Severe Acute Pancreatitis In Patients Research Articles

Comparison of Bedside Index for Severity in Acute Pancreatitis and Emergency Department SpO2, Age and Systemic Inflammatory Response Syndrome Scores in Predicting Severe Acute Pancreatitis in Patients with Acute Pancreatitis in the Emergency Department

BackgroundAs the mortality of severe acute pancreatitis (SAP) is significantly higher than those with mild or moderate severity, it is of clinical significance to identify patients most likely to develop SAP at the time of emergency department (ED) presentation. ObjectivesThe aim of this study was to compare the performance of the Bedside Index for Severity in Acute Pancreatitis (BISAP) and the Emergency Department SpO2, Age and SIRS (ED-SAS) scoring systems as early risk assessment tools for identifying patients at high-risk of developing SAP. MethodsWe retrospectively reviewed adult patients with AP presented to ED between January 2019–September 2022. We calculated the scores of each patient with the parameters of the initial data. The primary outcome was SAP. The secondary outcomes were 30-day mortality, intensive care admission, and identifying low-risk patients without complications. ResultsOf 415 patients, 34 (8.2%) developed SAP and 15 (3.6%) died. With regard to predicting SAP, BISAP and ED-SAS scores had similar discriminative ability with area under the curves (AUCs) of 0.84 (95% confidence interval [CI]:0.80–0.88) and 0.83 (95% CI:0.79–0.86), respectively (p = 0.642). At a cut-off score of ≥2 for SAP, sensitivity/specificity values were 73.5%/82.4% for BISAP, 76.5%/83.2% for ED-SAS. BISAP and ED-SAS scores of ≥3, yielded sensitivity/specificity values of 50%/95.8% and 35.3%/95.5%, respectively. BISAP and ED-SAS were also similar in predicting mortality (AUCs of 0.92 vs. 0.90, respectively) and intensive care unit admission (AUCs 0.91 vs. 0.91). ConclusionThe BISAP and ED-SAS scores performed similarly in predicting SAP, mortality, and intensive care unit admission. As an easily calculated tool early in the ED, ED-SAS may be helpful in disposition decisions for emergency physicians.

Construction of prediction model of severe acute pancreatitis based on serum soluble T cell immunogloblulin and mucin domain-containing protein 3

To investigate the predictive value of the model based on soluble T cell immunogloblulin and mucin domain-containing protein 3 (sTIM3) for the progression of severe acute pancreatitis (SAP) in patients with acute pancreatitis (AP). A retrospective cohort study was conducted. The AP patients admitted to Changzhou First People's Hospital and Changzhou Second People's Hospital from June 1, 2020 to June 30, 2022 were enrolled. Mild AP (MAP) and moderately severe AP (MSAP) patients were classified as non-SAP group, and SAP patients were classified as SAP group according to the progression of AP patients during hospitalization. The basic data, blood biological indicators, serum sTIM3 level, bedside index for severity in acute pancreatitis (BISAP), acute physiology and chronic health evaluation II (APACHE II) score, modified computed tomography severity index (MCTSI) score within 48 hours of admission, and prognosis indicators were collected. Multivariate Logistic regression analysis was conducted to analyze the risk factors of the progression of SAP in patients with AP during hospitalization. Based on the results of multivariate analysis and the best parameters selected based on the minimal Akaike information criterion (AIC), the SAP prediction model based on sTIM3 was constructed. The receive operator characteristic curve (ROC curve) was plotted to analyze the predictive efficacy of the model. A total of 99 AP patients were enrolled, 80 patients in the non-SAP group and 19 patients in the SAP group. Compared with the non-SAP group, body mass index (BMI), drinking history ratio, heart rate (HR), respiration rate (RR), white blood cell count (WBC), red blood cell count (RBC), C-reactive protein (CRP), alanine aminotransferase (ALT), serum creatinine (SCr), procalcitonin (PCT), interleukin-6 (IL-6), sTIM3, BISAP score, APACHE II score and MCTSI score were significantly increased, and pulse oxygen saturation (SpO2), direct bilirubin (DBil) and IL-10 were significantly decreased. The length of intensive care unit (ICU) stay and total length of hospital stay of patients in the SAP group were significantly longer than those in the non-SAP group [length of ICU stay (days): 1.0 (0, 1.5) vs. 0 (0, 0), total length of hospital stay (days): 17.11±9.39 vs. 8.40±3.08, both P < 0.01]. Multivariate Logistic regression analysis showed that HR [odds ratio (OR) = 1.059, 95% confidence interval (95%CI) was 1.010-1.110, P = 0.017], DBil (OR = 0.981, 95%CI was 0.950-0.997, P = 0.043), and sTIM3 (OR = 1.002, 95%CI was 1.001-1.003, P = 0.027) were independent risk factors for predicting the progression of SAP in patients with AP, and the SAP prediction model based on sTIM3 was constructed: Logit(P) = -14.602+0.187×BMI+0.057×HR+0.006×CRP-0.020×DBil+0.002×sTIM3. ROC curve analysis showed that among the aforementioned single factor quantitative indicators, IL-6 was the most effective in predicting the progression of AP patients to SAP during hospitalization, but the predictive performance of prediction model based on the sTIM3 was significantly better than IL-6 [area under the ROC curve (AUC) and 95%CI: 0.957 (0.913-1.000) vs. 0.902 (0.845-0.958), P < 0.05]. The model based on serum sTIM3 demonstrated good predictive value for the progression of SAP in patients with AP.

