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Chhoda A, Liyen Cartelle A, Manoj MA, Noriega M, Anderson K, Zuberi SA, Sur A, Olivares M, Kelly J, Freedman SD, Galler Rabinowitz L, Sheth SG. Investigation of the Association of Acute Pancreatitis Outcomes with Social Vulnerability Indicators. Am J Med 2025; 138:827-834. [PMID: 39743189 DOI: 10.1016/j.amjmed.2024.12.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2024] [Revised: 12/12/2024] [Accepted: 12/14/2024] [Indexed: 01/04/2025]
Abstract
BACKGROUND AND AIM Geospatial analyses integrate location-based sociodemographic data, offering a promising approach to investigate the impact of social determinants on acute pancreatitis outcomes. This study aimed to examine the association of Social Vulnerability Index (SVI) and its constituent 16 attributes in 4 domains (socioeconomic status, household composition and disability, minority status and language, and housing type and transportation), with outcomes in patients with acute pancreatitis. METHODS This study included acute pancreatitis patients hospitalized between 1/1/2008 and 12/31/2021 and recorded their demographics and clinical outcomes. Physical addresses were geocoded to determine SVI, a composite variable which was ranked and divided into quartiles (I-IV: IV representing the highest vulnerability). RESULT In 824 eligible patients [age of 53.0 ± 10 years and 48.2% females], with 993 acute pancreatitis-related hospitalizations, we noted a significant association in patients residing in communities with higher SVI, a higher prevalence of no/federal/state insurance (P < .001) and underserved ethnic/racial background (P < .001). We observed a significant association of alcohol withdrawal in patients with residence in areas with higher SVI despite adjustment for age, body mass index, and comorbidities (odds ratios: 1.62 [95% CI: 1.19-2.22]; P = .003). However, we observed no association of SVI with severity of acute pancreatitis, inpatient opioid use, length of stay, 30-day admission rate, and mortality. CONCLUSIONS We noted significantly higher alcohol withdrawal in patients residing in areas with higher SVI ranks, despite no differences in severity of acute pancreatitis, inpatient opioid use, length of stay, 30-day admission rate, and mortality.
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Affiliation(s)
- Ankit Chhoda
- Department of Medicine, Division of Gastroenterology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Mass
| | - Anabel Liyen Cartelle
- Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Mass
| | - Matthew Antony Manoj
- Department of Medicine, Division of Gastroenterology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Mass
| | - Marco Noriega
- Department of Medicine, Division of Gastroenterology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Mass
| | - Kelsey Anderson
- Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Mass
| | - Shaharyar A Zuberi
- Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Mass
| | - Alana Sur
- Department of Medicine, Division of Gastroenterology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Mass
| | - Miriam Olivares
- Geographical Information System Library, Yale University, New Haven, Conn
| | - Jill Kelly
- Yale School of Public Health, Yale University, New Haven, Conn
| | - Steven D Freedman
- Department of Medicine, Division of Gastroenterology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Mass
| | - Loren Galler Rabinowitz
- Department of Medicine, Division of Gastroenterology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Mass
| | - Sunil G Sheth
- Department of Medicine, Division of Gastroenterology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Mass.
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Cribari C, Tierney J, LaGrone L. Managing complicated pancreatitis with more knowledge and a bigger toolbox! Trauma Surg Acute Care Open 2025; 10:e001798. [PMID: 40400730 PMCID: PMC12094121 DOI: 10.1136/tsaco-2025-001798] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2025] [Accepted: 03/30/2025] [Indexed: 05/23/2025] Open
Abstract
Acute pancreatitis (AP) is a heterogeneous inflammation of the pancreas, most frequently attributable to gallstones or alcohol. AP accounts for an estimated 300 000 patients admitted each year in the USA, and an estimated US$2.6 billion/year in hospitalization costs. Disease severity is classified as mild, moderate, or severe, dependent on the presence or degree of concomitant organ failure. Locally, pancreatitis may be complicated by fluid collections, necrosis, infection, and hemorrhage. Infection of necrotizing pancreatitis (NP) is associated with a doubling of mortality risk. The modern management of AP is evolving. Recent data suggest a shift from normal saline to lactated Ringer's solution, and from aggressive to more judicious volume resuscitation. Similarly, while historical wisdom advocated keeping patients nothing by mouth to 'rest the pancreas', recent data convincingly show fewer complications and reduced mortality with early enteral nutrition, when tolerated by the patient. The use of antibiotics in NP is controversial. Current recommendations suggest reserving antibiotics for cases with highly suspected or confirmed infected necrosis, as well as in patients with biliary pancreatitis complicated by acute cholecystitis or cholangitis. Regarding the management of local complications, control of acute hemorrhage can be attained either endovascularly or via laparotomy. Abdominal compartment syndrome is associated with a mortality risk of 50%-75%. Routine monitoring of intra-abdominal pressure is recommended in patients at high risk. Pancreatic pseudocysts require intervention in symptomatic patients or those with infection or other complications. Endoscopic transmural drainage may be considered as the first step when technically feasible. Necrotizing pancreatitis without suspicion of infection is often managed medically, while the delay, drain, debride approach remains the standard of care for the vast majority of infected pancreatic necrosis. Robotic surgery, in appropriately selected patients, allows for a one-step approach, and merits further study to explore its initially promising results.
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Affiliation(s)
- Chris Cribari
- Trauma and Acute Care Surgery, Medical Center of the Rockies, Loveland, Colorado, USA
- Trauma and Acute Care Surgery, University of Colorado Health, Loveland, Colorado, USA
| | | | - Lacey LaGrone
- Trauma and Acute Care Surgery, Medical Center of the Rockies, Loveland, Colorado, USA
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Ramirez-Gonzalez LR, Ordonez-Forestiery LR, Garcia A, Iniguez-Martin-del-Campo MC, Llamas-Hernandez FD, Morfin-Meza KD, Gonzalez-Munoz SE, Capetillo-Texson CE, Gomez-Sierra JP, Suarez-Carreon LO, Cervantes-Guevara G, Cervantes-Perez E, Ramirez-Ochoa S, Alvarez-Villasenor AS, Cortes-Flores AO, Gonzalez-Ojeda A, Fuentes-Orozco C. Procalcitonin as a Predictor of Mortality in Patients With Severe Acute Pancreatitis. Gastroenterology Res 2025; 18:56-62. [PMID: 40322192 PMCID: PMC12045753 DOI: 10.14740/gr2029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2025] [Accepted: 04/10/2025] [Indexed: 05/08/2025] Open
Abstract
Background Acute pancreatitis (AP) is a severe inflammatory disorder that begins with the inappropriate activation of pancreatic enzymes within acinar cells due to biliary reflux, alcohol abuse, gallstones, and autoimmune disease. Several biomarkers have been studied that may aid in the early detection of pancreatic necrosis. The aim of this project was to evaluate the usefulness of procalcitonin (PCT) in predicting mortality in patients with severe AP in Mexican population. Methods An observational study, including 59 patients diagnosed with AP from 2018 to 2023, was conducted in a tertiary care hospital. Serum PCT levels were assessed on the first and third days of hospitalization (24 and 72 h). Results A total of 59 patients were included, and the main etiologies were lithiasis (28 patients, 47.5%) and endoscopic retrograde cholangiopancreatography (ERCP) (nine patients, 15.3%). Of the total patients, 16 (27.1%) died during their hospital stay, and the main etiologies were septic shock of abdominal origin (10 patients, 62.5%) followed by extra-abdominal shock (six patients, 37.5%). The average PCT level was 4.54 ± 8.12 on the first day of hospital stay, and 5.20 ± 10.90 at 72 h. The cut-off point was 1.26 ng/mL with the best sensitivity and specificity of PCT as a predictor of mortality at 72 h of 75% and 68%, respectively (area under the curve 0.7, 95% confidence interval (CI): 0.61 - 0.88), and positive and negative predictive values of 0.46 and 0.87, respectively. Conclusions We propose the usefulness of PCT as a biochemical marker to predict mortality in patients with severe AP due to its accessibility in the hospital environment. We propose to carry out studies with more patients and follow-up times. In addition, it is necessary to consider other biomarkers associated with PCT to help us improve the positive predictive value of mortality in this disease.
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Affiliation(s)
- Luis Ricardo Ramirez-Gonzalez
- Department of General Surgery, Specialty Hospital, Western National Medical Center, Mexican Institute of Social Security, Guadalajara, Jalisco, Mexico
| | - Leonardo Rafael Ordonez-Forestiery
- Department of General Surgery, Specialty Hospital, Western National Medical Center, Mexican Institute of Social Security, Guadalajara, Jalisco, Mexico
| | - Andrea Garcia
- Biomedical Research Unit 02, Specialty Hospital, Western National Medical Center, Mexican Institute of Social Security, Guadalajara, Jalisco, Mexico
| | | | - Francia Damary Llamas-Hernandez
- Biomedical Research Unit 02, Specialty Hospital, Western National Medical Center, Mexican Institute of Social Security, Guadalajara, Jalisco, Mexico
| | - Kathia Dayana Morfin-Meza
- Biomedical Research Unit 02, Specialty Hospital, Western National Medical Center, Mexican Institute of Social Security, Guadalajara, Jalisco, Mexico
| | - Samantha Emily Gonzalez-Munoz
- Biomedical Research Unit 02, Specialty Hospital, Western National Medical Center, Mexican Institute of Social Security, Guadalajara, Jalisco, Mexico
| | - Carlos Enrique Capetillo-Texson
- Biomedical Research Unit 02, Specialty Hospital, Western National Medical Center, Mexican Institute of Social Security, Guadalajara, Jalisco, Mexico
| | - Jose Pablo Gomez-Sierra
- Biomedical Research Unit 02, Specialty Hospital, Western National Medical Center, Mexican Institute of Social Security, Guadalajara, Jalisco, Mexico
| | - Luis Osvaldo Suarez-Carreon
- Department of General Surgery, Specialty Hospital, Western National Medical Center, Mexican Institute of Social Security, Guadalajara, Jalisco, Mexico
- Department Surgical Clinics, Universidad de Guadalajara, Guadalajara, Jalisco, Mexico
| | - Gabino Cervantes-Guevara
- Department of Welfare and Sustainable Development, University Center of the North, University of Guadalajara, 46200, Colotlan, Jalisco, Mexico
| | - Enrique Cervantes-Perez
- Department of Internal Medicine, Hospital Civil de Guadalajara Fray Antonio Alcalde, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Guadalajara 44280, Jalisco, Mexico
| | - Sol Ramirez-Ochoa
- Department of Internal Medicine, Hospital Civil de Guadalajara Fray Antonio Alcalde, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Guadalajara 44280, Jalisco, Mexico
| | | | | | | | - Clotilde Fuentes-Orozco
- Biomedical Research Unit 02, Specialty Hospital, Western National Medical Center, Mexican Institute of Social Security, Guadalajara, Jalisco, Mexico
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Fu L, Li H, Ni Q, Zhu Q, Wang B. Optimizing outcomes in acute pancreatitis: the impact of of heparin therapy duration on mortality in a multi-center retrospective study. BMC Gastroenterol 2025; 25:195. [PMID: 40128664 PMCID: PMC11931801 DOI: 10.1186/s12876-025-03763-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2024] [Accepted: 03/05/2025] [Indexed: 03/26/2025] Open
Abstract
OBJECTIVE Acute pancreatitis is a critical condition in the intensive care unit (ICU), often complicated by systemic issues, which may benefit from heparin therapy due to its anti-inflammatory and anticoagulant properties. However, the optimal duration of heparin therapy remained unclear. This retrospective study aimed to evaluate the association between heparin therapy duration and mortality outcomes in patients diagnosed with acute pancreatitis. METHOD This retrospective study utilized data from the Medical Information Mart for Intensive Care (MIMIC-IV) and eICU Collaborative Research Database (eICU-CRD), including 1705 patients diagnosed with acute pancreatitis between 2008 and 2019. Restricted cubic splines (RCS) were employed to analyze the non-linear relationship between heparin therapy duration and 30-day and 90-day mortality. Patients were categorized into four groups based on quartiles: < 4 days, 4-7 days, 8-14 days, and > 14 days, using characteristics identified in the RCS curves, with 4-7 days as the reference. Cox multivariate regression and Kaplan-Meier analysis assessed the association between these groups and mortality, with 30-day mortality as the primary outcome and 90-day mortality as the secondary outcome. RESULT The relationship between heparin therapy duration and mortality at 30 and 90 days in patients with acute pancreatitis exhibited a J-shaped curve, with the lowest mortality observed around 7 days for both 30-day and 90-day mortality. Heparin therapy durations less than 4 days were significantly associated with higher 30-day mortality (HR: 2.57, 95% CI: 1.53-4.30) and increased 90-day mortality (HR: 1.57, 95% CI: 1.07-2.32), with mortality stabilizing beyond 7 days of therapy. Subgroup analysis stratified by severity consistently supported these findings. CONCLUSION In critically ill patients with acute pancreatitis, heparin therapy lasting less than 4 days was associated with increased 30-day and 90-day mortality, whereas the lowest mortality was observed among patients receiving heparin therapy for approximately 7 days.
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Affiliation(s)
- Linlin Fu
- Department of Pharmacy, Nanjing Drum Tower Hospital, Basic Medicine and Clinical Pharmacy College, China Pharmaceutical University, 210008, Nanjing, China
| | - Hanyang Li
- Department of Biochemistry and Molecular Biology, Nanjing Medical University, 211166, Nanjing, China
| | - Qian Ni
- Department of Vascular Surgery, Nanjing Drum Tower Hospital, Nanjing Drum Tower Hospital Clinical College, Nanjing University of Chinese Medicine, Nanjing, China
| | - Qiaoling Zhu
- Department of Pharmacy, Affiliated Hospital of Medical School, Nanjing Drum Tower Hospital, Nanjing University, 210008, Nanjing, China.
| | - Baoyan Wang
- Department of Pharmacy, Affiliated Hospital of Medical School, Nanjing Drum Tower Hospital, Nanjing University, 210008, Nanjing, China.
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Wang ZH, Lv JH, Teng Y, Michael N, Zhao YF, Xia M, Wang B. Phospholipase D2: A biomarker for stratifying disease severity in acute pancreatitis? World J Gastroenterol 2025; 31:104033. [PMID: 40124273 PMCID: PMC11924012 DOI: 10.3748/wjg.v31.i11.104033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2024] [Revised: 02/03/2025] [Accepted: 02/18/2025] [Indexed: 03/13/2025] Open
Abstract
In this editorial, we critically evaluate the recent article by Niu et al, which explores the potential of phospholipase D2 (PLD2) as a biomarker for stratifying disease severity in acute pancreatitis (AP). AP is a clinically heterogeneous inflammatory condition that requires reliable biomarkers for early and accurate classification of disease severity. PLD2, an essential regulator of neutrophil migration and inflammatory responses, has emerged as a promising candidate. Although current biomarkers such as C-reactive protein and procalcitonin provide general indications of inflammation, they lack specificity regarding the molecular mechanisms underlying AP progression. Recent studies, including the research conducted by Niu et al, suggest an inverse correlation between PLD2 expression and AP severity, offering both diagnostic insights and mechanistic understanding. This editorial critically evaluates the role of PLD2 as a biomarker in the broader context of AP research. Evidence indicates that decreased levels of PLD2 are associated with increased neutrophil chemotaxis and cytokine release, contributing to pancreatic and systemic inflammation. However, several challenges remain, including the need for large-scale validation and functional studies to establish causation, and standardization of measurement protocols. Additionally, further investigation into the temporal dynamics of PLD2 expression and its variability across diverse populations is warranted. Looking ahead, PLD2 holds the potential to revolutionize AP management by integrating molecular diagnostics with precision medicine. The utilization of large-scale multi-omics approaches and advancements in diagnostic platforms could position PLD2 as a fundamental biomarker for early diagnosis, prognosis, and potentially therapeutic targeting. While promising, it is crucial to conduct critical evaluations and rigorous validations of PLD2's role to ensure its efficacy in improving patient outcomes.
