Prognosis Of Acute Pancreatitis Research Articles

The impact of skeletal muscle index at the third lumbar spine on nosocomial deterioration and short-term prognosis in acute pancreatitis: a retrospective observational study.

To investigate the impact of the third lumbar skeletal muscle index (L3-SMI) assessed by CT on the in-hospital severity and short-term prognosis of acute pancreatitis. A total of 224 patients with severe acute pancreatitis admitted to Yantaishan Hospital from January 2021 to June 2022 were selected as the subjects. Based on the in-hospital treatment outcomes, they were divided into a mortality group of 59 cases as well as a survival group of 165 cases. Upon admission, general information such as the Acute Physiology and Chronic Health Evaluation II (APACHE II) score, along with the abdominal CT images of each patient, were analyzed. The L3-SMI was calculated, and the Modified CT Severity Index (MCTSI) and Balthazar CT grade were used to assess the severity of in-hospital complications of acute pancreatitis. The evaluation value of L3-SMI for the prognosis of severe acute pancreatitis was analyzed, as well as the factors influencing the prognosis of severe acute pancreatitis. No statistically significant differences in gender, age, BMI, etiology, duration of anti-inflammatory drug use, and proportion of surgical patients between the survival and mortality groups were observed. But the mortality group showed higher proportions of patients with an elevated APACHE II score upon admission, mechanical ventilation, and renal replacement therapy, compared to the survival group, with statistically significant differences (P < 0.001). Furthermore, the mortality group had higher MCTSI scores (6.42 ± 0.69) and Balthazar CT grades (3.78 ± 0.45) than the survival group, with statistically significant differences (P < 0.001). The mortality group also had a lower L3-SMI (39.68 ± 3.25) compared to the survival group (42.71 ± 4.28), with statistically significant differences (P < 0.001). L3-SMI exhibited a negative correlation with MCTSI scores and Balthazar CT grades (r = -0.889, -0.790, P < 0.001). Logistic regression analysis, with mortality of acute pancreatitis patients as the dependent variable and MCTSI scores, Balthazar CT grades, L3-SMI, APACHE II score upon admission, mechanical ventilation, and renal replacement therapy as independent variables, revealed that MCTSI scores and L3-SMI were risk factors for mortality in acute pancreatitis patients (P < 0.001). Logistic regression analysis using the same variables confirmed that all these factors were risk factors for mortality in acute pancreatitis patients. This study confirmed that diagnosing muscle depletion using L3-SMI is a valuable radiological parameter for predicting in-hospital severity and short-term prognosis in patients with acute pancreatitis.

Predictive value of the Ranson and BISAP scoring systems for the severity and prognosis of acute pancreatitis: A systematic review and meta-analysis.

