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Xia H, Lin J, Liu M, Lai J, Yang Z, Qiu L. Association of blood urea nitrogen to albumin ratio with mortality in acute pancreatitis. Sci Rep 2025; 15:13327. [PMID: 40247063 PMCID: PMC12006543 DOI: 10.1038/s41598-025-97891-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2024] [Accepted: 04/08/2025] [Indexed: 04/19/2025] Open
Abstract
Blood urea nitrogen (BUN) and serum albumin (ALB) are strongly associated with the prognosis in acute pancreatitis (AP). The BUN/ALB ratio (BAR) reflects renal, nutritional, inflammatory, and endothelial functions. In this study, we investigated the association between the BAR and all-cause mortality in critically ill patients with AP. Using data from the Medical Information Market for Intensive Care (MIMIC-IV) database, we conducted a retrospective cohort analysis. The relationship between BAR and mortality was assessed through Kaplan-Meier survival curves, restricted cubic spline models, and multivariable Cox proportional hazards regression. The predictive capacity of BAR for 30-day and 1-year mortality was evaluated using receiver operating characteristic analysis. Our study included 780 participants, with 30-day and 1-year mortality rates of 12.6% and 23.6%, respectively. Higher BAR values were associated with poorer survival outcomes. BAR demonstrated superior predictive performance achieving an area under the curve of 0.74, surpassing BUN, ALB, and SOFA scores. The Cox model indicated a significant independent association between elevated BAR and increased mortality risk, with hazard ratios of 1.43 (95% CI 1.20-1.70) for 30-day mortality and 1.37 (95% CI 1.17-1.60) for 1-year mortality. Stratified and sensitivity analyses confirmed the robustness of these findings. Our results suggest that elevated BAR is associated with poor prognosis in critically ill patients with AP and may serve as a valuable tool for early risk stratification and for assessing both short- and long-term prognosis.
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Affiliation(s)
- Hao Xia
- Department of Medicine Intensive Care Unit, Zhangzhou Hospital Affiliated to Fujian Medical University, Zhangzhou, 363000, Fujian, China
| | - Jinzhan Lin
- Department of Medicine Intensive Care Unit, Zhangzhou Hospital Affiliated to Fujian Medical University, Zhangzhou, 363000, Fujian, China
| | - Minchao Liu
- Department of Hepatobiliary Surgery, Zhangzhou Hospital Affiliated to Fujian Medical University, Zhangzhou, 363000, Fujian, China
| | - Jiawei Lai
- Department of Medicine Intensive Care Unit, Zhangzhou Hospital Affiliated to Fujian Medical University, Zhangzhou, 363000, Fujian, China
| | - Zhaobin Yang
- Department of Medicine Intensive Care Unit, Zhangzhou Hospital Affiliated to Fujian Medical University, Zhangzhou, 363000, Fujian, China.
| | - Luzhen Qiu
- Department of Medicine Intensive Care Unit, Zhangzhou Hospital Affiliated to Fujian Medical University, Zhangzhou, 363000, Fujian, China.
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Liu B, Zhang X, Li J, Sun Z, Lin C, Ning C, Hong X, Zhu S, Shen D, Chen L, Huang G. The Global, Regional, and National Burden of Pancreatitis in 204 Countries and Territories, 1990-2021: A Systematic Analysis for the Global Burden of Disease Study 2021. Dig Dis Sci 2025:10.1007/s10620-025-08996-y. [PMID: 40140166 DOI: 10.1007/s10620-025-08996-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2024] [Accepted: 03/14/2025] [Indexed: 03/28/2025]
Abstract
BACKGROUND Pancreatitis, an inflammatory condition of the pancreas, poses a significant global health burden. This study provides up-to-date global, regional, and national estimates of pancreatitis burdens from 1990 to 2021, focusing on disparities and trends across regions, age groups, and sexes. METHODS Data from the Global Burden of Disease (GBD) 2021 study were analyzed to assess the incidence, prevalence, mortality, and disability-adjusted life years (DALYs) associated with pancreatitis. Trends over the 32-year period were examined across demographics and geographic regions. Average annual percentage changes (AAPC) with 95% confidence intervals (CI) were calculated. RESULTS In 2021, the age-standardized rates (95% uncertainty interval) per 100,000 population for pancreatitis were: prevalence 69.0 (51.3, 91.3), incidence 32.8 (28.9, 37.4), deaths 1.5 (1.3, 1.7), and DALYs 48.4 (43.1, 55.3). Eastern Europe had the highest burden, led by the Russian Federation. From 1990 to 2021, global pancreatitis burden decreased with AAPCs (95% CI) of - 1.0% (- 1.1%, - 1.0%) for prevalence, - 0.4% (- 0.5%, - 0.4%) for incidence, - 0.5% (- 0.6%, - 0.3%) for deaths, and - 0.5% (- 0.6%, - 0.4%) for DALYs. Most regions showed declines, except Eastern Europe and parts of Africa. The elderly, particularly those aged 65 and older, faced the highest burden. An upward incidence trend was noted in those aged 15 to 25. Men exhibited higher burden rates, with the peak burden occurring at younger ages compared to women. High alcohol use contributed to 15.2% of deaths and 17.0% of DALYs related to pancreatitis. CONCLUSIONS This study offers a comprehensive assessment of the global burden of pancreatitis from 1990 to 2021. Despite an overall decline, significant regional and demographic disparities persist, with Eastern Europe remaining disproportionately affected. The high burden among the elderly and rising incidence among the young highlight the need for targeted prevention, early detection, and management strategies.
