• diabetic patients
• mortality
• nomogram
• prediction model
• severe acute pancreatitis

• Humans
• Nomograms
• Female
• Male
• Retrospective Studies
• Middle Aged
• Pancreatitis/mortality
• Prognosis
• Tertiary Care Centers
• Risk Factors
• Aged
• Adult
• Severity of Illness Index
• Acute Disease
• ROC Curve
• Diabetes Mellitus/mortality
• Diabetes Complications/mortality
• Predictive Value of Tests
• Logistic Models

• Acute pancreatitis
• Adverse drug reaction
• Aetiology
• Drug-induced pancreatitis
• Estudio observacional
• Etiología
• Farmacovigilancia
• Observational study
• Pancreatitis aguda
• Pancreatitis inducida por medicamentos
• Pharmacovigilance
• Reacción adversa a medicamentos

• Humans
• Pancreatitis/chemically induced
• Pancreatitis/diagnosis
• Male
• Female
• Retrospective Studies
• Middle Aged
• Aged
• Adult
• Acute Disease
• Pharmacovigilance
• Length of Stay

• bisap score
• inflammation
• pancreatitis
• rdw
• rdw/plt

• Elderly patients
• Mortality
• Nomogram
• Prediction model
• Severe acute pancreatitis

• Humans
• Nomograms
• Aged
• Female
• Male
• Retrospective Studies
• Pancreatitis/mortality
• Pancreatitis/diagnosis
• Risk Factors
• Prognosis
• Aged, 80 and over
• Tertiary Care Centers
• ROC Curve
• Age Factors
• Logistic Models
• Severity of Illness Index
• Acute Disease

• Acute pancreatitis
• Hypertriglyceridemia
• Hypertriglyceridemic acute pancreatitis
• NF-κBp65
• TLR4

• Animals
• Male
• Pancreatitis/metabolism
• Hypertriglyceridemia/complications
• Rats, Sprague-Dawley
• Triglycerides/blood
• Triglycerides/metabolism
• Toll-Like Receptor 4/metabolism
• Rats
• Pancreas/metabolism
• Pancreas/pathology
• Transcription Factor RelA/metabolism
• Fenofibrate/pharmacology
• Disease Models, Animal
• Acute Disease
• Arginine/blood
• Hypolipidemic Agents/therapeutic use
• Hypolipidemic Agents/pharmacology

• 822MS178 Natural Science Foundation of Hainan Province

• blood biomarkers
• hepatic steatosis
• hypertriglyceridemia-associated acute pancreatitis
• nomogram
• severity

• Humans
• Male
• Female
• Hypertriglyceridemia/complications
• Hypertriglyceridemia/blood
• Pancreatitis/blood
• Pancreatitis/diagnostic imaging
• Pancreatitis/complications
• Tomography, X-Ray Computed/methods
• Retrospective Studies
• Middle Aged
• Nomograms
• Biomarkers/blood
• Adult
• Severity of Illness Index
• ROC Curve
• C-Reactive Protein/analysis
• Fatty Liver/blood
• Fatty Liver/diagnostic imaging
• Fatty Liver/complications
• Risk Factors
• L-Lactate Dehydrogenase/blood
• Aged
• Predictive Value of Tests

• Alcoholic pancreatitis
• D-dimer
• chronic pancreatitis
• lipase
• multiple organ failure
• pancreatitis
• prognosis

• United States/epidemiology
• Humans
• Pharmacovigilance
• Adverse Drug Reaction Reporting Systems
• United States Food and Drug Administration
• Acute Disease
• Pancreatitis/chemically induced
• Pancreatitis/epidemiology
• Drug-Related Side Effects and Adverse Reactions/diagnosis
• Drug-Related Side Effects and Adverse Reactions/epidemiology

• acute pancreatitis
• acute peripancreatic fluid collections
• apfc
• follow-up imaging
• incidence
• pancreatitis
• predictors
• radiology
• retrospective
• risk factors

• Humans
• Child
• Acute Disease
• Cohort Studies
• Reproducibility of Results
• Pancreatitis, Chronic/etiology
• Risk Factors
• Recurrence