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Affiliation(s)
- Zhi-Hui Wang
- Liaoning Provincial Key Laboratory of Cerebral Diseases, College of Basic Medical Sciences, National-Local Joint Engineering Research Center for Drug Research and Development of Neurodegenerative Diseases, Dalian Medical University, Dalian 116000, Liaoning Province, China
| | - Jia-Hui Lv
- Liaoning Provincial Key Laboratory of Cerebral Diseases, College of Basic Medical Sciences, National-Local Joint Engineering Research Center for Drug Research and Development of Neurodegenerative Diseases, Dalian Medical University, Dalian 116000, Liaoning Province, China
| | - Yun Teng
- The Second Affiliated Hospital, Dalian Medical University, Dalian 116000, Liaoning Province, China
| | - Ntim Michael
- Liaoning Provincial Key Laboratory of Cerebral Diseases, College of Basic Medical Sciences, National-Local Joint Engineering Research Center for Drug Research and Development of Neurodegenerative Diseases, Dalian Medical University, Dalian 116000, Liaoning Province, China
- Department of Physiology, School of Medicine and Dentistry, Kwame Nkrumah University of Science and Technology, Kumasi 00233, Ashanti, Ghana
| | - Yi-Fan Zhao
- Liaoning Provincial Key Laboratory of Cerebral Diseases, College of Basic Medical Sciences, National-Local Joint Engineering Research Center for Drug Research and Development of Neurodegenerative Diseases, Dalian Medical University, Dalian 116000, Liaoning Province, China
| | - Min Xia
- Liaoning Provincial Key Laboratory of Cerebral Diseases, College of Basic Medical Sciences, National-Local Joint Engineering Research Center for Drug Research and Development of Neurodegenerative Diseases, Dalian Medical University, Dalian 116000, Liaoning Province, China
- Department of Anesthesiology, General Hospital of The Yangtze River Shipping, Wuhan Brain Hospital, Wuhan 430012, Hubei Province, China
| | - Bin Wang
- Liaoning Provincial Key Laboratory of Cerebral Diseases, College of Basic Medical Sciences, National-Local Joint Engineering Research Center for Drug Research and Development of Neurodegenerative Diseases, Dalian Medical University, Dalian 116000, Liaoning Province, China
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AKTAŞ AA, TAŞAR P, SIĞIRLI D, KILIÇTURGAY SA. Comparison of the effectiveness of different scoring systems and biochemical markers in determining the severity and complications of acute pancreatitis. Turk J Med Sci 2025; 55:451-460. [PMID: 40342330 PMCID: PMC12058010 DOI: 10.55730/1300-0144.5989] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2024] [Revised: 04/17/2025] [Accepted: 02/24/2025] [Indexed: 05/11/2025] Open
Abstract
Background and study aim The aim of the study is to demonstrate the effectiveness of different scoring systems and inflammatory markers in predicting the severity, local complications, pancreatic necrosis, and mortality of acute pancreatitis (AP). Materials and methods The data of 357 patients whom the severity of pancreatitis was classified according to the Revised Atlanta Classification System diagnosed with AP were retrospectively examined. Also The APACHE II, BISAP, mCTSI, and Ranson scores of all patients were calculated. After determining the cut-off values for scoring systems and inflammatory markers with ROC analysis, comparison for AP severity, local complication, necrosis, and mortality. Results In the study, 2.8% of patients had severe pancreatitis. It was found that the risk of developing local complications increased 2.82 times in cases with an 48th-h CRP value >192 mg/L compared to those below this threshold, and 48.96 times in cases with an mCTSI score >2 compared to ≤ 2 cases. It was found that having a Ranson score >4 increased the risk of mortality by 9.07 times compared to having a score of ≤4 (p = 0.038). It was observed that having a BISAP >2 increased the risk of severe AP by 11.79 times compared to ≤2. In cases where the 48th-h NLR value was >13.33, the risk of severe AP was found to have increased by 5.85 times. Conclusion Although the superiority of scoring systems could not be demonstrated in our study, CRP and MCTSI for local complications, BISAP for severity and Ranson score for mortality were the determining variables.
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Affiliation(s)
- Ahmet Ali AKTAŞ
- Department of General Surgery, Faculty of Medicine, Bursa Uludağ University, Bursa,
Turkiye
| | - Pınar TAŞAR
- Department of General Surgery, Faculty of Medicine, Bursa Uludağ University, Bursa,
Turkiye
| | - Deniz SIĞIRLI
- Department of Biostatistics, Faculty of Medicine, Bursa Uludağ University, Bursa,
Turkiye
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Trad G, Hoekstra J, Haddadin R, Shetty K, Ryan J. Serum Lactate Dehydrogenase Levels: The Grim Reaper Sign in Acute Pancreatitis? J Community Hosp Intern Med Perspect 2025; 15:8-12. [PMID: 39867161 PMCID: PMC11759084 DOI: 10.55729/2000-9666.1430] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2024] [Revised: 09/30/2024] [Accepted: 10/15/2024] [Indexed: 01/28/2025] Open
Abstract
Background and aims Acute pancreatitis (AP) frequently presents in emergency departments and poses challenges in predicting severity and mortality. Established scoring systems like Ranson criteria, Acute Physiology And Chronic Health Evaluation II (APACHE) II, and Bedside Index of Severity in Acute Pancreatitis (BISAP) have varying effectiveness. Lactate dehydrogenase (LDH), an enzyme released during tissue damage, shows promise as a marker for organ injury in AP. This study aimed to evaluate LDH's potential to predict mortality risk and hospital stay duration in AP patients. Methods A retrospective cohort study analyzed AP cases at HCA Healthcare facilities from January 2011 to January 2021. Among 514 patients with LDH data at admission, groups were categorized based on LDH levels. Outcomes included hospital and ICU stay lengths, mortality rates, and factors such as age, gender, race, BMI, and medical history. Results Patients were stratified into three groups: Group 1 (<300 IU/L), Group 2 (300-600 IU/L), and Group 3 (>600 IU/L) based onLDHlevels. Patients withLDH>600 IU/L experienced an average hospital stay extension of 4.5 days,were 3.2 times more likely to require ICU admission, and faced a 12.1 times higher mortality risk compared to those with LDH <300 IU/L. Conclusion This study highlights LDH as a potentially valuable predictor of hospital stay duration, ICU requirements, and mortality rates in AP patients. Its cost-effectiveness and accessibility suggest LDH testing could aid clinical decision-making in AP management. Future prospective studies should further explore LDH's role in optimizing AP patient care.
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Affiliation(s)
- George Trad
- Department of Gastroenterology, HCA Healthcare, Southern Hills Hospital, 9300 W Sunset Rd, Las Vegas, NV, 89148,
USA
| | - Jackson Hoekstra
- Department of Internal Medicine, HCA Healthcare, MountainView Hospital, 2880 N Tenaya Way, Las Vegas, 89128, NV,
USA
| | - Rakahn Haddadin
- Department of Internal Medicine, HCA Healthcare, MountainView Hospital, 2880 N Tenaya Way, Las Vegas, 89128, NV,
USA
| | - Kartika Shetty
- Department of Internal Medicine, HCA Healthcare, MountainView Hospital, 2880 N Tenaya Way, Las Vegas, 89128, NV,
USA
| | - John Ryan
- Department of Gastroenterology, HCA Healthcare, Southern Hills Hospital, 9300 W Sunset Rd, Las Vegas, NV, 89148,
USA
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Qi M, Lu C, Dai R, Zhang J, Hu H, Shan X. Prediction of acute pancreatitis severity based on early CT radiomics. BMC Med Imaging 2024; 24:321. [PMID: 39604925 PMCID: PMC11603661 DOI: 10.1186/s12880-024-01509-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2024] [Accepted: 11/21/2024] [Indexed: 11/29/2024] Open
Abstract
BACKGROUND This study aims to develop and validate an integrated predictive model combining CT radiomics and clinical parameters for early assessment of acute pancreatitis severity. METHODS A retrospective cohort of 246 patients with acute pancreatitis was analyzed, with a 70%-30% split for training and validation groups. CT image segmentation was performed using ITK-SNAP, followed by the extraction of radiomics features. The stability of the radiomics features was assessed through inter-observer Intraclass Correlation Coefficient analysis. Feature selection was carried out using univariate analysis and least absolute shrinkage and selection operator (LASSO) regression with 10-fold cross-validation. A radiomics model was constructed through logistic regression to compute the radiomics score. Concurrently, univariate and multivariate logistic regression were employed to identify independent clinical risk factors for the clinical model. The radiomics score and clinical variables were integrated into a combined model, which was visualized with a nomogram. Model performance and net clinical benefit were evaluated through the area under the receiver operating characteristic curve (AUC), the DeLong test, and decision curve analysis. RESULTS A total of 913 radiomics features demonstrated satisfactory consistency. Eight features were selected for the radiomics model. Serum calcium, C-reactive protein, and white blood cell count were identified as independent clinical predictors. The AUC of the radiomics model was 0.871 (95% CI, 0.793-0.949) in the training cohort and 0.859 (95% CI, 0.751-0.967) in the validation cohort. The clinical model achieved AUCs of 0.833 (95% CI, 0.756-0.910) and 0.810 (95% CI, 0.692-0.929) for the training and validation cohorts, respectively. The combined model outperformed both the radiomics and clinical models, with an AUC of 0.905 (95% CI, 0.837-0.973) in the training cohort and 0.908 (95% CI, 0.824-0.992) in the validation cohort. The DeLong test confirmed superior predictive performance of the combined model over both the radiomics and clinical models in the training cohort, and over the clinical model in the validation cohort. Decision curve analysis further demonstrated that the combined model provided greater net clinical benefit than the radiomics or clinical models alone. CONCLUSION The clinical-radiomics model offers a novel tool for the early prediction of acute pancreatitis severity, providing valuable support for clinical decision-making.
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Affiliation(s)
- Mingyao Qi
- Department of Radiology, Affiliated People's Hospital of Jiangsu University, No. 8 Dianli Road, Zhenjiang, Jiangsu, P. R. China
| | - Chao Lu
- Department of Radiology, Affiliated People's Hospital of Jiangsu University, No. 8 Dianli Road, Zhenjiang, Jiangsu, P. R. China
| | - Rao Dai
- Department of Radiology, Affiliated People's Hospital of Jiangsu University, No. 8 Dianli Road, Zhenjiang, Jiangsu, P. R. China
| | - Jiulou Zhang
- Artificial Intelligence Imaging Laboratory, Nanjing Medical University, No.101 Longmian Avenue, Nanjing, Jiangsu, P. R. China
| | - Hui Hu
- Department of Radiology, Affiliated Hospital of Nanjing University of Chinese Medicine, No. 155 Hanzhong Road, Nanjing, Jiangsu, P. R. China.
| | - Xiuhong Shan
- Department of Radiology, Affiliated People's Hospital of Jiangsu University, No. 8 Dianli Road, Zhenjiang, Jiangsu, P. R. China.
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Chen JY, He JL, Feng FY, Yang XY, Xie WR. The Clinical Value of Serum Creatinine-to-Bilirubin Ratio in Predicting the Severity and Prognosis of Acute Pancreatitis. Dig Dis 2024; 43:115-124. [PMID: 39433027 DOI: 10.1159/000541901] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2024] [Accepted: 10/06/2024] [Indexed: 10/23/2024]
Abstract
INTRODUCTION Bilirubin (BIL) and creatinine (Cr) have long been recognized as potential early indicators of disease severity. A recent study found that the Cr-to-BIL ratio (CTR) was more sensitive and specific than either serum Cr or BIL alone. Our research focused on the clinical significance of CTR in evaluating the severity and prognosticating outcomes of acute pancreatitis (AP) in patients. METHODS Patients diagnosed with AP at the First Affiliated Hospital of Guangdong Pharmaceutical University between July 1, 2016, and December 31, 2020 were included. The analysis then focused on examining the relationship between CTR levels and the severity of the illness, the occurrence of complications, and the prognosticating outcomes for individuals diagnosed with AP. A total of 286 AP patients were enrolled. RESULTS Multivariate regression analyses indicated that AP patients with elevated CTR levels were more likely to develop severe AP. They exhibited higher MODS, Ranson, and APACHE-II scores, an increased incidence of organ failures (acute heart failure [AHF], acute kidney injury [AKI], and acute myocardial infarction), higher 30-day all-cause mortality rates, and a worse prognosis, often requiring more frequent use of vasoactive and diuretic agents compared to those with lower CTR levels. When CTR >14.05, AP patients had increased occurrence of AHF and AKI, higher 30-day all-cause mortality rates, more frequently using vasoactive agent and diuretic agent. Besides, the disease severity scores (MODS, Ranson, and APACHE-II) and hospital stays were markedly increased. CONCLUSION AP patients with elevated CTR levels are prone to more severe disease progression, increased complications, and poorer outcomes compared to those with lower CTR levels.
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Affiliation(s)
- Jun-Yi Chen
- Department of Gastroenterology, The First Affiliated Hospital of Guangdong Pharmaceutical University, Guangzhou, China,
- Department of Gastroenterology, Research Center for Engineering Techniques of Microbiota -Targeted Therapies of Guangdong Province, Guangzhou, China,
| | - Jun-Lian He
- Department of Gastroenterology, The First Affiliated Hospital of Guangdong Pharmaceutical University, Guangzhou, China
- Department of Gastroenterology, Research Center for Engineering Techniques of Microbiota -Targeted Therapies of Guangdong Province, Guangzhou, China
| | - Feng-Yi Feng
- Department of Gastroenterology, Foshan Nanhai District Sixth People's Hospital, Foshan, China
| | - Xiao-Ya Yang
- Department of Physiology, Guangzhou Health Science College, Guangzhou, China
| | - Wen-Rui Xie
- Department of Gastroenterology, The First Affiliated Hospital of Guangdong Pharmaceutical University, Guangzhou, China
- Department of Gastroenterology, Research Center for Engineering Techniques of Microbiota -Targeted Therapies of Guangdong Province, Guangzhou, China
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10
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Phan NT, Vo DMT, Huynh TM, Ho PT, Phuoc Ma N, Vo TD. Evaluating the prognostic performance of the novel ERAP score in Vietnamese acute pancreatitis patients. Medicine (Baltimore) 2024; 103:e39738. [PMID: 39312379 PMCID: PMC11419453 DOI: 10.1097/md.0000000000039738] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2024] [Accepted: 08/27/2024] [Indexed: 09/25/2024] Open
Abstract
Early recognition of severe acute pancreatitis (AP) is crucial for timely intervention. This study aims to evaluate the prognostic accuracy of the Emergency Room Assessment of AP (ERAP) score and compare it with the Bedside Index for Severity in AP (BISAP) score in predicting severe AP, mortality, and persistent multiple organ failure (MOF) in Vietnamese patients. This prospective cohort study included AP patients admitted to Cho Ray Hospital between August 2021 and May 2022. Patient data, including demographics, clinical presentations, and laboratory results, were collected upon admission. The ERAP and BISAP scores were calculated from these admission data. The prognostic accuracy for severe AP, mortality, and persistent MOF was assessed via the area under the receiver-operating characteristic curve (AUC). Among 167 AP patients (mean age 41.5 ± 12.0 years), hypertriglyceridemia (34.7%) and alcohol (22.2%) were the most prevalent etiologies. Severe AP accounted for 33.5% of the patients. Mortality rates were higher in persistent MOF patients (42.9%) than in persistent single-organ failure patients (3.6%), with a P value <.001. The ERAP score had AUCs for predicting severe AP, mortality, and persistent MOF of 0.899, 0.817, and 0.867, respectively, with an optimal cutoff of ≥2. The ERAP score had a better prognostic value than the BISAP score in predicting severe AP (AUC: 0.899 vs 0.820; P = .0072) and persistent MOF (AUC: 0.867 vs 0.785; P = .0193) but had a similar prognostic value for mortality (AUC: 0.817 vs 0.728; P = .0628). The ERAP score has strong predictive value for severe AP and persistent MOF, surpassing the BISAP score in these categories while maintaining similar accuracy for mortality prediction in the Vietnamese population. The ERAP score can be a valuable tool for the early identification of high-risk AP patients, enabling timely and appropriate clinical interventions.
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Affiliation(s)
- Nhan Trung Phan
- Department of Internal Medicine, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam
- Department of Gastroenterology, Cho Ray Hospital, Ho Chi Minh City, Vietnam
| | - Dung My Thi Vo
- Department of Internal Medicine, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam
| | - Tien Manh Huynh
- Department of Internal Medicine, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam
- Department of Gastroenterology, Cho Ray Hospital, Ho Chi Minh City, Vietnam
- Department of Gastroenterology, University Medical Center Ho Chi Minh City, Ho Chi Minh City, Vietnam and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam
| | - Phat Tan Ho
- Department of Internal Medicine, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam
| | - Nguyen Phuoc Ma
- Department of Internal Medicine, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam
| | - Thong Duy Vo
- Department of Gastroenterology, Cho Ray Hospital, Ho Chi Minh City, Vietnam
- Department of Gastroenterology, University Medical Center Ho Chi Minh City, Ho Chi Minh City, Vietnam and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam
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11
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Xing J, Xu M, Xu J, Liu J, He F. Development and validation of a nomogram combining pain score with laboratory indicators for predicting persistent organ failure in acute pancreatitis: a retrospective cohort study. Front Med (Lausanne) 2024; 11:1411288. [PMID: 39165374 PMCID: PMC11333219 DOI: 10.3389/fmed.2024.1411288] [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: 04/04/2024] [Accepted: 07/26/2024] [Indexed: 08/22/2024] Open
Abstract
Background Acute pancreatitis is an inflammatory disease that can lead to persistent organ failure (POF), which is associated with increased morbidity and mortality. Early prediction of POF in AP can significantly improve patient outcomes. Objective To develop and validate a nomogram that combines pain score with laboratory indicators for predicting POF in patients with AP. Methods A retrospective cohort study was conducted, including patients diagnosed with AP. Pain score and laboratory indicators were collected within the first 24 h of admission. A nomogram was developed using logistic regression models and validated in a separate cohort. Results There were 807 patients in the training cohort and 375 patients in the internal validation cohort.Multivariate logistic regression demonstrated that pain score, serum creatinine, hematocrit, serum calcium, and serum albumin were independent risk factors for the incidence of POF in patients with AP. The area under the curve of the nomogram constructed from the above factors were 0.924, respectively. The model demonstrated good calibration and discrimination in both the development and validation cohorts. Conclusion The nomogram had a good performance in predicting POF in patients with AP and can be used to guide clinical decision-making.
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Affiliation(s)
- Jiayu Xing
- Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Third Hospital of Shanxi Medical University, Taiyuan, China
- Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Musen Xu
- Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Third Hospital of Shanxi Medical University, Taiyuan, China
| | - Jiale Xu
- Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Third Hospital of Shanxi Medical University, Taiyuan, China
| | - Jiao Liu
- Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Third Hospital of Shanxi Medical University, Taiyuan, China
- Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Fang He
- Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Third Hospital of Shanxi Medical University, Taiyuan, China
- Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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12
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Jagodić Ejubović A, Ejubović M, Jahić R, Brkovic A, Letic E, Vujnic M, Lepara O, Kurtović A, Becirovic M, Becirovic E, Fajkić A. 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. Cureus 2024; 16:e66193. [PMID: 39233941 PMCID: PMC11374353 DOI: 10.7759/cureus.66193] [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: 08/05/2024] [Indexed: 09/06/2024] Open
Abstract
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.
