Severe Form Of Acute Pancreatitis Research Articles

Step-Up Management in Acute Pancreatitis: A Tertiary Care Center's Experience From Southern India.

Background The clinical spectrum of acute pancreatitis (AP) ranges from mild disease to severe form associated with multiorgan failure, prolonged hospital stay, high morbidity, and mortality. Acute necrotizing pancreatitis (ANP) is a severe form of AP. This study evaluates AP's outcomes after applying principles of the step-upapproach in a tertiary healthcare center in south India. Methodology This prospective observational study was carried out from January 2021 to December 2022. The study population includes patients admitted to our department with AP. Results Ninetypatients were included in the study, most of them were middle-aged males with ethanol ingestion as the common etiology. Thirty-seven (41.1%) patients had mild AP, 25 (27.7%)had moderately severe AP, and 28 (31.1%)had severe AP. Organ failure at admission was noted in 36 (40%) patients. Twenty-three (25.5%) patients developed ANP. Infected necrosis was noted in 3 (3.33%) patients. Eighteen (20%) patients needed image-guided percutaneous drainage. Seven (38.8%) needed necrosectomy following percutaneous drainage. Mortality was observed in 8 (8.8%) patients. Specifically, mortality was noted in 6 (6.6%) patients who presented later in their disease course. Conclusions Percutaneous catheter drainage is a safe and effective therapy to tide over the initial phase of AP. It also serves as a bridging therapy till the patient is clinically fit for a necrosectomy. Severe AP cases presenting late in their course are associated with significant mortality even after step-upmanagement. Standardized protocols for referral and management are essential to obtain a good clinical outcome.

The Use of Diets in the Diagnosis and Treatment of Common Gastrointestinal Diseases in Dogs and Cats.

The nutritional health of dogs and cats is important to pet owners around the world. Nutrition is inextricably linked to the health of the gastrointestinal system and vice versa. Gastrointestinal signs, such as vomiting, diarrhea, anorexia, or weight loss, are one of the most common reasons that dog and cat owners make non-routine appointments with veterinarians. Those patients are evaluated systematically to identify and/or rule out the causes of the symptoms. Some causes of chronic diarrhea are within the gastrointestinal tract while others are secondary to pathogenic factors outside the digestive system. Some useful biomarkers of chronic intestinal disease (enteropathy) exist in serum and feces. After determination that the clinical signs are due to primary gastrointestinal disease and that there is no parasitism, specific diets are used for at least two weeks. There are several types of diets for pets with chronic enteropathies. There are limited ingredient diets and hydrolyzed protein diets with reduced levels of allergens. There are also highly digestible and fiber-enhanced diets. Some diets contain probiotics and/or prebiotics. If symptoms do not improve and the patient is stable, a diet from a different class may be tried. For chronic enteropathies, the prognosis is generally good for symptom resolution or at least improvement. However, if interventions with novel diets do not ameliorate the symptoms of chronic enteropathy, then antibiotic, anti-inflammatory, or immunosuppressant therapy or further, more invasive diagnostics such as taking an intestinal biopsy, may be indicated. Pancreatitis is a common gastrointestinal disease in dogs and cats and patients may present with mild to severe disease. Many patients with mild to moderate disease can be successfully treated with early supportive care, including feeding a low-fat diet. A novel pharmaceutical, fuzapladib (Panoquell-CA1) looks very promising for treating more severe forms of acute pancreatitis in dogs. Maintenance on a low-fat diet may prevent pancreatitis in at-risk dogs. Future advances in medicine will allow pet owners and veterinarians to use dietary management to maximize the health of their dogs and cats.

RNA-sequencing approach for exploring the protective mechanisms of dexmedetomidine on pancreatic injury in severe acute pancreatitis.

