The in-hospital mortality of acute pancreatitis (AP) is determined by severity of AP, but also significantly impacted by patients' comorbidities. Therefore, we aimed to examine the association between comorbid risk-profiles and survival in hospitalized patients admitted with AP.

We utilized the German nationwide inpatient statistics to identify all AP patient-cases (ICD code K85) admitted to hospitals in Germany between 2005 and 2019. Hospitalization cases for AP were stratified by survival, and risk factors for in-hospital mortality were examined.

In total, 797,364 hospitalization-cases of patients admitted due to AP (median age 56.0 [IQR 44.0-71.0] years, 39.2 % females) were treated in Germany 2005-2019. Of these, 22,022 (2.8 %) patients died during hospitalization. AP survivors were younger (56.0 [44.0-71.0] vs. 76.0 [64.0-84.0], P < 0.001), more often males (61.0 % vs. 54.1 %, P < 0.001), and were less often afflicted by cardiovascular risk factors and diseases than non-survivors. Cardiovascular diseases (OR 2.08 (95 %CI 2.02-2.15), P < 0.001) and raising number of cardiovascular diseases (OR 1.48 (95 %CI 1.45-1.50), P < 0.001) were independently associated with increasing mortality. In particular, heart failure (OR 2.16 [95 %CI 2.09-2.24], P < 0.001), peripheral artery disease (OR 1.25 [1.15-1.35], P < 0.001), atrial fibrillation/flutter (OR 1.61 [95 %CI 1.55-1.66], P < 0.001), myocardial infarction (OR 4.71 [95 %CI 4.28-5.18], P < 0.001), pulmonary embolism (OR 12.19 [95 %CI 10.91-13.62], P < 0.001), and stroke (OR 7.21 [95 %CI 6.42-8.11], P < 0.001) were independently associated with in-hospital mortality.

Between 2005 and 2019, the in-hospital mortality among hospitalized AP patients was 2.8 % in Germany. Presence of cardiovascular diseases was associated with significantly reduced survival in AP patients.

Acute pancreatitis represents a severe health problem, not only because of the number of people affected but also because of the severity of its clinical presentation that can eventually lead to the death of patients. The study of the disease is complex, and we lack optimized models that can approach the clinical presentation in patients, in addition to the significant vulnerability of the organ itself. In the present work, we undertook the task of reviewing and analyzing the experimental methods most currently used for the induction of acute pancreatitis, emphasizing the advantages and disadvantages of each model and their delimitation based on experimental objectives. We aimed to provide an actual and quick-access guide for researchers interested in experimental acute pancreatitis.

Acute Pancreatitis (AP) poses a significant healthcare burden globally. While most cases present with a mild course, approximately one-fifth progress to severe forms characterized by severe pancreatitis and systemic complications, leading to a mortality rate of up to 40%. Effective management of severe acute pancreatitis necessitates a multidisciplinary approach involving gastroenterologists, interventional radiologists, intensive care teams, and surgeons. The advances in treatment modalities, including early hydration, nutrition, and pain control, have led to a decrease in the morbidity and long-term complications associated with severe acute pancreatitis down to 20%. In this review, we focus on the management challenges and outcomes associated with the difficult condition of severe acute pancreatitis.

Severe acute pancreatitis (SAP) is a highly morbid acute digestive disorder linked to pyroptosis. N-acetyltransferase 10 (NAT10) facilitates the production of N4-acetylcytidine (ac4C) modifications in mRNA, thereby contributing to the progression of various diseases. However, the specific role of NAT10 in SAP remains to be elucidated. This study aimed to elucidate the mechanism through which NAT10 mediates pyroptosis in SAP. Sprague-Dawley rats and AR42J rat pancreatic exocrine cells were used to establish in vivo and in vitro models of SAP. The levels of ac4C and NAT10 expression were quantified using dot blot analysis and quantitative real-time PCR. Assessment of cell viability, apoptosis, amylase content, and concentrations of lactate dehydrogenase, IL-1β, and IL-18 was conducted to evaluate the severity of SAP both in vivo and in vitro . Pyroptosis was assessed by measuring caspase-1 and gasdermin D (GSDMD)-N-terminal (GSDMD-N) expression. Further mechanistic insights were gained using methylated RNA immunoprecipitation, RNA immunoprecipitation, and dual-luciferase reporter assays. Our findings indicate that the levels of ac4C modification and NAT10 were elevated in both in vivo and in vitro SAP models. Knockdown of NAT10 inhibited cell death and reduced the levels of amylase, lactate dehydrogenase, IL-1β, and IL-18 as well as the protein expression of caspase-1 and GSDMD-N, suggesting that NAT10 knockdown suppresses pyroptosis in SAP cell models. Mechanistically, NAT10 knockdown decreased the expression and stability of NOD-like receptor thermal protein domain-associated protein 3 (NLRP3) mRNA by inhibiting ac4C modification of NLRP3. Moreover, NAT10 knockdown alleviated pancreatic tissue pathology, mitigated SAP severity, and suppressed pyroptosis in an SAP rat model. Collectively, these results demonstrate that NAT10 exacerbates pancreatic injury in SAP by promoting pyroptosis through ac4C modification of NLRP3, thereby enhancing its expression. These findings suggest a potential novel therapeutic target for SAP.