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Affiliation(s)
- Baiqi Liu
- Division of Pancreatic Surgery, Department of General Surgery, Xiangya Hospital, Central South University, Changsha, 410008, Hunan Province, China
- Division of Hernia and Abdominal Wall Surgery, Department of General Surgery, Xiangya Hospital, Central South University, Changsha, 410008, Hunan Province, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, 410008, Hunan Province, China
- FuRong Laboratory, Changsha, 410078, Hunan Province, China
| | - Xinge Zhang
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, China
| | - Jiarong Li
- Division of Pancreatic Surgery, Department of General Surgery, Xiangya Hospital, Central South University, Changsha, 410008, Hunan Province, China
- Division of Hernia and Abdominal Wall Surgery, Department of General Surgery, Xiangya Hospital, Central South University, Changsha, 410008, Hunan Province, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, 410008, Hunan Province, China
- FuRong Laboratory, Changsha, 410078, Hunan Province, China
| | - Zefang Sun
- Division of Pancreatic Surgery, Department of General Surgery, Xiangya Hospital, Central South University, Changsha, 410008, Hunan Province, China
- Division of Hernia and Abdominal Wall Surgery, Department of General Surgery, Xiangya Hospital, Central South University, Changsha, 410008, Hunan Province, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, 410008, Hunan Province, China
- FuRong Laboratory, Changsha, 410078, Hunan Province, China
| | - Chiayen Lin
- Division of Pancreatic Surgery, Department of General Surgery, Xiangya Hospital, Central South University, Changsha, 410008, Hunan Province, China
- Division of Hernia and Abdominal Wall Surgery, Department of General Surgery, Xiangya Hospital, Central South University, Changsha, 410008, Hunan Province, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, 410008, Hunan Province, China
- FuRong Laboratory, Changsha, 410078, Hunan Province, China
| | - Caihong Ning
- Division of Pancreatic Surgery, Department of General Surgery, Xiangya Hospital, Central South University, Changsha, 410008, Hunan Province, China
- Division of Hernia and Abdominal Wall Surgery, Department of General Surgery, Xiangya Hospital, Central South University, Changsha, 410008, Hunan Province, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, 410008, Hunan Province, China
- FuRong Laboratory, Changsha, 410078, Hunan Province, China
| | - Xiaoyue Hong
- Division of Pancreatic Surgery, Department of General Surgery, Xiangya Hospital, Central South University, Changsha, 410008, Hunan Province, China
- Division of Hernia and Abdominal Wall Surgery, Department of General Surgery, Xiangya Hospital, Central South University, Changsha, 410008, Hunan Province, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, 410008, Hunan Province, China
- FuRong Laboratory, Changsha, 410078, Hunan Province, China
| | - Shuai Zhu
- Division of Pancreatic Surgery, Department of General Surgery, Xiangya Hospital, Central South University, Changsha, 410008, Hunan Province, China
- Division of Hernia and Abdominal Wall Surgery, Department of General Surgery, Xiangya Hospital, Central South University, Changsha, 410008, Hunan Province, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, 410008, Hunan Province, China
- FuRong Laboratory, Changsha, 410078, Hunan Province, China
| | - Dingcheng Shen
- Division of Pancreatic Surgery, Department of General Surgery, Xiangya Hospital, Central South University, Changsha, 410008, Hunan Province, China
- Division of Hernia and Abdominal Wall Surgery, Department of General Surgery, Xiangya Hospital, Central South University, Changsha, 410008, Hunan Province, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, 410008, Hunan Province, China
- FuRong Laboratory, Changsha, 410078, Hunan Province, China
| | - Lu Chen
- Division of Pancreatic Surgery, Department of General Surgery, Xiangya Hospital, Central South University, Changsha, 410008, Hunan Province, China
- Division of Hernia and Abdominal Wall Surgery, Department of General Surgery, Xiangya Hospital, Central South University, Changsha, 410008, Hunan Province, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, 410008, Hunan Province, China
- FuRong Laboratory, Changsha, 410078, Hunan Province, China
| | - Gengwen Huang
- Division of Pancreatic Surgery, Department of General Surgery, Xiangya Hospital, Central South University, Changsha, 410008, Hunan Province, China.
- Division of Hernia and Abdominal Wall Surgery, Department of General Surgery, Xiangya Hospital, Central South University, Changsha, 410008, Hunan Province, China.
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, 410008, Hunan Province, China.
- FuRong Laboratory, Changsha, 410078, Hunan Province, China.
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Liu K, Lv T, He L, Tang W, Zhang Y, Xiao X, Li Y, Chang X, Wang S, Pandol SJ, Li L, Han X, Zhu Y. Endocrine-exocrine miR-503-322 drives aging-associated pancreatitis via targeting MKNK1 in acinar cells. Nat Commun 2025; 16:2613. [PMID: 40097383 PMCID: PMC11914046 DOI: 10.1038/s41467-025-57615-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2024] [Accepted: 02/23/2025] [Indexed: 03/19/2025] Open
Abstract
Aging is the risk factor for chronic pancreatitis and severity determinant for its acute attack, yet the underlying cause is unclear. Here, we demonstrate that senescent β-cells of endocrine pancreas decide the onset and severity of chronic and acute pancreatitis. During physiological aging, senescent β-cells increase the expression of miR-503-322 which is secreted as small extracellular vesicles to enter exocrine acinar cells, driving a causal and reversible role on aging-associated pancreatitis. Mechanistically, miR-503-322 targets MKNK1 to inhibit acinar-cell secretion leading to autodigestion and repress proliferation causing repair damage of exocrine pancreas. In the elderly population, serum miR-503 concentration is negatively correlated with amylase, prone to chronic pancreatitis due to increased miR-503 and decreased MKNK1 in the elderly pancreas. Our findings highlight the miR-503-322-MKNK1 axis mediating the endocrine-exocrine regulatory pathway specifically in aged mice and humans. Modulating this axis may provide potential preventive and therapeutic strategies for aging-associated pancreatitis.