Low-grade inflammation for predicting severe acute pancreatitis in patients with hypertriglyceridemic acute pancreatitis.

We aimed to evaluate the association between low-grade inflammation (LGI) and the severity of hypertriglyceridemic acute pancreatitis (HTG-AP). We retrospectively reviewed 311 patients with HTG-AP who were admitted to the Department of Gastroenterology, Fujian Provincial Hospital between April 2012 and March 2021. Inpatient medical and radiological records were reviewed to collect the clinical manifestations, disease severity, and comorbidities. C-reactive protein (CRP) level, white blood cell (WBC) count, platelet (PLT) count, and neutrophil-to-lymphocyte ratio (NLR) were considered LGI components and were combined to calculate a standardized LGI score. The association between the LGI score and the severity of HTG-AP was analyzed using univariate and multivariate logistic regression analyses. Of the 311 patients with HTG-AP, 47 (15.1%) had mild acute pancreatitis (MAP), 184 (59.2%) had moderately severe acute pancreatitis (MSAP), and 80 (25.7%) had severe acute pancreatitis (SAP), respectively. Patients with MSAP and SAP had a higher LGI score than those with MAP (1.50 vs -6.00, P < 0.001). Univariate logistic regression analysis revealed that patients with LGI scores in the fourth quartile were more likely to have MSAP and SAP (odds ratio [OR] 21.925, 95% confidence interval [CI] 5.014-95.867, P < 0.001). The multivariate logistic regression analysis confirmed that low calcium (OR 0.105, 95% CI 0.011-0.969, P = 0.047) and high LGI score (OR 1.253, 95% CI 1.066-1.473, P = 0.006) were associated with MSAP and SAP. When predicting the severity of acute pancreatitis, the LGI score had the highest area under the receiver operating characteristic (ROC) curve (0.7737) compared to its individual components. An elevated LGI score was associated with a higher risk of SAP in patients with HTG-AP.

Evaluation of Prognostic Criteria for Severe Acute Pancreatitis in Patients With Early Nasogastric and Nasojejunal Feeding

Objective: To evaluate the prognostic value of predictors of severe acute pancreatitis in patients with nasogastric (NG) and nasojejunal (NJ) feeding. Materials and methods: Our open-label randomized controlled study was carried out in the intensive care unit of Neftyanik Occupational Health Facility (Tyumen, Russian Federation) between November 2012 and October 2018 and included 64 patients who had predictors of severe acute pancreatitis (APACHE II score &gt; 8, C-reactive protein [CRP] &gt; 150 mg/L, SOFA score &gt; 2) and could start early NG and NJ feeding. We evaluated the prognostic value of APACHE II, SOFA, BISAP, blood urea, and CRP in the general group and for different enteral feeding methods during the first 24 hours and in 48 hours. Data were statistically processed using the SPSS 26 software. Results: Only one prognostic model was statistically significant for the first 24 hours and included APACHE II (AUC = 0.705, 95 % CI 0.577-0.834, P = 0.005, cutoff threshold of 8.5, sensitivity of 0.394, and specificity of 0.935 for all patients). In 48 hours models of the following groups were statistically significant: that of all patients, which included APACHE II, CRP, and blood urea (AUC = 0.904, 95 % CI 0.826-0.983, P &lt; .001, cutoff threshold of 0.65, sensitivity of 0.818, and specificity of 0.935), NJ feeding group with CRP (AUC = 0.775, 95% CI 0.611-0.94, P &lt; .001, cutoff threshold of 209.0 mg/L, sensitivity of 0.529, and specificity of 1.0), and NG feeding group with APACHE II (AUC = 0.767, 95% CI 0.599-0.934, P &lt; 0.001, cutoff threshold of 9, sensitivity of 0.625, and specificity of 0.882). Conclusions: Enteral feeding method does not affect the prognostic criteria for severe acute pancreatitis. 48 hours after admission is the best period period for severity prognosis, and the model with such independent predictors as APACHE II, blood CRP, and urea showed the best quality prognosis. If these predictors could not be used at once, we recommend APACHE II for NG feeding and blood CRP for NJ feeding.