The role of continuous venous-venous hemofiltration (CVVH) and combined CVVH with hemoperfusion (HP) in patients with acute pancreatitis (AP) is diverse. We hypothesized HP+CVVH, rather than CVVH alone, could have significant benefits in hypertriglyceridemia (HTG)-AP patients.

This single-center retrospective study included 347 patients with hypertriglyceride (HTH) -AP treated from January 2020 to December 2023. We assessed the association of short- and long-term outcomes (including incidence of systemic and local complications, length of ICU and hospital stays, and costs) between the HP+CVVH and CVVH groups. A subgroup analysis was performed to explore the effects of heterogeneity upon the incidence of severe AP (SAP).

Among 86 included patients, 40 received HP+CVVH therapy, and 46 received CVVH. Subgroup analysis revealed a lower incidence of severe AP after HP+CVVH therapy in patients with high procalcitonin, C-reactive protein, and interleukin-6 levels (46.4 % vs. 80.0 %, p = 0.019; 33.3 % vs. 72.7 %, p = 0.010; 37.5 % vs. 79.2 %, respectively). A significantly decreased hospital length of stay (LOS) in the HP+CVVH group was observed (10.40 [8.63-12.17] vs. 15.48 [13.02-17.94] days, p = 0.001). Furthermore, HP+CVVH showed a tendency towards lower hospital costs than CVVH ($5128 [4312-5943] vs. $8168 [6416-9920], p = 0.001). No significant differences were observed in the incidence of systemic or local complications, recurrence rates, or quality of life.

The use of HP+CVVH yielded superior outcomes in terms of the incidence of SAP compared to that of CVVH, for HTG-AP patients with a high inflammatory burden.

Fluid resuscitation represents a pivotal early therapeutic intervention in the management of acute pancreatitis (AP), yet a consensus on the optimal fluid type remains elusive. The present study endeavors to elucidate the differential effects of lactated Ringer's solution (LR) and normal saline (NS) in the initial treatment of AP.

A comprehensive literature search was conducted through the PubMed, EMBASE, and Cochrane Central Register of Controlled Trials (CENTRAL) databases, spanning from inception until July 2024. The primary outcome of interest was the likelihood of developing moderate-to-severe AP.

This meta-analysis synthesized evidence from six randomized controlled trials (RCTs) and four observational studies, involving a total of 1500 AP patients. Patients were stratified into two groups based on the administered fluid: LR (n = 689) and NS (n = 811). Our findings revealed that, compared to the NS group, patients in the LR group demonstrated a significantly lower risk of moderate-to-severe AP (OR 0.48; 95%Cl 0.34 to 0.67; P < 0.001; I2  = 0%), a shorter hospital stay (MD = -0.74, 95% confidence interval [CI] -1.20 to -0.28, P = 0.001; I2  = 0%), and a reduced intensive care unit (ICU) admission rate [relative risk (RR) = 0.42, 95% CI 0.20-0.89, P = 0.02; I2  = 0%]. Moreover, the LR group also showed a lower incidence of local complications (RR = 0.58, 95% CI 0.34-0.98, P = 0.04). Conversely, no statistically significant differences were observed between the two groups in terms of mortality, organ failure rates, Fluid administered 24 h, systemic inflammatory response syndrome (SIRS).

Our analysis underscores the superior efficacy of LR solution in comparison to NS. It provides compelling evidence of LR's ability to significantly mitigate the onset of moderate to severe pancreatitis. Additionally, our findings reveal that LR is associated with a reduced need for ICU admissions, a lower incidence of local complications, and a shorter overall hospital stay, thereby offering a more favorable clinical outcome. However, no notable differences were discerned in other complications. Subgroup analyses further suggest LR's potential to curb pancreatic necrosis and other indices, albeit these findings necessitate corroboration through extensive experimentation.

Severe acute pancreatitis (SAP) is a life-threatening condition associated with high mortality and limited therapeutic options. Current management strategies focus on infection prevention, immune regulation, and anticoagulation. Xuebijing Injection (XBJ), a widely used traditional Chinese medicine-derived intravenous preparation, has shown promising therapeutic effects in SAP. Herein, we sought to evaluate clinical and preclinical evidence on XBJ to reveal its potential mechanisms of action, and provide insights to guide future research and clinical applications.

