Ranson Score Research Articles

The prognostic value of fat necrosis deposits on CT imaging in acute pancreatitis

Background/aim Investigate the prognostic value of the fat necrosis deposit (FND) pattern in acute pancreatitis.Materials and methodsThe contrast-enhanced computed tomography (CT) images of 35 necrotizing pancreatitis (NP) and 51 edematous pancreatitis (EP) cases were included in our retrospective study. Computed tomography severity index (CTSI) and Ranson scores were calculated. Images were evaluated for FND, complications (infection/ hemorrhage), walled-off necrosis (WON), and venous thrombosis (VT). We developed a new grading system called fat necrosis deposit-CTSI (FND-CTSI), which was the sum of FND and CTSI scores. The relationship between grading systems and mortality, length of hospital-intensive care unit stay, surgical and percutaneous interventions were evaluated.ResultsFND-CTSI scores were significantly higher in NP than EP (P < 0.001). FND-CTSI demonstrated a significant correlation with CTSI (r:0.91, P < 0.001) and Ranson score (r:0.24, P = 0.025). CTSI was significantly higher in only mass form amongst the FND groups (P < 0.001). There was a significant difference in WON, complications, and mortality between FND groups (P < 0.05). CTSI and FND-CTSI scores were both significantly associated with WON, VT, surgical intervention, mortality (P < 0.001), and the presence of complications (P = 0.013 and P = 0.007, respectively). FND-CTSI was also significantly associated with percutaneous intervention (P = 0.019), while CTSI was not (P > 0.05). According to ROC analysis, AUC values of FND-CTSI were higher than CTSI for the detection of WON, complications, mortality, and percutaneous intervention (P < 0.05). FND-CTSI showed a highly significant correlation with the length of hospital and intensive care unit stays (P < 0.001). ConclusionFND-CTSI can be used in acute pancreatitis grading and considered as a prognostic factor.

Accuracy of conventional and novel scoring systems in predicting severity and outcomes of acute pancreatitis: a retrospective study

BackgroundRecently, several novel scoring systems have been developed to evaluate the severity and outcomes of acute pancreatitis. This study aimed to compare the effectiveness of novel and conventional scoring systems in predicting the severity and outcomes of acute pancreatitis.MethodsPatients treated between January 2003 and August 2020 were reviewed. The Ranson score (RS), Glasgow score (GS), bedside index of severity in acute pancreatitis (BISAP), pancreatic activity scoring system (PASS), and Chinese simple scoring system (CSSS) were determined within 48 h after admission. Multivariate logistic regression was used for severity, mortality, and organ failure prediction. Optimum cutoffs were identified using receiver operating characteristic curve analysis.ResultsA total of 1848 patients were included. The areas under the curve (AUCs) of RS, GS, BISAP, PASS, and CSSS for severity prediction were 0.861, 0.865, 0.829, 0.778, and 0.816, respectively. The corresponding AUCs for mortality prediction were 0.693, 0.736, 0.789, 0.858, and 0.759. The corresponding AUCs for acute respiratory distress syndrome prediction were 0.745, 0.784, 0.834, 0.936, and 0.820. Finally, the corresponding AUCs for acute renal failure prediction were 0.707, 0.734, 0.781, 0.868, and 0.816.ConclusionsRS and GS predicted severity better than they predicted mortality and organ failure, while PASS predicted mortality and organ failure better. BISAP and CSSS performed equally well in severity and outcome predictions.

Bedside index (BISAP) v/s Ranson scores in predicting mortality and severity in patients with acute pancreatitis.

