|
1
|
Hu WM, Hua TR, Zhang YL, Chen GR, Song K, Pendharkar S, Wu D, Windsor JA. Prognostic significance of organ failure and infected pancreatic necrosis in acute pancreatitis: An updated systematic review and meta-analysis. J Dig Dis 2023; 24:648-659. [PMID: 38037512 DOI: 10.1111/1751-2980.13243] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2023] [Revised: 10/15/2023] [Accepted: 11/21/2023] [Indexed: 12/02/2023]
Abstract
OBJECTIVES In patients with acute pancreatitis (AP), minimally invasive treatment and the step-up approach have been widely used to deal with infected pancreatic necrosis (IPN) in the last decade. It is unclear whether IPN has become a less important determinant of mortality relative to organ failure (OF). We aimed to statistically aggregate recent evidence from published studies to determine the relative importance of IPN and OF as determinants of mortality in patients with AP (PROSPERO: CRD42020176989). METHODS Relevant studies were sourced from MEDLINE and EMBASE databases. Relative risk (RR) or weighted mean difference (WMD) was analyzed as outcomes. A two-sided P value of less than 0.05 was regarded as statistical significance. RESULTS Forty-three studies comprising 11 601 patients with AP were included. The mortality was 28% for OF patients and 24% for those with IPN. Patients with OF without IPN had a significantly higher risk of mortality compared to those with IPN but without OF (RR 3.72, P < 0.0001). However, patients with both OF and IPN faced the highest risk of mortality. Additionally, IPN increased length of stay in hospital for OF patients (WMD 28.75, P = 0.032). CONCLUSION Though IPN remains a significant concern, which leads to increased morbidity and longer hospital stay, it is a less critical mortality determinant compared to OF in AP.
Collapse
Affiliation(s)
- Wen Mo Hu
- Department of Gastroenterology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Tian Rui Hua
- Department of Gastroenterology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yue Lun Zhang
- Medical Research Center, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- Clinical Epidemiology Unit, International Clinical Epidemiology Network, Beijing, China
| | - Guo Rong Chen
- Department of Gastroenterology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Kai Song
- Department of Gastroenterology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Sayali Pendharkar
- Surgical and Translational Research Centre, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Dong Wu
- Department of Gastroenterology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- Clinical Epidemiology Unit, International Clinical Epidemiology Network, Beijing, China
| | - John A Windsor
- Surgical and Translational Research Centre, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| |
Collapse
|
|
2
|
Ghiță AI, Pahomeanu MR, Negreanu L. Epidemiological trends in acute pancreatitis: A retrospective cohort in a tertiary center over a seven year period. World J Methodol 2023; 13:118-126. [PMID: 37456974 PMCID: PMC10348081 DOI: 10.5662/wjm.v13.i3.118] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Revised: 05/04/2023] [Accepted: 06/06/2023] [Indexed: 06/20/2023] Open
Abstract
BACKGROUND Acute pancreatitis (AP) remains a major cause of hospitalization and mortality with important health-related costs worldwide. Using an electronic database of a large tertiary center, we estimated the incidence, etiology, severity and costs of hospitalized AP cases in southern Romania. AIM To estimate the incidence, cost and tobacco usage of hospitalized AP cases in southern Romania and to update and upgrade the knowledge we have on the etiology, severity (in regard to Revised Atlanta Classification), outcome, morphology and local complications of AP. METHODS We performed an electronic health care records search on AP patients treated at Emergency University Hospital of Bucharest (Spitalul Universitar de Urgență București) between 2015 and 2022. The incidence, etiology, and severity were calculated; potential risk factors were evaluated, and the hospitalization costs of AP were documented and analyzed. The cohort of this study is part of the BUCharest - Acute Pancreatitis Index registry. RESULTS A total of 947 consecutive episodes of AP where the patients were hospitalized in the gastroenterology department were analyzed, with 79.45% as 1st episode and the rest recurrent. The majority of the patients were males (68.9%). Alcoholic (45.7%), idiopathic (16.4%) and biliary (15.2%) were the main causes. The incidence was estimated at 29.2 episodes/100000 people. The median length of stay was 7 d. The median daily cost was 747.96 RON (165 EUR). There was a high prevalence of active tobacco smokers (68.5%). The prevalence of severe disease was 11.1%. The admission rate to the intensive care unit was 4.6%, with a mortality rate of 38.6%. The overall mortality was 5.5%. CONCLUSION We estimated the incidence of AP at 29.2 episodes that required hospitalization per 100000 people. The majority of our cases were found in males (68.9%) and were related to alcohol abuse (45.7%). Out of the cases we were able to find data regarding tobacco usage, the majority were active smokers (68.5%). Most patients had a mild course (54.4%), with a mortality rate of 5.5%. Interstitial AP prevailed (45.3%). The median daily cost of hospitalization was 747.96 RON (165 EUR).
