Pancreatitis Severity Score Research Articles

Analysis of Pancreatitis Severity Scores and hospitalization length of Diabetic and Non-diabetic Patients with Nonbiliary Acute Pancreatitis

Analysis of Pancreatitis Severity Scores and hospitalization length of Diabetic and Non-diabetic Patients with Nonbiliary Acute Pancreatitis

Evaluation of red blood cell distribution width, neutrophil-to-lymphocyte ratio, and other hematologic parameters in canine acute pancreatitis.

To determine if RBC distribution width (RDW), neutrophil-to-lymphocyte ratio (NLR), and other hematological parameters are associated with increased odds of in-hospital mortality, increased length of hospitalization (LOH), or disease severity as measured by the Canine Acute Pancreatitis Severity (CAPS) score in dogs with acute pancreatitis (AP). Retrospective, multicenter study from January 2016 to August 2020. Four private emergency and specialty referral centers. On initial case search, 118 client-owned dogs were identified with a clinical diagnosis of AP. Out of these cases, 114 dogs met inclusion criteria, defined as sudden onset of ≥2 compatible clinic signs (lethargy, anorexia, vomiting, or abdominal pain), a specific canine pancreatic lipase concentration >400μg/L, hospital admission, as well as CBC and serum biochemistry run within 48hours of initial hospitalization. Disease severity was calculated and measured using the CAPS score, in addition to LOH and in-hospital mortality. None. Clinical endpoints were in-hospital mortality, LOH, and disease severity, as evaluated by the CAPS score. Overall in-hospital mortality was 36.8%. NLR was significantly associated with survival, with a higher percentage being associated with an increased likelihood of nonsurvival (odds ratio: 1.1, 95% confidence interval: 1.0-1.2; P=0.006, adjusted P=0.04). Increased NLR was found to be significantly associated with a longer LOH based on the unadjusted P-value (P=0.02) but was not statistically significant based on a P-value adjusted for multiple comparisons (P=0.12). No significant associations were noted when RDW, platelet-to-lymphocyte ratio, WBC count, mean platelet volume, RDW-to-platelet ratio, or RDW-to-total serum calcium ratio was evaluated against outcome measures. This study retrospectively evaluated the prognostic utility of several readily available hematological parameters in dogs hospitalized for AP. Dogs with an increased NLR may have a higher risk of in-hospital mortality and increased LOH, although future prospective studies are necessary to confirm these findings.

Role of Preoperative MRCP in the Management of Biliary Pancreatitis: A Retrospective Study from Saudi Arabia

Background: Gallstones are the leading cause of acute pancreatitis worldwide. Acute biliary pancreatitis occurs when distal common bile duct stones obstruct the ampulla. This can result in severe consequences for some patients, including significant fluid loss, metabolic imbalances, hypotension, and sepsis. Definitive management strategies for choledocholithiasis include laparoscopic cholecystectomy and/or endoscopic retrograde pancreatography. Magnetic resonance cholangiopancreatography (MRCP) has been increasingly used to evaluate bile duct pathology, leading to more frequent pre-operative biliary duct evaluations for patients with acute gallstone pancreatitis. Despite its widespread use, there have been conflicting reports in the literature regarding its effectiveness and impact on hospital stay duration and healthcare-associated costs. Aim: The aim of this study was to compare the impact of performing MRCP in biliary pancreatitis and its utility, measure its cost-effectiveness, and assess the sensitivity and specificity of different laboratory and radiological investigations in diagnosing impacted biliary stones. Methods: This study followed a retrospective design and analyzed, the records of all patients diagnosed with acute biliary pancreatitis during the study period (2015-2019). Data regarding the following variables were obtained and analyzed from patients’ records: age, comorbidities, and previous medications of the patients; BISAP pancreatitis severity score; serum amylase, at the time of admission; serial recordings for biomarkers and liver function test results (for Day, 1, 3, and 6); ultrasonography results; computed tomography results; MRCP and ERCP results; postoperative complications; length of hospital stay in days; and the time waiting for surgery in days. Results: 133 participants were found in the hospital admission registry and included in this analysis, with an average age of 51.73 years. At the time of admission, the average serum amylase level was 1310 units/liter. Regarding the length of hospital stay, 8.9 days was the average among the patients, with a maximum length of stay of 48 days. Our analysis revealed that MRCP has a sensitivity of 77% and a specificity of 64% for detecting CBD stones. Patients who had MRCP stayed longer at the hospital with an average of 9.21 days, although the difference was not statistically significant (p-value: 0.570), compared with International Journal of Surgery & Surgical Techniques 2 Shaher A, et al. Role of Preoperative MRCP in the Management of Biliary Pancreatitis: A Retrospective Study from Saudi Arabia. Int J Surg Surgical Tech 2023, 7(2): 000196. Copyright© Shaher A, et al. an average of 6.15 among patients who did not have MRCP. As for the days to surgery, the average time until surgery was 3.79 (standard deviation 3.73), with a maximum of 16 days until surgery. Patients who had MRCP had to wait for a longer period of time until surgery than their counterparts who waited for less than a day for their surgery (p-value: < 0.001). Conclusion: Our results revealed that patients who underwent MRCP preoperatively had a longer hospital stay and significantly waited longer for surgery than their counterparts. However, more multi-centered, large studies are needed to further support our findings.