To determine the diagnostic accuracy of the bedside index for severity in acute pancreatitis in comparison with Ranson scores in predicting mortalities and severities in patients with acute pancreatitis. The cross-sectional study was conducted at the Department of Emergency Medicine, Aga Khan University Hospital, Karachi, from July 1, 2017, to January 1, 2018, and comprised patients who presented with acute pancreatitis. The bedside index for severity in acute pancreatitis score was applied in the emergency department and the patients were followed up in ward/intensive care unit where Ranson scores were calculated within the following 48 hours. Both the scores were calculated and compared for the prediction of severity and mortality for each patient. Data was analysed using SPSS 20. Of the 136 patients, 88(64.7%) were males and 48(35.3%) were females. The overall mean age was 42.04±16.42 years (16-75 years), On the basis of two scores, mild and moderate acute pancreatitis was diagnosed in 123(90.4%) and 119(87.5%) patients respectively, while severe condition was diagnosed in 13(9.6%) and 17(12.5%) patients respectively. The bedside index had specificity 94.62% compared to 91.54% for Ranson score; sensitivity 100% vs 100%; negative predictive value 100% vs 100%; positive predictive value 46.15% vs 35.29%; and diagnostic accuracy 94.85% vs 91.91%. The bedside index for severity in acute pancreatitis and Ranson score were both found to be reliable tools in predicting mortalities and severities in patients with acute pancreatitis.

Acute pancreatitis: predictors of mortality, pancreatic necrosis and intervention.

Several predictive scoring systems are used in the prognostication of acute pancreatitis (AP). However, the quantity of evidence of these prognostic systems in the Indian population remains sparse. The aim of our study was to evaluate the usefulness of such prognostic scores to predict mortality, incidence of pancreatic necrosis and intervention in AP. This was an observational study of patients diagnosed with AP between June 2012 and November 2013 in a tertiary referral center in India. Vital signs, biochemical tests and CT-findings were recorded to identify SIRS, Ranson's score and CT-severity index at diagnosis. Chi square test was used to compare incidence of mortality, pancreatic necrosis, and intervention between mild versus severe acute pancreatitis groups. A total of 100 patients with AP were treated during out study period. Ranson's score more than 7 and presence of pancreatic necrosis were significantly associated with increased mortality (p <0.05). SIRS, CTSI score more than 7, inotropic support, and complications were more frequently associated with patients with necrosis. Prophylactic antibiotics did not decrease mortality, but decreased intervention rate (p <0.05). Presence of systemic inflammatory response syndrome (SIRS), Ranson's score > 7, necrosis, inotropic support and presence of complications were associated with a greater rate of interventions including surgery and percutaneous procedures (p <0.05). We validate SIRS, Ranson's, and CTSI score as prognostic markers for AP in the Indian population. These predictors, when used in combination, can direct early monitoring and aggressive management in order to decrease mortality associated with severe AP.

Comparative study between BISAP score and Ranson score in predicting severity of acute pancreatitis

Background: Acute pancreatitis has widely variable clinical and systemic manifestations spanning the spectrum from a mild, self-limiting episode of epigastric pain to severe, life-threatening, multi-organ failure. Since the morbidity and mortality of acute pancreatitis differ markedly between mild and severe disease (mild &lt;5% versus severe 20–25%), it is very important to assess severity as early as possible. To assess the accuracy of the BISAP scoring system versus Ranson scoring system in predicting severity in an attack of acute pancreatitis.Methods: It is a prospective and retro prospective study that was conducted, from August 2018 to November 2019. All surgical units in the headquarters hospital, Ooty. BISAP score and Ranson’s score is calculated in all such patients based on data obtained within 48 hours of hospitalization.Results: Ranson’s score of more than 3 and the BISAP score of less than or equal to 3 had the best accuracy of predicting the severity of acute pancreatitis. Both Ranson’s score and BISAP score showed higher sensitivity in the prediction of systemic complications than that of local complications.Conclusions: From this study, we can conclude that the BISAP scoring system is not inferior to Ranson’s scoring system in predicting the severity of acute pancreatitis. BISAP scoring system is very simple, cheap, easy to remember and calculate. BISAP scoring system accurately predicts the outcome in patients with acute pancreatitis.

Risk Factors and Distribution of Pathogens for Pulmonary Infection in Patients with Severe Acute Pancreatitis

Objective: To investigate risk factors and distribution of pathogens for pulmonary infection in patients with severe acute pancreatitis. Methods: The clinical data of 285 patients with severe acute pancreatitis were retrospectively analyzed. Sputum specimens of patients with lung infections were studied. Univariate analysis and logistic regression were performed to screening the factors correlating to lung infections. Results: Gram-negative bacilli were the principal microorganisms isolated from those lung infections, and these bacterial pathogens demonstrated a marked pattern of antibiotic resistance. It was identified that age (OR 1.05, 95% CI 1.01-1.09, p=0.01), Ranson scores (OR 3.01 , 95% CI 1.13-8.03, p = 0.03) and surgical treatment (OR4.27, 95% CI 1.03-17.65, p = 0.04)were independent risk factors of lung infections in patients with severe acute pancreatitis. Conclusion: Analysis of pathogen spectrum and drug sensitivity will contribute to choosing antibiotics empirically. And preventive measures aimed at risk factors could help reduce the incidence of lung infections in patients with severe acute pancreatitis.

