Severity In Acute Pancreatitis Score Research Articles

The Role of Red Cell Distribution Width (RDW), RDW/Platelet Ratio, and Mean Platelet Volume as Prognostic Markers in Acute Pancreatitis Severity and Complications Based on the Bedside Index for Severity in Acute Pancreatitis Score.

Background Acute pancreatitis (AP) is a condition with various etiological factors, marked by the sudden onset of inflammation in the pancreatic tissue. Predicting the severity and potential mortality of AP involves analyzing clinical data alongside laboratory tests and imaging. Among several grading methods with strong predictive capabilities for illness severity and mortality, the Bedside Index for Severity in Acute Pancreatitis (BISAP) score is notable. This study aims to explore the potential role of laboratory markers, specifically red cell distribution width (RDW), RDW/platelet (PLT) ratio, and mean platelet volume (MPV), in predicting disease severity, with patients being stratified according to the BISAP scoring system. Materials and methods This research included 161 patients hospitalized at Cantonal Hospital Zenica in Zenica, Bosnia and Herzegovina, with a diagnosis of AP. The BISAP score was determined based on laboratory and radiological analyses. This score was used to evaluate potential correlations between laboratory findings such as RDW, RDW/PLT ratio, and MPV. Results The age range was significantly higher in patients with BISAP scores ≥3 (68 years, 64-76) compared to those with BISAP scores <3 (59.5 years, 42.75-69) (p = 0.000). RDW values were also significantly higher in patients with BISAP scores ≥3 (15.6%, 14-16.9) compared to those with BISAP scores <3 (13.5%, 13-14.1) (p = 0.000). Hospital stay duration was significantly longer for patients with BISAP scores ≥3 (9 days, 6-11) compared to those with BISAP scores <3 (5 days, 5-7) (p = 0.000). Additionally, the RDW/PLT ratio was significantly lower in patients with BISAP scores <3 (0.063 ± 0.02) compared to those with BISAP scores ≥3 (0.09 ± 0.059) (p = 0.012). Conclusion Our results indicate a significant difference in RDW/PLT ratios between patient severity groups based on BISAP scores (scores <3 vs. ≥3). This suggests that the RDW/PLT ratio may serve as a useful predictor for assessing the severity of AP. However, further research is needed to explore the full potential of the RDW/PLT ratio in evaluating AP patients.

Enhancing predictive accuracy in hypertriglyceridemia-induced acute pancreatitis: Role of red cell distribution width and prospective studies.

This letter addresses the study titled "Red cell distribution width: A predictor of the severity of hypertriglyceridemia-induced acute pancreatitis" by Lv et al published in the World Journal of Experimental Medicine. The study offers a valuable analysis of red cell distribution width (RDW) as a predictive marker for persistent organ failure in patients with hypertriglyceridemia-induced acute pancreatitis. The study results suggest that RDW, combined with the Bedside Index for Severity in Acute Pancreatitis score, could enhance the predictive accuracy for severe outcomes. Further investigation into the role of RDW in different severities of acute pancreatitis is recommended. Additionally, the need for large-scale and multicenter prospective studies to validate these findings is emphasized.

Using Acidosis as a Surrogate for or Supplement to the Bedside Index of Severity in Acute Pancreatitis Scoring Prediction System Has a Nonsignificant Effect.

Currently, risk stratification calculators for acute pancreatitis (AP) can at best predict acute pancreatitis mortality at 12 hours from the presentation. Given the severe morbidity associated with AP, the identification of additional prognostic indicators, which may afford earlier prediction in length of stay (LOS) and mortality, is desired. Metabolic acidosis can be a prognostic marker for the severity of AP, and venous bicarbonate can reliably and accurately be substituted for arterial base deficit to detect metabolic acidosis. Since serum bicarbonate, anion gap (AG), and corrected AG (CAG) are routinely obtained upon presentation to the emergency department and often daily in the hospital, we conducted a retrospective analysis of 443 patients, evaluating if venous bicarbonate could predict the severity of pancreatitis as well as mortality, admission to the ICU, ICU LOS, and hospital LOS. The inclusion of venous bicarbonate, AG, and CAGin the first 12 hours only slightly improved the predictive capabilities of the Bedside Index for Severity in Acute Pancreatitis (BISAP) score for these secondary outcomes. None of our incorporations of acidemia improved severity predictions more than the BISAP alone. Adding CAG to BISAP scoring had the largest effect on predicting ICU admission and hospital LOS (area under the curve (AUC): 1.12 (confidence interval (CI) 95%: 1.06-1.19), p <.001 and AUC1.02 (CI 95%1.01-1.04), p <.001; respectively). ICU LOS was not impacted by the addition of AG, CAG, or venous bicarbonate. In-hospital death (n=12) was too small to be determined.