S121 A Comparison of Acute Pancreatitis Severity Scores in Predicting Patient Outcomes

Introduction: Acute pancreatitis is commonly seen in the inpatient setting, and its presentation can vary widely, ranging from mild disease to a more severe presentation, which is commonly associated with a high morbidity and mortality. With the advent of pancreatitis scoring systems, however, physicians can predict certain outcomes for patients with more reliability. The primary objective of this study is to compare two new pancreatitis scoring systems in determining illness severity, complications, and need for ICU level care. The secondary objective is to determine if there is a correlation with severity and age, gender, race, etiology of pancreatitis, and insurance. Methods: We performed a retrospective chart review of adult patients admitted with acute pancreatitis to a community hospital from 2018 to 2021. We utilized two novel scoring systems: the Chinese simple scoring system (CSSS) and the Pancreatic activity scoring system (PASS) and compared them with pre-existing and validated scoring systems: the APACHE-II scoring system, Ranson scoring system, BISAP scoring system, and Glasgow-Imrie scoring system by calculating each score. We included other variables such as length of stay, disposition (general ward, telemetry, ICU), readmission, complications, etiology of pancreatitis, presence of necrotizing pancreatitis, calcium level on Day 2, and C-reactive protein levels. Results: The main result of this study was to determine which score for both the CSSS and PAAA risk assessments was most predictive of a need for ICU level care. Overall, a total of 16/88 of patients admitted for pancreatitis (18%) were critical enough to require ICU monitoring. Of these patient’s triaged to the ICU for treatment of pancreatitis, the average CSSS score was 253. The average PASS score of those admitted to the ICU for pancreatitis was 3.88. Patients with a length of stay greater than 7 days, were re-admitted within 30 days 55% of the time and had a CSSS and PASSS score of 243 and 3.55, respectively. Conclusion: It is important as clinicians to evaluate severity of pancreatitis when triaging patients as predicting complications can be challenging. These scoring systems have been invented and validated to help determine the level of care needed for the patient and to foresee potential complications. Our data suggests the PASS and CSSS scoring systems can be essential triage tools to better predict patient outcomes, complications, mortality, and possible need for escalation of care.

Evaluation of diagnostic and prognostic usefulness of abdominal ultrasonography in dogs with clinical signs of acute pancreatitis.

To report abdominal ultrasonography (AUS) findings in dogs with clinical signs of acute pancreatitis (AP) during the first 2 days of hospitalization and to compare AUS findings with severity of disease and mortality rate. 37 client-owned dogs with clinical signs of AP. Dogs suspected of having AP with complete medical records, AUS examinations performed throughout the first 2 days of hospitalization, and available frozen surplus serum samples for quantitative measurement of canine pancreatic lipase (cPL) concentrations at hospital admission met the criteria for study inclusion. Dogs were grouped as AUS+ or AUS- on the basis of positive or negative findings for AP on AUS, respectively. Abdominal ultrasonography findings of AP were stratified (as mild, moderate, or severe) by use of an AUS severity index, and a canine acute pancreatitis severity score was calculated. 24 of 37 (64.8%) dogs had AUS findings of AP at hospital admission, whereas 10 had positive findings for AP on AUS within 2 days of hospitalization. Three (8%) dogs were AUS- but had serum cPL concentrations > 400 μg/L (ie, values considered diagnostic for AP). On the AUS severity index, 5 of 34 (14.7%) AUS+ dogs had mild findings, 18 (52.9%) AUS+ dogs had moderate findings, and 11 (32.4%) AUS+ dogs had severe findings. Severe findings were associated with a higher risk of death than mild and moderate findings. A significant association was found between canine acute pancreatitis severity scores and mortality rates. For dogs with clinical signs of AP, repeated AUS examinations during hospitalization should be performed, severe findings on the AUS severity index may indicate an increased risk of death, and serum cPL concentrations may increase earlier than findings on AUS of AP.