To systematically assess and compare the predictive value of the Ranson and Bedside Index of Severity in Acute Pancreatitis (BISAP) scoring systems for the severity and prognosis of acute pancreatitis (AP). PubMed, Embase, Cochrane Library, and Web of Science were systematically searched until February 15, 2023. Outcomes in this analysis included severity and prognosis [mortality, organ failure, pancreatic necrosis, and intensive care unit (ICU) admission]. The revised Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2) tool was used to evaluate the quality of diagnostic accuracy studies. The threshold effect was evaluated for each outcome. The sensitivity, specificity, positive likelihood ratio (PLR), negative likelihood ratio (NLR), diagnostic odds ratio (DOR), and the area under the summary receiver operating characteristic (SROC) curve (AUC) as well as 95% confidence intervals (CI) were calculated. The DeLong test was used for AUC comparisons. For the outcome evaluated by over 9 studies, publication bias was assessed using the Deeks' funnel plot asymmetry test. Totally 17 studies of 5476 AP patients were included. For severity, the pooled sensitivity of the Ranson and BISAP was 0.95 (95%CI: 0.87, 0.98) and 0.67 (95%CI: 0.27, 0.92); the pooled specificity of the Ranson and BISAP was 0.74 (0.52, 0.88) and 0.95 (95%CI: 0.85, 0.98); the pooled AUC of the Ranson and BISAP was 0.95 (95%CI: 0.93, 0.97) and 0.94 (95%CI: 0.92, 0.96) (P = 0.480). For mortality, the pooled sensitivity of the Ranson and BISAP was 0.89 (95%CI: 0.73, 0.96) and 0.77 (95%CI: 0.58, 0.89); the pooled specificity of the Ranson and BISAP was 0.79 (95%CI: 0.68, 0.87) and 0.90 (95%CI: 0.86, 0.93); the pooled AUC of the Ranson and BISAP was 0.91 (95%CI: 0.88, 0.93) and 0.92 (95%CI: 0.90, 0.94) (P = 0.480). For organ failure, the pooled sensitivity of the Ranson and BISAP was 0.84 (95%CI: 0.76, 0.90) and 0.78 (95%CI: 0.60, 0.90); the pooled specificity of the Ranson and BISAP was 0.84 (95%CI: 0.63, 0.94) and 0.90 (95%CI: 0.72, 0.97); the pooled AUC of the Ranson and BISAP was 0.86 (95%CI: 0.82, 0.88) and 0.90 (95%CI: 0.87, 0.93) (P = 0.110). For pancreatic necrosis, the pooled sensitivity of the Ranson and BISAP was 0.63 (95%CI: 0.35, 0.84) and 0.63 (95%CI: 0.23, 0.90); the pooled specificity of the Ranson and BISAP was 0.90 (95%CI: 0.77, 0.96) and 0.93 (95%CI: 0.89, 0.96); the pooled AUC of the Ranson and BISAP was 0.87 (95%CI: 0.84, 0.90) and 0.93 (95%CI: 0.91, 0.95) (P = 0.001). For ICU admission, the pooled sensitivity of the Ranson and BISAP was 0.86 (95%CI: 0.77, 0.92) and 0.63 (95%CI: 0.52, 0.73); the pooled specificity of the Ranson and BISAP was 0.58 (95%CI: 0.55, 0.61) and 0.84 (95%CI: 0.81, 0.86); the pooled AUC of the Ranson and BISAP was 0.92 (95%CI: 0.81, 1.00) and 0.86 (95%CI: 0.67, 1.00) (P = 0.592). The Ranson score was an applicable tool for predicting severity and prognosis of AP patients with reliable diagnostic accuracy in resource and time-limited settings. Future large-scale studies are needed to verify the findings.

A comparison of scoring systems and biomarkers to predict the severity of acute pancreatitis in patients referring to the emergency clinic.

To investigate scoring systems and biomarkers for determining the severity and prognosis of acute pancreatitis (AP). Between January and July 2023, 100 patients with AP diagnosed and treated in the emergency department were included. AP was divided into 2 groups according to severity: mild AP and moderately severe AP (MSAP-SAP), according to the revised Atlanta Classification in 2012. Demographic characteristics, severity, intensive care unit (ICU) admission, white blood cell count (WBC), hematocrit, red cell distribution width from whole blood taken at admission and 48 hours later, C-reactive protein (CRP) and biochemistry values, Bedside Index for Severity in Acute Pancreatitis (BISAP), Pancreatitis Activity Scoring System (PASS), and harmless AP score scores were recorded retrospectively. Our variables, which were found to be significant in multiple logistic regression results, were found to increase MSAP-SAP expectation by 4.36-, 7.85-, 6.63 and 5.80 times in the presence of CRP > 47.10, WBC > 13.10, PASS > 0, and necrotizing computed tomography findings, respectively. It was detected that the risk factor which was found significant as a single variable affecting the ICU admission increased the risk of ICU requirement by 28.88 when PASS > 0, by 3.96 when BISAP > 1, and it increased the Atlanta score by 9.93-fold. We found that WBC and CRP values at the time of hospital admission and WBC, CRP, and red cell distribution width values after 48 had the highest accuracy in determining AP disease severity. BISAP, which was found to be significant in determining MSAP-SAP expectations, lost its significance in multiple logistic regression results, and PASS was found to be effective. The PASS is an important score in the clinical evaluation of patients with AP and in determining the need for ICU hospitalization.

Diagnostic utility of HFLC% and IG% for acute Pancreatitis—A retrospective Case-Control study

