Persistent Organ Failure In Patients 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.

Enhancing predictive accuracy in hypertriglyceridemia-induced acute pancreatitis: Role of red cell distribution width and prospective studies.

This letter addresses the study titled "Red cell distribution width: A predictor of the severity of hypertriglyceridemia-induced acute pancreatitis" by Lv et al published in the World Journal of Experimental Medicine. The study offers a valuable analysis of red cell distribution width (RDW) as a predictive marker for persistent organ failure in patients with hypertriglyceridemia-induced acute pancreatitis. The study results suggest that RDW, combined with the Bedside Index for Severity in Acute Pancreatitis score, could enhance the predictive accuracy for severe outcomes. Further investigation into the role of RDW in different severities of acute pancreatitis is recommended. Additionally, the need for large-scale and multicenter prospective studies to validate these findings is emphasized.

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.

A Novel Serum Exosomal miRNA Signature in the Early Prediction of Persistent Organ Failure in Patients with Acute Pancreatitis.

Current study aims to investigate whether serum exosomal microRNAs (miRNAs) could be potential biomarkers in predicting APs with POF at early phase. Novel biomarkers are sorely needed for early prediction of persistent organ failure (POF) in acute pancreatitis (AP) patients. In the discovery stage, exosomal miRNAs were profiled in sera from APs with or without POF (5 vs. 5) using microarrays. POF-associated miRNA signatures then were assessed in training cohort (n=227) and further validated in three independent cohorts (n=516), including one nested case-control cohort. A total of 743 APs were recruited in this large-scale biomarker identification study with a nested case-control study. Data from the discovery cohort demonstrated that 90 exosomal miRNAs were significantly dysregulated in APs with POF compared with controls. One miRNA classifier (Cmi) comprising 3 miRNAs (miR-4265, 1208, 3127-5p) was identified in the training cohort, and was further evaluated in two validation cohorts for their predictive value for POF. AUCs for Cmi ranged from 0.88 to 0.90, which was statistically superior to AUCs of APACHE-II and BISAP, and outperformed BUN and creatinine in POF prediction across all cohorts (P<.05). Higher levels of Cmi indicated increased need for ICU admission, prolonged hospitalization, and elevated mortality rate, thus poor prognosis. In the nested case-control study, Cmi could help identify prediagnostic POF in post-ERCP pancreatitis cases within "golden hours" after ERCP with high efficacy. Serum exosomal Cmi may be an early predictor for POF in AP, even within "golden hours" after AP onset. ClinicalTrials.gov (NCT02602808).

Red cell distribution width: A predictor of the severity of hypertriglyceridemia-induced acute pancreatitis.

Compared with patients with other causes of acute pancreatitis, those with hypertriglyceridemia-induced acute pancreatitis (HTG-AP) are more likely to develop persistent organ failure (POF). Therefore, recognizing the individuals at risk of developing POF early in the HTG-AP process is a vital for improving outcomes. Bedside index for severity in acute pancreatitis (BISAP), a simple parameter that is obtained 24 h after admission, is an ideal index to predict HTG-AP severity; however, the suboptimal sensitivity limits its clinical application. Hence, current clinical scoring systems and biochemical parameters are not sufficient for predicting HTG-AP severity. To elucidate the early predictive value of red cell distribution width (RDW) for POF in HTG-AP. In total, 102 patients with HTG-AP were retrospectively enrolled. Demographic and clinical data, including RDW, were collected from all patients on admission. Based on the Revised Atlanta Classification, 37 (33%) of 102 patients with HTG-AP were diagnosed with POF. On admission, RDW was significantly higher in patients with HTG-AP and POF than in those without POF (14.4% vs 12.5%, P < 0.001). The receiver operating characteristic curve demonstrated a good discriminative power of RDW for POF with a cutoff of 13.1%, where the area under the curve (AUC), sensitivity, and specificity were 0.85, 82.4%, and 77.9%, respectively. When the RDW was ≥ 13.1% and one point was added to the original BISAP to obtain a new BISAP score, we achieved a higher AUC, sensitivity, and specificity of 0.89, 91.2%, and 67.6%, respectively. RDW is a promising predictor of POF in patients with HTG-AP, and the addition of RDW can promote the sensitivity of BISAP.

