Prediction Of Severe Pancreatitis Research Articles

Visceral adipose tissue for predicting severe acute pancreatitis

Background & objectives Acute pancreatitis (AP) is a well known gastrointestinal cause of hospital admissions. There is a proven association between the severity of AP and obesity due to increased rates of local complications, multiple organ failure and mortality. Increased visceral adiposity is reported to be a better predictor of severe pancreatitis than body mass index (BMI) in many studies. This study aimed to assess the relationship between visceral adiposity and the severity of AP by measuring the visceral adipose tissue (VAT) area. Methods This single-centre, prospective study was conducted on consecutive individuals admitted with AP. The severity of AP was correlated with the VAT area, as estimated between 48 and 72 h of admission. Results Seventy-four individuals with AP were recruited during the study period. The overall study cohort’s mean±SD for VAT area was 128.06±34.22 cm2. The VAT area was significantly larger in individuals with severe pancreatitis (141.01±33.75cm2) than in those with mild or moderate pancreatitis (115.11±29.85 cm2). The sensitivity, specificity and area under the receiver operating characteristics (AUROC) of VAT were 78.4 per cent, 54.1 per cent and 0.722 in predicting severe AP, respectively. Interpretation & conclusions There is a significant association between severe AP and VAT. With the worldwide increase in obesity incidences, incorporating VAT into one of the prognostic indices for AP needs to be further explored.

Prediction of severe pancreatitis in a population with low atmospheric oxygen pressure

To establish the severity of pancreatitis, there are many scoring systems, the most used are the Marshall and APACHE II systems, each one has advantages and disadvantages; but with good relation regarding mortality and prediction of complications. In populations with low barometric pressures produced by a decrease in atmospheric pressure, there is a decrease in partial pressure of oxygen, in these cases scores which take arterial oxygen partial pressure as one of their variables, may be overestimated. A diagnostic trial study was designed to evaluate the performance of APACHE II, Marshall and BISAP in a city 2640 m above sea level. A ROC analysis was performed to estimate the AUC of each of the scores, to evaluate the performance in predicting unfavorable outcomes (defined as the need for percutaneous drainage, surgery, or mortality) and a non-parametric comparison was made between the AUC of each of the scores with the DeLong test. From January 2018 to December 2019, data from 424 patients living in Bogota, with a diagnosis of gallstone pancreatitis was collected consecutively in a hospital in Bogota, Colombia. The ROC analysis showed AUC for predicting adverse outcomes for APACHE II in 0.738 (95% CI 0.647–0.829), Marshall in 0.650 (95% CI 0.554–0.746), and BISAP in 0.744 (95% CI 0.654–0.835). The non-parametric comparison to assess whether there were differences between the different AUC of the different scores showed that there is a statistically significant difference between Marshall and BISAP AUC to predict unfavorable outcomes (p=0.032). The mortality in the group of patients studied was 5.8%. We suggest the use of BISAP to predict clinical outcomes in patients with a diagnosis of biliary pancreatitis in populations with decreased atmospheric pressure because it is an easy-to-use tool and does not require arterial oxygen partial pressure for its calculation.

Novel insight on marker genes and pathogenic peripheral neutrophil subtypes in acute pancreatitis.

Acute pancreatitis is a common critical and acute gastrointestinal disease worldwide, with an increasing percentage of morbidity. However, the gene expression pattern in peripheral blood has not been fully analyzed. In addition, the mechanism of coronavirus disease 2019 (COVID-19)-induced acute pancreatitis has not been investigated. Here, after bioinformatic analysis with machine-learning methods of the expression data of peripheral blood cells and validation in local patients, two functional gene modules in peripheral blood cells of acute pancreatitis were identified, and S100A6, S100A9, and S100A12 were validated as predictors of severe pancreatitis. Additionally, through a combination analysis of bulk sequencing and single-cell sequencing data of COVID-19 patients, a pivotal subtype of neutrophils with strong activation of the interferon-related pathway was identified as a pivotal peripheral blood cell subtype for COVID-19-induced acute pancreatitis. These results could facilitate the prognostic prediction of acute pancreatitis and research on COVID-19-induced acute pancreatitis.

Clinical profile, etiology, and outcome of acute pancreatitis: Experience at a tertiary care center.