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Affiliation(s)
| | - Malik Ejubović
- Department of Internal Medicine, Cantonal Hospital Zenica, Zenica, BIH
- Department of Pathophysiology, University of Zenica, Zenica, BIH
| | - Rijad Jahić
- Department of Internal Medicine and Cardiology, University Clinical Center Sarajevo, Sarajevo, BIH
| | - Amer Brkovic
- Department of Internal Medicine, Cantonal Hospital Zenica, Zenica, BIH
| | - Emina Letic
- Department of Surgery, General Hospital "Prim.dr. Abdulah Nakaš", Sarajevo, BIH
| | - Milorad Vujnic
- Department of Pathophysiology, University of Banja Luka, Banja Luka, BIH
| | - Orhan Lepara
- Department of Human Physiology, Faculty of Medicine, University of Sarajevo, Sarajevo, BIH
| | - Avdo Kurtović
- Department of Orthopedics and Traumatology, University Clinical Center Tuzla, Tuzla, BIH
| | - Minela Becirovic
- Department of Internal Medicine and Nephrology, University Clinical Center Tuzla, Tuzla, BIH
| | - Emir Becirovic
- Department of Internal Medicine, University Clinical Center Tuzla, Tuzla, BIH
| | - Almir Fajkić
- Department of Pathophysiology and Internal Medicine, Faculty of Medicine, University of Sarajevo, Sarajevo, BIH
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13
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Şefoğlu ÖF, Yaka E, Pekdemir M, Yılmaz S, Özturan İU, Doğan NÖ. Comparison of Bedside Index for Severity in Acute Pancreatitis and Emergency Department SpO 2, Age and Systemic Inflammatory Response Syndrome Scores in Predicting Severe Acute Pancreatitis in Patients with Acute Pancreatitis in the Emergency Department. J Emerg Med 2024; 67:e10-e21. [PMID: 38806350 DOI: 10.1016/j.jemermed.2024.03.014] [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: 10/24/2023] [Revised: 02/12/2024] [Accepted: 03/06/2024] [Indexed: 05/30/2024]
Abstract
BACKGROUND As the mortality of severe acute pancreatitis (SAP) is significantly higher than those with mild or moderate severity, it is of clinical significance to identify patients most likely to develop SAP at the time of emergency department (ED) presentation. OBJECTIVES The aim of this study was to compare the performance of the Bedside Index for Severity in Acute Pancreatitis (BISAP) and the Emergency Department SpO2, Age and SIRS (ED-SAS) scoring systems as early risk assessment tools for identifying patients at high-risk of developing SAP. METHODS We retrospectively reviewed adult patients with AP presented to ED between January 2019-September 2022. We calculated the scores of each patient with the parameters of the initial data. The primary outcome was SAP. The secondary outcomes were 30-day mortality, intensive care admission, and identifying low-risk patients without complications. RESULTS Of 415 patients, 34 (8.2%) developed SAP and 15 (3.6%) died. With regard to predicting SAP, BISAP and ED-SAS scores had similar discriminative ability with area under the curves (AUCs) of 0.84 (95% confidence interval [CI]:0.80-0.88) and 0.83 (95% CI:0.79-0.86), respectively (p = 0.642). At a cut-off score of ≥2 for SAP, sensitivity/specificity values were 73.5%/82.4% for BISAP, 76.5%/83.2% for ED-SAS. BISAP and ED-SAS scores of ≥3, yielded sensitivity/specificity values of 50%/95.8% and 35.3%/95.5%, respectively. BISAP and ED-SAS were also similar in predicting mortality (AUCs of 0.92 vs. 0.90, respectively) and intensive care unit admission (AUCs 0.91 vs. 0.91). CONCLUSION The BISAP and ED-SAS scores performed similarly in predicting SAP, mortality, and intensive care unit admission. As an easily calculated tool early in the ED, ED-SAS may be helpful in disposition decisions for emergency physicians.
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Affiliation(s)
- Ömer Faruk Şefoğlu
- Department of Emergency Medicine, Arnavutkoy State Hospital, Istanbul, Turkey
| | - Elif Yaka
- Department of Emergency Medicine, Faculty of Medicine, Kocaeli University, Turkey.
| | - Murat Pekdemir
- Department of Emergency Medicine, Faculty of Medicine, Kocaeli University, Turkey
| | - Serkan Yılmaz
- Department of Emergency Medicine, Faculty of Medicine, Kocaeli University, Turkey
| | - İbrahim Ulaş Özturan
- Department of Emergency Medicine, Faculty of Medicine, Kocaeli University, Turkey
| | - Nurettin Özgür Doğan
- Department of Emergency Medicine, Faculty of Medicine, Kocaeli University, Turkey
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14
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Checketts TR, Sidhu S, Reiche WS, Walters RW, Buaisha H. Using Acidosis as a Surrogate for or Supplement to the Bedside Index of Severity in Acute Pancreatitis Scoring Prediction System Has a Nonsignificant Effect. Cureus 2024; 16:e63826. [PMID: 39100030 PMCID: PMC11297637 DOI: 10.7759/cureus.63826] [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] [Accepted: 07/01/2024] [Indexed: 08/06/2024] Open
Abstract
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 CAG in 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 AUC 1.02 (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.
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Affiliation(s)
| | - Suhail Sidhu
- Medicine, Creighton University School of Medicine, Omaha, USA
| | - Will S Reiche
- Gastroenterology, Creighton University School of Medicine, Omaha, USA
| | - Ryan W Walters
- Clinical Research and Public Health, Creighton University School of Medicine, Omaha, USA
| | - Haitam Buaisha
- Gastroenterology, Creighton University School of Medicine, Omaha, USA
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15
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Zhang C, Peng J, Wang L, Wang Y, Chen W, Sun MW, Jiang H. A deep learning-powered diagnostic model for acute pancreatitis. BMC Med Imaging 2024; 24:154. [PMID: 38902660 PMCID: PMC11188273 DOI: 10.1186/s12880-024-01339-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2024] [Accepted: 06/17/2024] [Indexed: 06/22/2024] Open
Abstract
BACKGROUND Acute pancreatitis is one of the most common diseases requiring emergency surgery. Rapid and accurate recognition of acute pancreatitis can help improve clinical outcomes. This study aimed to develop a deep learning-powered diagnostic model for acute pancreatitis. MATERIALS AND METHODS In this investigation, we enrolled a cohort of 190 patients with acute pancreatitis who were admitted to Sichuan Provincial People's Hospital between January 2020 and December 2021. Abdominal computed tomography (CT) scans were obtained from both patients with acute pancreatitis and healthy individuals. Our model was constructed using two modules: (1) the acute pancreatitis classifier module; (2) the pancreatitis lesion segmentation module. Each model's performance was assessed based on precision, recall rate, F1-score, Area Under the Curve (AUC), loss rate, frequency-weighted accuracy (fwavacc), and Mean Intersection over Union (MIOU). RESULTS Upon admission, significant variations were observed between patients with mild and severe acute pancreatitis in inflammatory indexes, liver, and kidney function indicators, as well as coagulation parameters. The acute pancreatitis classifier module exhibited commendable diagnostic efficacy, showing an impressive AUC of 0.993 (95%CI: 0.978-0.999) in the test set (comprising healthy examination patients vs. those with acute pancreatitis, P < 0.001) and an AUC of 0.850 (95%CI: 0.790-0.898) in the external validation set (healthy examination patients vs. patients with acute pancreatitis, P < 0.001). Furthermore, the acute pancreatitis lesion segmentation module demonstrated exceptional performance in the validation set. For pancreas segmentation, peripancreatic inflammatory exudation, peripancreatic effusion, and peripancreatic abscess necrosis, the MIOU values were 86.02 (84.52, 87.20), 61.81 (56.25, 64.83), 57.73 (49.90, 68.23), and 66.36 (55.08, 72.12), respectively. These findings underscore the robustness and reliability of the developed models in accurately characterizing and assessing acute pancreatitis. CONCLUSION The diagnostic model for acute pancreatitis, driven by deep learning, exhibits excellent efficacy in accurately evaluating the severity of the condition. TRIAL REGISTRATION This is a retrospective study.
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Affiliation(s)
- Chi Zhang
- Department of Intensive Care Medicine, The Third People's Hospital of Chengdu, Affiliated Hospital of Southwest Jiaotong University, Chengdu, China
| | - Jin Peng
- Institute for Emergency and Disaster Medicine, School of Medicine, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, China
- Department of Histology and Neuroscience, Sichuan University, Chengdu, China
| | - Lu Wang
- Institute for Emergency and Disaster Medicine, School of Medicine, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, China
- Department of Emergency Medicine, School of Medicine, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, China
- Sichuan Provincial Clinical Research Center for Emergency and Critical Care, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Yu Wang
- Sichuan Provincial Clinical Research Center for Emergency and Critical Care, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
- Department of Clinical Nutrition, Peking Union Medical College Hospital, Beijing, China
| | - Wei Chen
- Department of Clinical Nutrition, Peking Union Medical College Hospital, Beijing, China
| | - Ming-Wei Sun
- Institute for Emergency and Disaster Medicine, School of Medicine, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, China
| | - Hua Jiang
- Institute for Emergency and Disaster Medicine, School of Medicine, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, China.
- Department of Emergency Medicine, School of Medicine, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, China.
- Sichuan Provincial Clinical Research Center for Emergency and Critical Care, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China.
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16
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Dao YHT, Huynh TM, Tran DT, Ho PT, Vo TD. Clinical value of the Systemic Inflammatory Response Index for predicting acute pancreatitis severity in Vietnamese setting. JGH Open 2024; 8:e13101. [PMID: 38882631 PMCID: PMC11177285 DOI: 10.1002/jgh3.13101] [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: 02/25/2024] [Revised: 05/16/2024] [Accepted: 05/18/2024] [Indexed: 06/18/2024]
Abstract
BACKGROUND AND AIM Accurate prediction of severe acute pancreatitis (SAP) is crucial for timely intervention. This study focuses on the Systemic Inflammatory Response Index (SIRI) to assess its clinical value in predicting the severity of AP in the Vietnamese context. METHODS A cross-sectional prospective study was conducted with acute pancreatitis patients at a national hospital in Ho Chi Minh City. The patients were classified into nonsevere and severe groups, and the clinical characteristics were analyzed. The predictive abilities of SIRI, calculated using neutrophil × monocyte/lymphocyte, was assessed for predictive abilities. Multivariate regression and receiver operating characteristics (ROC) curves evaluated the prognostic factors and predictive accuracy. RESULTS Among 207 patients, 78.7% had nonsevere AP, and 21.3% had SAP. The severe group exhibited a significantly higher median SIRI (12.0) than the nonsevere group (4.9) (P < 0.001). Multivariate regression identified SIRI (odds ratio [OR] = 1.623) as an independent predictor of SAP. The ROC curve determined a SIRI cutoff of 7.82 with an area under the curve (AUC) of 0.737. Combining the SIRI and Bedside Index for Severity in Acute Pancreatitis (BISAP) score improved the predictive ability (AUC = 0.820) with increased sensitivity (90.91%) (P < 0.001). CONCLUSION SIRI, particularly when combined with the BISAP score, shows significant potential to predict SAP severity in the Vietnamese clinical setting, providing valuable information for effective patient management.
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Affiliation(s)
- Yen H T Dao
- University of Medicine and Pharmacy at Ho Chi Minh CityHo Chi Minh CityVietnam
| | - Tien M Huynh
- University of Medicine and Pharmacy at Ho Chi Minh CityHo Chi Minh CityVietnam
- University Medical Center Ho Chi Minh CityHo Chi Minh CityVietnam
| | | | - Phat T Ho
- Cho Ray HospitalHo Chi Minh CityVietnam
| | - Thong D Vo
- University of Medicine and Pharmacy at Ho Chi Minh CityHo Chi Minh CityVietnam
- University Medical Center Ho Chi Minh CityHo Chi Minh CityVietnam
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17
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Qian R, Zhuang J, Xie J, Cheng H, Ou H, Lu X, Ouyang Z. Predictive value of machine learning for the severity of acute pancreatitis: A systematic review and meta-analysis. Heliyon 2024; 10:e29603. [PMID: 38655348 PMCID: PMC11035062 DOI: 10.1016/j.heliyon.2024.e29603] [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: 09/18/2023] [Revised: 04/02/2024] [Accepted: 04/10/2024] [Indexed: 04/26/2024] Open
Abstract
Background Predicting the severity of acute pancreatitis (AP) early poses a challenge in clinical practice. While there are well-established clinical scoring tools, their actual predictive performance remains uncertain. Various studies have explored the application of machine-learning methods for early AP prediction. However, a more comprehensive evidence-based assessment is needed to determine their predictive accuracy. Hence, this systematic review and meta-analysis aimed to evaluate the predictive accuracy of machine learning in assessing the severity of AP. Methods PubMed, EMBASE, Cochrane Library, and Web of Science were systematically searched until December 5, 2023. The risk of bias in eligible studies was assessed using the Prediction Model Risk of Bias Assessment Tool (PROBAST). Subgroup analyses, based on different machine learning types, were performed. Additionally, the predictive accuracy of mainstream scoring tools was summarized. Results This systematic review ultimately included 33 original studies. The pooled c-index in both the training and validation sets was 0.87 (95 % CI: 0.84-0.89) and 0.88 (95 % CI: 0.86-0.90), respectively. The sensitivity in the training set was 0.81 (95 % CI: 0.77-0.84), and in the validation set, it was 0.79 (95 % CI: 0.71-0.85). The specificity in the training set was 0.84 (95 % CI: 0.78-0.89), and in the validation set, it was 0.90 (95 % CI: 0.86-0.93). The primary model incorporated was logistic regression; however, its predictive accuracy was found to be inferior to that of neural networks, random forests, and xgboost. The pooled c-index of the APACHE II, BISAP, and Ranson were 0.74 (95 % CI: 0.68-0.80), 0.77 (95 % CI: 0.70-0.85), and 0.74 (95 % CI: 0.68-0.79), respectively. Conclusions Machine learning demonstrates excellent accuracy in predicting the severity of AP, providing a reference for updating or developing a straightforward clinical prediction tool.
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Affiliation(s)
- Rui Qian
- Department of Gastroenterology, Shenzhen Bao'an Chinese Medicine Hospital, Guangzhou University of Chinese Medicine, Shenzhen 518000, China
| | - Jiamei Zhuang
- The Fourth Clinical Medical College of Guangzhou University of Chinese Medicine, Shenzhen, 518033, China
| | - Jianjun Xie
- Department of Gastroenterology, Shenzhen Bao'an Chinese Medicine Hospital, Guangzhou University of Chinese Medicine, Shenzhen 518000, China
| | - Honghui Cheng
- Department of Gastroenterology, Shenzhen Bao'an Chinese Medicine Hospital, Guangzhou University of Chinese Medicine, Shenzhen 518000, China
| | - Haiya Ou
- Department of Gastroenterology, Shenzhen Bao'an Chinese Medicine Hospital, Guangzhou University of Chinese Medicine, Shenzhen 518000, China
| | - Xiang Lu
- Department of Plumonary and Critical Care Medicine, Shenzhen Bao'an Chinese Medicine Hospital, Guangzhou University of Chinese Medicine, Shenzhen 518000, China
| | - Zichen Ouyang
- Department of Hepatology, Shenzhen Bao'an Chinese Medicine Hospital, Guangzhou University of Chinese Medicine, Shenzhen 518000, China
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18
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Zhu J, Wu L, Wang Y, Fang M, Liu Q, Zhang X. Predictive value of the Ranson and BISAP scoring systems for the severity and prognosis of acute pancreatitis: A systematic review and meta-analysis. PLoS One 2024; 19:e0302046. [PMID: 38687745 PMCID: PMC11060534 DOI: 10.1371/journal.pone.0302046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Accepted: 03/26/2024] [Indexed: 05/02/2024] Open
Abstract
BACKGROUND To systematically assess and compare the predictive value of the Ranson and Bedside Index of Severity in Acute Pancreatitis (BISAP) scoring systems for the severity and prognosis of acute pancreatitis (AP). METHODS PubMed, Embase, Cochrane Library, and Web of Science were systematically searched until February 15, 2023. Outcomes in this analysis included severity and prognosis [mortality, organ failure, pancreatic necrosis, and intensive care unit (ICU) admission]. The revised Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2) tool was used to evaluate the quality of diagnostic accuracy studies. The threshold effect was evaluated for each outcome. The sensitivity, specificity, positive likelihood ratio (PLR), negative likelihood ratio (NLR), diagnostic odds ratio (DOR), and the area under the summary receiver operating characteristic (SROC) curve (AUC) as well as 95% confidence intervals (CI) were calculated. The DeLong test was used for AUC comparisons. For the outcome evaluated by over 9 studies, publication bias was assessed using the Deeks' funnel plot asymmetry test. RESULTS Totally 17 studies of 5476 AP patients were included. For severity, the pooled sensitivity of the Ranson and BISAP was 0.95 (95%CI: 0.87, 0.98) and 0.67 (95%CI: 0.27, 0.92); the pooled specificity of the Ranson and BISAP was 0.74 (0.52, 0.88) and 0.95 (95%CI: 0.85, 0.98); the pooled AUC of the Ranson and BISAP was 0.95 (95%CI: 0.93, 0.97) and 0.94 (95%CI: 0.92, 0.96) (P = 0.480). For mortality, the pooled sensitivity of the Ranson and BISAP was 0.89 (95%CI: 0.73, 0.96) and 0.77 (95%CI: 0.58, 0.89); the pooled specificity of the Ranson and BISAP was 0.79 (95%CI: 0.68, 0.87) and 0.90 (95%CI: 0.86, 0.93); the pooled AUC of the Ranson and BISAP was 0.91 (95%CI: 0.88, 0.93) and 0.92 (95%CI: 0.90, 0.94) (P = 0.480). For organ failure, the pooled sensitivity of the Ranson and BISAP was 0.84 (95%CI: 0.76, 0.90) and 0.78 (95%CI: 0.60, 0.90); the pooled specificity of the Ranson and BISAP was 0.84 (95%CI: 0.63, 0.94) and 0.90 (95%CI: 0.72, 0.97); the pooled AUC of the Ranson and BISAP was 0.86 (95%CI: 0.82, 0.88) and 0.90 (95%CI: 0.87, 0.93) (P = 0.110). For pancreatic necrosis, the pooled sensitivity of the Ranson and BISAP was 0.63 (95%CI: 0.35, 0.84) and 0.63 (95%CI: 0.23, 0.90); the pooled specificity of the Ranson and BISAP was 0.90 (95%CI: 0.77, 0.96) and 0.93 (95%CI: 0.89, 0.96); the pooled AUC of the Ranson and BISAP was 0.87 (95%CI: 0.84, 0.90) and 0.93 (95%CI: 0.91, 0.95) (P = 0.001). For ICU admission, the pooled sensitivity of the Ranson and BISAP was 0.86 (95%CI: 0.77, 0.92) and 0.63 (95%CI: 0.52, 0.73); the pooled specificity of the Ranson and BISAP was 0.58 (95%CI: 0.55, 0.61) and 0.84 (95%CI: 0.81, 0.86); the pooled AUC of the Ranson and BISAP was 0.92 (95%CI: 0.81, 1.00) and 0.86 (95%CI: 0.67, 1.00) (P = 0.592). CONCLUSION The Ranson score was an applicable tool for predicting severity and prognosis of AP patients with reliable diagnostic accuracy in resource and time-limited settings. Future large-scale studies are needed to verify the findings.
