stress hyperglycemia and adverse clinical outcomes.

A Novel 5-Cytokine Panel Outperforms Conventional Predictive Markers of Persistent Organ Failure in Acute Pancreatitis.

INTRODUCTION:Existing laboratory markers and clinical scoring systems have shown suboptimal accuracies for early prediction of persistent organ failure (POF) in acute pancreatitis (AP). We used information theory and machine learning to select the best-performing panel of circulating cytokines for predicting POF early in the disease course and performed verification of the cytokine panel's prognostic accuracy in an independent AP cohort.METHODS:The derivation cohort included 60 subjects with AP with early serum samples collected between 2007 and 2010. Twenty-five cytokines associated with an acute inflammatory response were ranked by computing the mutual information between their levels and the outcome of POF; 5 high-ranking cytokines were selected. These cytokines were subsequently measured in early serum samples of an independent prospective verification cohort of 133 patients (2012–2016), and the results were trained in a Random Forest classifier. Cross-validated performance metrics were compared with the predictive accuracies of conventional laboratory tests and clinical scores.RESULTS:Angiopoietin 2, hepatocyte growth factor, interleukin 8, resistin, and soluble tumor necrosis factor receptor 1A were the highest-ranking cytokines in the derivation cohort; each reflects a pathologic process relevant to POF. A Random Forest classifier trained the cytokine panel in the verification cohort and achieved a 10-fold cross-validated accuracy of 0.89 (area under the curve 0.91, positive predictive value 0.89, and negative predictive value 0.90), which outperformed individual cytokines, laboratory tests, and clinical scores (all P ≤ 0.006).DISCUSSION:We developed a 5-cytokine panel, which accurately predicts POF early in the disease process and significantly outperforms the prognostic accuracy of existing laboratory tests and clinical scores.

English

BACKGROUND This study was conducted to compare BISAP scoring system, Ranson’s score and CRP levels in predicting the clinical outcome in acute pancreatitis and for early detection of severity and organ failure in acute pancreatitis. METHODS This study was an observational longitudinal analytical study conducted among patients admitted with diagnosis of acute pancreatitis, in Father Muller Medical College Hospital, Mangalore, from November 2016 to March 2018. The study was started after obtaining ethical clearance from the institution’s ethical clearance committee. All patients diagnosed with acute pancreatitis between the age 20 and 60 years were included in the study. RESULTS Comparison of serum CRP levels between the Atlanta classified groups shows that severe group has the maximum value of 340.966 and mild has the minimum value of 55.38. This difference is statistically significant with a test value of 16.543 and a P value of &lt; 0.001. On comparison of the test group, Ranson’s score with the BISAP score, the test group had a sensitivity of 89.3 % and specificity of 77.3 %. CONCLUSIONS The study has demonstrated the concordance between Ranson’s score, BISAP score and serum CRP level as predictors of clinical outcome in acute pancreatitis. KEY WORDS Acute Pancreatitis, Clinical Outcome, C Reactive Protein, Scoring Systems.

Role of Neutrophil-Lymphocyte Ratio (NLR) in predicting development of organ failure in Acute Pancreatitis

Background: Different modalities are available for predicting development of organ failure in Acute Pancreatitis. A single marker with high sensitivity and specificity is yet to be identified. This study intends to find out the utility of Neutrophil Lymphocyte Ratio (NLR) in predicting development of organ failure in Acute Pancreatitis.&#x0D; Methods: A total of 117 patients admitted with acute pancreatitis were included. Clinical parameters and biochemical tests were recorded on admission and on day 3 &amp; day 5 of admission. CT scan was performed in all patients. NLRwas calculated using these data.Every patient was followed regularly for identification of organ failure. Statistical analysis was done with SPSS V22.&#x0D; Results: Among 117 patients, 67(57.3%) were male and 50(42.73%) were female with a mean age of 47.99±15. Among the patients the etiology was found to be biliary, hypertriglyceridemia, alcohol, malignancy and post-ERCP complications in 25(21.4%),23(19.7%),8(6.8%),3(2.6%),2(1.7%) cases respectively. In 53(45.3%) cases no definite etiology could be found. 83(70.9%) patients had mild,15(12.8%) had moderately severe and 19(16.2%) had severe acute pancreatitis. 23 (19.65%) patients developed complication, whereas 94 (80.34%) developed no complication.Organ failure was present in 34(29.06%) cases among total 117 cases.Those patients who developed organ failure had a mean NLR of 6.25±0.96, in contrast to a mean of 3.64±0.50 in those who didn’t developed organ failure.ROC curve evaluating the role of NLR in predicting development of organ failure in acute pancreatitis showed an AUC of 0.984. ROC curve revealed a cutoff point of 5.04 with highest sensitivity (97.1%) &amp; specificity (97.6%) with a PPV &amp; NPV of 94.3% &amp; 98.8% respectively.&#x0D; Conclusion: Calculating NLR is simple, it is readily available, easy to assess and cost-effective. It can be used as a new simple &amp; cost-effective marker for the prediction of development of organ failure in Acute Pancreatitis.&#x0D; Mediscope Vol. 8, No. 1: January 2021, Page 45-52

Defining mechanisms of organ failure in acute pancreatitis: 3-hydroxykynurenine does not directly activate reporter cells for TLR1 through TLR9, cGAS-STING, or the NLRP3 inflammasome.

Defining mechanisms of organ failure in acute pancreatitis: 3-hydroxykynurenine does not directly activate reporter cells for TLR1 through TLR9, cGAS-STING, or the NLRP3 inflammasome.

Normal autohagic flux in the VMP1-Ela1 transgenic mouse pancreas prevents extrapancreatic organ failure in acute pancreatitis.

Normal autohagic flux in the VMP1-Ela1 transgenic mouse pancreas prevents extrapancreatic organ failure in acute pancreatitis.

Stress hyperglycaemia as an independent risk factor for persistent organ failure in acute pancreatitis: a Chinese population-based analysis of 2428 patients

Stress hyperglycaemia as an independent risk factor for persistent organ failure in acute pancreatitis: a Chinese population-based analysis of 2428 patients