ObjectiveTo evaluate the occurrence, development and outcome value of hyperfluorescent lymphocyte percentage (HFLC%) and immature granulocyte percentage (IG%) for acute pancreatitis (AP). MethodsThe laboratory data collected from 1533 patients diagnosed with AP between August 2018 and August 2022 were retrospectively analyzed. The patients were classified into mild acute pancreatitis (MAP) and non-mild acute pancreatitis (Non-MAP) groups; non-MAP groups were additionally subgrouped based on HFLC% at day 7. White blood cells (WBC), HFLC%, and IG% were examined from day 1 (baseline) to day 14 post-admission using Sysmex XN Series Hematology Analyzers. C-reactive protein (CRP), serum amylase (AMY), and lipase (LPS) were detected by Beckman AU5800. ResultsA total of 623 patients were finally included in the study [MAP group (n = 358) and Non-MAP group (n = 265)]. WBC, IG%, and CRP were higher in the Non-MAP group from day 1 to day 12 (all P<0.05). The HFLC% was not statistically significant from day 1 to day 6; yet, it increased on day 6 and 7 in the Non-MAP group. We divided patients in the Non-MAP group with complete data(101 patients) into HFLC% ≥ 2.9 %(31 patients) and HFLC% < 2.9 %(70 patients) according to the threshold of 7th day HFLC%. WBC, HFLC%, IG%, and CRP effectively predicted the progression of MAP to Non-MAP (all P < 0.001). HFLC% was the most obvious value, followed by CRP and IG%. Combined with HFLC%, IG%,CRP and WBC in day7, the ROC analysis showed that the area under ROC curve of the combined indicators was the largest (AUC = 0.912, P < 0.001) and had higher sensitivity and specificity than single-item assessment of AP outcomes(P < 0.05). HFLC% < 2.9 %, IG% > 1.7 %, CRP >28.66 mg/L, and WBC >9.24 × 109/L indicated the possibility of AP disease aggravation. Also, HFLC% <2.9 % was directly associated with infection, SIRS, APPACHII grade, and ICU admission (all P < 0.05). In non-MAP there was a significant negative correlation between HFLC% and APACHE-II score (rs = −0.312, P = 0.023). ConclusionHFLC% <2.9 % on 7th day was directly indicated more infection, systemic inflammatory response syndrome(SIRS), higher APPACH II grade and ICU admission. HFLC% may be an independent laboratory marker for prognosis in AP. Combining HFLC% with IG%, CRP, and WBC helps evaluate AP patients' disease development and outcome.

Real-world Insights for the Evolving Intervention Strategy for non-Mild Acute Pancreatitis: 35-Year Experience in a Chinese Tertiary Center

Background: With the accumulation of experience and evidence, guidelines for invasive intervention for acute pancreatitis (AP) have continuously evolved, followed in Peking Union Medical College Hospital (PUMCH). We aimed to review AP case series to help understand the impact of guideline evolution on the management and prognosis of AP in real-world practice. Methods: This was a single-center study of AP patients who had received invasive interventions from 1988 to 2022. Patient demographics, baseline severity, imaging findings, and the indication, timing, and specific modalities of invasive interventions were collected. The composite primary endpoint was death during hospitalization or major complications after intervention. Other endpoints included pancreatic fistula, incision infection, number of interventions, length of intensive care stay, length of hospitalization, and total medical cost. Results: A total of 195 patients were included. The most common indication for invasive intervention was suspected infection, followed by persistent symptoms. The step-up and delayed strategies reduced the incidence of major complications or death. Over 35 years, the number of patients requiring surgery has gradually declined, and more patients need only minimally invasive procedures for remission. The incidence of the primary outcome decreased as well as the duration of hospitalization. Conclusions: The management of AP patients at PUMCH in the last 35 years has undergone therapeutic guideline changes that support the efficacy and safety of the deferred step-up strategy in real-world practice.

Serum Lactate Is an Indicator for Short-Term and Long-Term Mortality in Patients with Acute Pancreatitis.

Serum lactate, as a single and an easily available biomarker, has been applied in various diseases. In this study, we aimed to explore the predictive value of serum lactate for short-term and long-term prognosis in acute pancreatitis (AP) admitted in intensive care unit (ICU) based on a large-scale database. AP patients admitted in ICU in the MIMIC-IV database were included. We constructed three different models to investigate the relationships between serum lactate and clinical outcomes, including 30-day, 180-day and 1-year mortality in AP. Smooth fitting curves were performed for intuitively demonstrating the relationship between serum lactate and different outcomes in AP by the generalized additive model. A total of 895 AP patients admitted in ICU were included. The mortalities of 30 days, 180 days, and 1 year were 12.63% (n = 113), 16.87% (n = 151), and 17.54% (n = 157). In model B, with 1-mmol/L increment in serum lactate, the values of OR in 30-day, 180-day and 1-year mortality were 1.20 (95%CI 1.04-1.37, P = 0.0094), 1.21 (95%CI 1.06-1.37, P = 0.0039), and 1.21 (95%CI 1.07-1.38, P = 0.0035). The AUCs of serum lactate for predicting 30-day, 180-day, and 1-year mortality in AP were 0.688 (95%CI 0.633-0.743), 0.655 (95%CI 0.605-0.705), and 0.653 (95%CI 0.603-0.701), respectively. The cut-off value of serum lactate predicting 30-day, 180-day and 1-year mortality in AP was 2.4mmol/L. Serum lactate could be an indicator for short-term and long-term mortality in patients with AP admitted in ICU.