• P30 DK054759 NIDDK NIH HHS
• R01 DK118752 NIDDK NIH HHS
• U01 DK108328 NIDDK NIH HHS
• U01 DK108334 NIDDK NIH HHS

• Hospital charges
• Length of stay
• Mortality
• Nationwide readmissions database

• Humans
• Adult
• United States/epidemiology
• Patient Readmission
• Retrospective Studies
• Pancreatitis/chemically induced
• Pancreatitis/diagnosis
• Pancreatitis/epidemiology
• Acute Disease
• Hospitalization
• Risk Factors
• Databases, Factual

• Acute pancreatitis
• Biliary pancreatitis
• Global surgery
• Guidelines compliance
• International audit

• Humans
• Acute Disease
• Cholecystectomy
• Enteral Nutrition
• Hospitalization
• Pancreatitis/surgery
• Pancreatitis/diagnosis

• MR/P008887/1 Medical Research Council

Pancreatitis usually presents with characteristic abdominal pain, radiological findings, and elevated lipase. The presence of jaundice may hint at a biliary etiology; however, it is not always present. We hypothesized that the presence of jaundice is associated with worse outcomes in patients admitted with pancreatitis. We conducted a retrospective analysis using the National Inpatient Sample, inquiring about patients admitted with pancreatitis with and without jaundice between October 2015 and December 2017. The primary outcome was in-hospital mortality in patients admitted for pancreatitis with and without jaundice. Secondary outcomes were the median length of stay, hospitalization cost, the incidence of ventilator-dependent respiratory failure (VDRF), acute respiratory distress syndrome (ARDS), sepsis, septic shock, dehydration and electrolyte disturbances, and ascites. A total of 1,267,744 patients were admitted with pancreatitis from October 2015 to December 2017. Among them, 8855 (0.7%) had concomitant jaundice on presentation. In-hospital mortality in this group was 4.3%. The patients with pancreatitis and jaundice had higher odds of in-hospital mortality (adjusted odds ratio [aOR]: 1.51, 99% CI 1.35–1.68, p < 0.0001) as compared to those without jaundice. Patients with jaundice showed a significantly higher incidence of sepsis (15.2% vs. 9.6%, p < 0.0001), septic shock (4.1% vs. 2.9%, p < 0.0001), ascites (6.5% vs. 3.1%, p < 0.0001), and dehydration and electrolyte disorders (47.6% vs. 43.8%, p < 0.0001). Patients with jaundice also had higher total hospital costs ($11,412 vs. $7893, p < 0.0001). There was no statistical difference in ARDS, VDRF, and median length of stay. In conclusion, patients admitted for pancreatitis with jaundice had worse outcomes, including in-hospital mortality and complications, compared to those without jaundice.

The incidence of hypertriglyceridemic acute pancreatitis (HTG-AP) has increased yearly, but updated population-based estimates on the incidence of HTG-AP are lacking. Reducing serum triglyceride (TG) levels quickly is crucial in the early treatment of HTG-AP. Decreased serum TG levels are treated by non-invasive methods, which include anti-lipidemic agents, heparin, low-molecular weight heparin, and insulin, and invasive methods, such as blood purification including hemoperfusion (HP), plasmapheresis, and continuous renal replacement therapy. However, authoritative guidelines have not been established. Early selection of appropriate treatment is important and beneficial in controlling the development of HTG-AP.

To evaluate the effect between patients treated with intravenous insulin (INS) and HP to guide clinical treatment.

We retrospectively reviewed 371 patients with HTG-AP enrolled in the Department of Fujian Provincial Hospital form April 2012 to March 2021. The inpatient medical and radiologic records were reviewed to determine clinical features, severity, complications, mortality, recurrence rate, and treatment. Multivariate logistic regression analyses were used to analyze risk factors for severe HTG-AP. Propensity score matching was used to compare the clinical outcomes of INS and HP.