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Affiliation(s)
- Kerong Liu
- Key Laboratory of Human Functional Genomics of Jiangsu Province, Biochemistry and Molecular Biology, Nanjing Medical University, Nanjing, Jiangsu, China
- Department of Endocrinology, Affiliated Children's Hospital of Jiangnan University, Wuxi Children's Hospital, Wuxi, Jiangsu, China
| | - Tingting Lv
- Key Laboratory of Human Functional Genomics of Jiangsu Province, Biochemistry and Molecular Biology, Nanjing Medical University, Nanjing, Jiangsu, China
| | - Lu He
- Key Laboratory of Human Functional Genomics of Jiangsu Province, Biochemistry and Molecular Biology, Nanjing Medical University, Nanjing, Jiangsu, China
| | - Wei Tang
- Department of Endocrinology, Geriatric Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Yan Zhang
- Children's Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Xiao Xiao
- Key Laboratory of Human Functional Genomics of Jiangsu Province, Biochemistry and Molecular Biology, Nanjing Medical University, Nanjing, Jiangsu, China
| | - Yating Li
- Key Laboratory of Human Functional Genomics of Jiangsu Province, Biochemistry and Molecular Biology, Nanjing Medical University, Nanjing, Jiangsu, China
| | - Xiaoai Chang
- Key Laboratory of Human Functional Genomics of Jiangsu Province, Biochemistry and Molecular Biology, Nanjing Medical University, Nanjing, Jiangsu, China
| | - Shusen Wang
- Organ Transplant Center, Tianjin First Central Hospital, Nankai University, Tianjin, China
| | - Stephen J Pandol
- Division of Gastroenterology, Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
| | - Ling Li
- Department of Endocrinology, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, Jiangsu, China.
| | - Xiao Han
- Key Laboratory of Human Functional Genomics of Jiangsu Province, Biochemistry and Molecular Biology, Nanjing Medical University, Nanjing, Jiangsu, China.
- Department of Endocrinology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China.
| | - Yunxia Zhu
- Key Laboratory of Human Functional Genomics of Jiangsu Province, Biochemistry and Molecular Biology, Nanjing Medical University, Nanjing, Jiangsu, China.
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Liu Y, Zhang H, Zeng M, Luo J, Lai Y, Huang H, Xu Q, Liu Y. Case Report: Severe acute pancreatitis accompanied by gastric mucosal exfoliation hemorrhage: clinical alerts and novel insights. Front Surg 2025; 11:1471966. [PMID: 39936141 PMCID: PMC11812061 DOI: 10.3389/fsurg.2024.1471966] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2024] [Accepted: 12/09/2024] [Indexed: 02/13/2025] Open
Abstract
Acute pancreatitis (AP), a condition marked by its swift progression, substantial individual discrepancies, and profound concealment, poses a formidable challenge. Within its severe form, known as severe acute pancreatitis (SAP), the disease assumes an even more prevalent status, often entwined with dire complications such as pancreatic abscess, circulatory shock, and the direst of all, multiple organ failure. Regrettably, the conjunction of SAP with gastric mucosal exfoliation culminating in massive hemorrhage remains an exceptionally rare phenomenon within the clinical realm. This study delves into a retrospective analysis of a singular, yet remarkable clinical case, where SAP's therapeutic odyssey unexpectedly led to gastric mucosa stripping and catastrophic gastrointestinal bleeding. This paper endeavors to unravel the diagnostic intricacies, explore the treatment modalities, and prognosticate the outcome, all with the ultimate aim of fostering a heightened clinical vigilance and fostering a novel, nuanced understanding of SAP's exceptional complications within the intensive care arena. Furthermore, this study aspires to serve as a beacon of reference, illuminating the path for clinical practitioners confronted with such elusive yet critical scenarios.
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Affiliation(s)
- Yanquan Liu
- The First School of Clinical Medicine, Guangdong Medical University, Guangdong, China
| | - Hehui Zhang
- Department of Intensive Medicine (Comprehensive ICU), The First Affiliated Hospital of Gannan Medical University, Ganzhou, China
| | - Minjuan Zeng
- The First School of Clinical Medicine, Guangdong Medical University, Guangdong, China
| | - Jian Luo
- Department of Gastroenterology, The First Affiliated Hospital of Gannan Medical University, Ganzhou, China
| | - Yun Lai
- Department of Dermatology, The First Affiliated Hospital of Gannan Medical University, Ganzhou, China
| | - He Huang
- Department of Cardiovascular Medicine (Cardiology), The First Affiliated Hospital of Gannan Medical University, Ganzhou, China
| | - Qinglin Xu
- Department of Intensive Medicine (Comprehensive ICU), The First Affiliated Hospital of Gannan Medical University, Ganzhou, China
| | - Yuan Liu
- Department of Operating Room, The First Affiliated Hospital of Gannan Medical University, Ganzhou, China
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Mittal N, Oza VM, Muniraj T, Kothari TH. Diagnosis and Management of Acute Pancreatitis. Diagnostics (Basel) 2025; 15:258. [PMID: 39941188 PMCID: PMC11816589 DOI: 10.3390/diagnostics15030258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2024] [Revised: 01/14/2025] [Accepted: 01/16/2025] [Indexed: 02/16/2025] Open
Abstract
Acute pancreatitis is an inflammatory condition of the exocrine pancreas that is a common indication for hospital admission and has had an increasing incidence in the last few decades. The diagnosis of acute pancreatitis requires the satisfaction of two out of three criteria: (1) abdominal pain radiating to the back, (2) serum lipase or amylase levels three or more times the upper limit of the normal level, and (3) findings indicating pancreatitis obtained via a computed tomography (CT) scan or magnetic resonance imaging (MRI). The different etiologies include gallstones, autoimmune disorders, alcohol abuse, smoking, hypertriglyceridemia, obesity, drugs, and post-endoscope retrograde cholangiopancreatography (ERCP). The initial investigation includes serum amylase and lipase analysis, a lipid panel including triglycerides, analysis of immunoglobulins, a full blood count, electrolyte analysis, a hemoglobin A1c test, a complete metabolic panel, and transabdominal ultrasound. The initial therapy includes oxygen supplementation, the provision of intravenous fluids, pain control, and a nutrition regime. Early oral feeding is encouraged if tolerated; if not, liquid supplement provision or enteral tube feeding within 48 h of admission has shown better outcomes. Some complications of acute pancreatitis are necrosis, infection, insulin resistance leading to diabetes mellitus, and pancreatic exocrine insufficiency requiring enzyme supplementation. Patients need to attend regular follow-ups and abstain from alcohol and smoking (if warranted) to prevent the recurrence of acute pancreatitis. The mortality rate of acute pancreatitis has decreased in the past few decades because of better management skills, but the recent rise in acute pancreatitis episodes is concerning. Sustained endeavors through clinical trials are required to establish a broad variety of drugs that can be used for acute pancreatitis episodes.