Early Predictive Value of Different Indicators for Persistent Organ Failure in Acute Pancreatitis: A Systematic Review and Network Meta-Analysis.

In this study, we conducted this network meta-analysis (based on the ANOVA model) to evaluate the predictive efficacy of each early predictor. Persistent organ failure (POF) is one of the determining factors in patients with acute pancreatitis (AP); however, the diagnosis of POF has a long-time lag (>48h). It is of great clinical significance for the early noninvasive prediction of POF. We conducted a comprehensive and systematic search in PubMed, Cochrane library, Embase, and Web of Science to identify relevant clinical trials, case-control studies, or cohort studies, extracted the early indicators of POF in studies, and summarized the predictive efficacy of each indicator through network meta-analysis. The diagnostic odds ratio (DOR) was used to rank the prediction efficiency of each indicator. We identified 23 studies in this network meta-analysis, including 10,393 patients with AP, of which 2014 patients had POF. A total of 10 early prediction indicators were extracted. The mean and 95% CI lower limit of each predictive indicator were greater than 1.0. Albumin had the largest diagnostic odds ratio, followed by high-density lipoprotein-cholesterol (HDL-C), Ranson Score, beside index for severity in acute pancreatitis Score, acute physiology and chronic health evaluation II, C-reactive protein (CRP), Interleukin 6 (IL-6), Interleukin 8 (IL-8), Systemic Inflammatory Response Syndrome (SIRS) and blood urea nitrogen. Albumin, high-density lipoprotein-cholesterol, Ranson Score, and beside index for severity in acute pancreatitis Score are effective in the early prediction of POF in patients with AP, which can provide evidence for developing effective prediction systems. However, due to the limitations of the extraction method of predictive indicators in this study, some effective indicators may not be included in this meta-analysis.

The epidemiology of acute pancreatitis in a tertiary care hospital in Dubai.

The prevalence of acute pancreatitis is rising especially in the Western world, but the prevalence remains unknown in most Middle Eastern Countries. Acute pancreatitis has been attributed with multiple etiologies with the two most common being alcohol abuse disorder and gallstones. The incidence and prevalence of it in the United Arab Emirates are yet to be reported. The Atlanta criteria were used for the diagnosis of acute pancreatitis and applied to patients that have been admitted to a single tertiary center in the year 2021. Several variables were investigated including gender, age, clinical presentation, etiology, radiological and laboratory results, complications, and outcome. Moreover, the Bedside Index for Severity in Acute Pancreatitis score was used to assess and determine the severity of acute pancreatitis in these patients. Nineteen patients were identified in our database with 52% being males. The mean age of patients was 41 years. The most frequent presentation was abdominal pain in 100% of our patients. Moreover, the most common etiology identified was idiopathic (52.63%), followed by biliary (21.05%). The mortality rate was 0%. This is the first retrospective study in Dubai on acute pancreatitis. Pancreatitis is a life-threatening condition with multiple etiologies. Physicians should consider multifactorial acute pancreatitis in patients with different comorbidities.

Acute pancreatitis: A review of diagnosis, severity prediction and prognosis assessment from imaging technology, scoring system and artificial intelligence.

Acute pancreatitis (AP) is a potentially life-threatening inflammatory disease of the pancreas, with clinical management determined by the severity of the disease. Diagnosis, severity prediction, and prognosis assessment of AP typically involve the use of imaging technologies, such as computed tomography, magnetic resonance imaging, and ultrasound, and scoring systems, including Ranson, Acute Physiology and Chronic Health Evaluation II, and Bedside Index for Severity in AP scores. Computed tomography is considered the gold standard imaging modality for AP due to its high sensitivity and specificity, while magnetic resonance imaging and ultrasound can provide additional information on biliary obstruction and vascular complications. Scoring systems utilize clinical and laboratory parameters to classify AP patients into mild, moderate, or severe categories, guiding treatment decisions, such as intensive care unit admission, early enteral feeding, and antibiotic use. Despite the central role of imaging technologies and scoring systems in AP management, these methods have limitations in terms of accuracy, reproducibility, practicality and economics. Recent advancements of artificial intelligence (AI) provide new opportunities to enhance their performance by analyzing vast amounts of clinical and imaging data. AI algorithms can analyze large amounts of clinical and imaging data, identify scoring system patterns, and predict the clinical course of disease. AI-based models have shown promising results in predicting the severity and mortality of AP, but further validation and standardization are required before widespread clinical application. In addition, understanding the correlation between these three technologies will aid in developing new methods that can accurately, sensitively, and specifically be used in the diagnosis, severity prediction, and prognosis assessment of AP through complementary advantages.