An Artificial Neural Networks Model for Early Predicting In-Hospital Mortality in Acute Pancreatitis in MIMIC-III.

Background Early and accurate evaluation of severity and prognosis in acute pancreatitis (AP), especially at the time of admission is very significant. This study was aimed to develop an artificial neural networks (ANN) model for early prediction of in-hospital mortality in AP. Methods Patients with AP were identified from the Medical Information Mart for Intensive Care-III (MIMIC-III) database. Clinical and laboratory data were utilized to perform a predictive model by back propagation ANN approach. Results A total of 337 patients with AP were analyzed in the study, and the in-hospital mortality rate was 11.2%. A total of 12 variables that differed between patients in survivor group and nonsurvivor group were applied to construct ANN model. Three independent variables were identified as risk factors associated with in-hospital mortality by multivariate logistic regression analysis. The predictive performance based on the area under the receiver operating characteristic curve (AUC) was 0.769 for ANN model, 0.607 for logistic regression, 0.652 for Ranson score, and 0.401 for SOFA score. Conclusion An ANN predictive model for in-hospital mortality in patients with AP in MIMIC-III database was first performed. The patients with high risk of fatal outcome can be screened out easily in the early stage of AP by our model.

The risk factors for acute respiratory distress syndrome in patients with severe acute pancreatitis: A retrospective analysis.

Acute respiratory distress syndrome (ARDS) is very common in patients with severe acute pancreatitis (SAP), the early interventions are essential to the prognosis of SAP patients. We aimed to evaluate the risk factors for ARDS in SAP patients, to provide insights into the management of SAP.SAP patients treated in our hospital from June 1, 2018 to May 31, 2020 were included. The characteristics and lab test results were collected and compared, and we conducted the logistic regression analyses were conducted to identify the potential risk factors for ARDS in patients with SAP.A total of 281 SAP patients were included finally, the incidence of ARDS in patients with SAP was 30.60%. There were significant differences on the respiratory rate, heart rate, APACHE II and Ranson score between 2 groups (all P < .05). And there were significant differences on the polymorphonuclear, procalcitonin, C-reactive protein, serum creatinine, albumin and PO2/FiO2 between 2 groups (all P < .05), and no significant differences on the K+, Na+, Ca+, white blood cell, neutrophils, urine and blood amylase, trypsin, lipase, alanine aminotransferase, aspartate aminotransferase, total bilirubin, triglyceride, total cholesterol, total bilirubin, fasting blood glucose, and pH were found (all P > .05). Respiratory rate >30/min (odds ratio [OR]: 2.405, 95% confidence interval[CI]: 1.163–4.642), APACHE II score >11 (OR: 1.639, 95% CI: 1.078–2.454), Ranson score >5 (OR: 1.473, 95% CI: 1.145–2.359), polymorphonuclear >14 × 109/L (OR: 1.316, 95% CI: 1.073–2.328), C-reactive protein >150 mg/L (OR: 1.127, 95% CI: 1.002–1.534), albumin ≤30 g/L (OR: 1.113, 95% CI: 1.005–1.489) were the independent risk factors for ARDS in patients with SAP (all P < .05).The incidence of ARDS in SAP patients is relatively high, and it is necessary to carry out targeted early prevention and treatment for the above risk factors.