Circulating Cell-free DNA in Patients With Acute Biliary Pancreatitis: Association With Disease Markers and Prolonged Hospitalization Time-A Prospective Cohort Study.

To evaluate cfDNA as an indicator of pancreatitis severity. Acute pancreatitis severity scores have limited proficiency, and are complex and challenging to use clinically. Elevation of circulating cfDNA concentration has been shown to be associated with hospital length of stay (LOS) and mortality. In a prospective study, cfDNA concentration was measured by a simple fluorometric test, at admission and for 2 consecutive days, in patients with acute biliary pancreatitis (ABP). Ranson and APACHE II scores were used as measures of pancreatitis severity. Hospital LOS and mortality were used as outcome measures. Seventy-eight patients were included. Patients with severe disease according to Ranson's Criteria (n = 24) had elevated median admission cfDNA compared to patients with mild disease (n = 54, 2252ng/ml vs 1228 ng/ml, P < 0.05 ). Admission cfDNA levels correlated with Ranson and APACHE II scores and markers of bile duct obstruction. LOS did not differ between patients with mild and severe disease according to Ranson and APACHE II scores. Patients with cfDNA at 24 hours concentrations above the cutoff value of healthy patients (>850 ng/ml) had a significantly longer LOS compared to those with normal cfDNA levels ( P < 0.001 ). cfDNA, measured by a rapid simple assay, proved a valuable early marker of severity in ABP with clear advantages for prediction of LOS over Ranson and APACHE II. Measurement of cfDNA has the potential to be an effective practical approach to predict the course of ABP and should be further evaluated in larger trials.

Protease inhibitors, inflammatory markers, and their association with outcome in dogs with naturally occurring acute pancreatitis.

BackgroundAcute pancreatitis (AP) presumably is associated with pancreatic protease activation, protease inhibitor (PI) depletion, and inflammatory mediator secretion.ObjectivesExamine PIs and inflammatory mediator concentrations in dogs with AP and their association with death.AnimalsThirty‐one dogs diagnosed with AP based on clinical signs, ultrasonographic findings, and increased canine pancreatic lipase immunoreactivity (cPLI) and 51 healthy control dogs.MethodsAntithrombin and α2‐antiplasmin activity (ATA and α2AP, respectively) and concentrations of α1‐proteinase inhibitor (α1PI), α2‐macroglobulin (α2MG), C‐reactive protein (CRP), interleukins (ILs)‐2,6,8 and tumor necrosis factor‐α (TNF‐α) were prospectively measured. Severity of AP was assessed by clinical severity scoring systems.ResultsMortality rate was 19%. Antithrombin activity was lower (P = .004) and maximal CRP, IL‐6, and TNF‐α concentrations higher (P < .04) in the AP group compared to the controls, whereas IL‐2, IL‐8, α1PI, and α2AP concentrations did not differ between groups. Serum α2MG concentration was not reliably detected. Serum cPLI, CRP, and IL‐6 concentrations were significantly and positively correlated. The ATA was lower (P = .04), and canine acute pancreatitis severity (CAPS) scores higher (P = .009) in nonsurvivors compared to survivors. Higher CAPS scores were associated (P < .05) with decreased ATA and increased cPLI, CRP, and IL‐6 concentrations.Conclusions and Clinical ImportanceSystemic inflammation in dogs with AP is manifested by increased inflammatory mediator concentrations, correlating with cPLI and CRP concentrations. Hypoantithrombinemia is associated with death. Serum concentrations of α2AP and α1PI are less useful prognostic markers. The CAPS score is a useful prognostic marker in dogs with AP.