A total of 371 patients met the HTG-AP criteria. The incidence of HTG-AP was increased by approximately 2.6 times during the 10 years (8.4% in April 2012-March 2013 and 22.3% in April 2020-March 2021). The highest incidence rate of acute pancreatitis was observed for men in the age group of 30-39 years. The amylase level was elevated in 80.1% of patients but was only three times the normal value in 46.9% of patients. The frequency of severe acute pancreatitis (26.9%), organ failure (31.5%), rate of recurrence (32.9%), and mortality (3.0%) of HTG-AP was high. Improved Marshall score, modified computed tomography severity index score, baseline TG, baseline amylase, C-reactive protein (CRP), albumin, aspartate aminotransferase, low-density lipoprotein cholesterol, urea nitrogen, creatinine, calcium, hemoglobin, free triiodothyronine, admission to intensive care unit, and mortality were significantly different between patients with different grades of severity (P < 0.050). Multivariate logistic regression analysis confirmed that high CRP [P = 0.005, odds ratio (OR) = 1.011, 95%CI: 1.003-1.019], low calcium (P = 0.003, OR = 0.016, 95%CI: 0.001-0.239), and low albumin (P = 0.023, OR = 0.821, 95%CI: 0.693-0.973) were risk factors of severe HTG-AP. After propensity score matching adjusted by sex, age, severity of HTG-AP, and baseline TG, the serum TG significantly decreased in patients treated with INS (P < 0.000) and HP (P < 0.000) within 48 h. However, the clearance rate of TG (57.24 ± 33.70% vs 56.38 ± 33.61%, P = 0.927) and length of stay (13.04 ± 7.92 d vs 12.35 ± 6.40 d, P = 0.730) did not differ between the two groups.

The incidence of HTG-AP exhibited a significant increase, remarkable severity, and recurrent trend. Patients with mild and moderately severe acute pancreatitis can be treated effectively with INS safely and effectively without HP.

• Hypertriglyceridemic acute pancreatitis
• Triglyceride
• Improved Marshall score
• Severity of acute pancreatitis
• Intravenous insulin
• Hemoperfusion

• Acute Disease
• Adult
• Amylases
• Aspartate Aminotransferases
• C-Reactive Protein
• Calcium/therapeutic use
• Cholesterol
• Creatinine
• Heparin/therapeutic use
• Humans
• Hypertriglyceridemia/complications
• Hypertriglyceridemia/epidemiology
• Hypertriglyceridemia/therapy
• Incidence
• Insulin/therapeutic use
• Lipoproteins, LDL
• Male
• Nitrogen
• Pancreatitis/diagnosis
• Pancreatitis/epidemiology
• Pancreatitis/therapy
• Retrospective Studies
• Triglycerides
• Triiodothyronine/therapeutic use
• Urea

• acute pancreatitis
• alcohol
• brief intervention
• gamma-glutamyl transferase
• recurrence

• Acute Disease
• Adult
• Alcohol Drinking/adverse effects
• Alcoholism/complications
• Female
• Hospitals
• Humans
• Male
• Middle Aged
• Pancreatitis/etiology
• Pancreatitis/prevention & control
• Patient Education as Topic
• gamma-Glutamyltransferase

• TKP2021-EGA/TKP2021-NVA/TKP2021-NKTA Ministry of Innovation and Technology of Hungary from the National Research, Development and Innovation Fund
• STIA-KFI-2021-TK2151VMKL Semmelweis University
• FK131864 Hungarian Academy of Sciences

A woman in her 30s who was 12 weeks pregnant with her third child presented with jaundice. Blood tests showed elevated hepatobiliary enzymes and direct bilirubin. Abdominal ultrasonography showed dilatation of the common bile duct and strong echo with a 9 mm acoustic shadow in the distal bile duct. She was diagnosed with common bile duct stone disease and biliary drainage was considered necessary. Percutaneous transhepatic biliary drainage (PTBD) was performed considering the effect on both the fetus and the mother, and the procedure was successful without any complications. The PTBD tube was left in place until delivery at 36 weeks 6 days of gestation and endoscopic stone removal was performed 14 days after delivery. The patient was discharged 18 days after delivery without any complications. In pregnant women with common bile duct stones, palliative PTBD followed by elective endoscopic stone removal after delivery can be considered a treatment strategy.