Background: Severe acute pancreatitis (SAP) is a severe form of acute pancreatitis with the potential to cause life-threatening complications. Patients with acute SAP require surgical intervention and are admitted to the intensive care unit for non-invasive ventilation. Dexmedetomidine (Dex) is currently used by intensive care clinicians and anaesthesiologists as an adjunctive sedative. Therefore, the clinical availability of Dex makes it easier to implement in SAP treatment than developing new drugs. Methods: Randomly dividing thirty rats into sham-operated (Sham), SAP, and Dex groups. The severity of pancreatic tissue injury in each rat was assessed by Hematoxylin and eosin (HE) staining. Serum amylase activity and inflammatory factor levels were measured using commercially available kits. The expressions of necroptosis-related proteins, myeloperoxidase (MPO), CD68, and 4-hydroxy-trans-2-nonenal (HNE) were detected using immunohistochemistry (IHC). Transferase-mediated dUTP nick-end labeling (TUNEL) staining was utilized to identify pancreatic acinar cell apoptosis. The subcellular organelle structure of pancreatic acinar cells was observed using transmission electron microscopy. The regulatory effect of Dex on the gene expression profile of SAP rat pancreas tissue was investigated using RNA sequencing. We screened for differentially expressed genes (DEGs). Quantitative real-time PCR (qRT-PCR) measured critical DEG mRNA expression in rat pancreatic tissues. Results: Dex attenuated SAP-induced pancreatic injury, infiltration of neutrophils and macrophages, and oxidative stress. Dex inhibited the expression of necroptosis-associated proteins RIPK1, RIPK3, and MLKL and alleviated apoptosis in acinar cells. Dex also mitigated the structural damage caused by SAP to mitochondria and endoplasmic reticulum. Dex inhibited SAP-induced 473 DEGs, as determined by RNA sequencing. Dex may regulate SAP-induced inflammatory response and tissue damage by inhibiting the toll-like receptor/nuclear factor κB (TLR/NF-κB) signaling pathway and neutrophil extracellular trap formation. Conclusion: This study elucidated the remarkable effect of Dex against SAP and investigated the potential mechanism of action, providing an experimental base for the future clinical application of Dex in the treatment of SAP.

SEVERE ACUTE PANCREATITIS REVEALING THROMBOTIC THROMBOCYTOPENIC PURPURA: A CASE REPORT AND REVIEW OF LITERATURE

Acute pancreatitis is an inflammatory condition marked by localized tissue damage that may lead to a broader inflammatory reaction. There is growing evidence that patients with a severe form of acute pancreatitis have endothelial dysfunction as one of the key pathophysiologic symptoms. In line with this, there have been new studies linking acute pancreatitis to the hematological condition thrombotic thrombocytopenic purpura (TTP).Here, we are describing a rare conversive event in which severe pancreatitis led to thrombocytopenic purpura.

Сучасні аспекти патогенезу та діагностики гострого панкреатиту

Early adequate treatment of patients with acute pancreatitis leads to a decrease in mortality and reduces the financial burden on medical institutions and the patient, which encourages the continued search for optimal markers for assessing severity and predicting the course of the disease. The aim of this work is to study the modern aspects of the pathogenesis of acute pancreatitis and the role of various biomarkers in the diagnosis of the severity of the course of the disease and the prediction of its complications. The study of the features of the pathogenesis of acute pancreatitis continues, which naturally contributes to the emergence of new diagnostic markers of this disease. It has been proven that most of the etiological factors that cause acute pancreatitis (alcohol, hypoxia, hypercalcemia, hyperlipidemia, certain pharmacological drugs) also contribute to abnormally high oscillations of the Ca2+ level. Therefore, it can be assumed that in acute pancreatitis, Ca2+ is a common trigger for various etiological factors, which trigger the pathological process. In turn, the enzymatic cascade is the starting point for the development of local and systemic inflammatory reactions, manifested by local and systemic effects. Based on the study of the features of the course of severe forms of acute pancreatitis, we established the role of vitamin D deficiency in the development of the disease. In addition, the study of the activity of tissue plasminogen activator and/or the level of thrombin-antithrombin III complex can be interesting as markers of the development of thrombohemorrhagic complications. An increase in the number of positive results of a serological examination for Helicobacter pylori (immunoglobulin M) in patients with a severe course of acute pancreatitis after 7 days from the moment of hospitalization gives reason to consider this indicator as one of the predictors of the development of purulent complications of the disease. Preliminary studies using the proposed diagnostic markers give encouraging results regarding the prognosis for the disease and the life of this extremely complex category of patients.

Prediction of Surgical Treatment in Acute Pancreatitis Using Biochemical and Clinical Parameters.