Endocrine Risk Index for Predicting Persistent Organ Failure in Patients with Acute Pancreatitis

Endocrine Risk Index for Predicting Persistent Organ Failure in Patients with Acute Pancreatitis

A Clinic-Radiomics Model for Predicting the Incidence of Persistent Organ Failure in Patients with Acute Necrotizing Pancreatitis.

Persistent organ failure (POF) is the leading cause of death in patients with acute necrotizing pancreatitis (ANP). Although several risk factors have been identified, there remains a lack of efficient instruments to accurately predict the incidence of POF in ANP. Retrospectively, the clinical and imaging data of 178 patients with ANP were collected from our database, and the patients were divided into training (n = 125) and validation (n = 53) cohorts. Through computed tomography image acquisition, the volume of interest segmentation, and feature extraction and selection, a pure radiomics model in terms of POF prediction was established. Then, a clinic-radiomics model integrating the pure radiomics model and clinical risk factors was constructed. Both primary and secondary endpoints were compared between the high- and low-risk groups stratified by the clinic-radiomics model. According to the 547 selected radiomics features, four models were derived from features. A clinic-radiomics model in the training and validation sets showed better predictive performance than pure radiomics and clinical models. The clinic-radiomics model was evaluated by the ratios of intervention and mechanical ventilation, intensive care unit (ICU) stays, and hospital stays. The results showed that the high-risk group had significantly higher intervention rates, ICU stays, and hospital stays than the low-risk group, with the confidence interval of 90% (p < 0.1 for all). This clinic-radiomics model is a useful instrument for clinicians to evaluate the incidence of POF, facilitating patients' and their families' understanding of the ANP prognosis.

Dynamic nomogram for persistent organ failure in acute biliary pancreatitis: Development and validation in a retrospective study.

Persistent organ failure (POF) increases the risk of death in patients with acute biliary pancreatitis (ABP). Currently, there is no early risk assessment tool for POF in patients with ABP. To establish and validate a dynamic nomogram for predicting the risk of POF in ABP. This was a retrospective study of 792 patients with ABP, with 595 cases in the development group and 197 cases in the validation group. Least absolute shrinkage and selection operator regression screened the predictors of POF, and logistic regression established the model (P < 0.05). A dynamic nomogram showed the model. We evaluated the model's discrimination, calibration, and clinical effectiveness; used the bootstrap method for internal validation; and conducted external validation in the validation group. Neutrophils, haematocrit, serum calcium, and blood urea nitrogen were predictors of POF in ABP. In the development group and validation group, the areas under the receiver operating characteristic curves (AUROCs) were 0.875 and 0.854, respectively, and the Hosmer-Lemeshow test (P > 0.05) and calibration curve showed good consistency between the actual and prediction probability. Decision curve analysis showed that the dynamic nomogram has excellent clinical value. This dynamic nomogram helps with the early identification and screening of high-risk patients with POF in ABP.

Neutrophil-Lymphocyte Ratio in Patients with Hypertriglyceridemic Pancreatitis Predicts Persistent Organ Failure

Background The neutrophil–lymphocyte ratio (NLR) has been proposed as a surrogate marker of inflammation with prognostic value in various diseases. Our objective was to investigate the predictive value of the NLR as an indicator of persistent organ failure (POF) in patients with hypertriglyceridemic pancreatitis (HTGP). Methods We retrospectively reviewed the data from patients with HTGP between 2016 and 2019. The NLR was obtained at admission. The diagnostic performance of the NLR for POF was evaluated by the area under the receiver operator characteristics curve (AUROC). Multivariate logistic regression determined whether elevated NLR was independently associated with POF. Results Of the 446 patients enrolled, 89 (20.0%) developed POF. Patients with POF showed a significantly higher NLR than those without POF (P < 0.001). A positive trend for the association across increasing NLR quartiles and the incidence of POF was observed (Ptrend < 0.001). The AUROC of NLR to predict POF was 0.673 (95% confidence interval, 0.627-0.716). With a cut-off of NLR > 6.56, the sensitivity and specificity were 73.0% and 55.7%, respectively. Multivariate analysis suggested that high NLR (>6.56) was independently associated with POF (odds ratio, 2.580; 95% confidence interval, 1.439-4.626; P = 0.001). Patients with a high NLR (>6.56) had a worse overall clinical course in HTGP. Conclusion Elevated NLR was significantly associated with an increased risk of developing POF and could be an early independent predictor of POF in patients with HTGP.