The role of interleukin-4 and interleukin-5 Th2 cytokines in assessing severity and prognosis of acute pancreatitis

Introduction/Objective. Acute pancreatitis (AP) is a relatively common disease which in most patients has favorable course. However, in approximately 20% patients, the course of the disease is more severe with high mortality (40?50%). The evaluation of disease severity is now primarily based on protocols that includes clinical, laboratory, and radiographic diagnostic procedures, APACHE II score, Ranson score, CT index, and CT necrosis score. Key cells in the immunopathogenesis of AP are T-lymphocytes, and recent studies indicate the role of Th2 and their effector cytokines: interleukin (IL) -4 and interleukin (IL) -5. The purpose of our study was to determine the potential clinical value of IL-4 and IL-5 as biochemical markers for predicting development of severe, necrotizing form of acute pancreatitis with systemic complication such as systemic inflammatory response syndrome (SIRS). Methods. This prospective study included 240 patients hospitalized at The Clinic for Emergency Surgery of Clinical Center of Serbia as AP. Levels of IL-4 and IL-5 in serum were detected using commercial Bender Med Systems (BMS716FF) kits. Results. IL-4 and IL-5 were statistically significant increased on the second day of hospitalization with maximum values on the third day. In patients with severe AP complicated with necrosis and/or sepsis values were rising all through the seventh day. Conclusion. Levels of IL-4 and IL-5 in peripheral blood correlate with SIRS, Ranson score and clinical outcome in AP patients, therefore these cytokines are potential early biomarkers of disease progression and related complications.

Pleural effusion volume in patients with acute pancreatitis: a retrospective study from three acute pancreatitis centers

Objective To assess the value of pleural effusion volume (PEV) quantified on chest computed tomography (CT) in patients with early stage acute pancreatitis (AP). Methods Data of PEV, and C-reactive protein (CRP) levels as well as Ranson, bedside index of severity in acute pancreatitis (BISAP), Marshall, acute physiology and chronic health evaluation II (APACHE II), CT severity index (CTSI), and extra-pancreatic inflammation on computed tomography (EPIC) scores in patients with AP were collected. Duration of hospitalization, severity of AP, infection, procedure, intensive care unit (ICU) admission, organ failure, or death were included as the outcome parameters. Results In 465 patients, the mean PEV was 98.8 ± 113.2 mL. PEV showed strong and significant correlations with the CRP levels, duration of hospitalization as well as the Ranson, BISAP, Marshall, APACHE II, CTSI, and EPIC scores (p < .05). PEV demonstrated significant accuracy in predicting severity, infection, procedure, ICU admission, organ failure, and death (p < .05). Conclusion PEV quantified on chest CT positively associated with the duration of hospitalization, CRP levels, Ranson, BISAP, Marshall, APACHE II, CTSI, and EPIC scores. It can be a reliable radiologic biomarker in predicting severity and clinical outcomes of AP. KEY MESSAGES Pleural effusion is a common chest finding in patients with acute pancreatitis. Pleural effusion volume quantified on chest CT examination positively associated with the duration of hospitalization, CRP level, as well as Ranson, BISAP, Marshall, APACHE II, CTSI, and EPIC scoring systems. Pleural effusion volume can be a reliable radiologic biomarker in the prediction of severity and clinical outcomes of acute pancreatitis.

Sequential Organ Failure Assessment (SOFA) Score Is Superior to Classical Prognostic Indices in Prediction of Severity, Intensive Care Unit Admissions and Mortality in Acute Pancreatitis

Introduction: Acute Pancreatitis (AP) is common and severe AP is potentially lethal. Many prognostic indices (APACHE-II, BISAP, Glasgow's, HAPS, Ranson's, SOFA) are used to predict severity. We evaluate utility of these indices in predicting severity, need for ICU admission, and mortality. Methodology: A retrospective audit of 653 patients with AP from July 2009 to September 2016 is done. The demographic and clinical profile and patient outcomes were collected. Severe acute pancreatitis (SAP) was defined as per revised Atlanta classification. Results: The mean age was 58.7±17.5 years with 58.7% males. Commonly identified etiologies of AP was gallstones(n=404, 61.9%), alcohol(n=38, 5.8%) and hypertriglyceridemia(n=19, 2.9%). 81(12.4%) patients developed SAP, 20(3.1%) required ICU admission and 12(1.8%) deaths were attributed to SAP. All-cause in-hospital mortality was 36(5.5%); 7(1.1%) cardiovascular causes, and 5(0.8%) pneumonia. Ranson's and APACHE-II demonstrated highest sensitivity in predicting SAP(92.6%, 80.2% respectively), ICU admission(100%) and mortality(100%). While SOFA and BISAP demonstrated lowest sensitivity in predicting SAP(13.6%, 24.7% respectively), ICU admission(40.0%, 25.0% respectively) and mortality(50.0%, 25.5% respectively). SOFA demonstrated highest specificity in predicting SAP(99.7%), ICU admission(99.2%) and mortality(98.9%). SOFA demonstrated highest positive predictive value, positive likelihood ratio, diagnostic odds ratio and overall accuracy in predicting SAP, ICU admission and mortality. The highest Area under Receiver-operator Curves(AUROC) was demonstrated by SOFA and Ranson's cumulative(Ranson score at 48 hours) in predicting SAP(0.966, 0.857 respectively), ICU admission(0.943, 0.946 respectively) and mortality(0.968, 0.917 respectively). Conclusion: SOFA score and Ranson's cumulative are accurate in severity stratification, prediction of ICU admission and mortality in acute pancreatitis.