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Affiliation(s)
- Nitish Mittal
- Department of Internal Medicine, The University of Texas Health Sciences Center, Houston, TX 77030, USA (V.M.O.)
| | - Veeral M. Oza
- Department of Internal Medicine, The University of Texas Health Sciences Center, Houston, TX 77030, USA (V.M.O.)
- Section of Digestive Disease, Edward via College of Osteopathic Medicine and Bon Secours Mercy Health Medical Center, Greenville, SC 29673, USA
| | - Thiruvengadam Muniraj
- Section of Digestive Disease, Yale University School of Medicine, New Haven, CT 06520, USA;
| | - Truptesh H. Kothari
- Section of Digestive Disease, University of Rochester Medical Center, Rochester, NY 14642, USA
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Zhang S, Chen Z, Hu C, Zhu P, Jin T, Li L, Lin Z, Shi N, Zhang X, Xia Q, Deng L. The Clinical Characteristics and Outcomes of Acute Pancreatitis Are Different in Elderly Patients: A Single-Center Study over a 6-Year Period. J Clin Med 2024; 13:4829. [PMID: 39200971 PMCID: PMC11355819 DOI: 10.3390/jcm13164829] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2024] [Revised: 08/04/2024] [Accepted: 08/14/2024] [Indexed: 09/02/2024] Open
Abstract
Objectives: This study aims to analyze the clinical characteristics of elderly patients with acute pancreatitis (AP) and investigate the effects of age on the clinical outcomes of AP. Methods: Patients aged ≥ 18 years with AP admitted within 72 h from 1 September 2013 to 31 August 2019 were included. Patients were divided into elderly (≥60 years) and non-elderly (<60 years) groups. Clinical data and outcomes were compared. Results: A total of 756 elderly and 4896 non-elderly patients with AP were included. The elderly patients had different etiological distributions and more severe clinical markers and scores. Age was an independent risk factor for mortality [odds ratio (OR): 2.911, 95% CI: 1.801-4.706, p < 0.001], intensive care unit admission (OR: 1.739, 95% CI: 1.126-2.685, p = 0.013), persistent organ failure (OR: 1.623, 95% CI: 1.326-1.987, p < 0.001), multiple organ failure (OR: 1.757, 95% CI: 1.186-2.604, p = 0.005), and infection (OR: 2.451, 95% CI: 1.994-3.013, p < 0.001). Adjusted multiple logistic regression and trend analysis confirmed the risk of the age for the outcomes. The deaths of elderly patients showed a biphasic pattern with peaks in the first and fifth weeks, in contrast to the single peak in the first week in the non-elderly patients. Conclusions: Elderly patients with AP were associated with worse clinical outcomes. It is crucial to devote considerable attention to the optimization of therapeutic approaches to reduce late mortality in this group of patients.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - Qing Xia
- West China Centre of Excellence for Pancreatitis, Institute of Integrated Traditional Chinese and Western Medicine, West China Hospital, Sichuan University, Chengdu 610041, China; (S.Z.); (Z.C.); (C.H.); (P.Z.); (T.J.); (L.L.); (Z.L.); (N.S.); (X.Z.)
| | - Lihui Deng
- West China Centre of Excellence for Pancreatitis, Institute of Integrated Traditional Chinese and Western Medicine, West China Hospital, Sichuan University, Chengdu 610041, China; (S.Z.); (Z.C.); (C.H.); (P.Z.); (T.J.); (L.L.); (Z.L.); (N.S.); (X.Z.)
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Høj K, Baldan J, Seymour PA, Rift CV, Hasselby JP, Sandelin A, Arnes L. Age-Related Decline in Pancreas Regeneration Is Associated With an Increased Proinflammatory Response to Injury. GASTRO HEP ADVANCES 2024; 3:973-985. [PMID: 39286614 PMCID: PMC11403435 DOI: 10.1016/j.gastha.2024.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Accepted: 07/03/2024] [Indexed: 09/19/2024]
Abstract
Background and Aims The regenerative capacity of the pancreas diminishes with age. Understanding acinar cell responses to injury and the resolution of regenerative processes is crucial for tissue homeostasis. However, knowledge about the impact of aging on these processes remains limited. Methods To investigate the influence of aging on pancreas regeneration, we established a cohort of young (7-14 weeks) and old (18 months) C57bl/6 mice. Experimental pancreatitis was induced using caerulein, and pancreas samples were collected at various time points after induction, covering acute damage response, inflammation, peak proliferation, and inflammation resolution. Our analysis involved immunohistochemistry, quantitative imaging, and gene expression analyses. Results Our study revealed a significant decline in the regenerative capacity of the pancreas in old mice. Despite similar morphology and transcriptional profiles between the pancreas of young and old mice under homeostasis, the aged pancreas is primed to generate an exacerbated proinflammatory reaction in response to injury. Specifically, we observed notable upregulation of Junb expression in acinar cells and aberrant myofibroblast activation in the aged pancreas. Conclusion The response of acinar cells to injury in the pancreas of aged mice is characterized by an increased susceptibility to inflammation and stromal reactions. Our findings uncover a pre-existing proinflammatory state in aged acinar cells, offering insights into potential strategies to prevent the onset of pancreatic insufficiency and the development of inflammatory conditions. These insights hold implications for preventing conditions such as chronic pancreatitis and pancreatic ductal adenocarcinoma.