Deep Acute pancreatitis (AP) is an urging cause of hospitalization in the gastroenterology due to different causes and an unpredictable outcome. Known causes are grouped into four main groups: metabolic, mechanical, vascular and infectious. To determine the role of certain biochemical or radiological parameters as predictors of an involvement of other organs in AP different pathological staging and the surgical outcome in the treatment of AP. Ninety-seven AP patients hospitalized in General Hospital "Prim.dr Abdulah Nakaš" Sarajevo, in a period between 2016 and 2021 for both sexes, were divided according to the etiological factors of AP into four groups: nutritional factors, biliary concernments, alcohol and morphological changes of the pancreas. Beside laboratory tests, the imaging methods of abdomen (transabdominal ultrasound, abdominal computed tomography) used in determining morphological changes in the pancreas and other organs were analyzed in relation to parameters that predict the need for surgical outcomes. AP etiological factors of patients differ significantly by gender and showed the dominance of dietary factors in female subjects (51%), followed by the presence of concernments in the biliary tract in 36% of cases, and alcohol consumption in male subjects in 28% of cases. The only variable correlated with the indicator of necessity for surgery is the existence of pleural effusion (coefficient of correlation was 0.38; risk ratio was 5.5) resulting that patients with pleural effusion have a 5.5 times higher chance of surgery indication than other patients. The application of simple parameters such as creatinine value with the values of amylases in serum and urine and the presence of pleural effusion confirmed by radiological imaging of the lungs opens the possibility of a simple and effective selection of patients for surgical treatment with a more severe form of AP.

Acute Pancreatitis in Patients After Liver Transplantation.

BACKGROUND Acute pancreatitis (AP) is a relatively rare but serious complication that can occur after organ transplantation. MATERIAL AND METHODS The aim of this study was to evaluate the incidence, potential risk factors, and course of AP in patients following liver transplantation at a single large-volume transplant center. RESULTS Out of a total of 1850 transplanted patients, 49 (2.8%) were diagnosed with AP. Of this group, 37 (75.5%) had a mild form of AP and 12 (24.5%) had a severe form of AP. The mortality rate was 10% overall and 42% in the group of patients with severe AP. An early form of AP (<30 days from transplantation) occurred in 13 patients (26.5%), most of whom presented with severe AP (10 patients, 76.9%); 4 patients died (40%). A late form of AP was diagnosed in 36 patients (73.5%), most of whom had mild AP (34 patients, 94.4%); 1 of 2 patients with severe AP died. The most common AP etiologies were post-ERCP (38.8%), idiopathic (34.7%), and postoperative (18.4%). Chronic HBV infection was a risk factor for development of AP (P=0.01). CONCLUSIONS AP in liver transplant recipients was more frequent and more severe than in the general population. This unfavorable course was associated with the occurrence of AP in the early post-transplant period. Liver transplantation due to complications of HBV infection was a risk factor for the development of AP.

Gut microbiota on admission as predictive biomarker for acute necrotizing pancreatitis.

BackgroundAcute necrotizing pancreatitis (NP), a severe form of acute pancreatitis (AP), has higher mortality and worse outcome than non-necrotizing pancreatitis (non-NP). Infected NP is a devastating subgroup of NP. To date neither NP nor infected NP has robust prediction strategies, which may delay early recognition and timely intervention. Recent studies revealed correlations between disturbed gut microbiota and AP severity. Some features of intestinal microbiota have the potential to become biomarkers for NP prediction.MethodsWe performed 16S rRNA sequencing to analyze gut microbiota features in 20 healthy controls (HC), and 58 AP patients on hospital admission. The AP patients were later classified into NP and non-NP groups based on subsequent diagnostic imaging features. Random forest regression model and ROC curve were applied for NP and infected NP prediction. PIRCUSt2 was used for bacterial functional pathway prediction analysis.ResultsWe found that the three groups (HC, NP, and non-NP) had distinct microorganism composition. NP patients had reduced microbial diversity, higher abundance of Enterobacteriales, but lower abundance of Clostridiales and Bacteroidales compared with the non-NP group. Correlation analyses displayed that intestine bacterial taxonomic alterations were related to severity, ICU admission, and prognosis. By pathway prediction, species more abundant in NP patients had positive correlation with synthesis and degradation of ketone bodies, and benzoate degradation. Enterococcus faecium (ASV2) performed best in discriminating NP and non-NP patients. Finegoldia magna (ASV3) showed the maximal prediction capacity among all ASVs and had comparable accuracy with Balthazar CT to detect patients with infected NP.ConclusionsOur study suggests that NP patients have distinct intestinal microbiota on admission compared to non-NP patients. Dysbiosis of intestinal microbiota might influence NP progression through ketone body or benzoate metabolism. Enterococcus faecium and Finegoldia magna are potential predictors for NP and infected NP. Our findings explore biomarkers which may inform clinical decision-making in AP and shed light on further studies on NP pathophysiology and management.