Predictive value of blood pressure variability for organ dysfunction in patients with sepsis.

Sepsis is a common disease in the intensive care unit, accompanied by many complications and high mortality. Organ dysfunction is a major risk factor for death in patients with sepsis. Analyzing the related factors of organ dysfunction caused by sepsis can provide more clinical prevention and treatment targets, and better predict patients' prognoses. This study aimed to investigate the relationship between blood pressure variability (BPV) and organ dysfunction in patients with sepsis. One hundred and two patients with sepsis treated in our hospital from January 2019 to January 2021 were retrospectively collected as an observation group, and 102 healthy people were collected as a control group. The 24-hour systolic blood pressure variability (24h SBPV) and 24-hour diastolic blood pressure variability (24h DBPV) of the two groups were compared, and the correlation between 24h SBPV, 24h DBPV, and organ function damage to sepsis patients were analyzed. Compared with the control group, the 24h DBPV in the observation group was significantly higher (0.56±0.16 vs. 0.37±0.16, P=0.000). 24h SBPV increased significantly (0.56±0.16 vs. 0.36±0.17, P=0.000). Pearson linear correlation analysis showed 24h SBPV was positively correlated with the level of procalcitonin, APACHEII score, and SOFA score (r=0.301, 0.216 and 0.218, P<0.05). 24h DBPV was positively correlated with the level of procalcitonin, APACHEII score, and SOFA score (r=0.302, 0.212 and 0.210, P<0.05). 24h SBPV and 24h DBPV are of certain value in the diagnosis of multiple organ failure in patients with sepsis, and the area under the curve was [0.649 (95% CI: 0.539-0.759), P=0.010] and [0.650 (0.540-0.760), P=0.009], respectively. 24h SBPV and 24h DBPV are of certain value in the diagnosis of persistent organ failure in patients with sepsis, and the area under the curve was [0.647 (95% CI: 0.538-0.757), P=0.010] and [0.647 (95% CI: 0.538-0.757), P=0.010], respectively. The increase of BPV in patients with sepsis has a certain value in predicting the prognosis and organ function damage to patients with sepsis.

Heparin-Binding Protein Levels at Admission and Within 24h Are Associated with Persistent Organ Failure in Acute Pancreatitis.

Identification of patients at risk for persistent organ failure (POF) early in the course of acute pancreatitis (AP) is critical for early intervention. Heparin-binding protein (HBP) levels are closely related to inflammation. Therefore, we investigated the relationship between HBP levels and POF in patients with AP. This observational cohort study analyzed 66 patients with AP and 14 healthy volunteers between June 2019 and December 2019. Baseline characteristics, laboratory data, and severity scores of patients with different degrees of AP were compared. Levels of HBP were measured by ELISA. Serum HBP levels were analyzed using receiver operating characteristic curves to identify POF in AP. Concentrations of serum HBP in healthy volunteers, MAP, MSAP, and SAP groups were 3.9 (range: 3.4-5) ng/ml, 5.2 (3.9-6.8) ng/ml, 5.9 (4.6-7.7) ng/ml, and 11 (8.0-13.8) ng/ml, respectively. The level of HBP in SAP patients was significantly elevated compared to the other groups (P < 0.01). HBP levels ≥ 7ng/ml showed a specificity of 74%, a sensitivity of 90%, and an AUC of 0.82 for predicting POF. HBP levels in patients with POF were significantly elevated. HBP is a useful marker for predicting severe AP.

Do the etiological factors of acute pancreatitis affect the course of the disease?