Utility of Urgent Endoscopic Retrograde Cholangiopancreatography in Patients with Predicted Mild Acute Pancreatitis and Cholestasis.

Endoscopic retrograde cholangiopancreatography (ERCP) within 72h is suggested for patients presenting with acute biliary pancreatitis (ABP) and biliary obstruction without cholangitis. This study aimed to identify if urgent ERCP (within 24h) improved outcomes compared to early ERCP (24-72h) in patients admitted with predicted mild ABP. Patients admitted for predicted mild ABP defined as a bedside index of severity in acute pancreatitis score < 3 and underwent ERCP for biliary obstruction within 72h of presentation during the study period were included. Patients with prior biliary sphincterotomy or surgically altered anatomy preventing conventional ERCP were excluded. The primary outcome was the development of moderately severe or severe pancreatitis based on the revised Atlanta classification. Secondary outcomes were the length of hospital stay, the need for ICU admission, and ERCP-related adverse events (AEs). Of the identified 166 patients, baseline characteristics were similar between both the groups except for the WBC count (9.4 vs. 8.3/µL; p < 0.044) and serum bilirubin level (3.0 vs. 1.6mg/dL; p < 0.0039). Biliary cannulation rate and technical success were both high in the overall cohort (98.8%). Urgent ERCP was not associated with increased development of moderately severe pancreatitis (10.4% vs. 15.7%; p = 0.3115). The urgent ERCP group had a significantly shorter length of hospital stay [median 3 (IQR 2-3) vs. 3days (IQR 3-4), p < 0.01]. Urgent ERCP did not impact the rate of developing more severe pancreatitis in patients with predicted mild ABP but was associated with a shorter length of hospital stay and a lower rate of hospital readmission.

The role of artificial neural networks in prediction of severe acute pancreatitis associated acute respiratory distress syndrome: A retrospective study.

Early identification and intervention of acute respiratory distress syndrome (ARDS) are particularly important. This study aimed to construct predictive models for ARDS following severe acute pancreatitis (SAP) by artificial neural networks and logistic regression. The artificial neural networks model was constructed using clinical data from 214 SAP patients. The patient cohort was randomly divided into a training set and a test set, with 149 patients allocated to the training set and 65 patients assigned to the test set. The artificial neural networks and logistic regression models were trained by the training set, and then the performance of both models was evaluated using the test set. The sensitivity, specificity, PPV, NPV, accuracy, and AUC value of artificial neural networks model were 68.0%, 87.5%, 77.3%, 81.4%, 80.0%, 0.853 ± 0.054 (95% CI: 0.749-0.958). The sensitivity, specificity, PPV, NPV, accuracy and AUC value of logistic regression model were 48.7%, 85.3%, 65.5%, 74.4%, 72.0%, 0.799 ± 0.045 (95% CI: 0.710-0.888). There were no significant differences between the artificial neural networks and logistic regression models in predictive performance. Bedside Index of Severity in Acute Pancreatitis score, procalcitonin, prothrombin time, and serum calcium were the most important predictive variables in the artificial neural networks model. The discrimination abilities of logistic regression and artificial neural networks models in predicting SAP-related ARDS were similar. It is advisable to choose the model according to the specific research purpose.

Obesity Exacerbates Acute Gastrointestinal Injury and Intestinal Barrier Dysfunction in Early-Stage Acute Pancreatitis.