Pulmonary complications in dogs with acute presentation of pancreatitis

BackgroundIn humans, respiratory complications in patients with acute pancreatitis (AP) are a common life-threatening comorbidity. Since possible lung impairment has not been individually evaluated in canine AP, the aims of the present study were to: (1) describe the prevalence, types and severity of pulmonary complications in dogs with acute presentation of AP, and (2) evaluate their association with mortality. AP diagnosis was based on compatible clinical and laboratory parameters, abnormal canine pancreatic-lipase test, and positive abdominal ultrasound within 48 h from admission. The canine acute pancreatitis severity score (CAPS) was calculated for each dog at admission. Arterial blood gas analysis and thoracic radiography were performed at admission. Thoracic radiography was classified on the basis of pulmonary pattern (normal, interstitial or alveolar) and a modified lung injury score (mLIS) was applied to the ventrodorsal projections for each dog. VetALI/VetARDS were diagnosed using current veterinary consensus. Dogs were divided into non-survivors or survivors (hospital discharge). Clinical, radiological and blood gas parameters collected at presentation were compared between survivors and non-survivors and associated with mortality.ResultsThis prospective cohort study included twenty-six client-owned dogs with AP. Twelve out of twenty-six dogs (46%) died or were euthanized. At admission, thirteen dogs showed respiratory distress at physical examination, which was associated with death (P < 0.001). Radiographic abnormalities were found in twenty-one dogs: alveolar (n = 11) and interstitial pattern (n = 10). Radiographic alterations and mLIS score were both associated with death (P = 0.02 and P = 0.0023). The results of the arterial blood-gas evaluation showed that non-survivors had lower PaCO2 and HCO3− levels, and higher A-a gradient than survivors (P = 0.0014, P = 0.019 and P = 0.004, respectively). Specifically, three dogs had aspiration pneumonia, and VetALI was diagnosed in nine dogs (34.6%), and no dogs met the criteria for VetARDS. The presence of VetALI was associated with mortality (P < 0.001).ConclusionsAs with humans, possible lung impairments, such as VetALI, should be investigated in dogs with acute presentation of pancreatitis.

Human umbilical cord mesenchymal stem cells pretreated with Angiotensin-II attenuate pancreas injury of rats with severe acute pancreatitis

Mesenchymal stem cells (MSCs) pretreatment is an effective route for improving cell-based therapy of endothelial cell survival, vascular stabilization, and angiogenesis. We hypothesized that the application of human umbilical cord-MSCs (hUC-MSCs) pretreated with angiotensin-II (Ang-II) might be a potential therapeutic approach for severe acute pancreatitis (SAP). Therefore, the effect of Ang-II pretreated hUC-MSCs on SAP was investigated in vitro and in vivo. MethodsIn the present study, human umbilical cord-derived MSCs pretreated with or without Ang-II were delivered through the tail vein of rats 12 h after induction of SAP. Pancreatitis severity scores and serum lipase levels, as well as the levels of VEGF and VEGFR2 were evaluated. ResultsWe found that the administration of Ang-II-MSCs significantly inhibited pancreatic injury, as reflected by reductions of pancreatitis severity scores, serum amylase and serum lipase levels. Furthermore, the reduced apoptotic rate and increased tube formation in human umbilical vein endothelial Cells (HUVEC) were found resulting from the administration of Ang-II-MSC-CM. Moreover, knockdown of VEGFR2 can block the effect of Ang-II-MSC-CM on preventing HUVEC from apoptosis, as well as the capacity of tube formation was also suppressed. In addition, the expression of increased Bcl-2 and alleviated caspase-3 were observed in HUVEC and HUVEC transfectants exposure to Ang-II-MSC-CM. ConclusionCollectively, these results elucidated that the pretreatment of hUC-MSCs with Ang-II improved the outcome of MSC-based therapy for SAP via enhancing angiogenesis and ameliorating endothelial cell dysfunction in a VEGFR2 dependent manner.

Development and validation of a novel clinical scoring system for short-term prediction of death in dogs with acute pancreatitis.