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Affiliation(s)
- Kristina Høj
- Biotech Research and Innovation Centre (BRIC), University of Copenhagen, Copenhagen, Denmark
| | - Jonathan Baldan
- Biotech Research and Innovation Centre (BRIC), University of Copenhagen, Copenhagen, Denmark
| | - Philip Allan Seymour
- Biotech Research and Innovation Centre (BRIC), University of Copenhagen, Copenhagen, Denmark
| | - Charlotte Vestrup Rift
- Department of Pathology, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Jane Preuss Hasselby
- Department of Pathology, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Albin Sandelin
- Biotech Research and Innovation Centre (BRIC), University of Copenhagen, Copenhagen, Denmark
- Department of Biology, University of Copenhagen Copenhagen, Denmark
| | - Luis Arnes
- Biotech Research and Innovation Centre (BRIC), University of Copenhagen, Copenhagen, Denmark
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8
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Sahin A. Neutrophil-Creatinine Index: A New Prognostic Factor for Severity of Acute Pancreatitis. MEDICINA (KAUNAS, LITHUANIA) 2024; 60:607. [PMID: 38674253 PMCID: PMC11051984 DOI: 10.3390/medicina60040607] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/09/2024] [Revised: 03/28/2024] [Accepted: 04/03/2024] [Indexed: 04/28/2024]
Abstract
Background and Objectives: Determining the severity of acute pancreatitis (AP) is the main goal in the early stage of AP. The aim of this study was to compare laboratory parameters and indices, including the neutrophil to lymphocyte ratio (NLR) and the neutrophil-creatinine index (NCI), at admission in order to predict the severity of AP. Materials and Methods: Data from 421 patients who were admitted with a diagnosis of AP were collected retrospectively. Disease severity was assessed using the Bedside Index of Severity in Acute Pancreatitis (BISAP) and the revised Atlanta classification (RAC). BISAP was graded as mild and severe, and RAC was graded as mild (MAP), moderately severe (MSAP), and severe (SAP). The laboratory parameters and indices, including the NLR and NCI, were compared. Results: Of the patients, 70 (16.6%) had severe AP according to BISAP; the AP subgroups according to the RAC were as follows: MAP (n = 213), MSAP (n = 158), and SAP (n = 50). The NCI had the highest area under the receiver operator characteristic (AUROC) curve value (0.862), demonstrating severe disease according to BISAP, with a sensitivity of 78.6% and a specificity of 79.8%. Age (OR:1.046), white blood cell count (WBC) (OR:1.141), hematocrit (OR:1.081), blood urea nitrogen (BUN) (OR:1.040), and NCI (OR:1.076) were independently associated with severe disease, according to the multivariate analysis results, and were determined as components of the newly developed nomogram. The AUROC of the nomogram (0.891) was superior to the AUROCs of all the components of the nomogram except the NCI. Moreover, the NCI was the only parameter to distinguish MSAP from MAP (OR:1.119, 95% CI: 1.015-1.235, p = 0.023) and SAP from MSAP (OR:1.095, 95% CI: 1.031-1.162, p = 0.003). Conclusions: The present study enabled the identification of the neutrophil-creatinine index as a new prognostic tool for the assessment of AP severity at hospital admission.
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Affiliation(s)
- Abdurrahman Sahin
- Gastroenterology Department, Faculty of Medicine, Tokat Gaziosmanpasa University, 60030 Tokat, Turkey
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9
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Nelson AC, Bhogadi SK, Hosseinpour H, Stewart C, Anand T, Spencer AL, Colosimo C, Magnotti LJ, Joseph B. There Is No Such Thing as Too Soon: Long-Term Outcomes of Early Cholecystectomy for Frail Geriatric Patients with Acute Biliary Pancreatitis. J Am Coll Surg 2023; 237:712-718. [PMID: 37350474 DOI: 10.1097/xcs.0000000000000790] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/24/2023]
Abstract
BACKGROUND Early cholecystectomy (CCY) for acute biliary pancreatitis (ABP) is recommended but there is a paucity of data assessing this approach in frail geriatric patients. This study compares outcomes of frail geriatric ABP patients undergoing index admission CCY vs nonoperative management (NOM) with endoscopic retrograde cholangiopancreatography (ERCP). STUDY DESIGN Retrospective analysis of the Nationwide Readmissions Database (2017). All frail geriatric (65 years or older) patients with ABP were included. Patients were grouped by treatment at index admission: CCY vs NOM with endoscopic retrograde cholangiopancreatography. Propensity score matching was performed in a 1:2 ratio. Primary outcomes were 6-month readmissions, mortality, and length of stay. Secondary outcomes were 6-month failure of NOM defined as readmission for recurrent ABP, unplanned pancreas-related procedures, or unplanned CCY. Subanalysis was performed to compare outcomes of unplanned CCY vs early CCY. RESULTS A total of 29,130 frail geriatric patients with ABP were identified and 7,941 were matched (CCY 5,294; NOM 2,647). Patients in the CCY group had lower 6-month rates of readmission for pancreas-related complications, unplanned readmissions for pancreas-related procedures, overall readmissions, and mortality, as well as fewer hospitalized days (p < 0.05). NOM failed in 12% of patients and 7% of NOM patients were readmitted within 6 months to undergo CCY, of which 56% were unplanned. Patients who underwent unplanned CCY had higher complication rates and hospital costs, longer hospital lengths of stay, and increased mortality compared with early CCY (p < 0.05). CONCLUSIONS For frail geriatric patients with ABP, early CCY was associated with lower 6-month rates of complications, readmissions, mortality, and fewer hospitalized days. NOM was unsuccessful in nearly 1 of 7 within 6 months; of these, one-third required unplanned CCY. Early CCY should be prioritized for frail geriatric ABP patients when feasible.