Development of a Score for Predicting Severe Acute Pancreatitis at Admission.

The identification of patients at risk of developing a severe form of acute pancreatitis is a major issue. The goal of this study was to identify parameters at admission associated with severe pancreatitis to develop a predictive severity score. We conducted a retrospective study at Caen University Hospital between January 2014 and December 2017, including 504 patients hospitalized for acute pancreatitis, of whom 74 had a severe form. We developed a predictive score named Admission Severe Acute Pancreatitis (ASAP) score based on parameters associated with a severe form in multivariate analysis. We validated our score in an independent validation cohort of 80 patients. Hypothermia, low oxygen saturation or albumin levels, and high creatinine levels were significantly associated with severe pancreatitis. The ASAP score showed notable predictive accuracy (area under receiver operating characteristic, 0.82), which was significantly higher than Sequential Organ Failure Assessment, persistent Systemic Inflammatory Response Syndrome, and Balthazar. Using the -2.1742 threshold, the ASAP score had a sensitivity and specificity of 74% and a negative predictive value of 95%. These predictive performances for ASAP score were confirmed in the validation cohort. The ASAP score demonstrates remarkable predictive accuracy in distinguishing severe forms of acute pancreatitis.

The role of endoscopic ultrasound in patients with acute pancreatitis.

Acute biliary pancreatitis is the most common form of acute pancreatitis worldwide. Endoscopic ultrasound (EUS) may be helpful in detecting common bile duct stones and in indicating more invasive endoscopic retrograde cholangiopancreatography (ERCP) examinations or determining rarer aetiologies of acute pancreatitis. Over a period of six years, we prospectively collected 131 patients with acute biliary pancreatitis and observed the need for endoscopic examination alongside with a decrease in the number of necessary ERCP examinations as a result of negative EUS results (no bile duct stones detected). We compared groups of patients given different endoscopic treatments in relation to their hospital mortality relative to the incidence of severe acute pancreatitis. As many as 68 % of primarily indicated EUS examinations had a negative result (no common bile duct stones detected) and this result saved the patients from needing to undergo an invasive ERCP procedure. Both the incidence of the severe form of acute pancreatitis and the hospital mortality rate were lower among patients who underwent only EUS or ERCP after EUS as compared to patients who underwent ERCP straight away. The use of EUS in patients with acute pancreatitis is very helpful in determining the treatment strategy (ERCP indication) and may reduce hospital mortality (Tab. 2, Ref. 14).