BackgroundAcute pancreatitis (AP) is associated with a high death rate in dogs, but accurate predictors of early death are still lacking.ObjectivesTo develop a scoring system for prediction of short‐term case fatality in dogs with AP.AnimalsOne hundred sixty‐nine dogs with AP including 138 dogs in the training cohort and 31 dogs in the validation cohort.MethodsMulticenter, retrospective cohort study. Survival analysis was used to assess the associations with short‐term death (within 30 days after admission). Independent predictors of death were identified by a stepwise selection method and used for the score calculation.ResultsDeath rate within 30 days after admission was 33% in the training cohort. Four independent risk factors for short‐term death were identified in the training cohort: presence of systemic inflammatory response syndrome, coagulation disorders, increased creatinine and ionized hypocalcemia. Canine Acute Pancreatitis Severity (CAPS) score was developed to predict short‐term death, integrating these 4 factors in a weighted way. A simplified version of CAPS score (sCAPS) including respiratory rate instead of SIRS was also assessed. The area under the receiver‐operating characteristic curve (AUC) of CAPS and sCAPS scores was 0.92 in the training cohort with an optimal cutoff of 11 (sensitivity, 89%; specificity, 90%) and 6 (sensitivity, 96%; specificity, 77%), respectively. CAPS and sCAPS score were validated in the validation cohort with respective AUC of 0.91 and 0.96.Conclusions and Clinical ImportanceWe propose 2 scoring systems that allow early and accurate prediction of short‐term death in dogs with AP.

Mild acute biliary pancreatitis: the timing of cholecystectomy should not exceed index admission.

Laparoscopic cholecystectomy (LC) to treat mild biliary acute pancreatitis (MBAP) during index admission is recommended. However, the optimal surgical timing is controversial, considering that patients are actually often discharged from hospital and readmitted for elective cholecystectomy. Moreover, previous studies showed an uneven patients' stratification for pancreatitis severity. The aim of this study was to determine the outcome of patients homogenously categorizedfor MBAP according to the newest pancreatitis classifications, undergoing cholecystectomy with different timing. We retrospectively identified all patients undergoing cholecystectomy from 2008 to 2015 for MBAP, according to the 2012 Revision of the Atlanta Classification and the Determinant-Based Classification of Acute Pancreatitis, and stratified them in two groups: index cholecystectomy (IC) and interval-delayed cholecystectomy (IDC, after at least 4 weeks). One hundred and three patients were analyzed. IC was performed in 40 patients (38.8%) while IDC in 63 patients (61.2%). The two groups were similar in comorbidities and pancreatitis severity at admission. There were no differences for conversion rate, operation length, total length of hospitalization and overall complication rates. However, IDC patients had a 33.3% rate of re-hospitalization for recurrent biliary-pancreatic events while waiting for the elective procedure and showed a higher rate of acute cholecystitis at histological diagnosis than IC (11.1% vs. 0%, P=0.041). Among patients affected by MBAP, homogenously assessed following the new acute pancreatitis severity scores, the performance of cholecystectomy during the index admission is the best treatment option in order to avoid further undesired hospitalizations for recurrent biliary/pancreatic events while waiting for surgery.

MDCT of acute pancreatitis: Intraindividual comparison of single-phase versus dual-phase MDCT for initial assessment of acute pancreatitis using different CT scoring systems