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Affiliation(s)
- Adam C Nelson
- From the Division of Trauma, Critical Care, Burns, and Emergency Surgery, Department of Surgery, College of Medicine, University of Arizona, Tucson, AZ
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García-Compeán D, Jiménez-Rodríguez AR, Muñoz-Ayala JM, González-González JA, Maldonado-Garza HJ, Villarreal-Pérez JZ. Post-acute pancreatitis diabetes: A complication waiting for more recognition and understanding. World J Gastroenterol 2023; 29:4405-4415. [PMID: 37576704 PMCID: PMC10415972 DOI: 10.3748/wjg.v29.i28.4405] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Revised: 06/22/2023] [Accepted: 07/11/2023] [Indexed: 07/26/2023] Open
Abstract
Post-acute pancreatitis diabetes (PAPD) is the second most common type of diabetes below type 2 diabetes mellitus. Due to the boom in research on this entity carried out during the last decade, its recognition has increased. However, much of the medical community still does not recognize it as a medium and long-term complication of acute pancreatitis (AP). Recent prospective cohort studies show that its incidence is about 23% globally and 34.5% in patients with severe AP. With the overall increase in the incidence of AP this complication will be certainly seen more frequently. Due to its high morbidity, mortality and difficult control, early detection and treatment are essential. However, its risk factors and pathophysiological mechanisms are not clearly defined. Its diagnosis should be made excluding pre-existing diabetes and applying the criteria of the American Diabetes Association after 90 d of resolution of one or more AP episodes. This review will show the evidence published so far on the incidence and prevalence, risk factors, possible pathophysiological mechanisms, clinical outcomes, clinical characteristics and preventive and corrective management of PAPD. Some important gaps needing to be clarified in forthcoming studies will also be discussed.
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Affiliation(s)
- Diego García-Compeán
- Department of Gastroenterology, Autonomous University of Nuevo León, Monterrey 64700, Nuevo León, Mexico
| | - Alan R Jiménez-Rodríguez
- Department of Gastroenterology, Autonomous University of Nuevo León, Monterrey 64700, Nuevo León, Mexico
| | - Juan M Muñoz-Ayala
- Department of Gastroenterology, Autonomous University of Nuevo León, Monterrey 64700, Nuevo León, Mexico
| | - José A González-González
- Department of Gastroenterology, Autonomous University of Nuevo León, Monterrey 64700, Nuevo León, Mexico
| | - Héctor J Maldonado-Garza
- Department of Gastroenterology, Autonomous University of Nuevo León, Monterrey 64700, Nuevo León, Mexico
| | - Jesús Z Villarreal-Pérez
- Department of Endocrinology, Autonomous University of Nuevo León, Monterrey 64700, Nuevo León, Mexico
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11
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Venishetty N, Parikh A, Trivedi M, Didia C. Periampullary Diverticula Causing Recurrent Pancreatitis: A Case Report. Cureus 2023; 15:e42189. [PMID: 37601985 PMCID: PMC10439679 DOI: 10.7759/cureus.42189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/20/2023] [Indexed: 08/22/2023] Open
Abstract
Acute p-ancreatitis (AP) is increasingly rising globally, especially among elderly populations. In many cases, AP can progress to chronic pancreatitis (CP) and cause damage to the pancreas. Common causes of AP include gallstones and alcoholic injury, but periampullary diverticula (PAD) have emerged as a complex etiology. PADs are rare bowel-filled outpouchings located near the main papilla or common bile duct (CBD). In this study, we present a 66-year-old female with recurrent pancreatitis that is caused by a PAD. Due to the paucity of information regarding the management of PADs, we hope this case highlights the need to advance treatment options in this area.
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Affiliation(s)
- Nikit Venishetty
- Department of Orthopedic Surgery, Texas Tech University Health Sciences Center El Paso Paul L. Foster School of Medicine, El Paso, USA
| | - Amish Parikh
- Department of Internal Medicine, Texas Tech University Health Sciences Center El Paso Paul L. Foster School of Medicine, El Paso, USA
| | - Meesha Trivedi
- Department of Internal Medicine, Texas Tech University Health Sciences Center El Paso Paul L. Foster School of Medicine, El Paso, USA
| | - Claudia Didia
- Department of Internal Medicine, Texas Tech University Health Sciences Center El Paso Paul L. Foster School of Medicine, El Paso, USA
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12
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Shi N, Zhang X, Zhu Y, Deng L, Li L, Zhu P, Xia L, Jin T, Ward T, Sztamary P, Cai W, Yao L, Yang X, Lin Z, Jiang K, Guo J, Yang X, Singh VK, Sutton R, Lu N, Windsor JA, He W, Huang W, Xia Q. Predicting persistent organ failure on admission in patients with acute pancreatitis: development and validation of a mobile nomogram. HPB (Oxford) 2022; 24:1907-1920. [PMID: 35750613 DOI: 10.1016/j.hpb.2022.05.1347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 01/15/2022] [Accepted: 05/31/2022] [Indexed: 02/07/2023]
Abstract
BACKGROUND Early prediction of persistent organ failure (POF) is important for triage and timely treatment of patients with acute pancreatitis (AP). METHODS All AP patients were consecutively admitted within 48 h of symptom onset. A nomogram was developed to predict POF on admission using data from a retrospective training cohort, validated by two prospective cohorts. The clinical utility of the nomogram was defined by concordance index (C-index), decision curve analysis (DCA), and clinical impact curve (CIC), while the performance by post-test probability. RESULTS There were 816, 398, and 880 patients in the training, internal and external validation cohorts, respectively. Six independent predictors determined by logistic regression analysis were age, respiratory rate, albumin, lactate dehydrogenase, oxygen support, and pleural effusion and were included in the nomogram (web-based calculator: https://shina.shinyapps.io/DynNomapp/). This nomogram had reasonable predictive ability (C-indexes 0.88/0.91/0.81 for each cohort) and promising clinical utility (DCA and CIC). The nomogram had a positive likelihood ratio and post-test probability of developing POF in the training, internal and external validation cohorts of 4.26/31.7%, 7.89/39.1%, and 2.75/41%, respectively, superior or equal to other prognostic scores. CONCLUSIONS This nomogram can predict POF of AP patients and should be considered for clinical practice and trial allocation.