STUDY OF INTRAABDOMINAL PRESSURE IN ACUTE PANCREATITIS AND ITS CORRELATION WITH DISEASE SEVERITY

INTRODUCTION: Acute pancreatitis is one of the commonly encountered surgical conditions in the emergency department. Prognostication is done by various biochemical assays and scoring systems. Intra abdominal pressure (IAP) measurement has strong potential use as a prognostication and interventional marker. In this study we aim to determine the association between the intra abdominal pressures and the severity, morbidity, mortality and the prognosis of the patient. METHODS: This study is prospective observational study. 100 patients diagnosed with acute pancreatitis were observed from the day of admission and followed up to the day of discharge. Intra abdominal pressure to be measured by the intravesical method.. RESULTS : There was significant linear correlation between raised intra abdominal pressure (IAP) and duration of hospitalization. In groups of patients who suffered complications, IAP was noted to be significantly higher, compared to the group of patients with no complications. (p &lt;0.0001)There was a significant correlation of the baseline IAP (IAP at admission) with the MCTSI (pearson correlation coefficient = 0.534), APACHE II score (Pearson correlation coefficient = 0.511). IAP also showed positive linear correlation with ranson score (Pearson correlation coefficient = 0.383) CONCLUSION: IAP measurement is cheap, easy, and minimally invasive modality. It can be easily measured in catheterized patients. It is faster and easier than the existing scoring modalities and can reliably predict hospital stay, complications, and the prognosis in acute pancreatitis.

Comparison of different risk stratification systems for prediction of acute pancreatitis severity in patients referred to the emergency department of a tertiary care hospital.

Prognostic prediction and estimation of severity at early stages of acute pancreatitis (AP) are crucial to reduce the complication rates and mortality. The objective of the present study is to evaluate the predicting ability of different clinical and radiological scores in AP. We retrospectively collected demographic and clinical data from 159 patients diagnosed with AP admitted to Canakkale Onsekiz Mart University Hospital between January 2017 and December 2019. Bedside index for severity AP (BISAP), and acute phys-iology and chronic health evaluation II (APACHE II) score at admission, Ranson and modified Glasgow Prognostic Score (mGPS) score at 48 h after admission were calculated. Modified computed tomography severity index (CTSI) was also calculated for each patient. Area under the curve (AUC) was calculated for each scoring system for predicting severe AP, pancreatic necrosis, length of hospital stay, and mortality by determining optimal cutoff points from the (ROC) curves. mGPS and APACHE II had the highest AUC (0.929 and 0.823, respectively) to predict severe AP on admission with the best specificity and sensitivity. In predicting mortality BISAP (with a sensitivity, specificity, negative predictive value (NPV), and positive predictive value (PPV) of 75.0%, 70.9%, 98.2%, and 12.0%, respectively, [AUC: 0.793]) and APACHE II (with a sensitivity, specificity, NPV and PPV of 87.5%, 86.1%, 99.2%, and 25.0%, respectively, [AUC: 0.840]). mGPS can be a valuable tool in predicting the patients more likely to develop severe AP and maybe somewhat better than BISAP score, APACHE II Ranson score, and mCTSI.