ObjectivesThe purpose of the retrospective study was to evaluate the additional value of dual-phase multidetector computed tomography (MDCT) protocols over a single-phase protocol on initial MDCT in patients with acute pancreatitis using three CT-based pancreatitis severity scores with regard to radiation dose. MethodsIn this retrospective, IRB approved study MDCT was performed in 102 consecutive patients (73 males; 55years, IQR48–64) with acute pancreatitis. Inclusion criteria were CT findings of interstitial edematous pancreatitis (IP) or necrotizing pancreatitis (NP) and a contrast-enhanced dual-phase (arterial phase and portal-venous phase) abdominal CT performed at ≥72h after onset of symptoms. The severity of pancreatic and extrapancreatic changes was independently assessed by 2 observers using 3 validated CT-based scoring systems (CTSI, mCTSI, EPIC). All scores were applied to arterial phase and portal venous phase scans and compared to score results of portal venous phase scans, assessed ≥14days after initial evaluation. For effective dose estimation, volume CT dose index (CTDIvol) and dose length product (DLP) were recorded in all examinations. ResultsIn neither of the CT severity scores a significant difference was observed after application of a dual-phase protocol compared with a single-phase protocol (IP: CTSI: 2.7 vs. 2.5, p=0.25; mCTSI: 4.0 vs. 4.0, p=0.10; EPIC: 2.0 vs. 2.0, p=0.41; NP: CTSI: 8.0 vs. 7.0, p=0.64; mCTSI: 8.0 vs. 8.0, p=0.10; EPIC: 3.0 vs. 3.0, p=0.06). The application of a single-phase CT protocol was associated with a median effective dose reduction of 36% (mean dose reduction 31%) compared to a dual-phase CT scan. ConclusionsAn initial dual-phase abdominal CT after ≥72h after onset of symptoms of acute pancreatitis was not superior to a single-phase protocol for evaluation of the severity of pancreatic and extrapancreatic changes. However, the effective radiation dose may be reduced by 36% using a single-phase protocol.

Efficacy of pediatric acute pancreatitis scores at a Japanese tertiary center.

Pediatric acute pancreatitis (AP) is a rare but important clinical entity associated with significant morbidity. Predicting the severity and outcome of AP in pediatric patients can be challenging because there are few validated severity scoring systems. Moreover, the etiology of pediatric AP in the Japanese population is different from that of Western populations. The performance of severity scores in pediatric AP with a high prevalence of severe cases is still unknown. The aim of this study was to assess the performance of existing severity scoring systems when used for Japanese children at a tertiary care center. We reviewed the electronic medical records of all children (≤18 years) treated for AP at between 2002 and 2012 at National Center for Child Health and Development, Tokyo. The modified Glasgow acute pancreatitis severity score (modified Glasgow), Ranson criteria (Ranson), Balthazar computed tomography severity index (CTSI), and pediatric acute pancreatitis severity (PAPS) score were assessed for their ability to distinguish severe pancreatitis from the milder forms. Thirty-three Japanese children with AP were identified. Among them, 37 episodes were analyzed for the performance of the scoring systems and 33 for the etiology. The most common etiology of AP was structural abnormality (n = 8). Sensitivity for the modified Glasgow, Ranson, PAPS, and CTSI was 42.9%, 52.4%, 81.0%, and 50.0%, respectively, while specificity was 81.3%, 81.3%, 37.5%, and 76.9%, respectively. We found PAPS to be the most reliable when used for discriminating the severe form of AP from the milder forms at a Japanese tertiary pediatric care center.

The role of D-dimer in prediction of the course and outcome in pediatric acute pancreatitis

BackgroundCurrent predictive severity scores for pediatric acute pancreatitis are either extrapolated from adult studies or difficult to use in practice. The aim of this study was to assess the value of the plasma D-dimer level as a marker of severity and outcome in pediatric AP. Methods36 patients (aged 1–17 yrs) with AP were included in the study. Levels of D-dimer and other routine laboratory parameters for AP were determined on admission. The Pediatric Acute Pancreatitis Severity Score was used to assess disease severity. The development of systemic and local complications was also recorded. ResultsD-dimer level was significantly higher in a group of patients with complications, median 1189.5 (271–4800) vs 172.5 (105–1086) in a group of patients without complications (p < 0.001). D-dimer showed high precision in the prediction of acute necrotic collection, with the optimal cut-off values of 442.5 μg/L, Sensitivity (Sn) 100%, Specificity (Sp) 62.1% and in the prediction of multiple organ failure with optimal cut-off value 1189 μg/L, Sn 100% and Sp 87.5%. According to the areas under the curve (AUCs) of each parameter, D-dimer seemed to have predictive power similar to PAPS score and higher than C-reactive protein and Lactate dehydrogenase level. ConclusionD-dimer level may be a simple clinical predictor of severity in pediatric acute pancreatitis.