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Affiliation(s)
- Na Shi
- Department of Integrated Traditional Chinese and Western Medicine, Sichuan Provincial Pancreatitis Center and West China-Liverpool Biomedical Research Center, West China Hospital, Sichuan University, Chengdu, China
| | - Xiaoxin Zhang
- Department of Integrated Traditional Chinese and Western Medicine, Sichuan Provincial Pancreatitis Center and West China-Liverpool Biomedical Research Center, West China Hospital, Sichuan University, Chengdu, China
| | - Yin Zhu
- Department of Integrated Traditional Chinese and Western Medicine, Sichuan Provincial Pancreatitis Center and West China-Liverpool Biomedical Research Center, West China Hospital, Sichuan University, Chengdu, China
| | - Lihui Deng
- Department of Integrated Traditional Chinese and Western Medicine, Sichuan Provincial Pancreatitis Center and West China-Liverpool Biomedical Research Center, West China Hospital, Sichuan University, Chengdu, China
| | - Lan Li
- Department of Integrated Traditional Chinese and Western Medicine, Sichuan Provincial Pancreatitis Center and West China-Liverpool Biomedical Research Center, West China Hospital, Sichuan University, Chengdu, China
| | - Ping Zhu
- Department of Integrated Traditional Chinese and Western Medicine, Sichuan Provincial Pancreatitis Center and West China-Liverpool Biomedical Research Center, West China Hospital, Sichuan University, Chengdu, China
| | - Liang Xia
- Department of Gastroenterology, First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Tao Jin
- Department of Integrated Traditional Chinese and Western Medicine, Sichuan Provincial Pancreatitis Center and West China-Liverpool Biomedical Research Center, West China Hospital, Sichuan University, Chengdu, China
| | - Thomas Ward
- Liverpool Pancreatitis Research Group, Liverpool University Hospitals NHS Foundation Trust and Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool, UK
| | - Peter Sztamary
- Liverpool Pancreatitis Research Group, Liverpool University Hospitals NHS Foundation Trust and Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool, UK
| | - Wenhao Cai
- Department of Integrated Traditional Chinese and Western Medicine, Sichuan Provincial Pancreatitis Center and West China-Liverpool Biomedical Research Center, West China Hospital, Sichuan University, Chengdu, China; Liverpool Pancreatitis Research Group, Liverpool University Hospitals NHS Foundation Trust and Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool, UK
| | - Linbo Yao
- Department of Integrated Traditional Chinese and Western Medicine, Sichuan Provincial Pancreatitis Center and West China-Liverpool Biomedical Research Center, West China Hospital, Sichuan University, Chengdu, China
| | - Xinmin Yang
- Department of Integrated Traditional Chinese and Western Medicine, Sichuan Provincial Pancreatitis Center and West China-Liverpool Biomedical Research Center, West China Hospital, Sichuan University, Chengdu, China
| | - Ziqi Lin
- Department of Integrated Traditional Chinese and Western Medicine, Sichuan Provincial Pancreatitis Center and West China-Liverpool Biomedical Research Center, West China Hospital, Sichuan University, Chengdu, China
| | - Kun Jiang
- Department of Integrated Traditional Chinese and Western Medicine, Sichuan Provincial Pancreatitis Center and West China-Liverpool Biomedical Research Center, West China Hospital, Sichuan University, Chengdu, China
| | - Jia Guo
- Department of Integrated Traditional Chinese and Western Medicine, Sichuan Provincial Pancreatitis Center and West China-Liverpool Biomedical Research Center, West China Hospital, Sichuan University, Chengdu, China
| | - Xiaonan Yang
- Department of Integrated Traditional Chinese and Western Medicine, Sichuan Provincial Pancreatitis Center and West China-Liverpool Biomedical Research Center, West China Hospital, Sichuan University, Chengdu, China
| | - Vikesh K Singh
- Pancreatitis Center, Division of Gastroenterology, Johns Hopkins Medical Institutions, Baltimore, USA
| | - Robert Sutton
- Liverpool Pancreatitis Research Group, Liverpool University Hospitals NHS Foundation Trust and Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool, UK
| | - Nonghua Lu
- Department of Gastroenterology, First Affiliated Hospital of Nanchang University, Nanchang, China
| | - John A Windsor
- Surgical and Translational Research Centre, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Wenhua He
- Department of Gastroenterology, First Affiliated Hospital of Nanchang University, Nanchang, China.
| | - Wei Huang
- Department of Integrated Traditional Chinese and Western Medicine, Sichuan Provincial Pancreatitis Center and West China-Liverpool Biomedical Research Center, West China Hospital, Sichuan University, Chengdu, China.
| | - Qing Xia
- Department of Integrated Traditional Chinese and Western Medicine, Sichuan Provincial Pancreatitis Center and West China-Liverpool Biomedical Research Center, West China Hospital, Sichuan University, Chengdu, China.
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Szatmary P, Grammatikopoulos T, Cai W, Huang W, Mukherjee R, Halloran C, Beyer G, Sutton R. Acute Pancreatitis: Diagnosis and Treatment. Drugs 2022; 82:1251-1276. [PMID: 36074322 PMCID: PMC9454414 DOI: 10.1007/s40265-022-01766-4] [Citation(s) in RCA: 228] [Impact Index Per Article: 76.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/04/2022] [Indexed: 11/11/2022]
Abstract
Acute pancreatitis is a common indication for hospital admission, increasing in incidence, including in children, pregnancy and the elderly. Moderately severe acute pancreatitis with fluid and/or necrotic collections causes substantial morbidity, and severe disease with persistent organ failure causes significant mortality. The diagnosis requires two of upper abdominal pain, amylase/lipase ≥ 3 ×upper limit of normal, and/or cross-sectional imaging findings. Gallstones and ethanol predominate while hypertriglyceridaemia and drugs are notable among many causes. Serum triglycerides, full blood count, renal and liver function tests, glucose, calcium, transabdominal ultrasound, and chest imaging are indicated, with abdominal cross-sectional imaging if there is diagnostic uncertainty. Subsequent imaging is undertaken to detect complications, for example, if C-reactive protein exceeds 150 mg/L, or rarer aetiologies. Pancreatic intracellular calcium overload, mitochondrial impairment, and inflammatory responses are critical in pathogenesis, targeted in current treatment trials, which are crucially important as there is no internationally licenced drug to treat acute pancreatitis and prevent complications. Initial priorities are intravenous fluid resuscitation, analgesia, and enteral nutrition, and when necessary, critical care and organ support, parenteral nutrition, antibiotics, pancreatic exocrine and endocrine replacement therapy; all may have adverse effects. Patients with local complications should be referred to specialist tertiary centres to guide further management, which may include drainage and/or necrosectomy. The impact of acute pancreatitis can be devastating, so prevention or reduction of the risk of recurrence and progression to chronic pancreatitis with an increased risk of pancreas cancer requires proactive management that should be long term for some patients.