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Affiliation(s)
- Jianpeng Zhu
- The Fourth School of Clinical Medicine, Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
| | - Linfei Wu
- The Fourth School of Clinical Medicine, Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
| | - Yue Wang
- Zhejiang University of Medicine, Hangzhou, Zhejiang, China
| | - Mengdie Fang
- The Fourth School of Clinical Medicine, Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
| | - Qiang Liu
- Department of Gastroenterology, Affiliated Hangzhou First People’s Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Xiaofeng Zhang
- Department of Gastroenterology, Affiliated Hangzhou First People’s Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
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19
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Vahapoğlu A, Çalik M. A comparison of scoring systems and biomarkers to predict the severity of acute pancreatitis in patients referring to the emergency clinic. Medicine (Baltimore) 2024; 103:e37964. [PMID: 38669403 PMCID: PMC11049751 DOI: 10.1097/md.0000000000037964] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2024] [Accepted: 03/29/2024] [Indexed: 04/28/2024] Open
Abstract
To investigate scoring systems and biomarkers for determining the severity and prognosis of acute pancreatitis (AP). Between January and July 2023, 100 patients with AP diagnosed and treated in the emergency department were included. AP was divided into 2 groups according to severity: mild AP and moderately severe AP (MSAP-SAP), according to the revised Atlanta Classification in 2012. Demographic characteristics, severity, intensive care unit (ICU) admission, white blood cell count (WBC), hematocrit, red cell distribution width from whole blood taken at admission and 48 hours later, C-reactive protein (CRP) and biochemistry values, Bedside Index for Severity in Acute Pancreatitis (BISAP), Pancreatitis Activity Scoring System (PASS), and harmless AP score scores were recorded retrospectively. Our variables, which were found to be significant in multiple logistic regression results, were found to increase MSAP-SAP expectation by 4.36-, 7.85-, 6.63 and 5.80 times in the presence of CRP > 47.10, WBC > 13.10, PASS > 0, and necrotizing computed tomography findings, respectively. It was detected that the risk factor which was found significant as a single variable affecting the ICU admission increased the risk of ICU requirement by 28.88 when PASS > 0, by 3.96 when BISAP > 1, and it increased the Atlanta score by 9.93-fold. We found that WBC and CRP values at the time of hospital admission and WBC, CRP, and red cell distribution width values after 48 had the highest accuracy in determining AP disease severity. BISAP, which was found to be significant in determining MSAP-SAP expectations, lost its significance in multiple logistic regression results, and PASS was found to be effective. The PASS is an important score in the clinical evaluation of patients with AP and in determining the need for ICU hospitalization.
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Affiliation(s)
- Ayşe Vahapoğlu
- Department of Anesthesiology and Reanimation, University of Health Sciences Turkey, Gaziosmanpaşa Training Research Hospital, İstanbul, Turkey
| | - Mustafa Çalik
- Department of Emergency Medicine, University of Health Sciences Turkey, Gaziosmanpaşa Training Research Hospital, İstanbul, Turkey
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20
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Malheiro F, Leitão do Nascimento M, Miguel Borrego L. Circulating Blood B and T Lymphocytes and Severity of Acute Pancreatitis: A Systematic Review Protocol. ACTA MEDICA PORT 2024; 37:274-279. [PMID: 38631060 DOI: 10.20344/amp.20087] [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: 04/28/2023] [Accepted: 08/09/2023] [Indexed: 04/19/2024]
Abstract
INTRODUCTION Acute pancreatitis is an acute inflammatory process of the pancreas with a high prevalence rate and varying degrees of severity that can be potentially life threatening. Much is still unknown about which mechanisms determine the course and severity of acute pancreatitis. The primary objective of this review is to identify the potential association between circulating B and T lymphocytes and the severity of acute pancreatitis. Subgroup analyses will be done according to the severity classification of the Revised Atlanta Classification System as well as according to the distinction between B lymphocytes and T lymphocytes and the severity of acute pancreatitis. METHODS A systematic search will be performed in Medline, Web of Science, EMBASE, Cochrane Central Register of Controlled trials and ClinicalTrials.gov. Three authors will independently do the selection process as well as data extraction that will be recorded into a flow diagram following the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols (PRISMA-P). The pathophysiology of acute pancreatitis is still not fully understood and its evolution is sometimes unpredictable. In this context, through this systematic review, the research team intends to determine what has been described about the role of serum lymphocytes in determining the severity of acute pancreatitis, by identifying a potential indicator of the severity of this acute disease.
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Affiliation(s)
- Filipa Malheiro
- Serviço de Medicina Interna. Hospital da Luz. Lisboa; NOVA Medical School. Universidade NOVA de Lisboa. Lisboa. Portugal
| | | | - Luís Miguel Borrego
- Serviço de Medicina Interna. Hospital da Luz. Lisboa; NOVA Medical School. Universidade NOVA de Lisboa. Lisboa. Portugal
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21
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Mann BK, Bhandohal JS, Kalha I, Fox K, Jean B. Relevance of Procalcitonin Levels as a Marker of Severity and Predictor of Mortality, Initiation and Duration of Antibiotics in Patients Admitted with Acute Pancreatitis: A Retrospective Cohort Study. Clin Exp Gastroenterol 2024; 17:31-39. [PMID: 38352170 PMCID: PMC10863456 DOI: 10.2147/ceg.s453345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Accepted: 02/07/2024] [Indexed: 02/16/2024] Open
Abstract
Introduction Procalcitonin levels have been studied to predict the benefit of adding antibiotics in a patient with acute pancreatitis. Through this study, we are searching for any possible correlation between serum procalcitonin levels and the severity of acute pancreatitis (included acute on chronic cases) to determine whether procalcitonin levels can predict a benefit from antibiotic therapy in acute pancreatitis. Methods This is a retrospective cohort study involving patients with acute pancreatitis and acute on chronic pancreatitis. We included all hospitalized patients admitted to Kern Medical from January 2020 to October 2022 with a diagnosis of acute pancreatitis in a consecutive manner. The primary outcome studied was mortality related to the pancreatitis episode. Logistic regression was used to control numerous confounders. Results Based on univariate analysis of procalcitonin, we found starting antibiotics on the day of admission statistically significant. We also found the median differences in mortality to be mildly significant (difference = 0.79, p = 0.0640) based on procalcitonin values. In a multivariate analysis of ln(procalcitonin), we found lipase (p = 0.0249), duration of antibiotics (p = 0.0009), multi-organ failure (p = 0.0045) to be statistically significant, and lactate being mildly significant in the multivariate model (p = 0.0643). Conclusion The procalcitonin level can predict the initiation of antibiotics, duration of antibiotics, multi-organ failure, and mortality in patients with acute pancreatitis.
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Affiliation(s)
- Baldeep Kaur Mann
- Division of Hospital Medicine, Department of Medicine, Kern Medical Center, Bakersfield, CA, USA
| | - Janpreet Singh Bhandohal
- Division of Hospital Medicine, Department of Medicine, Kern Medical Center, Bakersfield, CA, USA
| | - Ishaan Kalha
- Division of Gastroenterology, Department of Medicine, Kern Medical Center, Bakersfield, CA, USA
| | - Kasey Fox
- Division of Hospital Medicine, Department of Medicine, Kern Medical Center, Bakersfield, CA, USA
| | - Brian Jean
- Biostatistician, Professor Emeritus, Kern Medical Center, Bakersfield, CA, USA
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22
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Alkabbani SS, AlHalak RH, Al Smady MN, Alsaraj F. The epidemiology of acute pancreatitis in a tertiary care hospital in Dubai. Ann Afr Med 2024; 23:36-39. [PMID: 38358169 PMCID: PMC10922180 DOI: 10.4103/aam.aam_107_23] [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: 07/05/2023] [Revised: 09/25/2023] [Accepted: 10/03/2023] [Indexed: 02/16/2024] Open
Abstract
Background 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. Materials and Methods 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. Results 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%. Conclusion 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.
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Affiliation(s)
- Sarah S. Alkabbani
- College of Medicine, Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai, UAE
| | - Rouzy H. AlHalak
- College of Medicine, Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai, UAE
| | - Montaser N. Al Smady
- College of Medicine, Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai, UAE
| | - Fuad Alsaraj
- Department of Endocrinology, Mediclinic Parkview Hospital, Dubai, UAE
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23
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Capurso G, Ponz de Leon Pisani R, Lauri G, Archibugi L, Hegyi P, Papachristou GI, Pandanaboyana S, Maisonneuve P, Arcidiacono PG, de‐Madaria E. Clinical usefulness of scoring systems to predict severe acute pancreatitis: A systematic review and meta-analysis with pre and post-test probability assessment. United European Gastroenterol J 2023; 11:825-836. [PMID: 37755341 PMCID: PMC10637128 DOI: 10.1002/ueg2.12464] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2023] [Accepted: 08/05/2023] [Indexed: 09/28/2023] Open
Abstract
BACKGROUND Scoring systems for severe acute pancreatitis (SAP) prediction should be used in conjunction with pre-test probability to establish post-test probability of SAP, but data of this kind are lacking. OBJECTIVE To investigate the predictive value of commonly employed scoring systems and their usefulness in modifying the pre-test probability of SAP. METHODS Following PRISMA statement and MOOSE checklists after PROSPERO registration, PubMed was searched from inception until September 2022. Retrospective, prospective, cross-sectional studies or clinical trials on patients with acute pancreatitis defined as Revised Atlanta Criteria, reporting rate of SAP and using at least one score among Bedside Index for Severity in Acute Pancreatitis (BISAP), Acute Physiology and Chronic Health Examination (APACHE)-II, RANSON, and Systemic Inflammatory Response Syndrome (SIRS) with their sensitivity and specificity were included. Random effects model meta-analyses were performed. Pre-test probability and likelihood ratio (LR) were combined to estimate post-test probability on Fagan nomograms. Pooled severity rate was used as pre-test probability of SAP and pooled sensitivity and specificity to calculate LR and generate post-test probability. A priori hypotheses for heterogeneity were developed and sensitivity analyses planned. RESULTS 43 studies yielding 14,116 acute pancreatitis patients were included: 42 with BISAP, 30 with APACHE-II, 27 with Ranson, 8 with SIRS. Pooled pre-test probability of SAP ranged 16.6%-25.3%. The post-test probability of SAP with positive/negative score was 47%/6% for BISAP, 43%/5% for APACHE-II, 48%/5% for Ranson, 40%/12% for SIRS. In 18 studies comparing BISAP, APACHE-II, and Ranson in 6740 patients with pooled pre-test probability of SAP of 18.7%, post-test probability when scores were positive was 48% for BISAP, 46% for APACHE-II, 50% for Ranson. When scores were negative, post-test probability dropped to 7% for BISAP, 6% for Ranson, 5% for APACHE-II. Quality, design, and country of origin of the studies did not explain the observed high heterogeneity. CONCLUSIONS The most commonly used scoring systems to predict SAP perform poorly and do not aid in decision-making.
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Affiliation(s)
- Gabriele Capurso
- Pancreato‐Biliary Endoscopy and Endosonography DivisionPancreas Translational & Clinical Research CenterSan Raffaele Scientific Institute IRCCSVita‐Salute San Raffaele UniversityMilanItaly
| | - Ruggero Ponz de Leon Pisani
- Pancreato‐Biliary Endoscopy and Endosonography DivisionPancreas Translational & Clinical Research CenterSan Raffaele Scientific Institute IRCCSVita‐Salute San Raffaele UniversityMilanItaly
| | - Gaetano Lauri
- Pancreato‐Biliary Endoscopy and Endosonography DivisionPancreas Translational & Clinical Research CenterSan Raffaele Scientific Institute IRCCSVita‐Salute San Raffaele UniversityMilanItaly
| | - Livia Archibugi
- Pancreato‐Biliary Endoscopy and Endosonography DivisionPancreas Translational & Clinical Research CenterSan Raffaele Scientific Institute IRCCSVita‐Salute San Raffaele UniversityMilanItaly
| | - Peter Hegyi
- Centre for Translational MedicineSemmelweis UniversityBudapestHungary
- Institute of Pancreatic DiseasesSemmelweis UniversityBudapestHungary
- Translational Pancreatology Research GroupInterdisciplinary Centre of Excellence for Research Development and Innovation University of SzegedSzegedHungary
| | - Georgios I. Papachristou
- Division of Gastroenterology, Hepatology, and NutritionThe Ohio State UniversityWexner Medical CenterColumbusOhioUSA
| | - Sanjay Pandanaboyana
- Department of Hepato‐Pancreato‐Biliary and Transplant SurgeryThe Freeman HospitalNewcastle upon TyneTyne and WearUK
- Population Health Sciences InstituteNewcastle UniversityNewcastleUK
| | - Patrick Maisonneuve
- Division of Epidemiology and BiostatisticsIEO European Institute of OncologyMilanItaly
| | - Paolo Giorgio Arcidiacono
- Pancreato‐Biliary Endoscopy and Endosonography DivisionPancreas Translational & Clinical Research CenterSan Raffaele Scientific Institute IRCCSVita‐Salute San Raffaele UniversityMilanItaly
| | - Enrique de‐Madaria
- Gastroenterology DepartmentDr. Balmis General University HospitalISABIALAlicanteSpain
- Department of Clinical MedicineMiguel Hernández UniversityElcheSpain
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24
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Cazacu SM, Parscoveanu M, Cartu D, Moraru E, Rogoveanu I, Ungureanu BS, Iordache S, Florescu DN, Iovanescu VF, Dragomir MI. NLR48 is Better Than CRP, and mCTSI, and Similar to BISAP and SOFA Scores for Mortality Prediction in Acute Pancreatitis: A Comparison of 6 Scores. J Inflamm Res 2023; 16:4793-4804. [PMID: 37881651 PMCID: PMC10596122 DOI: 10.2147/jir.s432408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Accepted: 10/10/2023] [Indexed: 10/27/2023] Open
Abstract
Introduction The neutrophil-lymphocyte ratio (NLR) has been suggested as a reliable marker for predicting inflammation progression and severity of acute pancreatitis, although the role of the NLR stratified by etiology is still insufficiently studied. However, the NLR's role in mortality prediction was poorly evaluated in the literature. Patients and Methods We performed a retrospective, cross-sectional study to analyze the role of NLR0 (at admission) and NLR48 (at 48 hours) in acute pancreatitis as compared with CRP, BISAP, SOFA, and modified CTSI (mCTSI) for the prediction of mortality and severe acute pancreatitis (SAP) in patients admitted into the Emergency Clinical County Hospital of Craiova during 48 months. The primary assessed outcomes were the rate of in-hospital mortality, the rate of persistent organ failure, and ICU admissions. We analyzed mortality prediction for all acute pancreatitis, for biliary, alcoholic, and hypertriglyceridemic acute pancreatitis, for severe forms, and for patients admitted to the ICU. Results A total of 725 patients were selected; 42.4% had biliary acute pancreatitis, 27.7% had alcoholic acute pancreatitis, and 8.7% had hypertriglyceridemia-induced acute pancreatitis. A total of 13.6% had POF during admission. The AUC for NLR48 in predicting mortality risk and SAP was 0.81 and 0.785, superior to NLR0, CRP48, and mCTSI but inferior to BISAP and SOFA scores. The NLR48/NLR0 ratio did not add significantly to the accuracy. NLR0 and NLR48 performed poorly for mortality prediction in severe forms and in patients admitted to the ICU. NLR48 has good accuracy in our study for predicting death risk in biliary and alcoholic acute pancreatitis but not in hypertriglyceridemic acute pancreatitis. Conclusion NLR48 was a good indicator in predicting mortality risk and severe forms in all patients with acute pancreatitis, but not of death in SAP and in patients admitted to ICU, with good accuracy for predicting death risk in biliary and alcoholic acute pancreatitis but not in hypertriglyceridemic acute pancreatitis.