• biliary intervention
• endoscopy
• pregnancy

Unregulated use of a variety of drugs and supplements by bodybuilders and athletes is common and can lead to severe adverse complications. Only a small proportion of acute pancreatitis cases are drug induced, and case reports are essential for identifying potential drug-related risks for pancreatitis. Here we present the first case report published of acute pancreatitis linked to recreational use of anabolic–androgenic steroids, subcutaneous growth hormone, and clenbuterol in a previously healthy male after excluding all other causes of pancreatitis.

A 31-year-old Arab male bodybuilder presented with acute abdominal pain associated with nausea and sharp pain radiating to the back. The patient was not using tobacco or alcohol but was using multiple drugs related to bodybuilding, including anabolic–androgenic steroids, subcutaneous growth hormone, clenbuterol, and multiple vitamin supplements. Laboratory studies revealed a normal white blood cell count, elevated C-reactive protein, minimally elevated aspartate aminotransferase and total bilirubin with normal remaining liver tests, and elevated amylase and lipase. The patient had no hypertriglyceridemia or hypercalcemia, and had had no recent infections, abdominal procedures, trauma, or scorpion exposure. Imaging and laboratory investigations were negative for biliary disease and IgG4 disease. Abdominal computed tomography revealed hepatomegaly and diffuse thickening and edema of the body and tail of the pancreas with peripancreatic fat stranding. An abdominal ultrasound showed slight hepatomegaly with no evidence of cholelithiasis. Genetic testing for hereditary pancreatitis-related mutations was negative. A diagnosis of drug-induced acute pancreatitis was made, and he was treated with aggressive intravenous hydration and pain management. The patient has avoided further use of these drugs and supplements and had no further episodes of pancreatitis during 1 year of follow-up.

This case describes a patient with drug-induced acute pancreatitis after the intake of anabolic–androgenic steroids, subcutaneous growth hormone, and clenbuterol, where all other common causes of acute pancreatitis were excluded. Clinicians should be alert to the possibility of drug-induced acute pancreatitis occurring in bodybuilders and athletes using similar drug combinations.

• Anabolic–androgenic steroids
• Bodybuilder
• Case report
• Clenbuterol
• Drug-induced acute pancreatitis
• Growth hormone

• purines
• purine metabolism intermediates
• predictors of necrosis
• pancreas
• pancreatitis
• pancreatic necrosis

• Acute recurrent
• Exocrine insufficiency
• Pediatric pancreatitis

• acute pancreatitis
• drug induced pancreatitis
• idiopathic pancreatitis

Primary chylomicronemia (PCM) is a rare and intractable disease characterized by marked accumulation of chylomicrons in plasma. The levels of plasma triglycerides (TGs) typically range from 1,000 - 15,000 mg/dL or higher.

PCM is caused by defects in the lipoprotein lipase (LPL) pathway due to genetic mutations, autoantibodies, or unidentified causes. The monogenic type is typically inherited as an autosomal recessive trait with loss-of-function mutations in LPL pathway genes ( LPL , LMF1 , GPIHBP1 , APOC2 , and APOA5 ). Secondary/environmental factors (diabetes, alcohol intake, pregnancy, etc.) often exacerbate hypertriglyceridemia (HTG).

The signs, symptoms, and complications of chylomicronemia include eruptive xanthomas, lipemia retinalis, hepatosplenomegaly, and acute pancreatitis with onset as early as in infancy. Acute pancreatitis can be fatal and recurrent episodes of abdominal pain may lead to dietary fat intolerance and failure to thrive.

The main goal of treatment is to prevent acute pancreatitis by reducing plasma TG levels to at least less than 500-1,000 mg/dL. However, current TG-lowering medications are generally ineffective for PCM. The only other treatment options are modulation of secondary/environmental factors. Most patients need strict dietary fat restriction, which is often difficult to maintain and likely affects their quality of life.