The impact of obesity on the severity of acute pancreatitis and subsequent acute gastrointestinal injury remains an important consideration. This study aimed to determine the clinical relationship between obesity and acute gastrointestinal injury in earlystage acute pancreatitis. This was a prospective study that enrolled 194 acute pancreatitis patients. The median body mass index was 26.5 (7.0) kg/m2. Considering etiology of acute pancreatitis, 90 patients had gallstones, 48 had hypertriglyceridemia, 36 were alcohol users, and 20 were others. A total of 116 patients had mild acute pancreatitis and the rest had severe acute pancreatitis. The median of bedside index of severity in acute pancreatitis score was 1 (2) and the serum concentration of C-reactive protein was 80.5 (60.0) mg/L. Acute pancreatitis was accompanied by multiple organ dysfunction in 60 cases and by pancreatic necrosis in 34. A total of 52 patients were admitted to intensive care unit. The values of body mass index were higher in patients with severe acute pancreatitis than those with mild acute pancreatitis. A similar trend emerged in patients with hyperlipidemic acute pancreatitis compared to other causes. Body mass index had a positive relationship with bedside index of severity in acute pancreatitis scores. Noticeably, body mass index was statistically raised from gastrointestinal injury grade 1 to grade 4. The values of body mass index also showed relevance with intestinal barrier function evaluated by d-lactate, diamine oxidase, and intestinal fatty acid binding proteins. Furthermore, body mass indexes were statistically higher in patients having adverse outcomes of acute pancreatitis. This prospective study showed that obesity might contribute to increasing the severity of acute pancreatitis and aggravate subsequent intestinal injury in early-stage acute pancreatitis.

İnsülin direncinin akut pankreatit şiddetine etkisi

Giriş ve Amaç: Akut pankreatit, pankreasın çeşitli nedenlere bağlı inflamasyonudur. Tüm dünyada önemli bir morbidite ve mortalite nedenidir. Metabolik sendromun önemli bir komponenti olan insülin direncinin inflamatuvar bir durum olması nedeniyle akut pankreatit hastalarında hastalık şiddetini etkileyebileceği düşünülmektedir. Çalışmamızda insülin direncinin akut pankreatit şiddeti ile ilişkisini araştırmayı ve diğer prognostik faktörlerle karşılaştırmayı amaçladık. Gereç ve Yöntem: Çalışmamızda klinikte akut pankreatit tanısı ile yatarak tedavi almış 84 hasta değerlendirmeye alınmıştır. Çalışmamız prospektif olarak dizayn edilmiştir. Akut pankreatit şiddetini belirlemek için hastaların laboratuvar ve görüntüleme bulguları kullanılarak Atlanta Sınıflandırması, 'Bedside Index of Severity in Acute Pancreatitis' skoru, Imrie skoru, Ranson skoru, Balthazar skoru belirlenmiştir. Hastalarda insülin direnci değerlendirilmesi için “İnsülin Direncinin Homeostatik Modeli Değerlendirmesi” skoru kullanılmıştır. Buna göre insülin direnci olan ve olmayan gruplar arasında hastalık şiddeti açısından fark olup olmadığı araştırılmıştır. Bulgular: Hastaların %45.2’si insülin direnci olan grupta yer aldı. Atlanta sınıflandırmasına göre 6 hasta (%7.1) şiddetli akut pankreatit olarak sınıflandırıldı. 4 hasta prerenal akut böbrek hasarı gelişmesi ve 2 hasta sepsis ve yoğun bakım gereksinimi olması nedeniyle şiddetli akut pankreatit olarak değerlendirildi. Hastalık şiddeti açısından yapılan Receiver Operating Characteristic analizinde Balthazar ve “Yatak başı akut pankreatit şiddet indeksi” skorunun hastaların prognozunu belirlemede güçlü oldukları görüldü (sırasıyla eğri altındaki alan; 0.955 ve 0.979). İnsülin direnci olan grubun “Yatak başı akut pankreatit şiddet indeksi” ve Balthazar skorları, insülin direnci olmayan grup ile karşılaştırıldığında istatistiksel olarak anlamlı farklılık saptandı (sırasıyla p = 0.019 ve p = 0.013). Sonuç: Çalışmamızda insülin direnci olan akut pankreatit hastalarında “Yatak başı akut pankreatit şiddet indeksi” ve Balthazar skorlarının yüksek saptanması, insülin direnci varlığının akut pankreatitin şiddetli seyretmesi yönünde prognostik bir faktör olarak kullanılabileceğini düşündürmektedir.