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Affiliation(s)
- Sergiu Marian Cazacu
- Gastroenterology Department, University of Medicine and Pharmacy Craiova, Clinical Emergency Hospital Craiova, Craiova, Romania
| | - Mircea Parscoveanu
- Surgery Department, University of Medicine and Pharmacy Craiova, Clinical Emergency Hospital Craiova, Craiova, Romania
| | - Dan Cartu
- Surgery Department, University of Medicine and Pharmacy Craiova, Clinical Emergency Hospital Craiova, Craiova, Romania
| | - Emil Moraru
- Surgery Department, University of Medicine and Pharmacy Craiova, Clinical Emergency Hospital Craiova, Craiova, Romania
| | - Ion Rogoveanu
- Gastroenterology Department, University of Medicine and Pharmacy Craiova, Clinical Emergency Hospital Craiova, Craiova, Romania
| | - Bogdan Silviu Ungureanu
- Gastroenterology Department, University of Medicine and Pharmacy Craiova, Clinical Emergency Hospital Craiova, Craiova, Romania
| | - Sevastita Iordache
- Gastroenterology Department, University of Medicine and Pharmacy Craiova, Clinical Emergency Hospital Craiova, Craiova, Romania
| | - Dan Nicolae Florescu
- Gastroenterology Department, University of Medicine and Pharmacy Craiova, Clinical Emergency Hospital Craiova, Craiova, Romania
| | - Vlad Florin Iovanescu
- Gastroenterology Department, University of Medicine and Pharmacy Craiova, Clinical Emergency Hospital Craiova, Craiova, Romania
| | - Manuela Iuliana Dragomir
- Public Health Management Department, University of Medicine and Pharmacy Craiova, Craiova, Romania
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Hu JX, Zhao CF, Wang SL, Tu XY, Huang WB, Chen JN, Xie Y, Chen CR. Acute pancreatitis: A review of diagnosis, severity prediction and prognosis assessment from imaging technology, scoring system and artificial intelligence. World J Gastroenterol 2023; 29:5268-5291. [PMID: 37899784 PMCID: PMC10600804 DOI: 10.3748/wjg.v29.i37.5268] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Revised: 07/31/2023] [Accepted: 09/14/2023] [Indexed: 09/25/2023] Open
Abstract
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.
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Affiliation(s)
- Jian-Xiong Hu
- Intensive Care Unit, The Affiliated Hospital of Putian University, Putian 351100, Fujian Province, China
| | - Cheng-Fei Zhao
- School of Pharmacy and Medical Technology, Putian University, Putian 351100, Fujian Province, China
- Key Laboratory of Pharmaceutical Analysis and Laboratory Medicine, Putian University, Putian 351100, Fujian Province, China
| | - Shu-Ling Wang
- Department of Critical Care Medicine, Fujian Medical University Union Hospital, Fuzhou 350001, Fujian Province, China
| | - Xiao-Yan Tu
- Department of Critical Care Medicine, Fujian Medical University Union Hospital, Fuzhou 350001, Fujian Province, China
| | - Wei-Bin Huang
- Department of Critical Care Medicine, Fujian Medical University Union Hospital, Fuzhou 350001, Fujian Province, China
| | - Jun-Nian Chen
- Department of Critical Care Medicine, Fujian Medical University Union Hospital, Fuzhou 350001, Fujian Province, China
| | - Ying Xie
- School of Mechanical, Electrical and Information Engineering, Putian University, Putian 351100, Fujian Province, China
| | - Cun-Rong Chen
- Department of Critical Care Medicine, Fujian Medical University Union Hospital, Fuzhou 350001, Fujian Province, China
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26
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Lin XY, Lai YX, Lin Y, Lin ZH. Low-grade inflammation for predicting severe acute pancreatitis in patients with hypertriglyceridemic acute pancreatitis. J Dig Dis 2023; 24:562-569. [PMID: 37796144 DOI: 10.1111/1751-2980.13231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Revised: 08/30/2023] [Accepted: 10/04/2023] [Indexed: 10/06/2023]
Abstract
OBJECTIVES We aimed to evaluate the association between low-grade inflammation (LGI) and the severity of hypertriglyceridemic acute pancreatitis (HTG-AP). METHODS We retrospectively reviewed 311 patients with HTG-AP who were admitted to the Department of Gastroenterology, Fujian Provincial Hospital between April 2012 and March 2021. Inpatient medical and radiological records were reviewed to collect the clinical manifestations, disease severity, and comorbidities. C-reactive protein (CRP) level, white blood cell (WBC) count, platelet (PLT) count, and neutrophil-to-lymphocyte ratio (NLR) were considered LGI components and were combined to calculate a standardized LGI score. The association between the LGI score and the severity of HTG-AP was analyzed using univariate and multivariate logistic regression analyses. RESULTS Of the 311 patients with HTG-AP, 47 (15.1%) had mild acute pancreatitis (MAP), 184 (59.2%) had moderately severe acute pancreatitis (MSAP), and 80 (25.7%) had severe acute pancreatitis (SAP), respectively. Patients with MSAP and SAP had a higher LGI score than those with MAP (1.50 vs -6.00, P < 0.001). Univariate logistic regression analysis revealed that patients with LGI scores in the fourth quartile were more likely to have MSAP and SAP (odds ratio [OR] 21.925, 95% confidence interval [CI] 5.014-95.867, P < 0.001). The multivariate logistic regression analysis confirmed that low calcium (OR 0.105, 95% CI 0.011-0.969, P = 0.047) and high LGI score (OR 1.253, 95% CI 1.066-1.473, P = 0.006) were associated with MSAP and SAP. When predicting the severity of acute pancreatitis, the LGI score had the highest area under the receiver operating characteristic (ROC) curve (0.7737) compared to its individual components. CONCLUSION An elevated LGI score was associated with a higher risk of SAP in patients with HTG-AP.
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Affiliation(s)
- Xue Yan Lin
- Department of Gastroenterology, Fujian Provincial Hospital, Shengli Clinical Medical College of Fujian Medical University, Fuzhou, Fujian Province, China
| | - Yong Xing Lai
- Department of Gerontology, Fujian Provincial Hospital, Shengli Clinical Medical College of Fujian Medical University, Fuzhou, Fujian Province, China
| | - Yi Lin
- Department of Gastroenterology, Fujian Provincial Hospital, Shengli Clinical Medical College of Fujian Medical University, Fuzhou, Fujian Province, China
| | - Zhi Hui Lin
- Department of Gastroenterology, Fujian Provincial Hospital, Shengli Clinical Medical College of Fujian Medical University, Fuzhou, Fujian Province, China
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Barrera Gutierrez JC, Greenburg I, Shah J, Acharya P, Cui M, Vivian E, Sellers B, Kedia P, Tarnasky PR. Severe Acute Pancreatitis Prediction: A Model Derived From a Prospective Registry Cohort. Cureus 2023; 15:e46809. [PMID: 37954725 PMCID: PMC10636501 DOI: 10.7759/cureus.46809] [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] [Accepted: 10/10/2023] [Indexed: 11/14/2023] Open
Abstract
Background Severe acute pancreatitis (SAP) has a mortality rate as high as 40%. Early identification of SAP is required to appropriately triage and direct initial therapies. The purpose of this study was to develop a prognostic model that identifies patients at risk for developing SAP of patients managed according to a guideline-based standardized early medical management (EMM) protocol. Methods This single-center study included all patients diagnosed with acute pancreatitis (AP) and managed with the EMM protocol Methodist Acute Pancreatitis Protocol (MAPP) between April 2017 and September 2022. Classification and regression tree (CART®; Professional Extended Edition, version 8.0; Salford Systems, San Diego, CA), univariate, and logistic regression analyses were performed to develop a scoring system for AP severity prediction. The accuracy of the scoring system was measured by the area under the receiver operating characteristic curve. Results A total of 516 patients with mild (n=436) or moderately severe and severe (n=80) AP were analyzed. CART analysis identified the cutoff values: creatinine (CR) (1.15 mg/dL), white blood cells (WBC) (10.5 × 109/L), procalcitonin (PCT) (0.155 ng/mL), and systemic inflammatory response system (SIRS). The prediction model was built with a multivariable logistic regression analysis, which identified CR, WBC, PCT, and SIRS as the main predictors of severity. When CR and only one other predictor value (WBC, PCT, or SIRS) met thresholds, then the probability of predicting SAP was >30%. The probability of predicting SAP was 72% (95%CI: 0.59-0.82) if all four of the main predictors were greater than the cutoff values. Conclusions Baseline laboratory cutoff values were identified and a logistic regression-based prognostic model was developed to identify patients treated with a standardized EMM who were at risk for SAP.
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Affiliation(s)
| | - Ian Greenburg
- Gastroenterology Fellowship Program, Methodist Health System, Dallas, USA
| | - Jimmy Shah
- Methodist Digestive Institute, Methodist Health System, Dallas, USA
| | - Priyanka Acharya
- Clinical Research Institute, Methodist Health System, Dallas, USA
| | - Mingyang Cui
- Methodist Digestive Institute, Methodist Health System, Dallas, USA
| | - Elaina Vivian
- Performance Improvement, Methodist Health System, Dallas, USA
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Sbeit W, Abu Elheja F, Msheiil B, Shahin A, Khoury S, Sbeit M, Khoury T. Fatty pancreas was associated with a higher acute pancreatitis Systemic Inflammatory Response Syndrome score at hospital admission. Eur J Gastroenterol Hepatol 2023; 35:980-984. [PMID: 37395190 DOI: 10.1097/meg.0000000000002606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/04/2023]
Abstract
BACKGROUND Pancreatic fat infiltration was shown to be linked with acute pancreatitis and probably its severity. These interesting findings merit more investigation to elucidate the effect of fatty pancreas on acute pancreatitis severity. METHODS We performed a retrospective study of patients hospitalized with documented acute pancreatitis. Pancreatic fat was determined according to pancreas attenuation on computed tomography. Patients were divided into two groups, with and without fatty pancreas. The Systemic Inflammatory Response Syndrome (SIRS) score was compared. RESULTS Overall, 409 patients were hospitalized with acute pancreatitis. Among them, 48 patients had fatty pancreas (group A), vs. 361 patients who did not (group B). The mean ± SD age in group A was 54.6 ± 21.3, vs. 57.6 ± 16.8 in group B ( P = 0.51). Patients in group A, had a significantly higher rate of fatty liver, as compared to group B (85.4% vs. 35.5%, P < 0.001). There was no significant difference in the medical history among the two groups. Fatty pancreas was associated with more severe acute pancreatitis as assessed by SIRS score at admission. The mean ± SD of SIRS score was significantly higher in group A (0.92 ± 0.87), as compared to 0.59 ± 0.74 in group B ( P = 0.009). Positive SIRS score was present in a significantly higher proportion of patients with fatty pancreas (25%), as compared to only 11.4% in group B ( P = 0.02). CONCLUSION The occurrence of acute pancreatitis with higher SIRS score was significantly associated with fatty pancreas. Fatty pancreas may represent a predictor of acute pancreatitis severity.
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Affiliation(s)
- Wisam Sbeit
- Gastroenterology Department, Galilee Medical Center, Nahariya
- Azrieli Faculty of Medicine, Bar-Ilan University, Safed
| | - Fares Abu Elheja
- Gastroenterology Department, Galilee Medical Center, Nahariya
- Azrieli Faculty of Medicine, Bar-Ilan University, Safed
| | - Botros Msheiil
- Azrieli Faculty of Medicine, Bar-Ilan University, Safed
- Radiology Department, Galilee Medical Center, Nahariya 2210001, Israel
| | - Amir Shahin
- Gastroenterology Department, Galilee Medical Center, Nahariya
- Azrieli Faculty of Medicine, Bar-Ilan University, Safed
| | - Sharbel Khoury
- Azrieli Faculty of Medicine, Bar-Ilan University, Safed
- Radiology Department, Galilee Medical Center, Nahariya 2210001, Israel
| | - Moeen Sbeit
- Azrieli Faculty of Medicine, Bar-Ilan University, Safed
| | - Tawfik Khoury
- Gastroenterology Department, Galilee Medical Center, Nahariya
- Azrieli Faculty of Medicine, Bar-Ilan University, Safed
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Kim DH, Lukens FJ, Ko D, Kröner PT, Salazar M, Raimondo M, Palacios Argueta P. Modified Bedside Index for severity in acute pancreatitis (BISAP) score validation in the national inpatient sample database. Adv Med Sci 2023; 68:208-212. [PMID: 37329692 DOI: 10.1016/j.advms.2023.05.004] [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: 12/15/2022] [Revised: 03/08/2023] [Accepted: 05/31/2023] [Indexed: 06/19/2023]
Abstract
PURPOSE The aim of this study was to build and validate modified score to be used in the healthcare cost and utilization project databases for further classification of acute pancreatitis (AP). MATERIALS AND METHODS The National Inpatient Sample database for the years 2016-2019 was queried for all primary adult discharge diagnoses of AP. An mBISAP score system was created utilizing the ICD-10CM codes for pleural effusion, encephalopathy, acute kidney injury, systemic inflammatory response, and age >60. Each was assigned a 1-point score. A multivariable regression analysis was built to test for mortality. Sensitivity and specificity analyses were performed for mortality. RESULTS A total of 1,160,869 primary discharges for AP were identified between 2016 and 2019. The pooled mortality rate was: 0.1%, 0.5%, 2.9%, 12.7%, 30.9% and 17.8% (P < 0.01), respectively for scores 0 to 5. Multivariable regression analysis showed increasing odds of mortality with each one-point increment: mBISAP score of 1 (adjusted odds ratio [aOR] 6.67; 95% confidence interval [CI] 4.69-9.48), score of 2 (aOR 37.87; 95% CI 26.05- 55.03), score of 3 (aOR 189.38; 95% CI 127.47-281.38), score of 4 (aOR 535.38; 95% CI 331.74-864.02), score of 5 (aOR 184.38; 95% CI 53.91-630.60). Using a cut-off of ≥3, sensitivity and specificity analyses reported 27.0% and 97.7%, respectively, with an area under the curve (AUC) of 0.811. CONCLUSION In this 4-year retrospective study of a US representative database, an mBISAP score was constructed showing increasing odds of mortality with each 1-point increase and a specificity of 97.7% for a cut-off of ≥3.
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Affiliation(s)
- Do Han Kim
- Universidad Francisco Marroquin, School of Medicine, Guatemala City, Guatemala
| | - Frank J Lukens
- Gastroenterology and Hepatology Department, Mayo Clinic Florida, Jacksonville, FL, USA
| | - Donghyun Ko
- Universidad Francisco Marroquin, School of Medicine, Guatemala City, Guatemala
| | - Paul T Kröner
- Department of Gastroenterology, Riverside Regional Medical Center, Newport News, VA, USA
| | - Miguel Salazar
- Gastroenterology and Hepatology Department, University of California Riverside, Riverside, CA, USA
| | - Massimo Raimondo
- Gastroenterology and Hepatology Department, Mayo Clinic Florida, Jacksonville, FL, USA
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Luo X, Wang J, Wu Q, Peng P, Liao G, Liang C, Yang H, Huang J, Qin M. A modified Ranson score to predict disease severity, organ failure, pancreatic necrosis, and pancreatic infection in patients with acute pancreatitis. Front Med (Lausanne) 2023; 10:1145471. [PMID: 37332769 PMCID: PMC10273837 DOI: 10.3389/fmed.2023.1145471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Accepted: 05/19/2023] [Indexed: 06/20/2023] Open
Abstract
Background Although there are several scoring systems currently used to predict the severity of acute pancreatitis, each of them has limitations. Determine the accuracy of a modified Ranson score in predicting disease severity and prognosis in patients with acute pancreatitis (AP). Methods AP patients admitted or transferred to our institution were allocated to a modeling group (n = 304) or a validation group (n = 192). A modified Ranson score was determined by excluding the fluid sequestration parameter and including the modified computed tomography severity index (CTSI). The diagnostic performance of the modified Ranson score was compared with the Ranson score, modified CTSI, and bedside index of severity in acute pancreatitis (BISAP) score in predicting disease severity, organ failure, pancreatic necrosis and pancreatic infection. Results The modified Ranson score had significantly better accuracy that the Ranson score in predicting all four outcome measures in the modeling group and in the validation group (all p < 0.05). For the modeling group the modified Ranson score had the best accuracy for predicting disease severity and organ failure, and second-best accuracy for predicting pancreatic necrosis and pancreatic infection. For the verification group, it had the best accuracy for predicting organ failure, second-best accuracy for predicting disease severity and pancreatic necrosis, and third-best accuracy for predicting pancreatic infection. Conclusion The modified Ranson score provided better accuracy than the Ranson score in predicting disease severity, organ failure, pancreatic necrosis and pancreatic infection. Relative to the other scoring systems, the modified Ranson system was superior in predicting organ failure.
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Affiliation(s)
- Xiuping Luo
- Department of Gastroenterology, The Second Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Jie Wang
- Department of Gastroenterology, The Second Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Qing Wu
- Department of Gastroenterology, The Second Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Peng Peng
- Department of Gastroenterology, The Second Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Guolin Liao
- Department of Gastroenterology, The Second Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Chenghai Liang
- Department of Gastroenterology, The Second Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Huiying Yang
- Department of Gastroenterology, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Jiean Huang
- Department of Gastroenterology, The Second Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Mengbin Qin
- Department of Gastroenterology, The Second Affiliated Hospital of Guangxi Medical University, Nanning, China
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Yaowmaneerat T, Sirinawasatien A. Update on the strategy for intravenous fluid treatment in acute pancreatitis. World J Gastrointest Pharmacol Ther 2023; 14:22-32. [PMID: 37179816 PMCID: PMC10167805 DOI: 10.4292/wjgpt.v14.i3.22] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2023] [Revised: 03/21/2023] [Accepted: 04/18/2023] [Indexed: 04/27/2023] Open
Abstract
Fluid therapy/resuscitation is mandatory in acute pancreatitis due to the pathophysiology of fluid loss as a consequence of the inflammatory process. For many years, without clear evidence, early and aggressive fluid resuscitation with crystalloid solutions (normal saline solution or Ringer lactate solution) was recommended. Recently, many randomized control trials and meta-analyses on fluid therapy have revealed that high fluid rate infusion is associated with increased mortality and severe adverse events compared to those resulting from moderate fluid rates, and this has triggered a paradigm shift in fluid management strategies. Meanwhile, there is evidence to show that Ringer lactate solution is superior to normal saline solutions in this context. The purpose of this review is to provide an update on the strategies for intravenous fluid treatment in acute pancreatitis, including the type, optimal amount, rate of infusion, and monitoring guides. Recommendations from recent guidelines are critically evaluated for this review in order to reach the authors' recommendations based on the available evidence.