Timely diagnosis is critical for the best prognosis with currently available management, but PCM is often misdiagnosed and undertreated. The aim of this review is firstly to summarize the pathogenesis, signs, symptoms, diagnosis, and management of PCM, and secondly to propose simple diagnostic criteria that can be readily translated into general clinical practice to improve the diagnostic rate of PCM. In fact, these criteria are currently used to define eligibility to receive social support from the Japanese government for PCM as a rare and intractable disease.

Nevertheless, further research to unravel the molecular pathogenesis and develop effective therapeutic modalities is warranted. Nationwide registry research on PCM is currently ongoing in Japan with the aim of better understanding the disease burden as well as the unmet needs of this life-threatening disease with poor therapeutic options.

• Chylomicronemia
• Diagnostic criteria
• Pancreatitis
• Treatment guide
• Triglyceride

• Baylisascariasis-induced acute pancreatitis
• Baylisascaris schroederi
• Diagnosis
• Giant panda

The etiology of hypertriglyceridemia (HTG) and acute pancreatitis (AP) is complex. Herein, we dissected the underlying etiology in a patient with HTG and AP. The patient had a 20-year history of heavy alcohol consumption and an 8-year history of mild HTG. He was hospitalized for alcohol-triggered AP, with a plasma triglyceride (TG) level up to 21.4 mmol/L. A temporary rise in post-heparin LPL concentration (1.5–2.5 times of controls) was noted during the early days of AP whilst LPL activity was consistently low (50∼70% of controls). His TG level rapidly decreased to normal in response to treatment, and remained normal to borderline high during a ∼3-year follow-up period during which he had abstained completely from alcohol. Sequencing of the five primary HTG genes (i.e., LPL, APOC2, APOA5, GPIHBP1 and LMF1) identified two heterozygous variants. One was the common APOA5 c.553G > T (p.Gly185Cys) variant, which has been previously associated with altered TG levels as well as HTG-induced acute pancreatitis (HTG-AP). The other was a rare variant in the LPL gene, c.756T > G (p.Ile252Met), which was predicted to be likely pathogenic and found experimentally to cause a 40% loss of LPL activity without affecting either protein synthesis or secretion. We provide evidence that both a gene-gene interaction (between the common APOA5 variant and the rare LPL variant) and a gene-environment interaction (between alcohol and digenic inheritance) might have contributed to the development of mild HTG and alcohol-triggered AP in the patient, thereby improving our understanding of the complex etiology of HTG and HTG-AP.

• APOA5 gene
• LPL gene
• acute pancreatitis
• alcohol-induced hypertriglyceridemia
• gene-environment interaction

• Acute pancreatitis
• MKK3-p38 pathway
• TRAF3
• miR-92b-3p

• Acinar Cells/metabolism
• Animals
• Autophagy/genetics
• Cell Line
• Ceruletide/toxicity
• Cytokines/metabolism
• Inflammation/genetics
• MAP Kinase Kinase 3/metabolism
• MicroRNAs/genetics
• MicroRNAs/immunology
• MicroRNAs/metabolism
• Pancreas/metabolism
• Rats
• Signal Transduction/genetics
• TNF Receptor-Associated Factor 3/genetics
• TNF Receptor-Associated Factor 3/metabolism
• p38 Mitogen-Activated Protein Kinases/metabolism

Introduction

Hypertriglyceridemia (HTG)-induced pancreatitis is the third most common cause of acute pancreatitis after gallstone disease and alcohol. We analyzed data from the National (Nationwide) Inpatient Sample (NIS) with the aim of evaluating the outcomes of patients with HTG-induced pancreatitis when compared to those with biliary-induced pancreatitis.

Methods

The NIS database was sourced for data involving adult hospitalizations for HTG-induced pancreatitis in the United States between January 1, 2016 and December 31, 2017. The main outcome was mortality in patients with biliary pancreatitis vs HTG pancreatitis. Secondary outcomes were the incidence of sepsis, septic shock, non-ST-elevation myocardial infarction (NSTEMI), blood transfusion requirements, acute kidney failure, acute respiratory distress syndrome (ARDS), and length of hospital stay.