Collapse
Affiliation(s)
- Andreea Irina Ghiță
- Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, Bucharest 050474, Romania
| | - Mihai Radu Pahomeanu
- Internal Medicine I & Gastroenterology - University Emergency Hospital of Bucharest, Carol Davila University of Medicine and Pharmacy, Bucharest 050098, Romania
| | - Lucian Negreanu
- Internal Medicine I & Gastroenterology - University Emergency Hospital of Bucharest, Carol Davila University of Medicine and Pharmacy, Bucharest 050098, Romania
| |
Collapse
|
|
3
|
Zubia-Olaskoaga F, Maraví-Poma E, Urreta-Barallobre I, Ramírez-Puerta MR, Mourelo-Fariña M, Marcos-Neira MP. Validation of the Modified Determinant-Based Classification for Patients With Acute Pancreatitis in Intensive Care Medicine. Pancreas 2021; 50:867-872. [PMID: 34347731 DOI: 10.1097/mpa.0000000000001855] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVES To validate the Modified Determinant-Based Classification (MDBC) system, and compare it with the Revised Atlanta Classification (RAC) and the Determinant-Based Classification (DBC). METHODS Prospective observational research was conducted in 35 international intensive care units, on patients with acute pancreatitis, and at least 1 organ failure (OF). Patient classification according to the MDBC was as follows: group 1 (transient OF, without local complications [LCs]), group 2 (transient OF and LC), group 3 (persistent OF, without LC), and group 4 (persistent OF and LC). RESULTS A total of 316 patients were enrolled (mortality of 25.6%). In group 1, patients presented with low mortality (3.31%) and low morbidity (13.68%); in group 2, low mortality (5.26%) and moderate morbidity (55.56%); in group 3, high mortality (32.18%) and moderate morbidity (54.24%); and in group 4, high mortality (53.93%) and high morbidity (97.56%). The area under the receiver operator characteristic curve for mortality was 0.80 (95% confidence interval [CI], 0.75-0.84), with significant differences in comparison to RAC (0.76; 95% CI, 0.70-0.80) and DBC (0.79; 95% CI, 0.74-0.83) (P < 0.01). CONCLUSIONS The MDBC identified 4 groups with differentiated clinical evolutions. Its tiered mortality rating provided it with better discriminatory power than the DBC and the RAC.