Establishment of Early Multi-Indicator Prediction Models of Moderately Severe Acute Pancreatitis and Severe Acute Pancreatitis

Background It is critical to accurately identify patients with severe acute pancreatitis (SAP) and moderately SAP (MSAP) in a timely manner. The study was done to establish two early multi-indicator prediction models of MSAP and SAP. Methods Clinical data of 469 patients with acute pancreatitis (AP) between 2015 and 2020, at the First Affiliated Hospital of Fujian Medical University, and between 2012 and 2020, at the Affiliated Union Hospital of Fujian Medical University, were retrospectively analyzed. The unweighted predictive score (unwScore) and weighted predictive score (wScore) for MSAP and SAP were derived using logistic regression analysis and were compared with four existing systems using receiver operating characteristic curves. Results Seven prognostic indicators were selected for incorporation into models, including white blood cell count, lactate dehydrogenase, C-reactive protein, triglyceride, D-dimer, serum potassium, and serum calcium. The cut-offs of the unwScore and wScore for predicting severity were set as 3 points and 0.513 points, respectively. The unwScore (AUC = 0.854) and wScore (AUC = 0.837) were superior to the acute physiology and chronic health evaluation II score (AUC = 0.526), the bedside index for severity in AP score (AUC = 0.766), and the Ranson score (AUC = 0.693) in predicting MSAP and SAP, which were equivalent to the modified computed tomography severity index score (AUC = 0.823). Conclusions The unwScore and wScore have good predictive value for MSAP and SAP, which could provide a valuable clinical reference for management and treatment.

The Neutrophil-Lymphocyte Ratio as an Early Predictive Marker of the Severity of Post-Endoscopic Retrograde Cholangiopancreatography Pancreatitis

Background and objectives: Factors predictive of severe non-iatrogenic acute pancreatitis have been investigated, but few studies have evaluated prognostic markers of severe post-endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis (PEP). The neutrophil–lymphocyte ratio (NLR) has been studied for predicting severe acute pancreatitis. We examined the predictive value of NLR in patients with PEP. Materials and Methods: From January 2012 to August 2021, 125 patients who developed PEP were retrospectively evaluated. The NLR was measured before, and on days 1 and 2 after, ERCP. PEP was categorized as mild, moderate, or severe according to consensus guidelines, based on the prolongation of planned hospitalization. Patients were divided into two groups, mild-to-moderate vs. severe PEP. Results: We analyzed 125 patients with PEP, 18 (14.4%) of whom developed severe PEP. The baseline NLR was similar between the two groups (2.26 vs. 3.34, p = 0.499). The severe PEP group had a higher NLR than the mild/moderate PEP group on days 1 (11.19 vs. 6.58, p = 0.001) and 2 (15.68 vs. 5.32, p < 0.001) post-ERCP. The area under the curve of the NLR on days 1 and 2 post-ERCP for severe PEP was 0.75 (95% confidence interval (CI), 0.64–0.86)) and 0.89 (95% CI, 0.81–0.97), respectively; NLR on day 2 had greater power to predict severe PEP. The optimal cutoff value of the NLR on days 1 and 2 after ERCP for prediction of severe PEP was 7.38 (sensitivity, 72%; specificity, 69%) and 8.17 (sensitivity, 83%; specificity, 83%), respectively. In a multivariate analysis, a Bedside Index of Severity in Acute Pancreatitis score ≥3 (odds ratio (OR) 9.07, p = 0.012) and NLR on day 2 > 8.17 (OR 18.29, p < 0.001) were significantly associated with severe PEP. Conclusions: The NLR on day 2 post-ERCP is a reliable prognostic marker of severe PEP.

Chemoprophylaxis to Prevent Deep Venous Thrombosis in Patients Hospitalized for Pancreatitis: Beneficial or Harmful?