SURGICAL TREATMENT OF LOCAL PURULENT-SEPTIC COMPLICATIONS OF ACUTE SEVERE PANCREITIS

In the past decades, mortality in acute pancreatitis ranges from 3 to 15 % and depends mainly on the specific weight of severe forms of morbidity, which is characterized by the development of necrotic processes in the pancreas and systemic complications. Despite the large number of studies on severe forms of acute pancreatitis, a significant improvement of results of treatment of this category of patients is not observed. The integrated diagnosis and treatment of this pathology, prognosis and prevention of purulentseptic complications are relevant today. The aim of the study was to evaluate the effectiveness of surgical tactics depending on the nature and prevalence of local purulent-septic complications of acute pancreatitis. To solve this problem, the results of treatment were analyzed the results of treatment of 422 patients with acute pancreatitis who were treated in the surgical Department of the Poltava regional clinical hospital in the period from 2010 to 2015. All patients were admitted to hospital for 1-7 days after infection. 315 (74.6 %) of them are diagnosed as having acute pancreatitis easy, patients received conservative therapy and 7-10 days was discharged from the hospital. Moderate and severe pancreatitis with the development of local parapancreatic complications were diagnosed in 107 patients (25, 4%), 67 (62.6%) men and 40 (37, 4%) women. Their age ranged from 22 to 81 years (47, 9±1.5 years). The severity of the patients was determined by the BISAP scale, the presence of organ failure was diagnosed by applying the Marshal scale (modification 2012) [5]. The patients were examined according to the order Ministry of Healthcare of Ukraine № 297 dated 2 April 2010. Moderate acute pancreatitis is characterized by localization of purulent-septic complications in 12 anatomical areas with a predominantly liquid component. Severe acute pancreatitis is characterized by the localization of purulent-septic complications in more than 2 anatomical sites with primarily tissular component. Efficacy of simple drainage procedures depended on the incidence of fluid accumulations in the 1-2 anatomical region and presence of a predominantly liquid component. Among the patients with predominant tissue component in the liquid accumulation and the prevalence of local parapancreatic complications in more than two anatomic sites, the performance of open necrosectomy seems to be the most appropriate.

ПЕРФУЗІЙНА ДИСФУНКЦІЯ ПРИ ГОСТРОМУ ПАНКРЕАТИТІ: ПЕРСПЕКТИВНІ НАПРЯМКИ УДОСКОНАЛЕННЯ ДІАГНОСТИКИ ТА СТРАТИФІКАЦІЇ ЗАХВОРЮВАННЯ

Introduction. Acute pancreatitis (AP) is one of the most common diseases of the digestive system that require hospitalization. To date, the problem of stratification and differential diagnosis of AP in the early stages remains unresolved, which encourages the search for new methods of diagnosis and prediction of the severity of AP. Aim. To evaluate the possibility of creating a clinically oriented system of stratification and prognosis of AP on the basis of dynamic changes in microcirculation depending on the duration of the disease and severity of AP. Materials and methods. Assessment of the state of microcirculation (MC) of patients by laser Doppler flowmetry (LDF) was performed with the “LAKK-02” device. Kruskal-Wallis non-parametric analysis of variance and the median test were used to test statistical hypotheses when comparing independent samples. Pairwise comparison of independent samples was performed using the Mann-Whitney U test. Results. The study determined the indicators of MC in patients with different AP severity degrees on the first day of the disease. The microcirculation parameter (MP) in patients with mild, moderate, and severe AP was 3.9; 3.8 and 6.8 perfusion units (p.u.), respectively. The blood flow modulation rate (ơ) was 0.52; 0.54 and 0.69 p.u. in mild, moderate, and severe AP. In our study, the coefficient of variation (Kv) averaged 17.3%; 20.0% and 11.7% in patients with mild, moderate, and severe AP, respectively. Conclusions. LDF in AP is an informative method of diagnosing the state of MC, which is a universal link in all pathophysiological reactions of the organism. Changes of MC in AP depend on the severity of AP and the period of the disease. The pathophysiological microcirculatory phenomena, revealed on the first day of the disease, provide us with the perspectives of early clinical distinguishing the moderate and severe forms of AP from the so-called group of “destructive forms”.

Body type as a risk factor for progress of severe pancreatitis

Relevance. Early detection of severe forms of acute pancreatitis remains an unsolved problem of urgent surgery.Objective of the study: early detection of prognostically unfavorable forms of the disease based on the constitutional characteristics of the patient.Materials and methods. A comparative prospective analysis of the clinical course of acute pancreatitis in 270 patients with an assessment of the prognostic significance of clinical, instrumental and anthropological data in the early diagnosis of severe forms of acute pancreatitis was carried out. In 179 patients there was a moderate and severe form of the disease, in 91 patients the disease was mild.Results and discussion. ROC analysis of the studied criteria showed that clinical and laboratory data on the first day of the disease are not reliable predictors of the risk of death. The somatotype and the amount of adipose tissue in the body (type of nutrition) showed a significant predictive value of AUC (0.768 and 0.655, p &lt; 0.01 and p &lt; 0.05, respectively). At the same time, only the body type AUC (0.658, p &lt; 0.0001) showed statistical reliability as a significant prognostic factor for the progress severity of the patient's condition. The criti cal boundary calculated value of the somatotype is 20 nominal units. The risk group includes persons with a body type close to brachymorphic.Conclusion. Carrying out somatotyping with the calculation of its numerical values, attributing the patient to a particular type of physique in the group of patients with acute pancreatitis in the early stages from the moment of the disease, is an additional criterion for early prediction of the course of acute pancreatitis and will allow to determine the competent treatment to avoid manifestation of severe form of disease.