Nonbiliyer Akut Pankreatit Prognozunda Skorlama Sistemlerinin Tanısal Performansı: Ranson ve Balthazar Skorlarının Karşılaştırmalı Analizi

Amaç: Akut pankreatitli hastalarda ciddiyetin ve prognozunu tahmin edilmesinde Ranson skoru (RS) ve Balthazar Bilgisayarlı Tomografi Şiddet İndeksini (CTSI) yaygın olarak kullanılmaktadır. Ancak, bu skorlama sistemlerinin biliyer olmayan akut pankreatitin prognouzu tahmin etmedeki tanısal üstünlükleri belirsizliğini korumaktadır. Bu nedenle, bu çalışmada nonbiliyer AP'nin prognozunu tahmin etmede RS ve CTSI'yi karşılaştırmayı amaçladık.&#x0D; Gereç ve Yöntemler: Bu retrospektif çalışmaya, Ocak 2021 ile Mayıs 2023 arasında İç Hastalıkları kliniğinde takip edilen 67 nonbiliyer AP hastası dahil edildi. RS ve CTSI, hastaların laboratuvar ve radyolojik bulgularına dayanarak hesaplanmıştır. Son noktalar, uzun süreli hastanede yatış (≥8 gün), komplikasyonlar ve mortaliteden oluşmaktadır.&#x0D; Bulgular: Hastaların ortalama yaşı 50.1±8.3 yıl olup, çoğunluğu erkek (%59.7) idi. Hastaların %11.9'unda komplikasyon gelişti, %26.9'unda uzun süreli hastanede yatış meydana geldi ve %6'sında ölüm gözlendi. Uzun süreli hastanede yatış ve komplikasyon riskini tahmin etmede CTSI, RS'ye göre üstün tanısal performans sergiledi (uzun süreli hastanede kalma için eğri altındaki alan (AUC) = 0.590 vs. 0.856, p

Impact of stress hyperglycemia on long-term prognosis in acute pancreatitis without diabetes.

Stress hyperglycemia has been confirmed as a strong predictor of poor short-term prognosis in acute pancreatitis. However, whether stress hyperglycemia affects the long-term prognosis of patients with acute pancreatitis is unclear. We aimed to investigate the effect of stress hyperglycemia on the long-term prognosis of non-diabetic patients with acute pancreatitis. This retrospective observational study was conducted on 4055 patients with acute pancreatitis from 1 January 2016 to 31 October 2020. The association between stress hyperglycemia and the prognosis was evaluated using regression modeling. There were 935(71.5%) normoglycemic and 373(28.5%) stress hyperglycemia patients. 46(12.3%) patients with stress hyperglycemia had evidence of diabetes compared with 33(3.5%) patients without stress hyperglycemia (P < 0.001). After multivariate adjustment, patients with stress hyperglycemia were more likely to have evidence of diabetes (OR 2.905, 95% CI 1.688-4.999) compared with normoglycemic. However, stress hyperglycemia is not associated with the recurrence of pancreatitis and progression to chronic pancreatitis. Stress hyperglycemia was independently associated with diabetes secondary to acute pancreatitis. Accordingly, a follow-up diabetes-screening program for AP with stress hyperglycemia is an important part of identifying the disease as soon as possible, delaying islet damage, and improving the prognosis of post-acute pancreatitis diabetes mellitus.

Early encapsulation of peripancreatic fluid/necrosis collections on imaging (CECT) in acute pancreatitis: influential factors and clinical significance for prognosis