Clinical Prediction of outcomes in Acute Pancreatitis with Various Prognostic Indicators and Modified CTSI

Introduction: Acute pancreatitis is the most common cause of patients presenting to the emergency department with pain abdomen. It is an inflammatory process of the pancreas that can range from mild inflammation to severe extensive pancreatic necrosis and multi-organ failure with mortality rates of 20% to 30%. Diagnosis can be difficult, because there is no pathognomic clinical presentation and no diagnostic gold standard. Material and Methods: It was a prospective cross-sectional descriptive study conducted in the Department of Gastroenterology at Sapthagiri Institute of Medical Sciences and Research Center from December 2019 – August 2020 among 100 patients. Results: The total patients studied in this study were 100, which comprises of 93 males and 7 females. Among the male population the maximum age group is 41-50. Next comes the 31-40 which includes 30 patients. Among the female population the maximum age group is 41-50 which includes about 4 patients. In our study distribution of the SAP within and above the cut off value of the different prognostic scores. 11 patients with SAP had RANSONs score &lt; 3 and 10 with SAP had RANSON score ≥ 3. 11 patients with SAP had APACHE II score of ≥8 whereas 10 had APACHE II score &lt; 8. But only 8 patients with SAP had BISAP score &lt; 3 and 13 SAP patients had BISAP score ≥ 3. MCTSI score in 11 SAP was &lt; 4 and 10 patients with MCTSI had ≥ 4. Conclusion: BISAP score is simple and it is the better scoring system in predicting the prognosis when compared to other scores &amp; MCTSI. BISAP score has many advantages when compared to other scoring systems.

Circulating microRNA-146a and microRNA-146b exhibit potential to serve as markers for acute pancreatitis management and prognosis.

This study aimed to explore the association of microRNA(miR)-146a and miR-146b expressions with risk, severity, in-hospital death of acute pancreatitis (AP). 50 severe AP (SAP) patients, 50 moderate-severe AP (MSAP) patients, 50 mild AP (MAP) patients and 50 healthy controls (HCs) were enrolled. Plasma samples were collected after the enrollment, then miR-146a and miR-146b expressions were detected by reverse transcription-quantitative polymerase chain reaction (RT-qPCR). Ranson's score, Acute Physiology and Chronic Health Evaluation (APACHE) II score, sequential organ failure assessment (SOFA) score, C-reactive protein (CRP) as well as in-hospital mortality were assessed in AP patients. Both miR-146a and miR-146b expressions were the highest in SAP patients, followed by MSAP patients, MAP patients and HCs. Meanwhile, they distinguished SAP, MSAP, MAP patients from HCs, and also distinguished SAP, MSAP and MAP patients from each other. In SAP, MSAP and MAP patients, MiR-146a positively correlated with Ranson's score, APACHE II score, SOFA score and CRP. Besides, miR-146b positively correlated with Ranson's score, APACHE II score, SOFA score and CRP in SAP patients; correlated with Ranson's score, APACHE II score and CRP in MSAP patients; and correlated with Ranson's score and SOFA score in MAP patients. Notably, miR-146a predicted increased in-hospital death risk of both SAP and MSAP patients, while miR-146b predicted raised in-hospital death risk of SAP patients but not MSAP patients. Circulating miR-146a and miR-146b exhibit potential as markers for AP management and prognosis.

Analysis of associations of FBXL19-AS1 with occurrence, development and prognosis of acute pancreatitis.