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Affiliation(s)
- Thanapon Yaowmaneerat
- Nanthana-Kriangkrai Chotiwattanaphan Institute of Gastroenterology and Hepatology, Faculty of Medicine, Prince of Songkla University, Hat Yai , Songkhla 90110, Thailand
| | - Apichet Sirinawasatien
- Department of Medicine, Division of Gastroenterology, Rajavithi Hospital, College of Medicine, Rangsit University, Bangkok 10400, Thailand
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Madrigal TPR, Panlilio MTT, Burog AILD, Danguilan RA, Chavez JR. Incidence of acute pancreatitis among patients with leptospirosis requiring extracorporeal membrane oxygenation (ECMO): a descriptive study. BMJ Open Gastroenterol 2023; 10:e001094. [PMID: 36927735 PMCID: PMC10030540 DOI: 10.1136/bmjgast-2022-001094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Accepted: 03/05/2023] [Indexed: 03/18/2023] Open
Abstract
BACKGROUND Acute pancreatitis (AP) is an infrequently reported manifestation of leptospirosis. It is more commonly seen in patients with acute respiratory distress syndrome. Despite novel modalities such as extracorporeal membrane oxygenation (ECMO), the mortality rate remains high and whether this is associated with the lung injury caused by the inflammation in AP remains unclear. OBJECTIVES AND METHODS A descriptive study was conducted at a tertiary hospital in the Philippines. Primary outcome was defined as the presence or absence of AP. Secondary outcomes were defined as 28-day mortality rate, length of hospital stay, ECMO days, renal replacement therapy (RRT) days, days on mechanical ventilation, presence of local complications of AP and development of nosocomial infections. RESULTS A total of 27 patients were included in the study, and 88.89% (n=24) were men. The mean age for all patients was 33.59±10.22 years. Out of the 27 patients, 19 (70.37%) were diagnosed with AP. Among these 19 patients, one (5.26%) had necrotising pancreatitis and two (10.52%) developed local complications of pancreatitis. Six patients (31.58%) died among those who developed AP, while one (12.50%) died among those who did not. The duration of hospital stay, ECMO, RRT, mechanical ventilation and development of nosocomial infections was also higher in the group who presented with AP. CONCLUSION AP is an under-reported complication of leptospirosis. Our study demonstrated a higher mortality and morbidity in patients with leptospirosis who developed AP.
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Affiliation(s)
- Tristan Paulo R Madrigal
- Division of Internal Medicine, National Kidney and Transplant Institute, Quezon City, Philippines
| | - Mara Teresa T Panlilio
- Division of Internal Medicine, National Kidney and Transplant Institute, Quezon City, Philippines
| | | | - Romina A Danguilan
- Division of Adult Nephrology, National Kidney and Transplant Institute, Quezon City, Philippines
| | - Joselito R Chavez
- Division of Internal Medicine, National Kidney and Transplant Institute, Quezon City, Philippines
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Muacevic A, Adler JR, Arora JK, Soni RK. Comparative Evaluation of Harmless Acute Pancreatitis Score (HAPS) and Bedside Index of Severity in Acute Pancreatitis (BISAP) Scoring System in the Stratification of Prognosis in Acute Pancreatitis. Cureus 2022; 14:e32540. [PMID: 36654581 PMCID: PMC9840061 DOI: 10.7759/cureus.32540] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/14/2022] [Indexed: 12/23/2022] Open
Abstract
Acute pancreatitis is a common disease in patients presenting to the emergency room in any hospital. The most common causes are alcohol ingestion and gallstone disease. Diagnosis is usually based on clinical findings and elevated serum amylase and lipase levels. Imaging is often not necessary but may be used to confirm the diagnosis or rule out any other pathology or to evaluate for any complications. The majority of patients will have a mild, self-limiting disease but others may develop a severe fulminant course with organ failure. These patients are at high risk of developing complications, morbidity or mortality. Treatment of acute pancreatitis includes supportive treatment with antibiotics, fluids, analgesics and early enteral feeding. Several scores have been developed to predict the course of pancreatitis and help make informed decisions, monitoring and timely intervention. The majority of them are complicated, require extensive and expensive interventions or require time. Harmless acute pancreatitis score (HAPS) is one such score that is easy to calculate and is done at the time of admission, bedside index of severity in acute pancreatitis (BISAP) is another one requiring more parameters. The parameters used to calculate it are easily available and can be done at a majority of healthcare facilities in developing countries. HAPS thus seems to be a good option in aiding doctors in assessing acute pancreatitis. It may be considered as a standard scoring for acute pancreatitis for early and effective management. We have tried to study and compare the superiority of HAPS over BISAP in predicting prognosis in acute pancreatitis.
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Muacevic A, Adler JR. Predicting the Success of Catheter Drainage in Infected Necrotising Pancreatitis: A Cross-Sectional Observational Study. Cureus 2022; 14:e32289. [PMID: 36505951 PMCID: PMC9728500 DOI: 10.7759/cureus.32289] [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: 12/07/2022] [Indexed: 12/12/2022] Open
Abstract
Background Management of acute necrotising pancreatitis is often challenging for clinicians. Secondary infection of the necrotic collections leads to sepsis and warrants intervention. Minimally invasive techniques like catheter drainage have recently been proposed over more risky and morbid traditional open procedures. Factors that can predict successful catheter drainage of the necrotic pancreatic collection are still unclear and not well established. Materials and methods This study is designed as a retrospective cross-sectional observational study to investigate the association of 21 factors in predicting successful catheter drainage. Data from 30 patients admitted with acute necrotising pancreatitis treated with catheter drainage were collected and analysed. Twenty-one factors, including demographic variables, disease severity factors, drainage criteria, and morphological criteria on imaging, were studied for their predictive association with successful outcomes. Univariate analysis was done for each variable against the outcome. The study was conducted between December 2012 to March 2017. P-value <0.05 was considered statistically significant. Results Patients with no organ involvement responded better to primary catheter drainage. Patients with BMI>25 and multi-organ failure were poor candidates for primary catheter drainage. Clinically unwell patients with a Bedside Index for Severity in Acute Pancreatitis (BISAP) score of ≥4 had a negative outcome on catheter drainage and usually ended up in a surgical procedure or eventually succumbed to the disease. Other variables included in our study did not statistically associate with the success or failure of percutaneous catheter drainage. Conclusion BMI >25, multiple organ failure, and BISAP score ≥ 4 are independent negative predictors for the success of catheter drainage in infected necrotising pancreatitis. No organ failure showed a positive predictor for successful catheter drainage. Further studies are required to explore these predictive factors in a larger sample size to predict the success of catheter drainage in infected pancreatic necrosis.
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Song LJ, Xiao B. Medical imaging for pancreatic diseases: Prediction of severe acute pancreatitis complicated with acute respiratory distress syndrome. World J Gastroenterol 2022; 28:6206-6212. [PMID: 36504558 PMCID: PMC9730435 DOI: 10.3748/wjg.v28.i44.6206] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Revised: 10/15/2022] [Accepted: 11/17/2022] [Indexed: 02/06/2023] Open
Abstract
In this editorial we comment on the article published in the recent issue of the World Journal of Gastroenterology [2022; 28 (19): 2123-2136]. We pay attention to how to construct a simpler and more reliable new clinical predictive model to early identify patients at high risk of acute respiratory distress syndrome (ARDS) associated with severe acute pancreatitis (SAP), and to early predict the severity of organ failure from chest computed tomography (CT) findings in SAP patients. As we all know, SAP has a sudden onset, is a rapidly changing condition, and can be complicated with ARDS and even multiple organ dysfunction syndrome, and its mortality rate has remained high. At present, there are many clinical scoring systems for AP, including the bedside index for severity in AP, acute physiology and chronic health evaluation II, systemic inflammatory response syndrome, Japanese severe score, quick sepsis-related organ failure assessment, etc. However, some of these scoring systems are complex and require multiple and difficult clinical parameters for risk stratification. Although the aforementioned biomarkers are readily available, their ability to predict ARDS varies. Accor-dingly, it is extremely necessary to establish a simple and valuable novel model to predict the development of ARDS in AP. In addition, the extra-pancreatic manifestations of AP patients often involve the chest, among which pleural effusion and pulmonary consolidation are the more common complications. Therefore, by measuring the semi-quantitative indexes of chest CT in AP patients, such as the amount of pleural effusion and the number of lobes involved as pulmonary consolidation, it has important reference value for the early diagnosis of SAP complicated with ARDS and is expected to provide a basis for the early treatment of ARDS.
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Affiliation(s)
- Ling-Ji Song
- Department of Radiology, Affiliated Hospital of North Sichuan Medical College, Nanchong 637000, Sichuan Province, China
| | - Bo Xiao
- Department of Radiology, Affiliated Hospital of North Sichuan Medical College, Nanchong 637000, Sichuan Province, China
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Chan KS, Shelat VG. Diagnosis, severity stratification and management of adult acute pancreatitis-current evidence and controversies. World J Gastrointest Surg 2022; 14:1179-1197. [PMID: 36504520 PMCID: PMC9727576 DOI: 10.4240/wjgs.v14.i11.1179] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2022] [Revised: 10/08/2022] [Accepted: 10/25/2022] [Indexed: 02/07/2023] Open
Abstract
Acute pancreatitis (AP) is a disease spectrum ranging from mild to severe with an unpredictable natural course. Majority of cases (80%) are mild and self-limiting. However, severe AP (SAP) has a mortality risk of up to 30%. Establishing aetiology and risk stratification are essential pillars of clinical care. Idiopathic AP is a diagnosis of exclusion which should only be used after extended investigations fail to identify a cause. Tenets of management of mild AP include pain control and management of aetiology to prevent recurrence. In SAP, patients should be resuscitated with goal-directed fluid therapy using crystalloids and admitted to critical care unit. Routine prophylactic antibiotics have limited clinical benefit and should not be given in SAP. Patients able to tolerate oral intake should be given early enteral nutrition rather than nil by mouth or parenteral nutrition. If unable to tolerate per-orally, nasogastric feeding may be attempted and routine post-pyloric feeding has limited evidence of clinical benefit. Endoscopic retrograde cholangiopancreatogram should be selectively performed in patients with biliary obstruction or suspicion of acute cholangitis. Delayed step-up strategy including percutaneous retroperitoneal drainage, endoscopic debridement, or minimal-access necrosectomy are sufficient in most SAP patients. Patients should be monitored for diabetes mellitus and pseudocyst.
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Affiliation(s)
- Kai Siang Chan
- Department of General Surgery, Tan Tock Seng Hospital, Singapore 308433, Singapore
| | - Vishal G Shelat
- Department of General Surgery, Tan Tock Seng Hospital, Singapore 308433, Singapore
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore 308232, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore 117597, Singapore
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Macedo Silva V, Freitas M, Sousa Magalhães R, Cúrdia Gonçalves T, Boal Carvalho P, Rosa B, Cotter J. Prognostic scores in post-endoscopic retrograde cholangiopancreatography acute pancreatitis: should we use all, some, or none? Eur J Gastroenterol Hepatol 2022; 34:905-911. [PMID: 35830364 DOI: 10.1097/meg.0000000000002402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
BACKGROUND/AIMS Acute pancreatitis is the most commonly observed adverse event following endoscopic retrograde cholangiopancreatography (ERCP). Early risk stratification is crucial in the management of these patients, to reduce unfavorable outcomes. Multiple prognostic scores are already used in acute pancreatitis, regardless of its etiology. Scarce data is available for their use specifically on post-ERCP acute pancreatitis (PEP). We aimed to compare the accuracy of different prognostic scores at PEP diagnosis for the prediction of a moderate-to-severe course. METHODS Cross-sectional study of consecutive ERCPs performed between 2010 and 2020. The final sample included patients with PEP, with the severity graded according to the Atlanta classification. For each patient, different prognostic scores were calculated. Each score's accuracy for the prediction of a moderate-to-severe course was assessed by analysis of receiving-operating-characteristics (ROC) curves. RESULTS From 2012 ERCPs, 102 (5.1%) were complicated by PEP. From these, 34 (1.7% of all ERCPs) were classified as moderate-to-severe. The scores with the best accuracy in predicting a moderate-to-severe course were the BISAP [ area under curve (AUC) = 0.92], Balthazar (AUC = 0.89) and Glasgow-Imrie (AUC = 0.88) scores, with very good to excellent acuities. APACHE II (AUC = 0.81), Marshall score (AUC = 0.81) and PANC3 score (AUC = 0.76) revealed good accuracies. Ranson's criteria on admission (AUC = 0.70) and HAPS classification (AUC = 0.67) presented less accurate results. Optimal cutoffs for the top scoring classifications were BISAP ≥3 (sensitivity 88.3% and specificity 83.8%), Balthazar ≥2 (sensitivity 84.8% and specificity 85.3%) and Glasgow-Imrie ≥4 (sensitivity 81.0% and specificity 82.6%). CONCLUSION BISAP, Balthazar and Glasgow-Imrie classifications presented the best results for predicting moderate-to-severe PEP, and represent the most useful prognostic scores for risk stratification in this population.
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Affiliation(s)
- Vítor Macedo Silva
- Gastroenterology Department, Hospital da Senhora da Oliveira, Guimarães
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga
- ICVS/3B's, PT Government Associate Laboratory, Braga/Guimarães, Portugal
| | - Marta Freitas
- Gastroenterology Department, Hospital da Senhora da Oliveira, Guimarães
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga
- ICVS/3B's, PT Government Associate Laboratory, Braga/Guimarães, Portugal
| | - Rui Sousa Magalhães
- Gastroenterology Department, Hospital da Senhora da Oliveira, Guimarães
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga
- ICVS/3B's, PT Government Associate Laboratory, Braga/Guimarães, Portugal
| | - Tiago Cúrdia Gonçalves
- Gastroenterology Department, Hospital da Senhora da Oliveira, Guimarães
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga
- ICVS/3B's, PT Government Associate Laboratory, Braga/Guimarães, Portugal
| | - Pedro Boal Carvalho
- Gastroenterology Department, Hospital da Senhora da Oliveira, Guimarães
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga
- ICVS/3B's, PT Government Associate Laboratory, Braga/Guimarães, Portugal
| | - Bruno Rosa
- Gastroenterology Department, Hospital da Senhora da Oliveira, Guimarães
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga
- ICVS/3B's, PT Government Associate Laboratory, Braga/Guimarães, Portugal
| | - José Cotter
- Gastroenterology Department, Hospital da Senhora da Oliveira, Guimarães
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga
- ICVS/3B's, PT Government Associate Laboratory, Braga/Guimarães, Portugal
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Selvanathan DK, Johnson PG, Thanikachalam DK, Rajendran P, Gopalakrishnan N. Acute Kidney Injury Complicating Severe Acute Pancreatitis: Clinical Profile and Factors Predicting Mortality. Indian J Nephrol 2022; 32:460-466. [PMID: 36568598 PMCID: PMC9775600 DOI: 10.4103/ijn.ijn_476_20] [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: 10/05/2020] [Revised: 02/03/2021] [Accepted: 08/20/2021] [Indexed: 12/27/2022] Open
Abstract
Introduction Acute kidney injury (AKI) frequently complicates severe acute pancreatitis (SAP) among the critically ill. We studied clinical profile and risk factors predicting mortality in SAP-AKI. Materials and Methods We conducted a prospective observational study of 68 patients with SAP-AKI from September 2015 to September 2019. Patient data and outcomes grouped as survivors and deceased were analyzed. Results SAP-AKI constituted 2.14% (68 of 3,169) of all AKIs with 1.5%, 20.6%, and 77.9% in Kidney Disease Improving Global Outcomes (KDIGO) Stages I, II and III respectively. The mean age was 39.93 ± 11.79 years with males 65 (95.6%). The causes of acute pancreatitis were alcohol addiction 59 (86.8%), highly active antiretroviral therapy 1 (1.4%), hypercalcemia 1 (1.4%), IgG4-related disease 1 (1.4%), and unidentified 6 (8.8%). Complications were volume overload, shock, respiratory failure, and necrotizing pancreatitis in 21 (30.9%), 10 (14.7%), 6 (8.8%), and 14 (20.5%), respectively. Kidney replacement therapy done in 40 (58%), with intermittent hemodialysis 36 (53%) and acute intermittent peritoneal dialysis 4 (6%). The overall mortality was 23 (33.8%), three progressed to chronic kidney disease (thrombotic microangiopathy 2; biopsy inconclusive 1). In 45 survivors, AKI recovered in 22.7 ± 9.6 days. Death occurred within first 6 days. The risk factors associated with in-hospital mortality was necrotizing pancreatitis (odds ratio [OR] = 5.143; 95% confidence interval 1.472-17.972; P = 0.01), circulatory failure (OR = 6.125; P = 0.016), peak creatinine >3 mg/dL (OR = 7.118; P = 0.068), Bedside Index of Severity for Acute Pancreatitis score >3 (OR = 8.472; P = 0.001), need for kidney replacement therapy (OR = 3.764; P = 0.024), KDIGO III (OR = 9.935; P = 0.03). Conclusions Alcohol addiction was the commonest cause of severe acute pancreatitis. The overall mortality was 33.8%. Necrotizing pancreatitis, circulatory failure, peak creatinine >3 mg/dL, BISAPs >3, KDIGO III, and the need for kidney replacement therapy were independent risk factors for mortality.