New Paradigm for Determining Necrosis, Stage and Prognosis of Severe Acute Necrotizing Pancreatitis

Objective: To determine the clinical features and diagnostic parameters of acute alcohol-induced pancreatic necrosis to develop a new system to assess the severity of acute pancreatitis, diagnose necrotic inflammation, and understand prognosis. Methods: We performed a retrospective chart review of patients admitted to the General Surgery Department and Gastroenterology Department of The Third Central Hospital, and The First Central Hospital in Ulaanbaatar from November 1, 2008, to January 1, 2020, admitted with acute pancreatitis, gathering clinical data using a structured form. From these data, we developed a new scoring system. Results: The median age of patients with acute necrotic pancreatitis was 43 (range 25-71) years, with the majority (87.4%) ages 26 to 60. Of the 31 deaths reported in the study, 24 (77.4%) were hospitalized more than 72 hours after the onset of the disease. Using the new evaluation system, 12 out of 122 patients were classified as class A (score 0-3), 69 (56.5%) were class B (score 4-6), and 41 (33.6%) of the patients were class C (score ≥7) points. Conclusion: The evaluation system we developed aids with early diagnosis, progression and prognosis of severe forms of acute pancreatitis. It is easy to score, and it is possible to score using information available in Mongolia’s secondary and tertiary hospitals.

Necrotising Pancreatitis- A Cross-sectional Study on Surgical Outcomes of Pancreatic Necrosectomy

Introduction: Necrotising Pancreatitis (NP) is the severe form of acute pancreatitis accounting for significant mortality (15- 40%), morbidity (~25%) and has significant health costs. The traditional management of infected necrosis has centered on open surgical debridement which is accompanied by significant risk of stress, organ failure and complications. Short-term and long-term functional outcomes after operative treatment of NP have not been studied extensively. Aim: To evaluate the short-term and long-term surgical outcomes in patients undergoing surgery for NP. Materials and Methods: This was a cross-sectional study of patients who underwent surgery for NP conducted at Manipal Hospital, Bangalore between June 2009 to March 2016. The electronic records pertaining to such patients were retrieved. Various surgeries done were grouped. Surgical complications and short-term outcomes like new onset organ failure, Surgical Site Infection (SSIs), haemorrhage, bowel fistula, re-explorations, and requirement of additional procedures, hospital stay and the mortality were studied by hospital data. Long-term outcomes like endocrine/exocrine insufficiency, weight loss, recurrent pancreatitis, incision hernia were studied by prospective data collected from telephonic interview; questionnaires in addition to data collected as and when patient gets admitted and in Outpatient Department (OPD) during follow-up. A comparison with different surgical techniques like laparoscopy, open necrosectomy, Video assisted necrosectomy was made. Statistical analyses were performed by STATA 11.2 (College Station TX USA). Mann-Whitney test were used to find the significance difference between the length of stay and Intensive Care Unit (ICU) stay with the groups and it is expressed as mean and standard deviation, Chi-square test has been used to measure the association between different clinical variables. p&lt;0.05 was considered as statistically significance. Results: Forty six patients underwent surgical treatment during the study period. Patients’ age ranged from 25 to 75 years (median age- 44 years). Median postoperative ICU stay was 12 days (range of 01- 32 days). The mean follow-up was 3.5 years. The overall mortality rate was 26% (12 patients). The mortality rates between laparatomy (33%) and minimally invasive necrosectomy (23%) groups were not significantly different (p=0.436). Secondary diabetes mellitus was observed in 18 (40%) and exocrine insufficiency in 8 (18%) of patients. The other long-term complications were recurrent pancreatitis in 7 (15%), biliary stricture 3 (6%) and incisional hernia in 3 (6%). Conclusion: Mortality rate, organ failure rates and median ICU admission rate were similar across all surgical techniques though there was a trend of overall reduced complication rate. A long-term and close follow-up is advised in these patients for the late complications to be identified and treated.