Introduction: Vascular complications in pancreatitis generally occur in the form of hemorrhage or thrombosis. Pancreatitis resulting in splanchnic thrombosis has been well studied, but the cause of this correlation has not been studied in the current era of increasing anticoagulant use for deep venous thrombosis (DVT) prophylaxis. Hemorrhagic pancreatitis and peri-pancreatic bleeding are also known phenomena encountered in relation to pancreatitis, but these risks are not well established in the setting of chemical prophylaxis for DVT.Objectives: Our objective was to identify whether chemical DVT prophylaxis in pancreatitis harms the patient by increasing the risk of hemorrhagic conversion of pancreatitis or peri-pancreatic hemorrhage or if it is beneficial by preventing splanchnic venous thrombosis in the abdominal vasculature that surrounds the pancreas.Methods: We undertook a retrospective chart review with approval from the Institutional Review Board on patients who were hospitalized for or developed pancreatitis during their hospital stay from April 2014 to July 2015. We reviewed the charts for imaging suggestive of venous thrombosis or the development of intra-abdominal hemorrhage at admission during hospitalization and within 30 days after hospitalization. We also reviewed the methods of DVT prophylaxis to identify any correlation with the risk of hemorrhage or thrombosis. A bedside index of severity in acute pancreatitis score was used within 24 hours of admission to calculate the severity of the patients’ pancreatitis. The data collected were analyzed for descriptive statistics, correlation using Pearson’s coefficient, and multivariate regression analysis using Microsoft Excel and SPSS Inc. Released 2009. PASW Statistics for Windows, Version 18.0. Chicago: SPSS Inc.Results: This study included 389 patients who met the inclusion criteria. Of these, 74.6% of patients received chemical prophylaxis, mostly low molecular weight heparin, and 18.5% of patients were not on chemical or mechanical means of DVT prophylaxis. Only 12 patients (3%) had complications related to thrombosis and hemorrhage. Seven patients had splanchnic venous thrombosis, one had a hemorrhagic conversion of pancreatitis, three had a peri-pancreatic hemorrhage, and one had both the hemorrhagic conversion of pancreatitis and peri-pancreatic hemorrhage. Ten patients out of 12 patients had complications before admission, and nine of the 12 patients were on chemical prophylaxis. Pearson’s coefficient showed no statistically significant correlation between the incidence of complications and the use of chemical DVT prophylaxis. Multivariate analysis showed no specific variable that increased the risk of complications.Conclusions: Our study showed that chemoprophylaxis for DVT in patients hospitalized for acute pancreatitis is neither harmful by causing hemorrhagic conversion of pancreatitis, peri-pancreatic hemorrhage nor beneficial by preventing splanchnic venous thrombosis.

S1485 Atypical Presentation of COVID-19 Induced Pancreatitis

Introduction: Coronavirus 2019 is a viral infection that has the potential to affect multiple various organ systems. It is able to do so by attaching to the angiotensin-converting enzyme 2 (ACE-2) receptor via its spike S protein. ACE-2 is highly expressed in the pancreatic beta cells. A combination of direct cytotoxic injury from local viral invasion and indirect damage from an immune response may be at play. Overall morbidity and mortality are significantly higher in patients with acute pancreatitis who have positive PCR results for COVID-19 compared to those who were PCR negative, evidenced by higher Charlson Comorbidity Index and Bedside Index of Severity in Acute Pancreatitis scores. Case Description/Methods: A 41 year-old male with no significant medical history presented to the emergency room (ER) with a 3 day history of fevers, chills, dyspnea, sharp epigastric pain radiating to the back, nausea, non-bloody non-bilious vomiting, watery diarrhea, loss of appetite and myalgia’s. Family history was unremarkable. He denied a history of tobacco, alcohol, or any illicit drug use. In addition, he denied any recent medication use, steroids, infections, trauma, surgeries, or autoimmune diseases. Upon arrival he was hemodynamically stable. Physical exam was notable for epigastric discomfort, and hypoactive bowel sounds. Laboratory studies were significant for Lipase 1250 U/L, AST 98 U/L, ALT 65 U/L ALP 55 U/L, and total bilirubin 0.7 mg/dL. The lipid profile was unremarkable. He was found to be Covid-19 PCR positive, as well as rapid influenza B positive. Additionally, ferritin 959 ng/mL, LDH 546 U/L, and d-dimer 991 ng/ml were elevated. CT abdomen and pelvis with oral contrast showed peripheral opacities in lower lung fields. No acute changes were noted in the pancreas, liver, and biliary system. Abdominal ultrasound revealed no significant biliary duct dilation. Patient was subsequently made nil per mouth, started on fluid resuscitated, Decadron, remdesivir, Heparin drip, and oseltamivir. GI symptoms resolved after 2 days of treatment. Discussion: We propose that Covid-19 induced pancreatitis be included in the differential diagnosis in patients with gastrointestinal manifestations as it increases the likelihood of early diagnosis and aiding in early management. Misdiagnosis can result in mismanagement and potential harm. Also a need to raise suspicion of covid-19 infection in atypical unexplained abdominal pain, it has a potential role in reduction of transmission to other individuals.