Results

A total of 575,230 patients were admitted with a diagnosis of acute pancreatitis, 18.2% of which were classified as having HTG pancreatitis. The in-hospital mortality for pancreatitis was 0.59%. Patients with HTG pancreatitis had lower odds of in-hospital mortality (adjusted odds ratio [aOR]: 0.74, 95% CI 0.582-0.934, p=0.012) compared to those with biliary pancreatitis. Patients with HTG pancreatitis had less odds of developing comorbid sepsis (aOR: 0.52, 95% CI 0.441-0.612, p<0.001), septic shock (aOR: 0.64, 95% CI 0.482-0.851, p<0.001), and NSTEMI (aOR: 0.70, 95% CI 0.535-0.926, p<0.001) and had less odds of requiring transfusion of blood products (aOR: 0.57, 95% CI 0.478-0.678, p<0.001) when compared to those with biliary pancreatitis. Patients with HTG pancreatitis also had a lower average length of hospital stay and lower total hospital charges compared to those with biliary pancreatitis. There was no statistical difference, however, in acute kidney failure and ARDS between the two groups.

Conclusion

Patients with HTG-induced pancreatitis possibly have better inpatient outcomes including mortality when compared to those with biliary-induced pancreatitis.

• acute pancreatitis
• biliary pancreatitis
• gallstone pancreatitis
• hypertriglyceridemia
• mortality

• Infected pancreatic necrosis
• Open surgical necrosectomy
• Pancreatic abscess
• Pancreatic collection
• Walled-off necrosis

• Aged
• Feasibility Studies
• Humans
• Intraabdominal Infections/diagnostic imaging
• Intraabdominal Infections/surgery
• Male
• Middle Aged
• Pancreatitis, Acute Necrotizing/diagnostic imaging
• Pancreatitis, Acute Necrotizing/surgery
• Tomography, X-Ray Computed

Recent guidelines advise against prophylactic antibiotics in patients with necrotizing pancreatitis, advocating instead a step-up drainage and necrosectomy strategy with antibiotics as dictated by microbiological findings. However, prompt antibiotic therapy is recommended in patients with sepsis or septic shock, a possible presentation of infected pancreatic necrosis (IPN). Consequently, in many critically ill patients with IPN, pancreatic samples are collected only after broad-spectrum antibiotic therapy initiation. Whether this prior antibiotic exposure alters the microbiological findings is unknown. The main objective was to determine whether prior antibiotic exposure sterilized the samples collected during procedures for suspected IPN in patients admitted to the intensive care unit (ICU) for acute pancreatitis with suspected IPN. We retrospectively studied 56 consecutive ICU patients admitted with suspected IPN. We collected details on the microbiological samples and antimicrobials used. A definite diagnosis of IPN was given when bacteria were identified in pancreatic samples.

In all, 137 pancreatic samples were collected, including 91 (66.4%) after antibiotic therapy initiation. IPN was confirmed in 48 (86%) patients. The proportion of positive samples was 74 (81.3%) in antibiotic-exposed patients and 32/46 (69.5%) in unexposed patients (p = 0.58). Of the 74 positive samples from exposed patients, 62 (84%) had organisms susceptible to the antibiotics used. One-third of samples contained more than one organism. Among patients with IPN, 37.5% had positive blood cultures. Multidrug- or extensively drug-resistant bacteria were identified at some point in half the patients. Enterobacter cloacae complex was more frequent in the exposed group (p = 0.02), as were Gram-negative anaerobic bacteria (p = 0.03).

Antibiotic exposure before sampling did not seem to affect culture positivity of pancreatic samples to confirm IPN, but may affect microbiological findings. Our results suggest that, in patients with sepsis and suspected IPN, antibiotics should be started immediately and pancreatic samples obtained as soon as possible thereafter. In other situations, antibiotics can be withheld until the microbiological results of pancreatic samples are available, to ensure accurate targeting of the spectrum to bacterial susceptibility patterns.