ANTIMICROBIAL PEPTIDES AND UBIQUITIN PROTEIN LIGASE E3 IN DESTRUCTIVE FORMS OF PANCREATITIS

The development of methods for predicting and pre-venting the development of infectious destructive forms of acute pancreatitis for clinical practice is one of the important problems of pancreatology, the solu-tion of which would reduce post-operative mortality in severe acute pancreatitis, reaching 30-80%. To date, traditional laboratory and instrumental methods of diagnosis do not fully satisfy clinicians, since they do not always allow timely and reliable determination of the probability and time of microbial contamina-tion of pancreatic and parapancreatic tissue in pa-tients with destructive pancreatitis. In this regard, it is of interest to search for new methods for predicting and timely diagnosis of infected forms of pancreatic necrosis, which would significantly improve the re-sults of treatment of severe forms of acute pancreatitis. The use of changes in the dynamics of levels of antimi-crobial peptides - α-defensins and Ubiquitin Protein Ligase E3 in the blood serum of patients for diagnos-tic purposes makes it possible to predict and deter-mine earlier the transformation of sterile pancreone-crosis into infected and can be used as markers of the development of contamination of destructive forms of acute pancreatitis.

S3072 In-hospital Outcomes of Acute Pancreatitis in Patients With Liver Cirrhosis

INTRODUCTION: Acute pancreatitis (AP) is the most common disease of the gastrointestinal (GI) tract. Acute pancreatitis was noted to be the most common GI discharge with reported increased incidence in hospitalized patients. The estimated cost of hospitalization for AP was estimated at a cost of 2.6 billion dollars in 2009. A recent study of the NIS database revealed worse outcomes of AP in patients with liver cirrhosis between 2003 and 2013. We conducted this study to evaluate any changes in the outcomes of AP in hospitalized patients with liver cirrhosis between 2012 and 2015. METHODS: The study was derived from the National Inpatient Sample (NIS) database. We queried the database for hospitalization with a primary diagnosis of acute pancreatitis using the International Classification of Diseases, 9th revision, Clinical Modification code 577.0. The primary outcomes were in-hospital mortality and length of stay. We compared the outcomes between patients with and without history of liver cirrhosis/obesity. RESULTS: A total of 1,402,750 were included in the study after exclusion of patients under 18 years of age and those with a history of chronic pancreatitis. 62,110 (4.4%) had a documented history of liver cirrhosis. Overall, patients with liver cirrhosis had significant multiple co-morbidities as compared to those without liver cirrhosis. The in-hospital mortality (adjusted odds ratio: 3.1, 95% confidence interval 2.85 – 3.37, P < 0.001), length of stay and cost of hospitalization were significantly higher in patients with liver cirrhosis. CONCLUSION: Patients with AP and liver cirrhosis have significantly higher mortality, prolonged hospitalization, and healthcare expenditure. The study findings remain similar to a recently published study looking at mortality for patients admitted between 2003 and 2013. It is unclear if the increased mortality is related to complications related to severe forms of acute pancreatitis or liver cirrhosis.Table 1.: Baseline Characteristics of AP index hospitalizationsTable 2.: Adjusted Outcomes of AP admissions with liver cirrhosis (adjusted for age, gender and co-morbidities; obesity, congestive heart failure, hypertension, diabetes mellitus, metastatic cancer, immunodeficiency, alcohol abuse, renal failure and chronic lung disease)

Acute Pancreatitis in Celiac Disease: Has the Inpatient Prevalence Changed and Is It Associated With Worse Outcomes?