Collapse
Affiliation(s)
| | | | - Iratxe Urreta-Barallobre
- Clinical Epidemiology Unit, CASPe, CIBER-ESP, IIS BioDonostia, Donostia University Hospital, Donostia-San Sebastian
| | | | | | | |
Collapse
|
|
4
|
Alves JR, Ferrazza GH, Nunes Junior IN, Teive MB. THE ACCEPTANCE OF CHANGES IN THE MANAGEMENT OF PATIENTS WITH ACUTE PANCREATITIS AFTER THE REVISED ATLANTA CLASSIFICATION. ARQUIVOS DE GASTROENTEROLOGIA 2021; 58:17-25. [PMID: 33909792 DOI: 10.1590/s0004-2803.202100000-05] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Accepted: 10/21/2020] [Indexed: 11/22/2022]
Abstract
BACKGROUND New recommendations for the management of patients with acute pancreatitis were set after the Atlanta Classification was revised in 2012. OBJECTIVE The aim of the present systematic review is to assess whether these recommendations have already been accepted and implemented in daily medical practices. METHODS A systematic literature review was carried out in studies conducted with humans and published in English and Portuguese language from 10/25/2012 to 11/30/2018. The search was conducted in databases such as PubMed/Medline, Cochrane and SciELO, based on the following descriptors/Boolean operator: "Acute pancreatitis" AND "Atlanta". Only Randomized Clinical Trials comprising some recommendations released after the revised Atlanta Classification in 2012 were included in the study. RESULTS Eighty-nine studies were selected and considered valid after inclusion, exclusion and qualitative evaluation criteria application. These studies were stratified as to whether, or not, they applied the recommendations suggested after the Atlanta Classification revision. Based on the results, 68.5% of the studies applied the recommendations, with emphasis on the application of severity classification (mild, moderately severe, severe); 16.4% of them were North-American and 14.7% were Chinese. The remaining 31.5% just focused on comparing or validating the severity classification. CONCLUSION Few studies have disclosed any form of acceptance or practice of these recommendations, despite the US and Chinese efforts. The lack of incorporation of these recommendations didn't enable harnessing the benefits of their application in the clinical practice (particularly the improvement of the communication among health professionals and directly association with the worst prognoses); thus, it is necessary mobilizing the international medical community in order to change this scenario.
Collapse
Affiliation(s)
- José Roberto Alves
- Universidade Federal de Santa Catarina, Departamento de Cirurgia, Florianópolis, SC, Brasil
| | | | | | | |
Collapse
|
|
5
|
Zhang Y, Zhang C, Yu WQ, Wang ZE, Zhang J, Liang TB. The "Two-Step" approach for classifying the severity of acute pancreatitis: A retrospective study. JOURNAL OF HEPATO-BILIARY-PANCREATIC SCIENCES 2021; 28:902-912. [PMID: 33742555 DOI: 10.1002/jhbp.943] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Revised: 02/23/2021] [Accepted: 02/24/2021] [Indexed: 11/05/2022]
Abstract
BACKGROUND The Revised Atlanta Classification (RAC) and Determinant-Based Classification (DBC) are currently two widely adopted systems for evaluating the severity of acute pancreatitis (AP). This study aimed to overcome the inaccuracies and limitations that existed in them. METHODS We retrospectively analyzed 298 patients with AP. The "Two-Step" approach was divided into an early organ failure (OF) assessment: (I) none, (II) transient, (III) single persistent, and (IV) multiple persistent; and a later local complications assessment: (A) none, (B) sterile, and (C) infectious. Patients with AP who died before the second step were classified into category X. The "Two-Step" approach was then compared to the RAC and DBC. RESULTS As the patients' grades increased (I to IV), organ support treatment rates, intensive care unit lengths of stay, and mortalities increased. Invasive intervention rates displayed increasing trends with local complications aggravated (A to C). Patients in category X were older and had higher Marshall scores with the highest grades of severity. CONCLUSIONS By combining the early OF grades and the late local complications, the "Two-Step" approach represents an accurate classification system required for stratified studies of AP, and introduces the category X as the severest forms of AP.