The aim of the study was to explore the association between F-box and leucine-rich repeat protein 19-antisense ribonucleic acid 1 (FBXL19-AS1) and acute pancreatitis (AP) and its role in prognostic evaluation. According to the severity of AP, the patients were classified into mild group, moderate-severe group, and severe group, and the expression of FBXL19-AS1 was compared among the three groups. The associations of FBXL19-AS1 with Atlanta classification, computed tomography severity index (CTSI), acute physiology and chronic health evaluation (APACHE) II score, bedside index for severity in acute pancreatitis (BISAP) and Ranson score were analyzed. The optimal cut-off point of severe hyperlipidemia-induced AP was predicted by the receiver operating characteristic (ROC) curves. Then, the incidence rates of local and systemic complications were compared among AP patients with different levels of FBXL19-AS1. After overexpression of FBXL19-AS1 in AP cells, the quantitative Reverse Transcription-Polymerase Chain Reaction (qRT-PCR) results showed that significantly upregulated the mRNA level of interleukin-1β (IL-1β), tumor necrosis factor-α (TNF-α), and IL-6. The opposite results were obtained after the knockdown of FBXL19-AS1 in cells. There were no statistical differences in the basic data among the three groups. The FBXL19-AS1 level was increased in severe group than the moderate-severe group and mild group. The area under the curve (AUC) of FBXL19-AS1 in predicting severe AP was 0.9177 (p<0.001). According to the Spearman correlation analysis, the FBXL19-AS1 level had significant positive correlations with the predictive scores of AP severity. The incidence rate of shock, liver dysfunction, and pancreatic necrotic tissue infection was significantly higher in FBXL19-AS1 high-expression group than that in FBXL19-AS1 low-expression group. FBXL19-AS1 could promote the upregulation of inflammatory indexes. FBXL19-AS1 is highly expressed in the serum of AP patients, and it is positively correlated with the severity of AP. FBXL19-AS1 mediates the inflammatory response and promotes the occurrence and development of pancreatitis, harming the prognosis of patients.

Serum hydroxybutyrate dehydrogenase as an early predictive marker of the severity of acute pancreatitis: a retrospective study

BackgroundTo investigate the value of serum hydroxybutyrate dehydrogenase (HBDH) level, an isozyme of lactate dehydrogenase, in evaluating the severity of acute pancreatitis (AP).MethodsPatients diagnosed with AP from January 2013 to December 2018 were included in this retrospective study. Patients were divided into the normal serum HBDH levels group (n-HBDH group) and the high serum HBDH levels group (h-HBDH group) according to the criteria HBDH ≥ 182 U/L after admission. The demographic parameters, laboratory data and the severity of AP in the two groups were compared. The receiver operating curve (ROC) was used to evaluate the efficacy of serum HBDH in predicting persistent organ failure and systemic inflammatory response syndrome (SIRS).ResultsA total of 260 AP patients were enrolled, including 176 cases in the n-HBDH group and 84 cases in the h-HBDH group. The incidence of SIRS and organ failure in the h-HBDH group were significantly higher than those in n-HBDH group (both P < 0.001). In addition, the HBDH level was significantly decreased in 110 patients who were re-measured after AP treatment. The serum HBDH levels were positively correlated with Atlanta classification, Ranson score, and BISAP score (all P < 0.05). ROC analysis showed that a serum HBDH cut-off point of 195.0 U/L had optimal predictive value for the development of persistent organ failure (AUC = 0.778) and 166.5 U/L for the development of SIRS (AUC = 0.724).ConclusionThe elevated serum HBDH in early stage of AP is closely related to the adverse prognosis of AP patients, which can be used as a potential early biomarker for predicting the severity of AP.

English

BACKGROUND Accurate prediction of the severity of acute pancreatitis will help in identifying patients at increased risk for morbidity and mortality. We wanted to evaluate the different scoring systems in predicting the severity of acute pancreatitis. METHODS This cross-sectional study was undertaken in the Department of Surgery at a zonal hospital between April 2013 and December 2014. RESULTS 40 patients were selected and enrolled in the study as per the selection criteria. 20 (50 %) patients had fair outcome and 20 (50 %) had a poor outcome. Accuracy of different scoring systems in predicting patient outcome ranged from 45 % (48-hr APACHE II) to 62.5 % (Goris MOF at baseline and 48 hr). Baseline Goris MOF was 70 % sensitive and 55 % specific in prediction of poor outcome. It had an accuracy of 62.5 % in prediction of outcome. 48-hr Goris MOF was 80 % sensitive and 45 % specific in predicting the outcome. Baseline APACHE II scores were below the cut-off level in all the patients. 48-hr APACHE II scores were 5 % sensitive and 100% specific for prediction of outcome. Ranson score &gt; 3 was 25 % sensitive and 90 % specific in the prediction of outcome. Balthazar score &gt; 6 was 65 % sensitive and 55 % specific in prediction of outcome. Ranson score was found to have a limited sensitivity for different outcomes (ranging from 21.1 % to 50 %) but was found to have a high specificity (83.8 % to 90 %). CONCLUSIONS Goris scoring system (at 48 hrs) was found to be highly sensitive to different poor outcomes as well as duration of hospital stay. It also correlated with Balthazar scoring system, which was also highly sensitive to different poor outcomes studied. KEYWORDS Acute Pancreatitis, Prediction, Scoring System, APACHE II, Goris MOF, Ranson’s Score, Balthazar Score