BackgroundTo identify the factors influencing the early encapsulation of peripancreatic fluid/necrosis collections via contrast-enhanced computed tomography (CECT) and to determine the clinical significance of early encapsulation for determining the prognosis of acute pancreatitis (AP) patients.MethodsAP patients who underwent CECT between 4 and 10 days after disease onset were enrolled in this study. Early encapsulation was defined as a continuous enhancing wall around peripancreatic fluid/necrosis collections on CECT. Univariate and multivariate logistic regression analyses were performed to assess the associations between the variables and early encapsulation. Clinical outcomes were compared between the non-encapsulation and early encapsulation groups with 1:1 propensity score matching.ResultsA total of 289 AP patients were enrolled. The intra-observer and inter-observer agreement were considered good (kappa statistics of 0.729 and 0.614, respectively) for identifying early encapsulation on CECT. The ratio of encapsulation increased with time, with a ratio of 12.5% on day 5 to 48.7% on day 9. Multivariate logistic regression analysis revealed that the longer time from onset to CECT examination (OR 1.55, 95% CI 1.23–1.97), high alanine aminotransferase level (OR 0.98, 95% CI 0.97–0.99), and high APACHE II score (OR 0.89, 95% CI 0.81–0.98) were found to be independent factors associated with delayed encapsulation. The incidence of persistent organ failure was significantly lower in the early encapsulation group after matching (22.4% vs 6.1%, p = 0.043). However, there was no difference in the incidence of infected pancreatic necrosis, surgical intervention, or in-hospital mortality.ConclusionsAP patients without early encapsulation of peripancreatic fluid/necrosis collections have a greater risk of persistent organ failure. In addition to longer time, the high APACHE II score and elevated alanine aminotransferase level are factors associated with delayed encapsulation.

Can the FIB-4 score predict the severity of acute pancreatitis in NAFLD?

BackgroundNon-alcoholic fatty liver disease (NAFLD) is a liver pathology. NAFLD’s prevalence is increasing in the world and because of the increase non-invasive methods are gaining importance in diagnosis. The Fibrosis 4 (FIB-4) score is one of the most commonly used non-invasive scoring methods for diagnosing NAFLD today. Acute pancreatitis is a disease with inflammation and high morbidity. There are studies indicating that acute pancreatitis progresses more severely in patients with NAFLD. In our study, it was aimed to define the possible relationship between the FIB-4 score and the severity of acute pancreatitis, which has not been investigated before and contribute to the literature.MethodsOur study was conducted by retrospectively scanning 124 patients diagnosed with acute pancreatitis between 2018 and 2020. The patients were compared with the presence of NAFLD and the FIB-4 score results in those with NAFLD.ResultsThe 48th-hour Ranson score was found to be statistically significantly higher in patients with NAFLD compared to those without NAFLD. In patients with NAFLD, the total billurbin, direct billurbin, AST, ALT, ALP, GGT, and Ranson scores were found to be statistically significantly higher in those with FIB-4 score ≥ 2.67.ConclusıonAs liver fibrosis increases in patients with NAFLD, it is suggested that liver damage accompanying acute pancreatitis increases, and the prognosis of acute pancreatitis worsens. There is a need for further studies to be conducted while centering more on this subject, which has not been investigated before in the literature.

The red cell distribution width-to-albumin ratio: A simple index has high predictive accuracy for clinical outcomes in patients with acute pancreatitis

Background/objectivesOngoing research is seeking to identify the best prognostic marker for acute pancreatitis (AP). The purpose of this study was to investigate the role of the red blood cell distribution width-to-albumin ratio (RAR) in the prognosis of AP. MethodsThis 18-month prospective cohort study was conducted between June 2021 and December 2022 with patients diagnosed with AP. The patients were divided into two groups: severe AP (SAP) and non-severe AP. Factors associated with SAP within the first 48 h of admission were determined. In addition, RAR values at admission and at 48 h (RAR-48th) were calculated, and their ability to predict clinical outcomes was assessed. The primary outcomes were severe disease and in-hospital mortality. ResultsFifty (13.7 %) of 365 patients had SAP. Systemic inflammatory response syndrome, blood urea nitrogen, calcium, and RAR at 48 h after admission were independent predictors of SAP. When RAR-48th was >4.35, the risk of SAP increased approximately 18-fold (OR: 18.59; 95 % CI: 8.58–40.27), whereas no patients with a RAR-48th value of <4.6 died. For in-hospital mortality, the area under the curve (AUC) value of RAR-48th was 0.960 (95 % CI: 0.931–0.989), significantly higher than the AUC values of existing scoring systems. The results of RAR-48th were comparable to those of the other scoring systems with regard to the remaining clinical outcomes. ConclusionsRAR-48th successfully predicted clinical outcomes, particularly in-hospital mortality. Being simple and readily calculable, RAR-48th is a promising alternative to burdensome and complex scoring systems for the prediction of clinical outcomes in AP.