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Affiliation(s)
- Peter Szatmary
- Liverpool Pancreatitis Research Group, Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool, UK.,Department of Molecular and Clinical Cancer Medicine, Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool, UK.,Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
| | - Tassos Grammatikopoulos
- Paediatric Liver, GI and Nutrition Centre, King's College Hospital NHS Foundation Trust, London, UK
| | - Wenhao Cai
- Liverpool Pancreatitis Research Group, Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool, UK.,Department of Molecular and Clinical Cancer Medicine, Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool, UK.,West China Centre of Excellence for Pancreatitis and West China-Liverpool Biomedical Research Centre, West China Hospital, Sichuan University, Chengdu, China
| | - Wei Huang
- West China Centre of Excellence for Pancreatitis and West China-Liverpool Biomedical Research Centre, West China Hospital, Sichuan University, Chengdu, China
| | - Rajarshi Mukherjee
- Liverpool Pancreatitis Research Group, Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool, UK.,Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK.,Department of Molecular Physiology and Cell Signalling, Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool , UK
| | - Chris Halloran
- Department of Molecular and Clinical Cancer Medicine, Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool, UK.,Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
| | - Georg Beyer
- Department of Medicine II, University Hospital, LMU Munich, Munich, Germany
| | - Robert Sutton
- Liverpool Pancreatitis Research Group, Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool, UK. .,Department of Molecular and Clinical Cancer Medicine, Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool, UK. .,Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK.
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Yamamoto Y, Ohta R, Tanaka Y, Mishiro G, Sano C. Localized Pancreatitis in an Elderly Patient Without Suspected Etiology. Cureus 2022; 14:e28034. [PMID: 36120214 PMCID: PMC9473671 DOI: 10.7759/cureus.28034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/15/2022] [Indexed: 11/17/2022] Open
Abstract
Once pancreatic inflammation is triggered, it spreads throughout the pancreas. Here, we present a case of localized pancreatitis wherein the inflammation was confined to the pancreatic head. A 91-year-old woman was admitted with complaints of vomiting and epigastric pain. Blood tests showed elevated pancreatic enzyme levels, whereas imaging studies showed an enlarged pancreatic head and an area of increased density in the surrounding fatty tissue extending along the retroperitoneum below the subrenal pole. Atrophy of the pancreatic parenchyma in the pancreatic body and tail and dilatation of the main pancreatic duct were observed. The patient was diagnosed with acute pancreatitis, was kept nil by mouth, and was administered supplemental fluids. The symptoms resolved within two weeks. Age-related anatomical and histological changes in the pancreas may influence the development of pancreatitis, making it difficult to rule out the possibility of cancer. As age-related changes in the pancreas could lead to the development of pancreatitis, it is an important differential diagnosis of abdominal pain, even in older patients without suspected etiologies.
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15
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Construction of Dual-Target Recognition-Based Specific MicroRNA Detection Method for Acute Pancreatitis Analysis. Appl Biochem Biotechnol 2022; 194:3136-3144. [PMID: 35347672 DOI: 10.1007/s12010-022-03907-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Accepted: 03/14/2022] [Indexed: 01/15/2023]
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Characteristics and clinical outcomes of patients over 80 years of age with acute pancreatitis. Eur Geriatr Med 2022; 13:1013-1022. [PMID: 35246826 DOI: 10.1007/s41999-022-00631-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2021] [Accepted: 02/16/2022] [Indexed: 10/18/2022]
Abstract
BACKGROUND In this study, we aimed to compare differences in disease course, etiology of acute pancreatitis admission to the intensive care unit, in-hospital mortality, disease severity, and local and systemic complications between patients aged ≥ 80 years (octogenarians) and patients aged between 65 and 79 years (non-octogenarians), all of whom were being followed with the diagnosis of acute pancreatitis. METHODS Patients aged 65 years and older with a diagnosis of acute biliary pancreatitis were included in the study. Clinical findings, routine laboratory test results, and imaging findings of all patients were reviewed retrospectively via the hospital's records system. RESULTS Of a total of 402 enrolled patients, 238 (59.2%) were female. Mean age was 77.1 ± 7.37 years. Pancreatitis after endoscopic retrograde cholangiopancreatography was detected more frequently among octogenarians than non-octogenarians (12.9% versus 5.3%, respectively; p = 0.007). Levels of blood urea nitrogen, creatinine, and total bilirubin were higher among octogenarians, while lymphocyte, calcium, and albumin levels were lower. The frequency of patients without local complications was higher among octogenarians than non-octogenarians (75.5% versus 63.6%, respectively; p = 0.013). Necrosis was less frequent in the octogenarian group than the non-octogenarian group (2.6% versus 8.9%, respectively; p = 0.012). Mild acute pancreatitis was higher in the octogenarian group, while moderate acute pancreatitis was higher in the non-octogenarian group (p = 0.028 and p = 0.012, respectively). CONCLUSION The frequencies of prolonged hospitalization, intensive care unit admission, and in-hospital mortality were similar in the octogenarian and non-octogenarian groups. In terms of disease severity, mild acute pancreatitis was higher in the octogenarian group, while moderate acute pancreatitis was higher in the non-octogenarian group.
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