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Affiliation(s)
| | | | | | - Padmaraj Rajendran
- Institute of Nephrology, Madras Medical College, Chennai, Tamil Nadu, India
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Lv YC, Yao YH, Wu DB, Lei JJ. Value of BISAP score for predicting severity of hyperlipidemic acute pancreatitis: A meta-analysis. Shijie Huaren Xiaohua Zazhi 2022; 30:710-717. [DOI: 10.11569/wcjd.v30.i16.710] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Affiliation(s)
- Yong-Cai Lv
- Department of Gastroenterology, Zhenning Buyi and Miao Autonomous County People's Hospital, Zhenning 561200, Guizhou Province, China
| | - Yan-Hua Yao
- Department of Ultrasound, Zhenning Buyi and Miao Autonomous County Traditional Chinese Hospital, Zhenning 561200, Guizhou Province, China
| | - De-Biao Wu
- Department of Gastroenterology, Zhenning Buyi and Miao Autonomous County People's Hospital, Zhenning 561200, Guizhou Province, China
| | - Jing-Jing Lei
- Department of Geriatric Medicine, Affiliated Hospital of Guizhou Medical University, Guiyang 550004, Guizhou Province, China
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Liu GH, Chen J, Li LQ, Huan XS, Lei P. Development and validation of a nomogram for early assessment the severity of acute pancreatitis. Scand J Gastroenterol 2022; 57:990-995. [PMID: 35275756 DOI: 10.1080/00365521.2022.2050293] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Acute pancreatitis is an acute inflammatory disorder of the pancreas, and severe acute pancreatitis is associated with high mortality. Early assessment the severity of AP has an important significance for improving clinical outcomes. Our object aimed to develop a nomogram with high simplicity and rapidity for predicting the severity of acute pancreatitis. METHODS Patients admitted to the Hunan Provincial People's Hospital within 72 h from onset of AP from January 2010 and December 2020 were enrolled to establish a nomogram. Independent predictors were determined using univariate and multivariate analysis and then assembled to construct a predicting nomogram. The performance of proposed nomogram was evaluated by Brier score and Harrell's concordance index (C-index). Meanwhile, clinical data of AP patients from January 2021 to January 2022 were collected for external validation. RESULTS Album (OR 0.891, 95%CI 0.867-0.917), calcium (OR 0.151, 95%CI 0.084-0.273), neutrophil to lymphocyte ratio (OR 1.055, 95%CI 1.023-1.088) and systemic inflammatory response syndrome (OR 6.292, 95%CI 4.459-8.879) were identified as independent factors of SAP after univariate and multivariate analysis (p < .05). A predictive nomogram was accordingly established using these four independent variables. The internally verified C-index was 0.796 (95% CI 0.773-0.818), Brier score was 0.138. The externally verified C index was 0.820 (95% CI 0.754-0.887). CONCLUSION A nomogram for predicting the severity of AP was well developed, it may be of great significance for clinicians to quickly assess the progress of AP and choose more-targeted strategies.
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Affiliation(s)
- Guang-Hua Liu
- Department of Blood Transfusion, Hunan Provincial People's Hospital, The First Affiliated Hospital of Hunan Normal University, Changsha, China.,Laboratory of Hematology, Hunan Provincial People's Hospital, The First Affiliated Hospital of Hunan Normal University, Changsha, China
| | - Jie Chen
- Department of Clinical Laboratory, Hunan Provincial People's Hospital, The First Affiliated Hospital of Hunan Normal University, Changsha, China
| | - Ling-Qian Li
- Department of Blood Transfusion, Hunan Provincial People's Hospital, The First Affiliated Hospital of Hunan Normal University, Changsha, China
| | - Xi-Sha Huan
- Department of Blood Transfusion, Hunan Provincial People's Hospital, The First Affiliated Hospital of Hunan Normal University, Changsha, China
| | - Ping Lei
- Department of Blood Transfusion, Hunan Provincial People's Hospital, The First Affiliated Hospital of Hunan Normal University, Changsha, China.,Laboratory of Hematology, Hunan Provincial People's Hospital, The First Affiliated Hospital of Hunan Normal University, Changsha, China
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Red cell distribution width to serum albumin ratio as an early prognostic marker for severe acute pancreatitis: A retrospective study. Arab J Gastroenterol 2022; 23:206-209. [PMID: 35918288 DOI: 10.1016/j.ajg.2022.06.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Revised: 04/26/2022] [Accepted: 06/01/2022] [Indexed: 12/08/2022]
Abstract
BACKGROUND AND STUDY AIMS The ability to predict severe acute pancreatitis (SAP) at an early stage is crucial for reducing the associated complications and mortality. In this study, we compared the ratio of red cell distribution width to albumin (RDW-to-ALB) using predictive scoring systems, such as the Ranson score, BISAP, and MCTSI, to develop a simple and accurate method of predicting SAP. PATIENTS AND METHODS We included 212 patients with mild acute pancreatitis (MAP) and 89 with SAP between January 2013 and December 2018. The differences in the general characteristics and biochemical analysis as well as the various predictive scores were compared between the two groups. We evaluated the sensitivity and specificity between the RDW-to-ALB ratio, RDW, ALB, and multiple predictive scores in patients with early acute pancreatitis (AP) by using the receiver operating characteristic (ROC) curve. RESULTS The RDW-to-ALB ratio (%) of patients with SAP was higher than that of patients with MAP (0.43 ± 0.08 vs. 0.32 ± 0.04, p < 0.001). Patients with SAP had higher Ranson, BISAP, and MCTSI scores than those with MAP. The ROC curve revealed that, when the RDW-to-ALB ratio (%) was >0.36, the sensitivity and specificity of the predicted SAP were 80.0% and 80.7%, respectively. Further statistical analysis found that the RDW-to-ALB ratio and Ranson, BISAP, and MCTSI scores were consistent in predicting SAP effectiveness (P > 0.05). CONCLUSIONS The RDW-to-ALB ratio has a promising predictive power for SAP, and its effectiveness is comparable with those of Ranson, BISAP, and MCTSI scores.
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Abstract
BACKGROUND Acute pancreatitis (AP) is the most common pancreatic disease. Predicting the severity of AP is critical for making preventive decisions. However, the performance of existing scoring systems in predicting AP severity was not satisfactory. The purpose of this study was to develop predictive models for the severity of AP using machine learning (ML) algorithms and explore the important predictors that affected the prediction results. METHODS The data of 441 patients in the Department of Gastroenterology in our hospital were analyzed retrospectively. The demographic data, blood routine and blood biochemical indexes, and the CTSI score were collected to develop five different ML predictive models to predict the severity of AP. The performance of the models was evaluated by the area under the receiver operating characteristic curve (AUC). The important predictors were determined by ranking the feature importance of the predictive factors. RESULTS Compared to other ML models, the extreme gradient boosting model (XGBoost) showed better performance in predicting severe AP, with an AUC of 0.906, an accuracy of 0.902, a sensitivity of 0.700, a specificity of 0.961, and a F1socre of 0.764. Further analysis showed that the CTSI score, ALB, LDH, and NEUT were the important predictors of the severity of AP. CONCLUSION The results showed that the XGBoost algorithm can accurately predict the severity of AP, which can provide an assistance for the clinicians to identify severe AP at an early stage.
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Soluble mannose receptor CD206 and von Willebrand factor are early biomarkers to identify patients at risk for severe or necrotizing acute pancreatitis. J Intensive Care 2022; 10:28. [PMID: 35690841 PMCID: PMC9188125 DOI: 10.1186/s40560-022-00619-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Accepted: 05/30/2022] [Indexed: 11/10/2022] Open
Abstract
Background In acute pancreatitis (AP), microcirculatory dysfunction and leukocyte activation contribute to organ damage, inflammation, and mortality. Given the role of macrophage activation, monocyte recruitment, and microthrombus formation in the early pathogenesis of AP, we examined the macrophage activation marker soluble mannose receptor (sCD206) and the endothelial function marker von Willebrand factor (vWF) in patients admitted for AP. Methods In an exploratory analysis, serum sCD206 and plasma vWF were prospectively analyzed on day 1 and day 3 in 81 patients with AP admitted to the hospital. In addition, blood samples from 59 patients with early AP admitted to the intensive care unit and symptom onset < 24 h were retrospectively analyzed. Patients were dichotomized as per study protocol into two groups: (i) “non-severe edematous AP” including patients with mild AP without organ failure and patients with transient organ failure that resolves within 48 h and (ii) “severe/necrotizing AP” including patients with severe AP and persistent organ failure > 48 h and/or patients with local complications. Results In the prospective cohort, 17% developed severe/necrotizing pancreatitis compared with 56% in the ICU cohort. Serum concentrations of sCD206 on admission were higher in patients with severe/necrotizing AP than in patients with non-severe edematous AP (prospective: 1.57 vs. 0.66 mg/l, P = 0.005; ICU: 1.76 vs. 1.25 mg/l, P = 0.006), whereas other inflammatory markers (leukocytes, C-reactive protein, procalcitonin) and disease severity (SOFA, SAPS II, APACHE II) did not show significant differences. Patients with severe/necrotizing AP had a greater increase in sCD206 than patients with non-severe edematous AP at day 3 in the prospective cohort. In contrast to routine coagulation parameters, vWF antigen levels were elevated on admission (prospective cohort: 375 vs. 257%, P = 0.02; ICU cohort: 240 vs. 184%, P = 0.03). When used as continuous variables, sCD206 and VWF antigen remained predictors of severe/necrotizing AP after adjustment for etiology and age in both cohorts. Conclusions sCD206 identifies patients at risk of severe AP at earlier timepoints than routine markers of inflammation and coagulation. Prospective studies are needed to investigate whether incorporating early or repeated measurements into the existing scoring system will better identify patients at increased risk for complications of AP. Supplementary Information The online version contains supplementary material available at 10.1186/s40560-022-00619-2.
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Han T, Cheng T, Liao Y, Lai Q, Tang S, Liu B, He Y, Lei C, Cao Y, Cao Y. Thrombo-Inflammatory Prognostic Scores Improve BISAP-Based Risk Stratification in Acute Pancreatitis Patients: A Retrospective Cohort Study. J Inflamm Res 2022; 15:3323-3335. [PMID: 35692952 PMCID: PMC9176634 DOI: 10.2147/jir.s366246] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Accepted: 05/28/2022] [Indexed: 12/01/2022] Open
Abstract
Purpose The thrombo-inflammatory prognostic score (TIPS) and the bedside index for severity in acute pancreatitis (BISAP) are both scoring systems that enable the rapid prognostic assessment of early-stage acute pancreatitis (AP) patients, but the overall prognostic utility of these individual systems is limited. This study was thus developed to explore whether a combination of TIPS and BISAP scores would offer better insight to facilitate the risk stratification of AP patients. Methods This single-center retrospective cohort research evaluated AP cases referred to the emergency department from January 1, 2017 to September 30, 2017. The ability of TIPS scores to improve BISAP-based AP patient risk stratification was appraised employing the curves of receiver-operating characteristic (ROC) and decision curve analysis (DCA) approaches. The initial endpoint for this research was 28-day mortality, while secondary endpoints comprised intensive care unit admission (AICU) and mechanical ventilation (MV) over a 28-day follow-up period. Results Totally, 440 cases enrolled in the current study were divided at a ratio of 1:1 to derivation and validation cohorts. When estimating 28-day mortality, the combination of TIPS and BISAP (T-BISAP) improved the area under the curve (AUC) value in the derivation group from 0.809 to 0.903 (P < 0.05), in addition to similarly improving this AUC value from 0.709 to 0.853 (P < 0.05) in the validation cohort. Moreover, T-BISAP significantly improved the AUC values for 28-day AICU from 0.751 to 0.824 (P < 0.05) and the AUC values for 28-day MV from 0.755 to 0.808 (P < 0.05). A DCA approach revealed T-BISAP to exhibit higher net benefit when used for patient risk stratification as compared to BISAP alone. Conclusion The addition of TIPS scores to BISAP scores can enable prediction of 28-day adverse clinical outcomes with AP patients in the ED.
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Affiliation(s)
- Tianyong Han
- Emergency Department, West China Hospital of Sichuan University, Chengdu, Sichuan, People’s Republic of China
| | - Tao Cheng
- Emergency Department, West China Hospital of Sichuan University, Chengdu, Sichuan, People’s Republic of China
| | - Ye Liao
- Medical Intensive Care Unit, West China Hospital of Sichuan University, Chengdu, Sichuan, People’s Republic of China
| | - Qiang Lai
- Emergency Department, West China Hospital of Sichuan University, Chengdu, Sichuan, People’s Republic of China
| | - Shiyuan Tang
- Emergency Department, West China Hospital of Sichuan University, Chengdu, Sichuan, People’s Republic of China
| | - Bofu Liu
- Emergency Department, West China Hospital of Sichuan University, Chengdu, Sichuan, People’s Republic of China
| | - Yarong He
- Emergency Department, West China Hospital of Sichuan University, Chengdu, Sichuan, People’s Republic of China
| | - Chenxi Lei
- Emergency Department, West China Hospital of Sichuan University, Chengdu, Sichuan, People’s Republic of China
| | - Yuling Cao
- Operations Management Department, West China Hospital of Sichuan University, Chengdu, Sichuan, People’s Republic of China
| | - Yu Cao
- Emergency Department, West China Hospital of Sichuan University, Chengdu, Sichuan, People’s Republic of China
- Correspondence: Yu Cao, Emergency Department, West China Hospital of Sichuan University, 37 Guoxue Lane, Wuhou District, Chengdu, Sichuan, 610041, People’s Republic of China, Tel +86 28-85422288, Email
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Kui B, Pintér J, Molontay R, Nagy M, Farkas N, Gede N, Vincze Á, Bajor J, Gódi S, Czimmer J, Szabó I, Illés A, Sarlós P, Hágendorn R, Pár G, Papp M, Vitális Z, Kovács G, Fehér E, Földi I, Izbéki F, Gajdán L, Fejes R, Németh BC, Török I, Farkas H, Mickevicius A, Sallinen V, Galeev S, Ramírez‐Maldonado E, Párniczky A, Erőss B, Hegyi PJ, Márta K, Váncsa S, Sutton R, Szatmary P, Latawiec D, Halloran C, de‐Madaria E, Pando E, Alberti P, Gómez‐Jurado MJ, Tantau A, Szentesi A, Hegyi P, the Hungarian Pancreatic Study Group. EASY-APP: An artificial intelligence model and application for early and easy prediction of severity in acute pancreatitis. Clin Transl Med 2022; 12:e842. [PMID: 35653504 PMCID: PMC9162438 DOI: 10.1002/ctm2.842] [Citation(s) in RCA: 50] [Impact Index Per Article: 16.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Revised: 04/06/2022] [Accepted: 04/11/2022] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Acute pancreatitis (AP) is a potentially severe or even fatal inflammation of the pancreas. Early identification of patients at high risk for developing a severe course of the disease is crucial for preventing organ failure and death. Most of the former predictive scores require many parameters or at least 24 h to predict the severity; therefore, the early therapeutic window is often missed. METHODS The early achievable severity index (EASY) is a multicentre, multinational, prospective and observational study (ISRCTN10525246). The predictions were made using machine learning models. We used the scikit-learn, xgboost and catboost Python packages for modelling. We evaluated our models using fourfold cross-validation, and the receiver operating characteristic (ROC) curve, the area under the ROC curve (AUC), and accuracy metrics were calculated on the union of the test sets of the cross-validation. The most critical factors and their contribution to the prediction were identified using a modern tool of explainable artificial intelligence called SHapley Additive exPlanations (SHAP). RESULTS The prediction model was based on an international cohort of 1184 patients and a validation cohort of 3543 patients. The best performing model was an XGBoost classifier with an average AUC score of 0.81 ± 0.033 and an accuracy of 89.1%, and the model improved with experience. The six most influential features were the respiratory rate, body temperature, abdominal muscular reflex, gender, age and glucose level. Using the XGBoost machine learning algorithm for prediction, the SHAP values for the explanation and the bootstrapping method to estimate confidence, we developed a free and easy-to-use web application in the Streamlit Python-based framework (http://easy-app.org/). CONCLUSIONS The EASY prediction score is a practical tool for identifying patients at high risk for severe AP within hours of hospital admission. The web application is available for clinicians and contributes to the improvement of the model.