Studies suggest that adults diagnosed with celiac disease (CD) are at higher risk of developing acute pancreatitis (AP). The aim of this study is to explore the relationship between CD and AP in terms of inpatient prevalence, mortality, morbidity, and resource utilization in the past decade. Retrospective cohort study using the Nationwide Inpatient Sample (2007-2016). The primary outcome was the occurrence of AP in CD patients. Secondary outcomes were the trend in AP cases in CD patients, and mortality, morbidity, length of stay, and total hospital charges and costs. Of 337,201 CD patients identified, 7372 also had AP. The mean age was 53 years, 71% were women. The inpatient prevalence of AP in CD was 2.2% versus 1.2% in non-CD cohort (P < 0.01). Patients with CD displayed increased odds of having AP (adjusted odds ratio, 1.92; P < 0.01). Patients with AP and CD displayed lower odds of morbidity and mortality than non-CD patients with AP. The inpatient prevalence of AP is higher in CD patients, and increased from 2007 to 2016. Patients with CD and AP displayed lower morbidity and mortality, which may suggest that they have a less severe form of AP or lower baseline comorbidity.

The impacts of infectious complications on outcomes in acute pancreatitis: a retrospective study

BackgroundThe occurrence of infectious complications characterizes the more severe forms of acute pancreatitis (AP) and is associated with high mortality. We investigated the effects of infection at different sites in patients with AP, including those with necrotizing pancreatitis (NP).MethodsWe conducted a retrospective analysis of 285 patients who met the inclusion criteria for AP and were admitted to Tianjin Nankai Hospital between January 2016 and September 2019. According to the source of the culture positivity during hospitalization, patients were divided into four groups: sterile group(n = 148), pancreatic infection group(n = 65), extrapancreatic infection group(n = 22) and combined infection group(n = 50). The source of infection, microbiology, biochemical parameters and prognostic indicators were analyzed.ResultsIn terms of baseline characteristics, the four groups were similar in age, sex, aetiology, previous pancreatitis and diabetes. Compared with the severity of the disease in the other groups, the APACHE II scores(9.91 ± 4.65, 9.46 ± 5.05, respectively) and organ failure rate (40.9 and 50%, respectively)were higher in the extrapancreatic infection group and the combined infection group (P < 0.05). The frequency of surgical intervention and hospitalization time in patients with NP complicated with extrapancreatic infection was greatly increased (P < 0.05). Regarding the primary outcome, patients in the combined infection group had longer hospital stays (68.28 ± 51.80 vs 55.58 ± 36.24, P < 0.05) and higher mortality (24.0% vs 9.2%, P < 0.05) than patients in the pancreatic infection group. In addition, patients in the extrapancreatic infection group also showed high intensive care utilization (59.1%) and mortality rates (18.2%). Among the 137 AP patients with infection complications, 89 patients exhibited multidrug-resistant (MDR) microorganisms, and the mortality rate of patients with MDR bacterial infection was higher than that of patients with non-MDR bacterial infection (24.7% vs 3.6%, P = 0.001).ConclusionClinicians should be aware that extrapancreatic infection (EPI) significantly aggravates the main outcome in pancreatic infection patients. Infection with MDR bacteria is also associated with AP mortality.

IL-10-1082G>A polymorphism, use of opioids and age affect the course of acute pancreatitis.

We aimed to determine the association of two of the most important functional polymorphisms of IL-8 and IL-10 with the clinical course and outcome of acute pancreatitis. Ninety-three patients with acute pancreatitis were genotyped for IL-8-251T>A and IL-10-1082G>A using PCR-RFLP. The severity of the disease was determined based on the Atlanta Classification system. In patients treated with opioids, the odds for severe form of acute pancreatitis, its complications, and death were increased. Advanced age was associated with higher odds of organ/multiple organ failure and other systemic complications. Multivariate logistic regression analyses confirmed the observed effect of age and use of opioids, and revealed higher odds for the development of severe form of acute pancreatitis [P = 0.017, odds ratio (OR): 4.324, 95% confidence interval (CI): 1.305-14.323], its complications in general (P = 0.011, OR: 4.936, 95% CI: 1.442-16.897), pancreatic necrosis (P = 0.032, OR: 3.922, 95% CI: 1.122-13.707) and systemic inflammatory response syndrome (P = 0.037, OR: 3.838, 95% CI: 1.085-13.583) in the absence of IL-10-1082G>A variant allele. The effect of IL-8 -251T>A on acute pancreatitis severity or mortality was not detected. Our study suggests the IL-10 -1082A allele as a protective factor in acute pancreatitis. Opioid analgesics treatment in acute pancreatitis is associated with severity, complications and mortality, while advanced age increases the risk of systemic complications.