COMPARATIVE STUDY BETWEEN BISAP SCORE AND RANSON SCORE IN PREDICTING SEVERITY OF ACUTE PANCREATITIS

Background: Acute pancreatitis has widely variable clinical and systemic manifestations spanning the spectrum from a mild, self-limiting episode of epigastric pain to severe, life-threatening, multiorgan failure. Since the morbidity and mortality of Acute Pancreatitis differ markedly between mild and severe disease (mild &lt; 5% vs severe 20–25%), it is very important to assess severity as early as possible. Various scoring systems like APACHE II scoring, RANSON scoring and BISAP have been used to asses Severity in Acute Pancreatitis. Aim and objective: To assess the accuracy of BISAP scoring system vs RANSON scoring system in predicting Severity in an attack of acute pancreatitis. Materials and methods: In this study, 60 in-patients presenting with features of acute pancreatitis at Department of Surgery, Govt. Medical College and Hospital, Bettiah, W. Champaran, Bihar from April 2019 to March 2020 had been studied. It was a perspective and a retro prospective study. BISAP score and Ranson’s score was calculated in all such patients based on data obtained within 48 hours of hospitalization. Results: According to Atlanta Revised criteria, 30 patients had mild pancreatitis, 20 patients had moderately severe pancreatitis, 10 patients had severe pancreatitis. Of the 60 patients, 37 patients had Ranson's score less than or equal to 3. 23 patients had a score of more than 3.Of the 60 patients, 39 patients had a BISAP score less than or equal to 3, 21 patients had a score more than 3. Conclusion: From this study, we can conclude that the BISAP scoring system is not inferior to Ranson’s scoring system in predicting the severity of acute pancreatitis. BISAP scoring system is very simple, cheap, easy to remember and calculate. BISAP scoring system accurately predicts the outcome in patients with acute pancreatitis. Moreover, the values in BISAP score are instantaneous and there is no time delay. Ranson’s score takes a minimum of 24 hours.

Hematolojik Parametreler Akut Pankreatitin Şiddetini Öngörebiliyor mu?

Aim: Neutrophil-lymphocyte ratio (NLR), platelet-lymphocyte ratio (PLR), mean platelet volume (MPV) and erythrocyte distribution width (RDW) are considered to be associated with systemic inflammation. In this study, it was aimed to evaluate NLR, PLR, MPV and RDW as prognostic factors in acute pancreatitis (AP).Material and Methods: A total of 315 patients admitted to Health Sciences University Gazi Yaşargil Training and Research Hospital between May 2016 and May 2019 and diagnosed with AP were included in the study. Data of the patients were analyzed retrospectively. Laboratory values of the patients at the time of admission to the hospital were recorded and the Ranson score was calculated. Patients were divided into two groups as Ranson score &amp;lt;3 (mild AP) and ≥3 (severe AP). NLR, PLR, MPV and RDW parameters were compared between these groups.Results: Of the patients, 103 (32.7%) were males and 212 (67.3%) were females, and mean age was 57.2±19.5. According to the Ranson criteria, number of patients with a score below 3 was 274 (87.0%), and number of patients with a score of 3 or above was 41 (13.0%). In the severe AP group, NLR and PLR were significantly higher than in the mild AP group (16.2±14.3 vs. 8.2±7.7, p&amp;lt;0.001 and 283.7±223.0 vs. 195.5±139.3, p=0.004 respectively), but there was no statistically significant difference in terms of RDW-CV and MPV (13.7±1.0 vs. 13.9±1.9, p=0.849 and 9.7±1.3 vs. 9.5±1.1, p=0.201, respectively).Conclusion: NLR and PLR are simple and safe tests that can be used to determine the severity of AP.