Effect of early antibiotic treatment strategy on prognosis of acute pancreatitis

BackgroundAntibiotic use in the early stages of acute pancreatitis is controversial. The purpose of this study was to investigate the effect of early antibiotic application on the prognosis of acute pancreatitis (AP).Materials and methodsClinical data of patients with primary AP admitted to our emergency ward within 72 hours of onset were retrospectively collected from January 2016 to December 2020. We classified patients with acute pancreatitis according to etiology and disease severity, and compared the differences in hospital stay, laparotomy rate, and in-hospital mortality among AP patients who received different antibiotic treatment strategies within 72 hours of onset.ResultsA total of 1134 cases were included, with 681 (60.1%) receiving early antibiotic treatment and 453 (39.9%) not receiving it. There were no significant differences in baseline values and outcomes between the two groups. In subgroup analysis, patients with biliary severe acute pancreatitis (SAP) who received early antibiotics had lower rates of laparotomy and invasive mechanical ventilation, as well as shorter hospital stays compared to those who did not receive antibiotics. In logistic regression analysis, the early administration of carbapenem antibiotics in biliary SAP patients was associated with a lower in-hospital mortality rate. Early antibiotic use in biliary moderate-severe acute pancreatitis (MSAP) reduced hospital stays and in-hospital mortality. Quinolone combined with metronidazole treatment in biliary mild acute pancreatitis (MAP) shortened hospital stays. Early antibiotic use does not benefit patients with non-biliary AP.ConclusionStrategies for antibiotic use in the early stages of AP need to be stratified according to cause and disease severity.

A Retrospective Review of Children followed up with the Diagnosis of Acute Pancreatitis.

Acute pancreatitis (AP) is an inflammatory disease of the pancreas, the frequency of which increases in childhood. To investigate the demographic, etiological, clinical, laboratory, and radiological characteristics of children followed up with the diagnosis of AP. The study also included genetic studies of recurrent cases. This retrospective cohort study included pediatric patients <18 years of age with AP who were followed up with recurrent pancreatitis in the Pediatrics Department of a University Hospital between January 2010 and April 2021. Patients who met at least 2 of the 3 criteria defined by the International Pediatric Pancreatitis Study Group (INSPPIRE) were accepted as AP. Demographic, etiological, and clinical data of the patients, developing complications, pathological evaluation of the samples, and genetic analysis results were obtained from the patient files. The obtained data were statistically analyzed using the SPSS version 26.0 program. Descriptive statistics of the data were expressed as mean ± standard deviation, median, minimum and maximum values, number (n), and percentage (%). Kolmogorov-Smirnov test, Mann Whitney U test, Chi-square test and Fischer test were used. Fifty-four (50%) female and 54 (50%) male patients with a mean age of 9.96 ± 4.8 years who met the study criteria were included in the study. In the follow-up, it was reported that acute recurrent pancreatitis developed in 23 (21%) patients and chronic pancreatitis developed in 8 (7%) patients. The most common complaints were abdominal pain (94.4%), and vomiting (60.2%), followed by malnutrition (36.1%), nausea (17.6%), diarrhea (13%), and fever (13%). Etiology could not be determined in 19.4% of the patients. It was noted that the genetic predisposition of the patients played a role in the development of recurrent and chronic pancreatitis. Amylase, lipase, and CRP values, which are among the laboratory parameters showing the severity and prognosis of AP, were found to be significant. Sociocultural and demographic data of the patients should also be taken into account. Gene sequences that cause to genetic predisposition should be determined in recurrent and chronic pancreatitis cases. Acute pancreatitis should be considered in the differential diagnosis of patients with frequent abdominal pain and vomiting.

Value of CRP/albumin ratio as a prognostic marker of acute pancreatitis: a retrospective study.

the C-reactive protein (CRP) to albumin ratio is an inflammatory marker that has shown promise in the prognosis of critically ill patients. This study is aimed to assess the value of CRP/albumin ratio to predict severity in acute pancreatitis. a retrospective study was performed using a prospectively collected database of patients diagnosed with AP admitted to the Department of Gastroenterology between March 2014 and December 2021. among 722 patients included in the study, 78.67 % had mild, 15.65 % had moderately severe, and 5.67 % had severe acute pancreatitis. The CRP/albumin ratio was significantly associated with severe AP (OR 1.02; 95 % CI: 1.01-1.03; p < 0.001), and each ten-unit increase in the ratio was associated with a 20 % increased likelihood of severe acute pancreatitis. The area under the ROC curve (AUC) value of the CRP/albumin ratio in severe acute pancreatitis was 0.68 (95 % CI: 0.58-0.77), which was higher than that of the Ranson criteria (0.62). The optimal cut-off value for predicting severe acute pancreatitis was 7.51, with a sensitivity of 63.4 % and specificity of 65.6 %. despite its low sensitivity and specificity, the CRP/albumin ratio could be used as a complementary marker to the current scoring systems for the initial assessment of acute pancreatitis prognosis. It is easily obtainable and can provide additional prognostic information to clinicians.