Collapse
Affiliation(s)
- Yun Zhang
- Department of Hepatobiliary and Pancreatic Surgery, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China.,Zhejiang Provincial Key Laboratory of Pancreatic Disease, Hangzhou, China.,Innovation Center for the Study of Pancreatic Diseases, Hangzhou, China
| | - Cheng Zhang
- Department of Hepatobiliary and Pancreatic Surgery, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China.,Zhejiang Provincial Key Laboratory of Pancreatic Disease, Hangzhou, China.,Innovation Center for the Study of Pancreatic Diseases, Hangzhou, China
| | - Wen-Qiao Yu
- Department of Surgical Intensive Care Unit, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Zhi-En Wang
- Department of Rehabilitation Medicine, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Jian Zhang
- Department of Hepatobiliary and Pancreatic Surgery, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China.,Zhejiang Provincial Key Laboratory of Pancreatic Disease, Hangzhou, China.,Innovation Center for the Study of Pancreatic Diseases, Hangzhou, China
| | - Ting-Bo Liang
- Department of Hepatobiliary and Pancreatic Surgery, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China.,Zhejiang Provincial Key Laboratory of Pancreatic Disease, Hangzhou, China.,Innovation Center for the Study of Pancreatic Diseases, Hangzhou, China
| |
Collapse
|
|
6
|
Infectious Complications in Severe Acute Pancreatitis: Pathogens, Drug Resistance, and Status of Nosocomial Infection in a University-Affiliated Teaching Hospital. Dig Dis Sci 2020; 65:2079-2088. [PMID: 31691173 DOI: 10.1007/s10620-019-05924-9] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2019] [Accepted: 10/25/2019] [Indexed: 12/13/2022]
Abstract
BACKGROUND Secondary infection is an important factor affecting mortality and quality of life in patients with severe acute pancreatitis. The characteristics of secondary infection, which are well known to clinicians, need to be re-examined in detail, and their understanding among clinicians needs to be updated accordingly. AIM This study aims to investigate the characteristics and drug resistance of pathogens causing severe acute pancreatitis (SAP) secondary infection, to objectively present infection situation, and to provide reference for improved clinical management. METHODS A retrospective analysis was performed on 55 consecutive patients with SAP who developed secondary infection with an accurate evidence of bacterial/fungal culture from 2016 to 2018. The statistics included the spectrum and distribution of pathogens, the drug resistance of main pathogens, and associations between multiple infectious parameters and mortality. RESULTS A total of 181 strains of pathogens were isolated from (peri)pancreas; bloodstream; and respiratory, urinary, and biliary systems in 55 patients. The strains included 98 g-negative bacteria, 58 g-positive bacteria, and 25 fungi. Bloodstream infection (36.5%) was the most frequent infectious complication, followed by (peri)pancreatic infection (32.0%). Acinetobacter baumannii, Pseudomonas aeruginosa, Klebsiella pneumoniae, Escherichia coli, and Stenotrophomonas maltophilia were predominant among gram-negative bacteria. Gram-positive bacterial infections were mainly caused by Enterococcus faecium and Staphylococcus spp. Fungal infections were predominantly caused by Candida spp. The drug resistance of pathogens causing SAP secondary infection was generally higher than the surveillance level. Patients in the death group were older (55 ± 13 years vs. 46 ± 14 years; p = 0.039) and had longer intensive care unit (ICU) stay (14 vs. 8; p = 0.026) than those in the survival group. A. baumannii infection (68.4% vs. 33%; p = 0.013), number of pathogens ≥ 4 (10 vs. 6; p = 0.005), pancreatic infection (14 vs. 15, p = 0.024), and urinary infection (8 vs. 5; p = 0.019) were significantly associated with mortality. CONCLUSION Gram-negative bacteria are the main pathogens causing SAP secondary infection, in which nosocomial infections play a major role. The drug resistance profile of gram-negative bacteria is seriously threatening, and the commonly used antibiotics in SAP are gradually losing their effectiveness. Much attention should be paid to the rational use of antibiotics, and strategies should be established for infection prevention in SAP.