RISK FACTORS ASSOCIATED WITH WORSENING OF ACUTE PANCREATITIS.

Background: The aim of the present study was to investigate risk factors for developing more severe pancreatitis, including moderately severe (MSAP) and severe acute pancreatitis (SAP), in patients admitted with mild acute pancreatitis (MAP).&#x0D; Material/Methods: This was a hospital based retrospective and prospective study conducted in the Department of Gastroentrology, SKIMS Soura,Srinagar, Kashmir for a period of 2 years w.e.f. September 2017 to September 2019 on patients of all age groups with clinical/Laboratory/imaging findings suggestive of acute pancreatitis. The protocol of the study was approved by the Institutional Ethical Committee. Patients admitted with MAP to our hospital were included and prospectively evaluated. Possible risk factors for developing MSAP or SAP were Evaluated.&#x0D; Results: Risk factors like BMI &gt;25kg/m2 was observed in 61 (19.3%) patients with mild pancreatitis and 142 (42.5%) patients with moderate to severe pancreatitis. Waist circumference &gt;100cm was observed in 23 (7.3%) and 129 (38.6%) patients of mild and moderate to severe pancreatitis. High blood sugar &gt;200mg/dl was observed in 37 (11.7%) patients with mild pancreatitis and 152 (45.2%) patients with moderate to severe pancreatitis. 27 (8.5%) and 167 (50%) patients of mild and moderate to severe pancreatitis had hematocrit &gt;44 whereas 13 (4.1%) patients with mild pancreatitis and 140 (41.9%) patients with moderate to severe pancreatitis had CRP &gt;150mg/dl.&#x0D; This table concluded that there is statistically significant association between high BMI &gt;25 Kg/m2, waist circumference &gt;100 cm, high blood sugar &gt;200 mg /dl, hematocrit &gt;44, CRP &gt;150 mg/d and worsening of AP.&#x0D; Conclusions: Significant risk factors for developing MSAP or SAP in patients admitted with MAP included BMI (≥25 kg/m2), APACHE-II (≥5), and blood glucose level on admission (&gt;11.1 mmol/L). These factors should be used in the prediction of more severe pancreatitis in patients admitted with MAP.&#x0D; Keywords: Obesity, Pancreatitis, Risk Factors

Adoption of Computerized Tomography Quantitative Imaging Data in the Evaluation of Severe Acute Pancreatitis by Pleural Effusion

In order to study the pleural effusion (PE) in Severe acute pancreatitis (SAP) in patients with the clinical value of diagnosis, in this study, 78 patients with SAP who were included in Shandong Jinan Municipal Hospital of Traditional Chinese Medicine from January 31, 2017 to December 30, 2019 were selected as the experimental group (EG) and 78 patients with mild acute pancreatitis (MAP) as the control group (CG). The PE was diagnosed by computerized tomography (CT) imaging technology, and the patients with PE in the two groups were divided into small group, medium group and large group according to the volume of PE. The concurrent symptoms of SAP were recorded, and the relation between the occurrence of PE and the complications of SAP was analyzed by a multivariate Logistic regression model (LRM). It was concluded that the concurrent rate of PE in the EG was greatly higher than that in the CG, and the number of cases in the medium and multiple groups was also greatly higher than that in the CG (P &lt; 0.05). There were statistically significant differences (SSD) in acute renal failure, hypovolemic shock and pancreatic pseudocyst in the PE small amount group, medium amount group and large amount group (P &lt; 0.05). The complications of SAP in patients with acute renal failure, hypovolemic shock and pancreatic pseudocyst were positively correlated with age and PE (P &lt; 0.05), which showed that CT could present the PE more directly, which was beneficial to the diagnosis of SAP. In addition, the increased amount of PE indicated the aggravation of SAP and the occurrence of concurrent symptoms, which is helpful for early assessment of patients’ condition and prediction of poor prognosis as an independent indicator to evaluate the early stage of SAP.

Activin A Modulates Inflammation in Acute Pancreatitis and Strongly Predicts Severe Disease Independent of Body Mass Index.