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Affiliation(s)
- Balázs Kui
- Department of MedicineUniversity of SzegedSzegedHungary
- Centre for Translational Medicine, Department of MedicineUniversity of SzegedSzegedHungary
| | - József Pintér
- Department of Stochastics, Institute of MathematicsBudapest University of Technology and EconomicsBudapestHungary
| | - Roland Molontay
- Department of Stochastics, Institute of MathematicsBudapest University of Technology and EconomicsBudapestHungary
- MTA‐BME Stochastics Research GroupBudapestHungary
| | - Marcell Nagy
- Department of Stochastics, Institute of MathematicsBudapest University of Technology and EconomicsBudapestHungary
| | - Nelli Farkas
- Institute for Translational Medicine, Szentágothai Research Centre, Medical SchoolUniversity of PécsPécsHungary
- Institute of Bioanalysis, Medical SchoolUniversity of PécsPécsHungary
| | - Noémi Gede
- Institute for Translational Medicine, Szentágothai Research Centre, Medical SchoolUniversity of PécsPécsHungary
| | - Áron Vincze
- Division of Gastroenterology, First Department of MedicineUniversity of Pécs, Medical SchoolPécsHungary
| | - Judit Bajor
- Division of Gastroenterology, First Department of MedicineUniversity of Pécs, Medical SchoolPécsHungary
| | - Szilárd Gódi
- Division of Gastroenterology, First Department of MedicineUniversity of Pécs, Medical SchoolPécsHungary
| | - József Czimmer
- Division of Gastroenterology, First Department of MedicineUniversity of Pécs, Medical SchoolPécsHungary
| | - Imre Szabó
- Division of Gastroenterology, First Department of MedicineUniversity of Pécs, Medical SchoolPécsHungary
| | - Anita Illés
- Division of Gastroenterology, First Department of MedicineUniversity of Pécs, Medical SchoolPécsHungary
| | - Patrícia Sarlós
- Division of Gastroenterology, First Department of MedicineUniversity of Pécs, Medical SchoolPécsHungary
| | - Roland Hágendorn
- Division of Gastroenterology, First Department of MedicineUniversity of Pécs, Medical SchoolPécsHungary
| | - Gabriella Pár
- Division of Gastroenterology, First Department of MedicineUniversity of Pécs, Medical SchoolPécsHungary
| | - Mária Papp
- Department of Gastroenterology, Institute of Internal Medicine, Faculty of MedicineUniversity of DebrecenDebrecenHungary
| | - Zsuzsanna Vitális
- Department of Gastroenterology, Institute of Internal Medicine, Faculty of MedicineUniversity of DebrecenDebrecenHungary
| | - György Kovács
- Department of Gastroenterology, Institute of Internal Medicine, Faculty of MedicineUniversity of DebrecenDebrecenHungary
| | - Eszter Fehér
- Department of Gastroenterology, Institute of Internal Medicine, Faculty of MedicineUniversity of DebrecenDebrecenHungary
| | - Ildikó Földi
- Department of Gastroenterology, Institute of Internal Medicine, Faculty of MedicineUniversity of DebrecenDebrecenHungary
| | - Ferenc Izbéki
- Szent György Teaching Hospital of County FejérSzékesfehérvárHungary
| | - László Gajdán
- Szent György Teaching Hospital of County FejérSzékesfehérvárHungary
| | - Roland Fejes
- Szent György Teaching Hospital of County FejérSzékesfehérvárHungary
| | - Balázs Csaba Németh
- Department of MedicineUniversity of SzegedSzegedHungary
- Centre for Translational Medicine, Department of MedicineUniversity of SzegedSzegedHungary
| | - Imola Török
- County Emergency Clinical Hospital of Târgu Mures—Gastroenterology Clinic and University of Medicine, Pharmacy, Sciences and Technology ‘George Emil Palade’Targu MuresRomania
| | - Hunor Farkas
- County Emergency Clinical Hospital of Târgu Mures—Gastroenterology Clinic and University of Medicine, Pharmacy, Sciences and Technology ‘George Emil Palade’Targu MuresRomania
| | | | - Ville Sallinen
- Department of Transplantation and Liver SurgeryHelsinki University Hospital and University of HelsinkiHelsinkiFinland
| | | | | | - Andrea Párniczky
- Institute for Translational Medicine, Szentágothai Research Centre, Medical SchoolUniversity of PécsPécsHungary
- Heim Pál National Pediatric InstituteBudapestHungary
| | - Bálint Erőss
- Institute for Translational Medicine, Szentágothai Research Centre, Medical SchoolUniversity of PécsPécsHungary
- Division of Pancreatic Diseases, Heart and Vascular CentreSemmelweis UniversityBudapestHungary
- Centre for Translational MedicineSemmelweis UniversityBudapestHungary
| | - Péter Jenő Hegyi
- Institute for Translational Medicine, Szentágothai Research Centre, Medical SchoolUniversity of PécsPécsHungary
- Division of Pancreatic Diseases, Heart and Vascular CentreSemmelweis UniversityBudapestHungary
| | - Katalin Márta
- Division of Pancreatic Diseases, Heart and Vascular CentreSemmelweis UniversityBudapestHungary
- Centre for Translational MedicineSemmelweis UniversityBudapestHungary
| | - Szilárd Váncsa
- Institute for Translational Medicine, Szentágothai Research Centre, Medical SchoolUniversity of PécsPécsHungary
- Division of Pancreatic Diseases, Heart and Vascular CentreSemmelweis UniversityBudapestHungary
- Centre for Translational MedicineSemmelweis UniversityBudapestHungary
| | - Robert Sutton
- Institute of Systems, Molecular and Integrative BiologyUniversity of Liverpool and Liverpool University Hospitals NHS Foundation Trust, Liverpool, EnglandUK
| | - Peter Szatmary
- Institute of Systems, Molecular and Integrative BiologyUniversity of Liverpool and Liverpool University Hospitals NHS Foundation Trust, Liverpool, EnglandUK
| | - Diane Latawiec
- Institute of Systems, Molecular and Integrative BiologyUniversity of Liverpool and Liverpool University Hospitals NHS Foundation Trust, Liverpool, EnglandUK
| | - Chris Halloran
- Institute of Systems, Molecular and Integrative BiologyUniversity of Liverpool and Liverpool University Hospitals NHS Foundation Trust, Liverpool, EnglandUK
| | - Enrique de‐Madaria
- Gastroenterology DepartmentAlicante University General HospitalISABIALAlicanteSpain
| | - Elizabeth Pando
- Department of Hepato‐Pancreato‐Biliary and Transplant SurgeryHospital Universitari Vall d'Hebron, Universitat Autònoma de BarcelonaBarcelonaSpain
| | - Piero Alberti
- Department of Hepato‐Pancreato‐Biliary and Transplant SurgeryHospital Universitari Vall d'Hebron, Universitat Autònoma de BarcelonaBarcelonaSpain
| | - Maria José Gómez‐Jurado
- Department of Hepato‐Pancreato‐Biliary and Transplant SurgeryHospital Universitari Vall d'Hebron, Universitat Autònoma de BarcelonaBarcelonaSpain
| | - Alina Tantau
- The 4th Medical ClinicIuliu Hatieganu’ University of Medicine and PharmacyCluj‐NapocaRomania
- Gastroenterology and Hepatology Medical CenterCluj‐NapocaRomania
| | - Andrea Szentesi
- Centre for Translational Medicine, Department of MedicineUniversity of SzegedSzegedHungary
- Institute for Translational Medicine, Szentágothai Research Centre, Medical SchoolUniversity of PécsPécsHungary
| | - Péter Hegyi
- Institute for Translational Medicine, Szentágothai Research Centre, Medical SchoolUniversity of PécsPécsHungary
- Division of Pancreatic Diseases, Heart and Vascular CentreSemmelweis UniversityBudapestHungary
- Centre for Translational MedicineSemmelweis UniversityBudapestHungary
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Establishment of Early Multi-Indicator Prediction Models of Moderately Severe Acute Pancreatitis and Severe Acute Pancreatitis. Gastroenterol Res Pract 2022; 2022:5142473. [PMID: 35419053 PMCID: PMC9001090 DOI: 10.1155/2022/5142473] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Revised: 03/03/2022] [Accepted: 03/14/2022] [Indexed: 12/23/2022] Open
Abstract
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.
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Hamzoian H, Plasencia R, Ekpa N, Srinivasan A, Elias G. An Unusual Case of Isolated Pancreatitis Secondary to Blunt Abdominal Trauma. Cureus 2022; 14:e23717. [PMID: 35505706 PMCID: PMC9056755 DOI: 10.7759/cureus.23717] [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: 03/31/2022] [Indexed: 11/05/2022] Open
Abstract
Acute pancreatitis is an inflammatory condition affecting a large population and resulting in one of the most common causes of gastrointestinal hospitalizations in the United States. The pathogenesis resulting in pancreatic injury has multiple etiologies with gallstones and alcohol consumption contributing to a large majority of cases. Consequently, one uncommon cause of acute pancreatitis, direct abdominal trauma, often gets overlooked. This case describes a 20-year-old male with no past medical history or surgical interventions presenting to the hospital with two days worth of abdominal pain. Physical exam was negative for erythema, ecchymosis and lacerations but further questioning revealed a recent history of an altercation resulting in multiple blunt blows to the abdomen. CT abdomen with contrast was positive for an edematous appearing pancreatic tail with surrounding soft tissue stranding; no pancreatic fluid collections, normal gallbladder and no intrahepatic or extrahepatic biliary ductal dilation. Pancreatitis has a multitude of etiologies and practitioners should address the insulting event as well as the pathological sequelae to prevent reoccurrence of the condition. The importance of taking a full and thorough history should not be overlooked; this could lead to misdiagnosis and misjudgment of the underlying pathological process. We propose the notion that there is a significant number of patients diagnosed with idiopathic pancreatitis who may have more accurately been diagnosed with traumatic pancreatitis with a more thorough history. Additionally, due to the pancreas’s retroperitoneal location, isolated injury with abdominal trauma, such as in this patient, is quite rare. It is critical to differentiate the underlying cause of acute pancreatitis to further counsel patients about avoidance of precipitating factors. We would like to stress the importance of obtaining a thorough history and ruling out alternative causes of patient presentation as management differs greatly after treatment of the acute phase reaction. In patients with traumatic pancreatitis, physicians should establish that there were no residual abdominal injuries and advise patients to restrain from any activities that would result in any sequential abdominal trauma.
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Blood Urea Nitrogen as a Prognostic Marker in Severe Acute Pancreatitis. DISEASE MARKERS 2022; 2022:7785497. [PMID: 35392494 PMCID: PMC8983180 DOI: 10.1155/2022/7785497] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/26/2021] [Accepted: 03/10/2022] [Indexed: 12/12/2022]
Abstract
Objectives To explore independent risk factors with good and early predictive power for SAP severity and prognosis. Methods Patients with SAP were enrolled at Central South University Xiangya Hospital between April 2017 and May 2021 and used as the training cohort. From June 2021 to February 2022, all patients with SAP were defined as external patients for validation. Patients were grouped by survival status at a 30-day posthospital admission and then compared in terms of basic information and laboratory tests to screen the independent risk factors. Results A total of 249 patients with SAP were enrolled in the training cohort. The all-cause mortality rate at a 30-day postadmission was 25.8% (51/198). Blood urea nitrogen (BUN) levels were significantly higher in the mortality group (20.45 [interquartile range (IQR), 19.7] mmol/L) than in the survival group (6.685 [IQR, 6.3] mmol/L; P < 0.001). After propensity score matching (PSM), the BUN level was still higher in the mortality group than in the survival group (18.415 [IQR, 19.555] mmol/L vs. 10.63 [IQR, 6.03] mmol/L; P = 0.005). The area under the curve (AUC) of the receiver operating characteristic curve (ROC) of BUN was 0.820 (95% confidence interval, 0.721–0.870; P < 0.001). The optimal BUN level cut-off for predicting a 30-day all-cause mortality was 10.745 mmol/L. Moreover, patients with SAP were grouped according to BUN levels and stratified according to optimal cut-off value. Patients with high BNU levels were associated with significantly higher rates of invasive mechanical ventilation (before PSM: 61.8% vs. 20.6%, P < 0.001; after PSM: 71.1% vs. 32%, P = 0.048) and a 30-day all-cause mortality (before PSM: 44.9% vs. 6.9%, P < 0.001; after PSM: 60% vs. 34.5%, P = 0.032) than those with low BNU levels before or after PSM. The effectiveness of BUN as a prognostic marker was further validated using ROC curves for the external validation set (n = 49). The AUC of BUN was 0.803 (95% CI, 0.655–0.950; P = 0.011). It showed a good ability to predict a 30-day all-cause mortality in patients with SAP. We also observed similar results regarding disease severity, including the Acute Physiology and Chronic Health Evaluation II score (before PSM: 16 [IQR, 8] vs. 8 [IQR, 6], P < 0.001; after PSM: 18 [IQR, 10] vs. 12 [IQR, 7], P < 0.001), SOFA score (before PSM: 7 [IQR, 5] vs. 3 [IQR, 3], P < 0.001; after PSM: 8 [IQR, 5] vs. 5 [IQR, 3.5], P < 0.001), and mMarshall score (before PSM: 4 [IQR, 3] vs. 3 [IQR, 1], P < 0.001; after PSM: 5 [IQR, 2.5] vs. 3 [IQR, 1], P < 0.001). There was significant increase in intensive care unit occupancy in the high BUN level group before PSM (93.3% vs. 73.1%, P < 0.001), but not after PSM (97.8% vs. 86.2%, P = 0.074). Conclusions Our results showed that BUN levels within 24 h after hospital admission were independent risk factors for a 30-day all-cause death in patients with SAP.
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Vannier E, Dupont-Lucas C, Lagarde B, Menahem B, Chaigneau T, Piquet MA, Dupont B. Development of a Score for Predicting Severe Acute Pancreatitis at Admission. Pancreas 2022; 51:128-134. [PMID: 35404887 DOI: 10.1097/mpa.0000000000001984] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
OBJECTIVES The identification of patients at risk of developing a severe form of acute pancreatitis is a major issue. The goal of this study was to identify parameters at admission associated with severe pancreatitis to develop a predictive severity score. METHODS We conducted a retrospective study at Caen University Hospital between January 2014 and December 2017, including 504 patients hospitalized for acute pancreatitis, of whom 74 had a severe form. We developed a predictive score named Admission Severe Acute Pancreatitis (ASAP) score based on parameters associated with a severe form in multivariate analysis. We validated our score in an independent validation cohort of 80 patients. RESULTS Hypothermia, low oxygen saturation or albumin levels, and high creatinine levels were significantly associated with severe pancreatitis. The ASAP score showed notable predictive accuracy (area under receiver operating characteristic, 0.82), which was significantly higher than Sequential Organ Failure Assessment, persistent Systemic Inflammatory Response Syndrome, and Balthazar. Using the -2.1742 threshold, the ASAP score had a sensitivity and specificity of 74% and a negative predictive value of 95%. These predictive performances for ASAP score were confirmed in the validation cohort. CONCLUSIONS The ASAP score demonstrates remarkable predictive accuracy in distinguishing severe forms of acute pancreatitis.
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Affiliation(s)
- Elise Vannier
- From the Departement d'Hepato-Gastroenterologie et Nutrition
| | | | - Benoît Lagarde
- From the Departement d'Hepato-Gastroenterologie et Nutrition
| | - Benjamin Menahem
- Service de Chirurgie Digestive, CHU de Caen Normandie, Normandie Université, UNICAEN, Caen, France
| | | | | | - Benoît Dupont
- From the Departement d'Hepato-Gastroenterologie et Nutrition
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Argueta PP, Salazar M, Vohra I, Corral JE, Lukens FJ, Vargo JJ, Chahal P, Simons-Linares CR. Thirty-Day Readmission Among Patients with Alcoholic Acute Pancreatitis. Dig Dis Sci 2021; 66:4227-4236. [PMID: 33469806 DOI: 10.1007/s10620-020-06765-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2020] [Accepted: 12/06/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND/OBJECTIVES Alcoholic acute pancreatitis (AAP) comprises the second most common cause of acute pancreatitis in the USA, and there is lack of data regarding 30-day specific readmission causes and predictors. We aim to identify 30-day readmission rate, causes, and predictors of readmission. METHODS Retrospective analysis of the 2016 National Readmission Database of adult patients readmitted within 30 days after an index admission for AAP. RESULTS Totally, 76,609 AAP patients were discharged from the hospital in 2016. The 30-day readmission rate was 12%. The main cause of readmission was another episode of AAP. Readmission was not associated with higher mortality (1.3% vs. 1.2%; P = 0.21) or prolonged length of stay (5.2 vs. 5.0 days; P = 0.06). The total health care economic burden was $354 million in charges and $90 million in costs. Independent predictors of readmission were having Medicaid insurance, a Charlson comorbidity index score ≥ 3, use of total parenteral nutrition, opioid abuse disorder, prior pancreatic cyst, chronic alcoholic pancreatitis, and other chronic pancreatitis. Obesity was associated with lower odds of readmission. CONCLUSION Readmission rate for AAP is high and its primary cause are recurrent episodes of AAP. Alcohol and substance abuse pose a high burden on our health care system. Public health strategies should be targeted to provide alcohol abuse disorder rehabilitation and cessation resources to alleviate the burden on readmission, the health care system and to improve patient outcomes.
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Affiliation(s)
- Pedro Palacios Argueta
- Internal Medicine Department, John Stroger Hospital of Cook County, Rush University, Chicago, IL, USA
| | - Miguel Salazar
- Gastroenterology, Hepatology and Nutrition Department, Digestive Diseases and Surgery Institute, Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, OH, 44195, USA
| | - Ishaan Vohra
- Internal Medicine Department, John Stroger Hospital of Cook County, Rush University, Chicago, IL, USA
| | - Juan E Corral
- Gastroenterology and Hepatology Department, Mayo Clinic Florida, Jacksonville, FL, USA
| | - Frank J Lukens
- Gastroenterology and Hepatology Department, Mayo Clinic Florida, Jacksonville, FL, USA
| | - John J Vargo
- Gastroenterology, Hepatology and Nutrition Department, Digestive Diseases and Surgery Institute, Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, OH, 44195, USA
| | - Prabhleen Chahal
- Gastroenterology, Hepatology and Nutrition Department, Digestive Diseases and Surgery Institute, Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, OH, 44195, USA
| | - C Roberto Simons-Linares
- Gastroenterology, Hepatology and Nutrition Department, Digestive Diseases and Surgery Institute, Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, OH, 44195, USA.
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