The value of CT-based radiomics in predicting the prognosis of acute pancreatitis

PurposeEarly judgment of the progress of acute pancreatitis (AP) and timely intervention are crucial to the prognosis of patients. The purpose of this study was to investigate the application value of CT-based radiomics of pancreatic parenchyma in predicting the prognosis of early AP.Materials and methodsThis retrospective study enrolled 137 patients diagnosed with AP (95 cases in the progressive group and 42 cases in the non-progressive group) who underwent CT scans. Patients were randomly divided into a training set (n = 95) and a validation set (n = 42) in a ratio of 7: 3. The region of interest (ROI) was outlined along the inner edge of the pancreatic parenchyma manually, and the Modified CT Severity Index (MCTSI) was assessed. After resampling and normalizing the CT image, a total of 2,264 radiomics features were extracted from the ROI. The radiomics features were downscaled and filtered using minimum redundancy maximum correlation (mRMR) and the least absolute shrinkage and selection operator algorithm (LASSO) regression, in turn, and the more optimal subset of radiomics features was selected. In addition, the radiomics score (rad-score) was calculated for each patient by the LASSO method. Clinical data were also analyzed to predict the prognosis of AP. Three prediction models, including clinical model, radiomics model, and combined clinical–radiomics model, are constructed. The effectiveness of each model was evaluated using receiver operating characteristic (ROC) curve analysis. The DeLong test was employed to compare the differences between the ROC curves. The decision curve analysis (DCA) is used to assess the net benefit of the model.ResultsThe mRMR algorithm and LASSO regression were used to select 13 radiomics features with high values. The rad-score of each texture feature was calculated to fuse MCTSI to establish the radiomics model, and both the clinical model and clinical–radiomics model were established. The clinical–radiomics model showed the best performance, the AUC and 95% confidence interval, accuracy, sensitivity, and specificity of the clinical–radiomics model in the training set were 0.984 (0.964–1.000), 0.947, 0.955, and 0.931, respectively. In the validation set, they were 0.942 (0.870–1.000), 0.929, 0.966, and 0.846, respectively. The Delong test showed that the predictive efficacy of the clinical–radiomics model was higher than that of the clinical model (Z = 2.767, p = 0.005) and the radiomics model (Z = 2.033, p = 0.042) in the validation set. Decision curve analysis demonstrated higher net clinical benefit for the clinical–radiomics model.ConclusionThe pancreatic parenchymal CT clinical–radiomics model has high diagnostic efficacy in predicting the progression of early AP patients, which is significantly better than the clinical or radiomics model. The combined model can help identify and determine the progression trend of patients with AP and improve the prognosis and survival of patients as early as possible.

Impact of Fluid Collection According to Revised ATLANTA Classification on Patient Prognosis in Acute Pancreatitis: A Radiological Study

Background: Acute pancreatitis is a complex and challenging disease. The revised Atlanta Classification emphasizes accurate characterization of collections that complicate acute pancreatitis and standardizes terminology across specialties, which helps to decide the treatment strategy. As a result, the role of imaging in the management of acute pancreatitis has substantially increased. Objective: This study aimed to categorize the fluid collections in acute pancreatitis using the 2012 ATLANTA classification and to compare the type of collection with the patient's clinical variables like length of hospital stay, ICU stay, presence of organ failure, type of organ failure, presence of infection, and outcome. Methods: This descriptive cross-sectional hospital-based study was conducted for two years. A total of 120 patients with acute pancreatitis-associated fluid collections were included in the study. Results: In our study, hospital and intensive care unit admission, as well as the length of stay, presence of organ failure, presence of infection, and the patient's outcome, all showed statistically significant relationships with walled-off necrosis (WON). Conclusions: The revised ATLANTA classification provides clear definitions to classify acute pancreatitis using easily identified clinical and radiologic criteria and thereby helps to determine the proper patient outcome and management.