INTRODUCTION:Acute pancreatitis (AP) is a healthcare challenge with considerable mortality. Treatment is limited to supportive care, highlighting the need to investigate disease drivers and prognostic markers. Activin A is an established mediator of inflammatory responses, and its serum levels correlate with AP severity. We hypothesized that activin A is independent of body mass index (BMI) and is a targetable promoter of the AP inflammatory response.METHODS:We assessed whether BMI and serum activin A levels are independent markers to determine disease severity in a cohort of patients with AP. To evaluate activin A inhibition as a therapeutic, we used a cerulein-induced murine model of AP and treated mice with activin A-specific neutralizing antibody or immunoglobulin G control, both before and during the development of AP. We measured the production and release of activin A by pancreas and macrophage cell lines and observed the activation of macrophages after activin A treatment.RESULTS:BMI and activin A independently predicted severe AP in patients. Inhibiting activin A in AP mice reduced disease severity and local immune cell infiltration. Inflammatory stimulation led to activin A production and release by pancreas cells but not by macrophages. Macrophages were activated by activin A, suggesting activin A might promote inflammation in the pancreas in response to injury.DISCUSSION:Activin A provides a promising therapeutic target to interrupt the cycle of inflammation and tissue damage in AP progression. Moreover, assessing activin A and BMI in patients on hospital admission could provide important predictive measures for screening patients likely to develop severe disease.

&lt;p&gt;Association Between Metabolic Syndrome and Its Components with Severity of Acute Pancreatitis&lt;/p&gt;

BackgroundAcute pancreatitis (AP) and metabolic syndrome (MetS) are common clinical problems with serious complications and high cost of treatment. The relationship between MetS and severity of AP is unknown, and because there are very few published articles, further studies had been recommended. Therefore, we designed this study to estimate the association between MetS and its components with AP severity.Patients and MethodsIn this prospective analytical cross-sectional study, all AP patients who referred to two referral hospitals affiliated with Shiraz University of Medical Sciences between 2016 and 2019 were evaluated. The diagnosis of MetS syndrome as well as follow-up of patients for evaluation of severity and outcome of AP was performed in all enrolled patients. National Cholesterol Education Program Adult Treatment Panel III (NCEP/ATP-III) was used for diagnosis of MetS. Bedside Index for Severity in Acute Pancreatitis (BISAP) and revised Atlanta classification (RAC) were used to estimate the severity of AP. Finally, the association between MetS syndrome and its components at different AP severities was compared.ResultsOf the 214 patients referred to our center, a total of 76 patients with AP were included in this study. Of the included patients, 40 (52.6%) were male and 36 (47.4%) were female. Frequency of patients in Mets and non-MetS groups was 34 (44.74%) and 42 (55.26%), respectively. The gender and mean age difference between Mets and non-MetS groups were not statistically significant. According to Mets groups, 25 (73.5%) and 9 (26.5%) AP patients with MetS had BISAP score of 0–2 and 3–5, respectively. BISAP score in MetS group was significantly higher than non-MetS group (P = 0.022). Overall, 20 (58.8%), 11 (32.4%), and 3 (8.8%) of AP patients with MetS had mild, moderately severe, and severe AP based on RAC, respectively. Severe RAC was significantly higher in the MetS group than in the non-MetS group (P = 0.029). The frequency of complications in MetS group was significantly higher than in non-MetS group (P= 0.008). The length of hospital stay was also significantly higher in the MetS group than in the non-MetS group (P = 0.001). Overall, three patients died, two of whom had MetS and all had severe RAC and BISAP 3–5. Waist circumference, fasting blood sugar, and triglyceride were significantly higher in the severe and moderately severe types of AP group than in the mild AP group, according to RAC. Although, mean of all components of MetS except HDL-cholesterol were higher in BISAP of 3–5 group than BISAP of 0–2 group, the difference was only significant in waist circumference.ConclusionThe present study showed that there was a significant association between the rate of MetS and its components including waist circumference, hyperglycemia and hypertriglyceridemia with increasing AP severity. This study showed that the incidence of more severe AP in patients with MetS is much higher than in patients without MetS. We recommend that the new studies with larger sample sizes are conducted with careful consideration of confounding factors to investigate the relationship between the severity of MetS and AP as well as the effect of MetS treatment on the nature of AP.

Low Serum Ionized Calcium, Elevated High-Sensitivity C-Reactive Protein, Neutrophil-Lymphocyte Ratio, and Body Mass Index (BMI) Are Risk Factors for Severe Acute Pancreatitis in Patients with Hypertriglyceridemia Pancreatitis.