CP Severity Index: A Reliable Scoring System to Assess Severity and Progression of Chronic Pancreatitis

Background: Chronic pancreatitis (CP) is a syndrome characterized by structural changes in the pancreas that lead to chronic abdominal pain and varying degree of pancreatic functional failure. It has difficult to assess the severity and progression of CP based upon pancreatic duct (PD) changes alone. The aims of this study were: (1) to develop a 'CP severity index' to assess the severity of CP; and (2) correlate the 'CP severity index' with different clinical outcomes in the natural history of CP. Patients and Methods: A prospective study of subjects with established CP was performed at the Pancreatitis Center of the VCU Medical Center, Richmond, VA. Baseline clinical, laboratory and radiologic findings were recorded. Patients were followed in the pancreatitis clinic at 6-month intervals or as the clinical situation warranted. Desirability function methodology was used to develop the CP severity score which ranges between 0 (most severe) and 1 (not severe). Of the 14 recorded variables, on the a stepwise ordinal logistic regression analysis, 8 variables were selected based on a stepwise ordinal logistic regression and combined into a 'pancreatitis severity score' alcohol use, side branch size, side branch ectasia (SBE >3),main PD (MPD) irregularity, MPD stricture, MPD leak, MPD calculi, and contour abnormality of the bile duct. The key outcomes assessed included: exocrine failure, endocrine insufficiency (diabetes), presence or development of a pseudocyst and bile duct stricture. An ordinal 'response' score was created at baseline and at one-year followup, which counted the number of the above outcomes in each patient. Results: Eighty nine subjects with CP (mean age 48 yrs, 54% males) were evaluated, of whom 48 (54%) were African American and 41 (46%) were Caucasian. On independent ordinal regression analysis, only the side branch size correlated with the severity of CP (p= 0.03). The 'CP severity score' significantly correlated with the number of adverse outcomes in CP (p=0.038) and was negatively associated with the number of outcomes. The average CP severity score in subjects with none, one, two, three and four adverse outcomes was 0.74, 0.70, 0.63, 0.60 and 0.43, respectively. For each 0.1 unit increase in the CP severity score the odds of moving to more adverse outcomes decreased by 0.85 times. Conclusions: The 'CP severity score' significantly correlates with the severity of CP. The 'CP severity index' reliably predicts the progression of CP by taking into consideration both imaging changes as well as behavioral risk factors as ongoing alcohol use.

13 C-Di-Peptide Breath Test to Assess Exocrine Pancreatic Function in Chronic Pancreatitis: A Novel Non-Invasive Method

Background: Chronic pancreatitis (CP) is a syndrome characterized by structural changes in the pancreas that lead to chronic abdominal pain and varying degree of pancreatic functional failure. It has difficult to assess the severity and progression of CP based upon pancreatic duct (PD) changes alone. The aims of this study were: (1) to develop a 'CP severity index' to assess the severity of CP; and (2) correlate the 'CP severity index' with different clinical outcomes in the natural history of CP. Patients and Methods: A prospective study of subjects with established CP was performed at the Pancreatitis Center of the VCU Medical Center, Richmond, VA. Baseline clinical, laboratory and radiologic findings were recorded. Patients were followed in the pancreatitis clinic at 6-month intervals or as the clinical situation warranted. Desirability function methodology was used to develop the CP severity score which ranges between 0 (most severe) and 1 (not severe). Of the 14 recorded variables, on the a stepwise ordinal logistic regression analysis, 8 variables were selected based on a stepwise ordinal logistic regression and combined into a 'pancreatitis severity score' alcohol use, side branch size, side branch ectasia (SBE >3),main PD (MPD) irregularity, MPD stricture, MPD leak, MPD calculi, and contour abnormality of the bile duct. The key outcomes assessed included: exocrine failure, endocrine insufficiency (diabetes), presence or development of a pseudocyst and bile duct stricture. An ordinal 'response' score was created at baseline and at one-year followup, which counted the number of the above outcomes in each patient. Results: Eighty nine subjects with CP (mean age 48 yrs, 54% males) were evaluated, of whom 48 (54%) were African American and 41 (46%) were Caucasian. On independent ordinal regression analysis, only the side branch size correlated with the severity of CP (p= 0.03). The 'CP severity score' significantly correlated with the number of adverse outcomes in CP (p=0.038) and was negatively associated with the number of outcomes. The average CP severity score in subjects with none, one, two, three and four adverse outcomes was 0.74, 0.70, 0.63, 0.60 and 0.43, respectively. For each 0.1 unit increase in the CP severity score the odds of moving to more adverse outcomes decreased by 0.85 times. Conclusions: The 'CP severity score' significantly correlates with the severity of CP. The 'CP severity index' reliably predicts the progression of CP by taking into consideration both imaging changes as well as behavioral risk factors as ongoing alcohol use.