Collapse
|
|
7
|
|
|
8
|
Wu D, Lu B, Xue HD, Yang H, Qian JM, Lee P, Windsor JA. Validation of Modified Determinant-Based Classification of severity for acute pancreatitis in a tertiary teaching hospital. Pancreatology 2019; 19:217-223. [PMID: 30642724 DOI: 10.1016/j.pan.2019.01.003] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2016] [Revised: 01/04/2019] [Accepted: 01/05/2019] [Indexed: 12/11/2022]
Abstract
BACKGROUND The relative merits of two recent classifications of acute pancreatitis severity, the Determinant-Based Classification (DBC) and the Revised Atlanta Classification (RAC), have been debated. A Modified DBC (MDBC) was recently proposed in intensive care unit (ICU) patients. By dividing the DBC 'severe' category into two groups, the MDBC classified non-mild acute pancreatitis into 4 groups rather than 2 in RAC and 3 in DBC. In this study we aim to validate MDBC in both ICU and non-ICU patients and evaluate infected necrosis as a determinant of severity. METHODS Prospective data collected on consecutive patients admitted to a tertiary teaching hospital were retrospectively analyzed. Patients were assigned to the categories of severity defined by the DBC, RAC and MDBC. Clinical interventions and outcomes were compared between categories. RESULTS A total of 1102 patients were enrolled and the overall mortality was 5.7%. When MDBC was applied, the four Groups were significantly different in regard to ICU admission rates (30%, 40%, 69% and 87%) and mortality (2%, 15%, 40% and 57%). Groups 2 and 3 were different in intervention rates and morbidity, providing evidence that IN is an important determinant of severity. CONCLUSIONS This study validates the MDBC proposal to subdivide the DBC 'severe' category into two groups for ICU and non-ICU patients in a tertiary hospital.
Collapse
Affiliation(s)
- Dong Wu
- Department of Gastroenterology, Translational Medicine Center, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, People's Republic of China
| | - Bo Lu
- Department of Gastroenterology, Translational Medicine Center, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, People's Republic of China
| | - Hua-Dan Xue
- Department of Radiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, People's Republic of China
| | - Hong Yang
- Department of Gastroenterology, Translational Medicine Center, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, People's Republic of China
| | - Jia-Ming Qian
- Department of Gastroenterology, Translational Medicine Center, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, People's Republic of China
| | - Peter Lee
- Divison of Gastroenterology, Department of Medicine, Hospital of the University of Pennsylvania, United States
| | - John Albert Windsor
- Department of Surgery, Faculty of Medical and Health Sciences, The University of Auckland, Park Road, Auckland, New Zealand.
| |
Collapse
|
|
9
|
Wang X, Qin L, Cao J. Value of the revised Atlanta classification (RAC) and determinant-based classification (DBC) systems in the evaluation of acute pancreatitis. Curr Med Res Opin 2018; 34:1231-1238. [PMID: 28990794 DOI: 10.1080/03007995.2017.1389705] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
OBJECTIVE Since increasing acute pancreatitis (AP) severity is significantly associated with mortality, accurate and rapid determination of severity is crucial for effective clinical management. This study investigated the value of the revised Atlanta classification (RAC) and the determinant-based classification (DBC) systems in stratifying severity of acute pancreatitis. METHODS This retrospective observational cohort study included 480 AP patients. Patient demographics and clinical characteristics were recorded. The primary outcome was mortality, and secondary outcomes were admission to intensive care unit (ICU), duration of ICU stay, and duration of hospital stay. RESULTS Based on the RAC classification, there were 295 patients with mild AP (MAP), 146 patients with moderate-to-severe AP (MSAP), and 39 patients with severe AP (SAP). Based on the DBC classification, there were 389 patients with MAP, 41 patients with MSAP, 32 patients with SAP, and 18 patients with critical AP (CAP). ROC curve analysis showed that the DBC system had a significantly higher accuracy at predicting organ failure compared to the RAC system (p < .001). Multivariate regression analysis showed that age and ICU stay were independent risk factors of mortality. CONCLUSION The DBC system had a higher accuracy at predicting organ failure. Age and ICU stay were significantly associated with risk of death in AP patients. A classification of CAP by the DBC system should warrant close attention, and rapid implementation of effective measures to reduce mortality.