To investigate the accuracy of resistin, leptin and adiponectin levels in predicting persistent organ failure in patients with acute pancreatitis (AP).Data from 90 consecutive patients admitted to our hospital for AP were retrospectively collected from an ongoing prospective cohort study. The levels of adiponectin, leptin and resistin were measured and compared between patients with and without persistent organ failure. The accuracy of the adipokines in predicting persistent organ failure were compared with the patients' Acute Physiology and Chronic Health Evaluation II (APACHE-II) score, and were separately investigated in overweight and non-overweight groups.Persistent organ failure occurred in 26.7% of the patients. The levels of resistin were significantly increased in AP patients with persistent organ failure, in both the overweight and the non-overweight subgroups. Resistin and APACHE-II score predicted persistent organ failure with comparable areas under the curve (AUC) of 0.72 and 0.75, respectively (p = 0.66). Resistin demonstrated similar accuracy with the APACHE-II score in predicting persistent organ failure in the overweight (0.69 vs. 0.66, p = 0.82) and non-overweight (0.76 vs. 0.87, p = 0.39) subgroups. There was no correlation between adiponectin and persistent organ failure, but a weak correlation between leptin and persistent organ failure was demonstrated.Resistin and leptin levels, rather than adiponectin, correlate with persistent organ failure in patients with AP.

Investigation of CFTR and SLC26A6 transporters in the course of acute pancreatitis

To investigate the accuracy of resistin, leptin and adiponectin levels in predicting persistent organ failure in patients with acute pancreatitis (AP).Data from 90 consecutive patients admitted to our hospital for AP were retrospectively collected from an ongoing prospective cohort study. The levels of adiponectin, leptin and resistin were measured and compared between patients with and without persistent organ failure. The accuracy of the adipokines in predicting persistent organ failure were compared with the patients' Acute Physiology and Chronic Health Evaluation II (APACHE-II) score, and were separately investigated in overweight and non-overweight groups.Persistent organ failure occurred in 26.7% of the patients. The levels of resistin were significantly increased in AP patients with persistent organ failure, in both the overweight and the non-overweight subgroups. Resistin and APACHE-II score predicted persistent organ failure with comparable areas under the curve (AUC) of 0.72 and 0.75, respectively (p = 0.66). Resistin demonstrated similar accuracy with the APACHE-II score in predicting persistent organ failure in the overweight (0.69 vs. 0.66, p = 0.82) and non-overweight (0.76 vs. 0.87, p = 0.39) subgroups. There was no correlation between adiponectin and persistent organ failure, but a weak correlation between leptin and persistent organ failure was demonstrated.Resistin and leptin levels, rather than adiponectin, correlate with persistent organ failure in patients with AP.

Effect of Serum Triglycerides on Clinical Outcomes in Acute Pancreatitis: Findings From a Regional Integrated Health Care System.

The aim of this study was to evaluate the effect of serum triglycerides on the development of multiple or persistent organ failure in patients with acute pancreatitis. A retrospective cohort study was conducted among patients hospitalized for acute pancreatitis between 2006 and 2013. Triglyceride levels measured before and within 72 hours of admission were compared. In addition, the effect of triglyceride levels on the development of multiple or persistent organ failure during hospitalization for acute pancreatitis was assessed. Among 2519 patients, 267 patients (10.6%) developed organ failure, of which 75 patients developed multiple system organ failure and 82 patients developed persistent organ failure. Triglyceride levels in patients who developed organ failure were initially much higher than in patients who did not develop organ failure, but by 72 hours into admission, approached levels of patients who did not develop organ failure. Approximately 8% of patients had triglyceride levels greater than 500 mg/dL, the majority of which had similarly high levels before admission. Increased triglyceride levels were associated with the development of multiple or persistent organ failure among patients hospitalized with acute pancreatitis. Patients with high triglyceride levels at the time of admission were likely to have high triglyceride levels before admission.