Establishing a Predictive Model for the Treatment Prognosis of Acute Pancreatitis Based on Biomarkers

Establishing a Predictive Model for the Treatment Prognosis of Acute Pancreatitis Based on Biomarkers

Vliv pandemie covidu-19 na akutní pankreatitidu v České republice – pilotní data studie PANACOTA (PANcreatitis Acuta in COvid Time Analysis)

Summary: Introduction: The COVID-19 pandemic had a significant impact on health care. Previous studies point to a possible negative impact of COVID-19 infection on the development and severity of acute pancreatitis. The aim of this study is to analyze the impact of the COVID-19 pandemic on the epidemiology, treatment and prognosis of acute pancreatitis at the population level. Methods: Using data from the National Registry of Reimbursed Health Services (NRRHS) parameters of hospital admissions for acute pancreatitis, the provided health care and treatment outcomes in the pandemic period (2020 and 2021) with previous years (2010–2019) were compared. Results: The incidence during the pandemic was not significantly different from the previous period: 67 vs. 63 per 100,000 population. Hospitalizations for acute pancreatitis in each month of 2020 and 2021 did not correlate with the number of COVID-19 positive patients. The overall mortality rates for acute pancreatitis before and during the pandemic were almost identical – at 3.8% and 3.9%, respectively. There was a trend towards a decrease in the number of surgical procedures, a gradual decrease in ERCPs and an increase in endoscopic drainages throughout the 2010–2021 period. The crude mortality rate of patients hospitalized for COVID-19 and concomitant acute pancreatitis was 14.2% and these patients were operated in 4.7%. Conclusions: Based on pilot population data, the COVID-19 pandemic did not have an impact on the incidence of acute pancreatitis in the Czech Republic. A more severe course and prognosis of the disease was associated with near-term COVID-19 positivity. More frequent indication of surgical and other interventions for acute pancreatitis in COVID-19 positive individuals may have been related to the disruption of standard quality and availability of care. Key words: acute pancreatitis – COVID-19 – epidemiology – endoscopic drainage – surgery – complications

Serum iron fluctuations link ferroptosis process with mortality and prognosis of acute pancreatitis

Recently, the existence of ferroptosis has been confirmed in chronic pancreatitis. However, its role in acute pancreatitis (AP) process, especially in critical status, has not yet been mentioned. To verify this hypothesis, we included 873 AP patients (training set) and 1,188 NAFLD patients (internal validation set) selected from MIMIC-III (Medical Information Mark for Intensive Care) database and 218 AP patients (external validation set) in Linshui County People's Hospital ICU data. We analyzed the correlation between mortality and ferroptosis associating factors (such as serum iron, ALP, lactate, etc.) in them through regression analysis. In addition, to test the significance of these factors, the nomogram, AUC, and DCA analysis were applied. The results showed that serum iron, IBC, ALP, and lactate (p<0.05) were independent factors for the mortality and prognosis of these patients. These correlations suggest ferroptosis and follow-up cell programmed death may own an important clinical interference significance among this population.

The value of procalsitonin in determining the severity acute pancreatitis cases

Objectives: Many markers and indication systems are being used to indicate the prognosis of acute pancreatitis. Our study was planned to investigate the importance of procalcitonin(PCT) in patients with severe pancreatitis in terms of predicting prognosis by comparing C-reactive protein , modified CT severity index, and duration of hospitalization.&#x0D; Methods: In our cross-sectional retrospective study, 30 patients who were hospitalized with a diagnosis of A. pancreatitis were included in the study. Our study was conducted from January 2013 to January 2019 at Katip Çelebi University. PCT, CRP, duration of hospitalization, gender, age, CRE, CA, pleural effusion, and modified CT severity scores were recorded in all patients.&#x0D; Results: Of the 30 patients included in the study,13 (43.33%) were male and 17(56.66%) were female. The presence of stones in 80% of patients was detected in 6.7% of patients due to hypertriglestrimia. The PCT value was found to be a minimum of 0.0 ng/ml, a maximum of 39.68 ng/ml, and an average of 1.97 ng/ml. There is a significant relationship between the PCT value and the length of hospitalization for the patients. The hospitalization period was a minimum of 3 days, a maximum of 23 days, and an average of 10.13 days in the 30 patients studied. It was determined that there was a statistically significant relationship between PCT and length of stay (r = 0.437; p 0.016).&#x0D; Conclusion: In patients with A. pancreatitis, the evaluation of PCT, CRP, and modified CT severity index can be used to estimate the duration of hospitalization.