BackgroundTo investigate the clinical characteristics of hypertriglyceridemia pancreatitis (HTGP) and evaluate the correlative risk factors for severe acute pancreatitis (SAP) in HTGP patients.Material/MethodsA total of 1005 patients with acute pancreatitis (AP) admitted to Peking Union Medical College Hospital (PUMCH) from 1 Jan 2013 to 1 Aug 2018 were retrospectively reviewed. After screening, we enrolled 159 patients with HTGP and 172 with non-hypertriglyceridemia pancreatitis (NHTGP). We gathered and assessed demographic and blood biochemical information and analyzed the risk factors for SAP.ResultsAge, serum amylase (AMY), lipase (LIP), and serum ionized calcium (Ca2+) in the HTGP group were lower than in the NHTGP group (P<0.05), while high-sensitivity C-reactive protein (hsCRP), neutrophil–lymphocyte ratio (NLR), and body mass index (BMI) in the HTGP group were higher than in the NHTGP group (P<0.05). Among the HTGP patients, the results indicated that Ca2+ (OR=0.018, P<0.001, 95%CI: 0.002–0.129) was an independent protective factor for SAP, while higher CRP (OR=1.008, P=0.004, 95%CI: 1.003–1.013), NLR (OR=1.314, P<0.001, 95%CI: 1.161–1.488), and BMI (OR=1.597, P=0.002, 95%CI: 1.195–2.314) were independent risk factors for SAP.ConclusionsPatients with HTGP had lower serum Ca2+ and higher hsCRP, NLR, and BMI, and these were associated with higher risk of developing SAP.

Comparison between Ransons score and modified CTSI in predicting the severity of acute pancreatitis based on modified Atlanta classification 2012

Background: Acute pancreatitis is an inflammatory process of the pancreas with possible peripancreatic tissue and multiorgan involvement inducing multiorgan dysfunction syndrome (MODS) with a high mortality rateand hence early identification of patients at risk for severe disease is of vital importance.Methods: Data were collected from 50 patients who presented to the emergency department of hospitals attached to BMCRI, Bangalore, having acute pancreatitis.Results: The study included 50 patients- 40 males and 10 females and median patient age was 54.5years.Out of the 50 patients, 40% had gall stones, 56% were alcoholic and 4% had idiopathic pancreatitis.56% were found to have a Ransons score of &gt;3 and 44% had score &lt; 3; 52%had a modified CTSI score of 0-2, 52%had a score of 4-6 and 22% had a score of 8-10. The incidence of severe acute pancreatitis in patients with Ransons score &gt;3 has a p value &lt;0.002. Also, the incidence of severe acute pancreatitis in patients with modified CTSI score &gt;4 has a p value of &lt;0.001.With respect to mortality, all 4 patients who died had a modified CTSI score of &gt;4 (p=0.002) and 3 patients had Ransons score &gt;3 (p=0.03) which is statistically significant.Conclusions: In our country where facility for CECT is not available to a major proportion of population, early assessment of severe pancreatitis can be performed by Ransons scoring, which is found to be comparable to modified CTSI scoring.

Relationship between low-density lipoprotein cholesterol and severe acute pancreatitis ("the lipid paradox").

Background and aimThe aim of this study was to investigate the association between low-density lipoprotein cholesterol (LDL-C) and the development of severe acute pancreatitis (SAP).Patients and methodsA total of 674 patients with acute pancreatitis were enrolled. Non-linearity in the relationship between LDL-C and SAP was assessed by restricted cubic spline analysis. Univariable and multivariable regression analyses were used to identify independent risk factors of SAP.ResultsThe restricted cubic spline analysis suggested a nonlinear association between high-density lipoprotein cholesterol (HDL-C), LDL-C and triglyceride levels and incidence of SAP. The incidence of SAP in patients with low LDL-C (<90 mg/dL), moderate LDL-C (90–150 mg/dL) and high LDL-C (>150 mg/dL) levels was 15.1%, 3.7% and 9.8%, respectively. Multivariable analysis confirmed that low LDL-C levels (odds ratio [OR] 3.05; 95% confidence interval [CI] 1.35–6.90), high LDL-C levels (OR 4.42; 95% CI 1.41–13.87) and low HDL-C levels (OR 6.90; 95% CI 2.61–18.23) but not high triglyceride levels (OR 1.05; 95% CI 0.40–2.72) were associated with the development of SAP.ConclusionBoth low LDL-C (<90 mg/dL) and high LDL-C (>150 mg/dL) levels within 24 hours from admission are independently associated with an increased risk of SAP.