Collapse
Affiliation(s)
- Xiaolei Wang
- a Department of Gastroenterology , Shanghai Tenth People's Hospital, Tongji University , Shanghai , People's Republic of China
| | - Li Qin
- b Department of Gastroenterology , Tongji Hospital , Tongji University , Shanghai , People's Republic of China
| | - Jingli Cao
- b Department of Gastroenterology , Tongji Hospital , Tongji University , Shanghai , People's Republic of China
| |
Collapse
|
|
10
|
Kamal A, Faghih M, Moran RA, Afghani E, Sinha A, Parsa N, Makary MA, Zaheer A, Fishman EK, Khashab MA, Kalloo AN, Singh VK. Persistent SIRS and acute fluid collections are associated with increased CT scanning in acute interstitial pancreatitis. Scand J Gastroenterol 2018; 53:88-93. [PMID: 29017354 DOI: 10.1080/00365521.2017.1383510] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND The use of computed tomography (CT) in acute pancreatitis (AP) continues to increase in parallel with the increasing use of diagnostic imaging in clinical medicine. AIM To determine the factors associated with obtaining >1 CT scan in acute interstitial pancreatitis (AIP). METHODS Demographic and clinical data of all adult patients admitted between 1/2010 and 1/2015 with AP (AP) were evaluated. Only patients with a CT severity index (CTSI) ≤ 3 on a CT obtained within 48 h of presentation were included. RESULTS A total of 229 patients were included, of whom 206 (90%) had a single CT and 23 (10%) had >1 CT during the first week of hospitalization. Patients undergoing >1 CT had significantly higher rates of acute fluid collection (AFC), persistent SIRS, opioid use ≥4 days, and persistent organ failure compared to those undergoing 1 CT (p < .05 for all). On multivariable analysis, only persistent SIRS (OR = 3.6, 95% CI 1.4-9.6, p = .01) and an AFC on initial CT (OR = 3.5, 95% CI 1.4-9, p = .009) were independently associated with obtaining >1 CT. CONCLUSION An AFC on initial CT and persistent SIRS are associated with increased CT imaging in AIP patients. However, these additional CT scans did not change clinical management.
Collapse
Affiliation(s)
- Ayesha Kamal
- a Division of Gastroenterology , Johns Hopkins Medical Institutions , Baltimore , MD , USA
| | - Mahya Faghih
- a Division of Gastroenterology , Johns Hopkins Medical Institutions , Baltimore , MD , USA
| | - Robert A Moran
- a Division of Gastroenterology , Johns Hopkins Medical Institutions , Baltimore , MD , USA
| | - Elham Afghani
- a Division of Gastroenterology , Johns Hopkins Medical Institutions , Baltimore , MD , USA
| | - Amitasha Sinha
- a Division of Gastroenterology , Johns Hopkins Medical Institutions , Baltimore , MD , USA
| | - Nasim Parsa
- a Division of Gastroenterology , Johns Hopkins Medical Institutions , Baltimore , MD , USA
| | - Martin A Makary
- b Division of Surgical Oncology, Department of Surgery , Johns Hopkins Medical Institutions , Baltimore , MD , USA
| | - Atif Zaheer
- c Pancreatitis Center, Johns Hopkins Medical Institutions , Baltimore , MD , USA.,d Department of Radiology , Johns Hopkins Medical Institutions , Baltimore , MD , USA
| | - Elliot K Fishman
- d Department of Radiology , Johns Hopkins Medical Institutions , Baltimore , MD , USA
| | - Mouen A Khashab
- a Division of Gastroenterology , Johns Hopkins Medical Institutions , Baltimore , MD , USA
| | - Anthony N Kalloo
- a Division of Gastroenterology , Johns Hopkins Medical Institutions , Baltimore , MD , USA.,c Pancreatitis Center, Johns Hopkins Medical Institutions , Baltimore , MD , USA
| | - Vikesh K Singh
- a Division of Gastroenterology , Johns Hopkins Medical Institutions , Baltimore , MD , USA.,c Pancreatitis Center, Johns Hopkins Medical Institutions , Baltimore , MD , USA
| |
Collapse
|
|
11
|