ClinicalTrials.gov number NCT03253861

• Acute pancreatitis
• Infected pancreatic necrosis
• Multidrug-resistant infection
• Step-up approach

• Acute pancreatitis
• Drug-induced pancreatitis
• Etiology
• Inflammation
• Mechanism of action
• Pharmacology

• Acute Disease
• Case-Control Studies
• Hospitalization
• Humans
• Pancreatitis/chemically induced
• Pancreatitis/diagnosis
• Pancreatitis/epidemiology
• Pharmaceutical Preparations
• United States/epidemiology

• Acute pancreatitis
• Complications
• Hypertriglyceridemia
• Prognosis
• Severity

• NF-κB
• hyperlipidemia
• pancreatitis
• peroxisome proliferator-activated receptor-γ
• saikosaponin a

To explore the risk factors of developing chronic pancreatitis (CP) in patients with acute pancreatitis (AP) and develop a prediction score for CP.

Using the National Health Insurance Research Database in Taiwan, we obtained large, population-based data of 5971 eligible patients diagnosed with AP from 2000 to 2013. After excluding patients with obstructive pancreatitis and biliary pancreatitis and those with a follow-up period of less than 1 year, we conducted a multivariate analysis using the data of 3739 patients to identify the risk factors of CP and subsequently develop a scoring system that could predict the development of CP in patients with AP. In addition, we validated the scoring system using a validation cohort.

Among the study subjects, 142 patients (12.98%) developed CP among patients with RAP. On the other hand, only 32 patients (1.21%) developed CP among patients with only one episode of AP. The multivariate analysis revealed that the presence of recurrent AP (RAP), alcoholism, smoking habit, and age of onset of < 55 years were the four important risk factors for CP. We developed a scoring system (risk score 1 and risk score 2) from the derivation cohort by classifying the patients into low-risk, moderate-risk, and high-risk categories based on similar magnitudes of hazard and validated the performance using another validation cohort. Using the prediction score model, the area under the curve (AUC) [95% confidence interval (CI)] in predicting the 5-year CP incidence in risk score 1 (without the number of AP episodes) was 0.83 (0.79, 0.87), whereas the AUC (95%CI) in risk score 2 (including the number of AP episodes) was 0.84 (0.80, 0.88). This result demonstrated that the risk score 2 has somewhat better prediction performance than risk score 1. However, both of them had similar performance between the derivation and validation cohorts.

In the study,we identified the risk factors of CP and developed a prediction score model for CP.

• Chronic pancreatitis
• Acute pancreatitis
• Prediction score
• Endoscopic ultrasound
• Recurrent acute pancreatitis

• Adult
• Aged
• Area Under Curve
• Cohort Studies
• Databases, Factual/statistics & numerical data
• Female
• Humans
• Incidence
• Male
• Middle Aged
• Multivariate Analysis
• National Health Programs/statistics & numerical data
• Pancreatitis, Chronic/epidemiology
• Predictive Value of Tests
• Risk Factors
• Taiwan/epidemiology

• cholecystectomy
• laparoscopic
• meta-analysis
• pancreatitis
• review

• Pancreatic necrosis
• Perfusion CT
• Persistent organ failure
• Severe acute pancreatitis

• Adult
• Aged
• Cohort Studies
• Early Diagnosis
• Female
• Humans
• Male
• Middle Aged
• Pancreatitis, Acute Necrotizing/diagnostic imaging
• Pancreatitis, Acute Necrotizing/physiopathology
• Perfusion Imaging/methods
• Predictive Value of Tests
• Prospective Studies
• ROC Curve
• Severity of Illness Index
• Tomography, X-Ray Computed/methods

• lipase inhibition
• obesity
• pancreatitis
• unsaturated fatty acids

• conversion to open surgery
• laparoscopic cholecystectomy
• pancreatitis

We report an usual case of hepatic portal venous gas (HPVG) in the setting of acute pancreatitis and small bowel ischemia. Interestingly, the HPVG disappeared within 2 hours of the original computed tomography scan, despite the patient having small bowel ischemia. The patient had a complicated clinical course, dying 62 days postadmission. This case highlights that HPVG in setting of acute pancreatitis and small bowel ischemia has a very high morbidity and mortality, requiring early detection and aggressive surgical management.

• Acute pancreatitis
• Hepatoportal venous gas
• Ischemic bowel
• Portal venous gas
• Small bowel ischemia
• Surgical management