Background:Acute pancreatitis (AP) is an inflammatory process of the pancreas with varying degree of involvement of regional tissues. This was a population-based study on the incidence of AP. We aimed to determine the incidence, etiology, and outcome of AP.Materials and Methodology:This prospective study was conducted in the Department of Medicine, King George's Medical University, Lucknow, India, on 120 patients of AP. Clinical history, examination, and laboratory investigations were done. Severity of AP was assessed using the modified Atlanta classification.Results:A total of 120 patients comprising of 88 men (73.33%) and 32 women (26.66%) were recruited. The mean age of study participant was 36.96 ± 13.44 years. The most common presentation was abdominal pain followed by vomiting. The leading etiological factors were alcohol in 85 patients (70.8%) and gallstones in 25 (20.8%). It was idiopathic 5 patients (4.1%). Mortality was seen in three (2.5%) patients, all of which had severe pancreatitis. Patients with body mass index (BMI) ≥25 kg/m2, Hematocrit (HCT) ≥44% and C-reactive protein (CRP) ≥150 mg/l had an increased risk of developing a severe AP.Conclusions:Alcohol and gallstones were the most common etiological factors of AP, whereas HCT, CRP, and BMI were the useful predictors of severe pancreatitis.

Electrocardiogram Heart Rate as a Predictor of Severity in Acute Alcohol-Related Pancreatitis With Alcohol Withdrawal Syndrome.

BackgroundThe severity of acute alcohol-related pancreatitis (AAP) with alcohol withdrawal syndrome (AWS) has not been studied. Electrocardiogram (ECG) has not been used as a predictor of severity in patients with AWS and acute pancreatitis.ObjectivesThe study aimed to determine whether the ECG heart rate (HR) could predict the severity of AAP; secondarily, whether AWS influenced the severity of AAP based on Acute Physiology and Chronic Health Evaluation (APACHE) II and Bedside Index for Severity in Acute Pancreatitis (BISAP).MethodsDemographics, comorbid illnesses, AWS, biochemistry, ECG, arterial blood gases, and CT findings were noted in patients with AAP. The severity of pancreatitis was scored into mild, moderate, and severe based on CT. BISAP, APACHE II, and ECG heart rate-APACHE (E-APACHE) were compared in patients with and without AWS. A receiver operating characteristic curve was used to find the best predictor of severity.ResultsAmong 138 patients (M=128), 94 had AWS. ECG changes (≥1) were seen in 50%. Patients with AWS were younger, had consumed alcohol for a shorter duration, had higher systemic inflammatory response syndrome (SIRS), APACHE II, and E-APACHE II scores. APACHE II and E-APACHE II correlated significantly with severity grading, HR, alcohol duration, and AWS. HR was the best predictor of severe pancreatitis; E-APACHE was the best predictor for moderately severe pancreatitis.ConclusionsMostly, AAP appears to be mild; >2/3rds have AWS. ECG findings were seen in 50%. HR has not been previously studied in patients with both AAP and AWS and is an easy and inexpensive test to predict the severity of pancreatitis in this cohort.

Evaluation of Platelet Count as a Predictor of Severe Pancreatitis

Evaluation of Platelet Count as a Predictor of Severe Pancreatitis

Mo1359 Early Predictors of Severe Pancreatitis in Children

Mo1359 Early Predictors of Severe Pancreatitis in Children

Sa1379 Electronic Health Record (EHR) Information Is Useful to Predict Clinically Relevant Outcomes in Acute Pancreatitis (AP)

tis. Independent predictors of severe pancreatitis include age . 55 (OR, 1.6; P, 0.04), male gender (OR, 1.5; P,0.05), white blood cell count .16,000 cells/mm3 (OR, 2.7; P ,0.01), serum glucose .200 mg/dL (OR, 2.1; P,0.02) and serum calcium ,8 mg/dL (OR, 6.3; P,0.01). Conclusions: Compared to other recent population-based epidemiologic studies, we report a higher incidence of AP (1.0 vs. 0.6 per 1,000), less severe pancreatitis (5% severity) and lower mortality (0.2%). Independent predictors of severe pancreatitis include age .55, male gender, elevated wbc, elevated glucose and decreased serum calcium, which have been validated in other studies.