Value of modified objective Bedside Index for Severity in Acute Pancreatitis score in predicting the severity and prognosis of acute pancreatitis

Objective To investigate the value of modified objective Bedside Index for Severity in Acute Pancreatitis (BISAP) score (MBISAP) in predicting the severity and prognosis of acute pancreatitis (AP). Methods A retrospective analysis was performed for the data of 313 patients with AP who were treated in Affiliated Hospital of North Sichuan Medical College from June 2018 to June 2020, and the subjective indicator of mental state in BISAP score was removed. According to the scoring criteria for Computed Tomography Severity Index (CTSI), the degree of pancreatic necrosis was classified as 4 grades (0%, 0%-30%, 30%-50%, and > 50%) and was assigned a score of 0-3 points, respectively, and MBISAP score was determined by adding the above points, with the highest score of 7 points. According to the receiver operating characteristic (ROC) curve, the 313 patients with pancreatitis were divided into low-level MBISAP group (MBISAP Results There were significant differences between the two groups in age (Z=-5.480, P 0.05). In predicting peripancreatic infection in AP, MBISAP score had an AUC of 0.842 (95% CI: 0.796-0.880, P 2, MBISAP score was better than BISAP score (AUC=0.776) and was inferior to CTSI score (AUC=0.932) (both P 2, MBISAP score was similar to BISAP score (AUC=0.855) and CTSI score (AUC=0.829) (both P > 0.05). Conclusion MBISAP score is better than BISAP score in predicting the severity of AP patients and peripancreatic infection, and it also has a good value in predicting mortality and MODS in patients with AP. MBISAP score can evaluate the conditions of AP patients more accurately and objectively than BISAP score.

Comparative evaluation of various scoring systems to predict prognosis in patients with acute biliary pancreatitis

Background and Aims: To identify the severity of pancreatitis in patients diagnosed with acute biliary pancreatitis, and it also seeks to assess the congruence between the revised Atlanta classification and clinical and laboratory findings and prognostic scoring systems. Materials and Methods: A total of sixty-six patients with biliary pancreatitis were evaluated with revised Atlanta classification. Ranson score, Glasgow-Imrie score, Bedside Index of Severity in Acute Pancreatitis, Harmless Acute Pancreatitis Score, Japanese Severity Score, Acute Physiology and Chronic Health Evaluation-II, Sequential Organ Failure Assessment score, albumin-bilirubin grade were evaluated and compared, along with clinical and laboratory findings. SPSS Windows version 23.0 and Medcalc 19.2 were used in the analysis. Results: Bedside Index of Severity in Acute Pancreatitis had the highest correlation coefficient in differentiating moderate and severe pancreatitis. Glasgow-Imrie, albumin-bilirubin grade (48 h) and Japanese Severity Score score and Sequential Organ Failure Assessment score were also moderately correlated. Albumin-bilirubin grade (admission) and Harmless Acute Pancreatitis Score were weakly correlated. No correlation was found with the Ranson score and Acute Physiology and Chronic Health Evaluation score. The presence of albumin-bilirubin grade 3 at 48th hour increases the risk of moderate and severe pancreatitis by 17 times. Presence of antibiotic use increases the risk 6.6 times and positive Bedside Index of Severity in Acute Pancreatitis score increases the risk 4.7 times. Conclusion: The use of multiple scoring systems or co-evaluation of laboratory data can increase the sensitivity and specificity of clinical decisions. Combined use of Bedside Index of Severity in Acute Pancreatitis and antibiotherapy requirement is a candidate for predicting moderate and severe pancreatitis. Further studies on albumin-bilirubin grade, especially in acute biliary pancreatitis, are necessary.

Pleural Effusion Is Associated with Severe Renal Dysfunction in Patients with Acute Pancreatitis.

BackgroundRenal dysfunction is a leading cause of death in patients with acute pancreatitis (AP) and often occurs later than respiratory complications. Whether respiratory complications can predict renal impairment remains unclear. The aim of this study was to investigate the association between pleural effusion and renal dysfunction in AP.Material/MethodsMedical records were reviewed from individuals who were hospitalized with AP from January 1, 2015 to December 31, 2019. The patients were divided into 2 groups, based on the presence or absence of pleural effusion on admission. Disease severity, renal function parameters, and outcomes were compared between the 2 groups.ResultsA total of 222 patients were enrolled, 25 of whom had pleural effusion on admission and 197 who did not. Patients with AP who had pleural effusion had more serious illness (higher incidences of pancreatic inflammation, pancreatic fluid collection, and moderate-to-severe AP; worse Bedside Index for Severity in Acute Pancreatitis score; and a higher modified computed tomography severity index [all P<0.05]) plus worse outcomes (higher incidences of ventilation and vasopressor use [both P<0.05]). Moreover, patients with pleural effusion had a higher level of blood urea nitrogen and lower estimated glomerular filtration rate (both P<0.05). After adjustment for potential confounders, pleural effusion was a risk factor for renal failure in patients with AP (odds ratio 6.32, 95% confidence interval 1.08–36.78, P=0.040).ConclusionsPleural effusion is associated with severe renal dysfunction in AP. Therefore, efforts should be made to improve early recognition and timely treatment of renal failure by closely monitoring renal function in patients with AP and pleural effusion on admission.