Predictive value of apolipoprotein B and A-I ratio in severe acute pancreatitis.

Severe acute pancreatitis (SAP) has considerable mortality and morbidity rates. Although many indices have been developed to classify the severity of acute pancreatitis (AP), an optimal method for predicting SAP has not been identified. The ratio of apolipoprotein B to A-I (apoB/A-I) is associated with metabolic syndrome and inflammatory status. This study investigated the association between severity of AP and serum apoB/A-I ratio. Patients with AP were prospectively enrolled at Yonsei University Wonju College of Medicine from March 2015 to August 2016. The severity of AP was assessed according to the revised Atlanta classification criteria (Atlanta 2012). Of 191 patients with AP, 134 (70.2%) had mild AP, 42 (22%) had moderately severe AP, and 15 (7.9%) had SAP; apoB/A-I ratio was highest in patients with SAP (P=0.001). The apoB/A-I ratio was positively correlated with Atlanta classification, computed tomography severity index, and Bedside index for severity of AP. The apoB/A-I ratio showed the highest predictive value for SAP in patients with AP compared with apolipoprotein B or apolipoprotein A-I alone. Serum apoB/A-I ratio appears to have value for predicting SAP in patients with AP.

Risk Factors for Worsening of Acute Pancreatitis in Patients Admitted with Mild Acute Pancreatitis.

BackgroundThe aim of the present study was to investigate risk factors for developing more severe pancreatitis, including moderately severe (MSAP) and severe acute pancreatitis (SAP), in patients admitted with mild acute pancreatitis (MAP).Material/MethodsPatients admitted with MAP to our hospital from March 2013 to May 2016 were included and prospectively evaluated. Possible risk factors for developing MSAP or SAP were age, blood glucose level on admission, etiology, sex, Ranson score, amylase level, Acute Physiology and Chronic Health Evaluation II (APACHE-II) scores, C-reactive protein (CRP) level, serum calcium level, visceral fat area (VFA), body mass index (BMI), whether this was the first episode of AP, and method of administration of octreotide. The effects of variables for developing MSAP or SAP were evaluated using univariate and multivariate logistic regression models. Mortality, hospital duration, and rate of ICU transfer of patients were compared between patients who developed MSAP or SAP and patients who did not.ResultsA total of 602 patients admitted with MAP were recruited into this study (256 men and 346 women). Seventy-four patients (12.3%) developed MSAP or SAP. According to univariate logistic regression analyses, the results indicated that there were 5 significant differences between patients who developed MSAP or SAP and those who did not: VFA (>100 cm2) (p=0.003), BMI (≥25 kg/m2) (p=0.001), Ranson score(p=0.004), APACHE-II (≥5) (p=0.001), and blood glucose level on admission (>11.1 mmol/L) (p=0.040). Further multivariate logistic regression analyses revealed that BMI (≥25 kg/m2) (p=0.005), APACHE-II (≥5) (p=0.001), and blood glucose level on admission (>11.1 mmol/L) (p=0.004) were independent risk factors for developing MSAP or SAP in patients admitted with MAP. Moreover, patients who developed MSAP or SAP had a mortality rate of 5.4%.ConclusionsSignificant risk factors for developing MSAP or SAP in patients admitted with MAP included BMI (≥25 kg/m2), APACHE-II (≥5), and blood glucose level on admission (>11.1 mmol/L). These factors should be used in the prediction of more severe pancreatitis in patients admitted with MAP.

Application of raw rhubarb acupoint sticking with nasal feeding therapy among severe acute pancreatitis patients complicated with the paralytic ileus

Objective To observe curative effect of rhubarb acupoint sticking with nasal feeding therapy among severe acute pancreatitis (SAP) patients complicated with the paralytic ileus. Methods During July 2012 to April 2014 in Gastroenterology Department in Zhejiang Provincial Hospital of Traditional Chinese Medicine and the First Affiliated Hospital of Zhejiang University, a total of 40 SAP inpatients were divided into experimental group and control group by random number table. All patients in the two groups received routine anti-infection, fluid infusion treatment, but the patients of experimental group underwent rhubarb acupoint sticking of Shenque Point with nasal feeding therapy while patients were taken placebo of Shenque point and nasal feeding therapy in the control group. We observed patient′s recovery time of bowl sound, time of first self defecation, recovery time of hemodlastase, local complication and mortality in two groups. Results The recovery time of bowl sound, time of first self defecation, recovery time of hemodlastase were (2.85±1.04), (3.55±1.32) and (8.85±2.30) d in the experimental group lower than these of the control group (t=2.226, 2.332, 2.067, respectively; P 0.05). Conclusions Rhubarb acupoint sticking with nasal feeding therapy can minimize the lasting time of paralytic ileus, reduce complication, enhance peristalsis function and clinical effect and operation, and is worth of clinical promotion. Key words: Severe acute pancreatitis; Paralytic ileus; Raw rhubarb; Acupoint sticking

Circulating cytokines in predicting development of severe acute pancreatitis.