The incidence of Purtscher retinopathy in acute pancreatitis

Acute pancreatitis is one of the most common causes of Purtscher retinopathy, accounting for a third of cases in a recent UK and Ireland survey.1 As the incidence of acute...

Early Management of Acute Gallstone Pancreatitis

Early Management of Acute Gallstone Pancreatitis

Treatment for pancreatic abscesses via omentalization with abdominal closure versus open peritoneal drainage in dogs: 15 cases (1994–2004)

To compare survival rate, duration of hospitalization, and complications in dogs with pancreatic abscesses treated with omentalization with abdominal closure versus open peritoneal drainage and evaluate a pancreatitis severity score for potential prognostic value. Retrospective case series. 15 dogs with pancreatic abscesses. Data regarding species, breed, age, initial clinical signs, CBC, serum biochemical abnormalities, pancreatitis severity score, anatomic location of the abscess, intraoperative bacteriologic culture results, treatment modality, postoperative complications, outcome (dismissed alive from the hospital, died in the postoperative period, or euthanized at surgery), and duration of hospitalization were evaluated. 6 dogs survived, 6 dogs died or were euthanized after surgery, and 3 were euthanized during surgery. Five of 8 dogs treated with omentalization and abdominal closure survived, and 1 of 4 dogs treated with open peritoneal drainage survived. In several dogs, treatment required additional surgical procedures, which did not appear to affect outcome. Postoperative complications were similar among survivors and nonsurvivors. Mean duration of hospitalization for dogs treated with omentalization and abdominal closure was less than that of dogs treated with open peritoneal drainage. Neither pancreatitis severity score nor any individual components of the score were associated with outcome. Omentalization is a viable treatment option for pancreatic abscess in dogs. Furthermore, shorter hospitalization and better survival outcomes may make omentalization preferred over open peritoneal drainage.

Exacerbation of Acute Pancreatitis in the Presence of Chronic Liver Injury in Rats, with Special Reference to Therapeutic Efficacy of Prostaglandin E1

The pathophysiology of acute pancreatitis accompanied by chronic liver injury, and the therapeutic efficacy of prostaglandin (PG)E1 were studied experimentally in rats. Chronic liver injury was produced by subcutaneous administration of CCl4. Acute pancreatitis was induced by the closed duodenal loop (CDL) method, immediately after which PGE1 (60 ng/kg/min) was infused intravenously via the jugular vein. Serum levels of amylase, alpha2-macroglobulin-trypsin complex (alpha2M-TRY), C-reactive protein (CRP), and tumor necrosis factor-alpha (TNF-alpha) were determined before and at 3 and 6 h after the onset of acute pancreatitis. Rats without administration of CCl4 served as controls. Serum amylase levels were lower in the liver injury (LI) group than in the normal liver (NL) group at 3 and 6 h. PGE1 had no effect on amylase levels in either group. Serum alpha2M-TRY levels were similar in the two groups at 3 h, but significantly higher in LI than in NL at 6 h. PGE1 tended to decrease alpha2M-TRY levels only in LI. Serum CRP levels were significantly more elevated in LI than in NL at 0, 3, and 6 h. PGE1 decreased CRP levels only in LI. Serum TNF-alpha concentrations were higher in LI, especially at 6 h. PGE1 reduced TNF-alpha levels in LI. Pancreatitis severity scores were significantly higher in LI. PGE1 significantly decreased the severity scores only in LI. Fat necrosis scores were significantly lower in LI. Histologically, interstitial edema was much more prominent in NL than in LI, whereas interstitial hemorrhage was more severe in LI at 3 and 6 h. PGE1 lessened the hemorrhage in LI. The extent of both vacuolization and necrosis of acinar cells was similar for both groups and tended to be improved by PGE1. It is concluded that acute pancreatitis becomes much more serious in the presence of chronic liver injury, and that PGE1 can ameliorate the exacerbated lesions, probably by improvements in blood flow through the pancreatic tissue.