Early prediction of persistent organ failure by serum apolipoprotein A-I and high-density lipoprotein cholesterol in patients with acute pancreatitis. Clin Chim Acta 2017; 476:139-145. [PMID: 29183667 DOI: 10.1016/j.cca.2017.11.028] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2017] [Revised: 09/26/2017] [Accepted: 11/23/2017] [Indexed: 12/11/2022]
Abstract
BACKGROUND Early identification of acute pancreatitis (AP) patients at high-risk of developing persistent organ failure (persistent OF) is a vital clinical goal. This research intends to assess the ability of apolipoprotein A-I (APO A-I) and high-density lipoprotein cholesterol (HDL-C) to predict persistent OF. METHODS Between January 2011 and September 2016, a total of 102 adult AP patients with organ failure, local complications or deterioration of former comorbidities disease during hospitalization were included in this study retrospectively. Serum lipids were tested and computed the correlation with clinical outcomes or scoring systems. The AUCs to predict persistent OF were also calculated and compared with each other. RESULTS Serum APO A-I and HDL-C levels were negatively associated with scoring systems. Meanwhile, serum lipids were negatively correlated with poor clinical outcomes. The AUCs of APO A-I, HDL-C, the combination of APO A-I and BISAP, or the combination of APO A-I and MCTSI to predict persistent OF among Moderately severe acute pancreatitis (MSAP) and Severe acute pancreatitis (SAP) patients were 0.886, 0.811, 0.912, and 0.900 or among those with organ failure were 0.915, 0.859, 0.933, and 0.933, respectively. CONCLUSIONS The concentrations of APO A-I, HDL-C, and the combinations of APO A-I and scoring systems have high predictive value to predict persistent OF.
Collapse
|
|
12
|
Li Z, Qin YQ, Huang ZS, Huang GL. Changes of etiology and therapeutics for severe acute pancreatitis during past ten years in western Guangxi area. Shijie Huaren Xiaohua Zazhi 2016; 24:1748-1753. [DOI: 10.11569/wcjd.v24.i11.1748] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
AIM: To investigate the changes of etiology and therapeutics for severe acute pancreatitis (SAP) during the past ten years in western Guangxi area, and to summarize experiences in the treatment of SAP.
METHODS: In this retrospective clinical trial, 1291 patients with acute pancreatitis (AP) were enrolled, in which 243 cases of SAP were divided into two groups for analyzing the changes of etiology, therapeutic regimens, complications and prognosis. Patients with SAP from January 2004 to December 2008 were recruited into group A and those from January 2009 to December 2013 were recruited into group B.
RESULTS: A total of 1291 AP patients were admitted during the 10 years. There were 589 cases in the previous five years, of which 16.5% (97 cases) had SAP and were included in group A. There were 702 cases in the latter five years, of which 20.8% (146 cases) had SAP and were included in group B. When comparing the etiology of SAP in the two groups, biliary tract diseases were found in 37.1% of patients in group A and 36.1% in group B; alcoholic factor was found in 24.7% and 27.6%; idiopathic factor in 21.6% and 17.7%; and hyperlipidemic factor in 11.3% and 14.3%. The effective rate was significantly higher (84.9% vs 74.2%) and the fatality rate was significantly lower (6.2% vs 15.8%) in group B than in group A (P < 0.05). The incidence rates of pancreatic pseudocyst and organ failure were significantly lower in group B than in group A (13.0% vs 23.7%, 21.9% vs 34.0%; P < 0.05).
CONCLUSION: The constituent ratio of SAP is rising in western Guangxi area in recent ten years, and biliary tract diseases are still the primary etiology of SAP. With the improvement of therapeutic regimens, the effective rate for SAP in western Guangxi is higher than before, and the incidence of complications and mortality rate decrease obviously.
Collapse
|