IntroductionSevere acute pancreatitis (AP) is associated with high morbidity and mortality. Early prediction of severe AP is needed to improve patient outcomes. The aim of the present study was to find novel cytokines or combinations of cytokines that can be used for the early identification of patients with AP at risk for severe disease.MethodsWe performed a prospective study of 163 nonconsecutive patients with AP, of whom 25 had severe AP according to the revised Atlanta criteria. Admission serum levels of 48 cytokines and growth factors were determined using Bio-Plex Pro Human Cytokine Assay 21-plex and 27-plex magnetic bead suspension panels. Admission plasma levels of C-reactive protein (CRP), creatinine and calcium were measured for comparison. In subgroup analyses, we assessed the cytokine profiles of patients with severe AP (n = 14) who did not have organ dysfunction (OD) upon admission (modified Marshall score <2).ResultsOf 14 cytokines elevated in the severe AP group, interleukin 6 (IL-6) and hepatocyte growth factor (HGF) levels were independent prognostic markers of severe AP. IL-6, HGF and a combination of them predicted severe AP with sensitivities of 56.0%, 60.0% and 72.0%, respectively, and specificities of 90.6%, 92.8% and 89.9%, respectively. The corresponding positive likelihood ratio (LR+) values were 5.9, 8.3 and 7.1, respectively. The predictive values of CRP, creatinine and calcium were comparable to those of the cytokines. In subgroup analyses of patients with severe AP and without OD upon admission, we found that IL-8, HGF and granulocyte colony-stimulating factor (G-CSF) levels predicted the development of severe AP, with G-CSF being the most accurate cytokine at a sensitivity of 35.7%, a specificity of 96.1% and a LR+ of 9.1.ConclusionsIL-6 and HGF levels upon admission have prognostic value for severe AP which is similar to levels of CRP, creatinine and calcium. Although IL-6 and HGF, as either single or combined markers, were not perfect in identifying patients at risk for severe AP, the possibility that combining them with novel prognostic markers other than cytokines might improve prognostic accuracy needs to be studied. The accuracy of IL-8, HGF and G-CSF levels in predicting severe AP in patients without clinical signs of OD upon admission warrants larger studies.

Indication of pancreatoduodenectomy following severe acute pancreatitis in patients with distal bile duct or pancreas head cancer

Indication of pancreatoduodenectomy following severe acute pancreatitis in patients with distal bile duct or pancreas head cancer

High-dose versus low-dose octreotide in the treatment of acute pancreatitis: A randomized controlled trial

To evaluate the therapeutic efficacy of high-dose octreotide in patients with predicted severe acute pancreatitis (SAP) or SAP, two hundred and thirty-six patients with predicted SAP and 136 patients with SAP were randomized into control, high-dose octreotide (High-O) and low-dose octreotide (Low-O) groups. In addition to the conventional managements administrated in control group, High-O group received an intravenous infusion of octreotide at 50μg/h×3d+25μg/h×4d, and Low-O group received octreotide at 25μg/h×7d. The major primary outcomes included the numbers of predicted SAP patients which developed SAP after intervention and the number of patients with SAP amelioration. Secondary outcomes included APACHE II, SIRS scores, plasma levels of somatostatin (SST), tumor necrosis factor-α (TNF-α), and interleukin-6 (IL-6). There were no significant differences between the control and Low-O groups in terms of prevention and treatment for SAP. The incidence of SAP in patients with predicted SAP who received High-O was significantly lower than the Low-O group: 37.5% vs. 59.8%, p=0.005. Compared with Low-O group, the number of SAP patients in the SAP arm in the High-O group was reduced by 29.8%. Plasma levels of SST in both predicted SAP and the SAP patients were efficiently recovered (from 132.71±31.40pg/ml to 180.00±23.50pg/ml, p<0.05) after high-dose octreotide supplementation, which concomitantly reduced TNF-α and IL-6 levels. High-dose octreotide administration within 48h after AP onset may efficiently reduce the risk of SAP developing and partly attenuate SAP through raising plasma SST to a normal level and decreasing IL-6 and TNF-α.