Accuracy of circulating histones in predicting persistent organ failure and mortality in patients with acute pancreatitis

BackgroundEarly prediction of acute pancreatitis severity remains a challenge. Circulating levels of histones are raised early in mouse models and correlate with disease severity. It was hypothesized that circulating histones predict persistent organ failure in patients with acute pancreatitis.MethodsConsecutive patients with acute pancreatitis fulfilling inclusion criteria admitted to Royal Liverpool University Hospital were enrolled prospectively between June 2010 and March 2014. Blood samples were obtained within 48 h of abdominal pain onset and relevant clinical data during the hospital stay were collected. Healthy volunteers were enrolled as controls. The primary endpoint was occurrence of persistent organ failure. The predictive values of circulating histones, clinical scores and other biomarkers were determined.ResultsAmong 236 patients with acute pancreatitis, there were 156 (66·1 per cent), 57 (24·2 per cent) and 23 (9·7 per cent) with mild, moderate and severe disease respectively, according to the revised Atlanta classification. Forty-seven healthy volunteers were included. The area under the receiver operating characteristic (ROC) curve (AUC) for circulating histones in predicting persistent organ failure and mortality was 0·92 (95 per cent c.i. 0·85 to 0·99) and 0·96 (0·92 to 1·00) respectively; histones were at least as accurate as clinical scores or biochemical markers. For infected pancreatic necrosis and/or sepsis, the AUC was 0·78 (0·62 to 0·94). Histones did not predict or correlate with local pancreatic complications, but correlated negatively with leucocyte cell viability (r = –0·511, P = 0·001).ConclusionQuantitative assessment of circulating histones in plasma within 48 h of abdominal pain onset can predict persistent organ failure and mortality in patients with acute pancreatitis. Early death of immune cells may contribute to raised circulating histone levels in acute pancreatitis.

Efficacy of resistin and leptin in predicting persistent organ failure in patients with acute pancreatitis

BackgroundTo investigate the accuracy of resistin, leptin and adiponectin levels in predicting persistent organ failure in patients with acute pancreatitis (AP). MethodsData from 90 consecutive patients admitted to our hospital for AP were retrospectively collected from an ongoing prospective cohort study. The levels of adiponectin, leptin and resistin were measured and compared between patients with and without persistent organ failure. The accuracy of the adipokines in predicting persistent organ failure were compared with the patients' Acute Physiology and Chronic Health Evaluation II (APACHE-II) score, and were separately investigated in overweight and non-overweight groups. ResultsPersistent organ failure occurred in 26.7% of the patients. The levels of resistin were significantly increased in AP patients with persistent organ failure, in both the overweight and the non-overweight subgroups. Resistin and APACHE-II score predicted persistent organ failure with comparable areas under the curve (AUC) of 0.72 and 0.75, respectively (p = 0.66). Resistin demonstrated similar accuracy with the APACHE-II score in predicting persistent organ failure in the overweight (0.69 vs. 0.66, p = 0.82) and non-overweight (0.76 vs. 0.87, p = 0.39) subgroups. There was no correlation between adiponectin and persistent organ failure, but a weak correlation between leptin and persistent organ failure was demonstrated. ConclusionsResistin and leptin levels, rather than adiponectin, correlate with persistent organ failure in patients with AP.