Comparison of clinical characteristics and outcomes between alcohol-induced and gallstone-induced acute pancreatitis: An Australian retrospective observational study.

Objectives:To compare the characteristics and outcomes of patients presenting to hospital with alcohol-induced and gallstone-induced acute pancreatitis.Methods:Retrospective study of all patients with alcohol-induced or gallstone-induced pancreatitis during the period 1 June 2012 to 31 May 2016. The primary outcome measure was hospital mortality. Secondary outcome measures included hospital length of stay, requirements for intensive care unit admission, intensive care unit mortality, mechanical ventilation, renal replacement therapy, requirement of inotropes and total parenteral nutrition.Results:A total of 642 consecutive patients (49% alcohol; 51% gallstone) were included. No statistically significant differences were found between alcohol-induced and gallstone-induced acute pancreatitis with respect to hospital mortality, requirement for intensive care unit admission, intensive care unit mortality and requirement for mechanical ventilation, renal replacement therapy, inotropes or total parenteral nutrition. There was significant difference in hospital length of stay (3.07 versus 4.84; p < 0.0001). On multivariable regression analysis, Bedside Index of Severity in Acute Pancreatitis score (estimate: 0.393; standard error: 0.058; p < 0.0001) and admission haematocrit (estimate: 0.025; standard error: 0.008; p = 0.002) were found to be independently associated with prolonged hospital length of stay.Conclusion:Hospital mortality did not differ between patients with alcohol-induced and gallstone-induced acute pancreatitis. The duration of hospital stay was longer with gallstone-induced pancreatitis. Bedside Index of Severity in Acute Pancreatitis score and admission haematocrit were independently associated with hospital length of stay.

S0131 Addition of Serum Bicarbonate and Anion Gap to Bedside Index of Severity in Acute Pancreatitis Score Do Not Improve Its Predictive Performance

INTRODUCTION: Reliable and easy to use clinical prediction score is important in optimal management of acute pancreatitis. Currently, Bedside Index of Severity in Acute Pancreatitis (BISAP) score is the most accurate and easy to use clinical prediction score for acute pancreatitis (AP). Patients with AP are often hypovolemic at the time of presentation, which is a contributing factor to AP associated multi-organ dysfunction. We hypothesize that an elevated serum bicarbonate level and anion gap, which are readily available in most clinical settings, could improve performance of the BISAP score. Here, we assessed the performance of BISAP including serum bicarbonate in prognosticating moderate and severe acute pancreatitis. METHODS: Consecutive adults with acute pancreatitis admitted to our academic and two community hospitals between Jan 2014 and Dec 2019 were included in this study. We excluded patients with pregnancy or with diseases independently affecting their bicarbonate level (i.e., diabetic ketoacidosis, chronic renal failure stage 4 and 5). In cases of recurrent pancreatitis, only the initial episode was included. The severity of pancreatitis was defined based on the revised Atlanta classification: mild, moderate and severe. Performance of BISAP with and without bicarbonate levels and the anion gap was assessed using the ROC analysis. RESULTS: During the study period, 3 hospitals together had 653 admission for acute pancreatitis; a total of 444 unique patient admission were included. Of these, 316 patients had mild, 94 moderate and 34 patients had severe AP. Clinical characteristics of the cohort by severity of pancreatitis are summarized in Table 1. Bicarbonate levels were slightly lower in patients with moderate to severe acute pancreatitis, P = 0.038). The area under the curve (AUC) for BISAP score was 0.87 (95% CI 0.81–0.93) for severe and 0.72 (0.67–0.77) for moderate and severe pancreatitis combined. Inclusion of bicarbonate levels and the anion gap into BISAP improved AUC to 0.88 (0.81–0.95) and 0.89 (0.84–0.95), respectively (Table 2). This difference was not statistically significant. CONCLUSION: Inclusion of serum bicarbonate levels and the anion gap to the BISAP score did not improve its performance significantly.Table 1.: Clinical and laboratory characteristicsTable 2.: Discrimination by predictors—Two Revised Atlanta Classification

Prevalence, Risk Factors, and Outcomes of Hospitalized Patients With Coronavirus Disease 2019 Presenting as Acute Pancreatitis

Prevalence, Risk Factors, and Outcomes of Hospitalized Patients With Coronavirus Disease 2019 Presenting as Acute Pancreatitis