Plasma D-dimer changes and prognostic implication in severe acute pancreatitis

To study the role of plasma D-dimer in human severe acute pancreatitis (SAP) and its relationship with disease severity. A prospective study was performed. From February 2010 to June 2011, plasma concentration of D-dimer and the results of other routine laboratory tests were measured in 32 SAP inpatients at admission immediately and 24, 48, 72 hours after admission. Ranson scores were also recorded. The relationship between plasma concentration of D-dimer and the results of other routine laboratory tests, Ranson scores were analyzed, and so did the relationship between plasma concentration of D-dimer and severity of patient's condition. (1) There were no obvious changes for plasma concentration of D-dimer and the results of other routine laboratory index in 32 SAP inpatients at each time points after admission. (2) Plasma concentration of D-dimer of SAP was positively related to white blood count (WBC), creatinine (Cr), prothrombin time (PT) and activated partial thromboplastin time (APTT) and negatively related to hematocrit (Hct), albumin and calcium (P<0.05 or P<0.01). Plasma concentration of D-dimer of SAP at 48 hours after admission had positive relationship with Ranson scores (r=0.729, P=0.001). (3) Plasma concentration of D-dimer of SAP inpatients in CT grade D, E stage were significantly higher than that in CT grade B, C stage (1.18±0.02 mg/L, 1.23±0.01 mg/L vs. 0.90±0.02 mg/L, 0.93±0.01 mg/L, all P<0.05). (4) Plasma concentration of D-dimer of SAP in inpatients with multiple organ failure (MOF) at 24 hours and 48 hours were significantly higher than that in inpatients without MOF (24 hours: 1.26±0.02 mg/L vs. 0.93±0.02 mg/L, 48 hours:1.25±0.02 mg/L vs. 0.93±0.02 mg/L, both P<0.05). Plasma concentration of the D-dimer is significantly increased in SAP patients, and is related to the severity. The first plasma concentration of D-dimer of SAP after admission can well reflect severity of patient's condition.

Increased risk of severe acute pancreatitis in patients with diabetes

We prospectively assessed the age- and sex-specific incidence rates and relative risks of overall and severe acute pancreatitis in Taiwanese with diabetes. The study cohort included age- and-sex-matched groups of patients with (n = 547,554) and without (n = 584,373) diabetes. Incidence rate was estimated under Poisson assumption and relative risks of acute pancreatitis and severe acute pancreatitis, based on modified Atlanta criteria, were indicated by hazard ratios estimated from Cox proportional hazard regression models. Over an 8-year follow-up period, the incidence of acute pancreatitis was 2.98 and 1.68 per 1000 person-years for patients with and without diabetes, respectively, representing a covariate adjusted hazard ratio of 1.53 (95% confidence interval 1.49-1.58). Diabetes was associated with a significantly elevated risk of acute pancreatitis in all sex and age stratifications, with the highest hazard ratio noted for study subjects aged < 45 years (men 2.37; women 2.95). Diabetes was also significantly associated with an increased hazard ratio of severe acute pancreatitis [1.46 (1.36-1.57)], and especially of acute pancreatitis with local complications [1.65 (1.14-2.39)]. Diabetes is associated with an increased risk of overall and severe acute pancreatitis, and the relation is stronger in women and young patients.

The Panc 3 Score

The goal of our study was to develop a simple rule that could rapidly identify those at risk for severe acute pancreatitis (SAP) in the ER. We identified all published studies reporting risk factors for SAP. We identified 3 risk factors which had been shown to predict SAP. The risk factors we identified were a serum hematocrit greater than 44 mg/dL, a body mass index (BMI) greater than 30 mg/kg, and a chest x-ray which reveals a pleural effusion (Panc 3 criteria). We computed the test-operating characteristics and likelihood ratios for each risk factor using the patients originally sampled in each of the studies (n=393). For validation, we examined Panc 3's ability to predict SAP in patients seen at our medical center [University of North Carolina at Chapel Hill (UNC) hospitals n=238]. The likelihood ratios positive and negative for HCT, BMI>30 kg/M, and a chest x-ray with a pleural effusion were 14, 9.8, and 8.7, respectively, for the original data and 178, 2.4, and 1.3 for the UNC data. Sensitivity analysis revealed satisfaction of the HCT, BMI, and pleural effusion criteria had a posttest likelihood of disease 99% when the pretest probability of disease varied from 12-25%. These values were true for the original and UNC data. The Panc 3 score is easy to use and accurate for the prediction of SAP. The serum HCT was the strongest predictor of SAP. The combination of the Panc 3 variables was highly predictive of SAP.