Early prediction of persistent organ failure in patients with acute pancreatitis

s / Pancreatology 16 (2016) S1eS63 S35 Introduction: Pancreatic ductal adenocarcinoma (PDAC) is still one of the poorest prognoses cancers, lacking understanding. In PDAC, abnormal activity of Hedgehog (HH) pathway, inflammation(Nuclear factor-kappa B, NF-kB) and K-ras mutation were all involved in. Exploring the interaction of the three elements of PDAC is quite critical to uncover the mechanism of PDAC. Methods: K-ras gene-type, protein expression of Shh and nuclear protein expression of Gli1 and NF-kB of 32 PDAC tissues were detected, the correlation of the three factors were also analyzed. SW1990 were transfected with Gli1 cDNA;SW1990, Panc-1and BxPC-3 were treated with Shh, using untreated group as control, then we examined expression of Shh, Gli1 and NF-kB, cell proliferation and apoptosis changes; K-ras downstream p-/t-ERK1/2 and p-/t-AKT1 expression, as well as Ras activity were tested to estimate K-ras activation. And, the correlation between HH pathway and NF-kB in different K-ras gene-type cells were analyzed separately. Then K-ras expression was knocked-down by si-Kras, experiments above were done again. At last, mutant K-ras cDNA was transfected into K-ras wild-type cells, Shh, Gli1 and NF-kB mRNA expression changes were detected after Shh stimulation. Results: Positive correlation of HH pathway and NF-kB was significant in K-ras mutant PDAC tissues. In K-ras mutant PDAC cells, HH activation could promote NF-kB activation, accelerate cell proliferation, and inhibit apoptosis, up-regulate p-ERK1/2 and p-AKT1, and increase active-Ras expression. When K-ras expression was down-regulated by si-Kras, all the effects above were all weakened. But in wild-type K-ras cells, little significant change happened under such circumstances. But when they transfectedwithmutant K-ras cDNA, themRNA expression of Shh, Gli1 and NF-kB were all increased significantly by Shh stimulation. Conclusions: HH pathway induced NF-kB activation was based on mutant K-ras gene-type in PDAC, and K-ras activity change is the critical molecular mechanism behind them.

The ability of current scoring systems in differentiating transient and persistent organ failure in patients with acute pancreatitis

PurposeThe purpose of this study is to investigate the accuracy of currently used scoring systems in differentiating transient and persistent organ failure in patients with acute pancreatitis (AP). Materials and methodsIn this retrospective study, 127 consecutive patients with AP and organ failure were included. Patients were divided into transient and persistent organ failure groups. The Acute Physiology and Chronic Health Examination II score, bedside index of severity in acute pancreatitis, harmless acute pancreatitis score, and modified Marshall scores within the first 24 hours of organ failure were collected, and their accuracy in predicting transient organ failure was assessed. ResultsTransient organ failure occurred in 46 patients (36.2%). Fewer patients with transient organ failure initiated with multiple organ failure (13.0% vs 37.0%, P = .004) and renal failure (17.4% vs 44.4%, P = .002). In predicting transient organ failure, the area under the curves of the 4 scoring systems is from 0.66 to 0.71. The area under the curve of serum amylase was 0.78, which was slightly better than that of the modified Marshall and Acute Physiology and Chronic Health Examination II score and was significantly better than that of the bedside index of severity in acute pancreatitis and harmless acute pancreatitis score (P <.05). ConclusionsCurrent scoring systems are not accurate enough in differentiating transient and persistent organ failure in patients with AP.

Use of an artificial neural network to predict persistent organ failure in patients with acute pancreatitis

One-third to one-half of the deaths that occur due to acute pancreatitis (AP) during the first week after the onset of AP symptoms are primarily due to progressive organ failure (OF). Deaths that occur more than one week after admission to the hospital are often associated with local complications, such as infected pancreatic necrosis, and these patients often present symptoms of sepsis and multiple organ dysfunction syndromes (1). A recent meta-analysis indicated that organ failure is the key determinant of severity, regardless of the presence or absence of local pancreatic complications (2). Early identification of patients who are likely to develop organ failure would assist physicians in selecting the patients who would benefit from close surveillance or aggressive intervention. Many prognostic models or single predictors have been developed to predict mortality or the severity of acute pancreatitis, which is primarily defined based on the Atlanta classification (3-6). However, information regarding the early prediction of persistent organ failure in patients with acute pancreatitis is not widely available (7). As one of the clinical prediction rules (8), an artificial neural network (ANN) is composed of a series of interconnecting parallel nonlinear processing elements (nodes) with limited numbers of inputs and outputs (9). A systematic review suggested that artificial neural network analysis is potentially more successful than conventional statistical techniques at predicting clinical outcomes when the relationship between the variables that determine the prognosis is complex, multidimensional and non-linear (10). The aim of this study was to develop an artificial neural network to predict persistent organ failure in patients with acute pancreatitis.

Exam 2: Comparison of Existing Clinical Scoring Systems to Predict Persistent Organ Failure in Patients With Acute Pancreatitis

Exam 2: Comparison of Existing Clinical Scoring Systems to Predict Persistent Organ Failure in Patients With Acute Pancreatitis