We conducted a comprehensive survey of studies on XBJ in the treatment of SAP across PubMed, Embase, Cochrane Library, CBM, CNKI, Wanfang and VIP databases from their inception to March 21st, 2024.

A total of 239 studies were included, comprising 12 animal experiments, 7 systematic reviews, 220 clinical trials. Mechanistic studies suggest that XBJ downregulates the expression of inflammatory mediators, improves immune function, and alleviates oxidative stress via multiple signaling pathways, including the TLR4/NF-κB, p38-MAPK, HMGB1/TLR, TLR4/NF-κB, FPR1/NLRP3, and JAK/STAT pathways. These effects contribute to reducing organ damage. Compared to standard treatment, XBJ has more effective at reducing mortality and complications, improving overall clinical outcomes, shortening ventilator use time, and hospital stay in SAP patients.

Preclinical evidence and clinical trial data indicated that XBJ can simultaneously regulate inflammatory responses, immune function, microcirculatory disorders, oxidative stress, and apoptosis. However, further research is required to elucidate the specific mechanisms of action, clinical characteristics and safety of XBJ.

Low- and middle-income countries are facing an increase in the incidence of acute pancreatitis (AP)-characterized by rapid onset, fast progression, high rate of severity, and high mortality. Progression of AP into severe AP (SAP) results in a series of complications such as organ dysfunction, local abscesses, pseudocysts, and necrosis. Although the treatment of AP is primarily supportive, including fluid resuscitation and organ support, there is still a lack of consensus on the optimal management regimen for fluid therapy, and strategies to promote gastrointestinal recovery remain limited. As no effective intervention measure has yet been developed, supportive therapy remains the primary approach for the early treatment of AP. DaXianXiong decoction is a widely used traditional Chinese medicine formulation; however, limited research has been conducted on its clinical efficacy.

This study aims to evaluate the efficacy and safety of DaXianXiong decoction in preventing AP from progressing to SAP, assessing its impact on SAP incidence, clinical severity scores, inflammation markers, and gastrointestinal function, and providing evidence for AP management.

This study is a randomized, double-blind, placebo-controlled, single-center clinical trial. The primary outcomes will include the incidence of SAP, modified computed tomography severity index score, APACHE II (Acute Physiology and Chronic Health Evaluation II) score, modified Marshall score, and levels of the inflammation factor. The secondary outcomes will include the effect of the gastrointestinal dysfunction treatment. Evaluations will be conducted at baseline; 24 hours after the intervention; and on days 3, 7, and 28 after the intervention in both groups. A total of 60 eligible patients will be randomly allocated in a 1:1 ratio to the intervention group and the control group. Both groups will receive standard Western medical treatment for pancreatitis. The intervention group will additionally receive DaXianXiong decoction, while the control group will receive a placebo similar to the decoction.

This study has been funded by the Performance Incentive Project of Scientific Research Institutions in Chongqing. The trial was registered in April 2024, and data analysis is expected to be completed by April 2025. The study results will be presented at both national and international conferences and published in peer-reviewed journals.

This trial will help us assess the effectiveness and safety of DaXianXiong decoction in patients with AP and provide clinical evidence on the efficacy and safety of DaXianXiong decoction in preventing the progression of AP to SAP. By evaluating its impact, the findings will contribute to the understanding of DaXianXiong decoction as an adjunct therapy in AP management and may offer a novel complementary treatment strategy for AP, potentially improving patient outcomes and reducing complications.

Chinese Clinical Trial Registry ChiCTR2300076885; https://www.chictr.org.cn/showproj.html?proj=207084.

DERR1-10.2196/67392.

This study aimed to evaluate the prognostic significance of the levels of admission hematocrit (HCT) and the changes in the initial blood urea nitrogen (BUN) levels in predicting the efficacy of blood purification (BP) therapy in ameliorating severe acute pancreatitis (SAP) patients at admission. A retrospective study was conducted on 139 SAP patients from the People's Hospital of Guangxi Zhuang Autonomous Region from 2013 to 2022 and the data retrieved from the Medical Information Mart for Intensive Care IV (MIMIC-IV) database for 346 SAP patients. The patients were stratified based on their HCT0 levels at admission; HCT < 44% (n = 93) and HCT ≥ 44% (n = 46) and ΔBUN levels within the first 24 h post-admission; ΔBUN ≤ 0 (n = 78) and ΔBUN > 0 (n = 61). Propensity score matching (PSM) was performed on factors such as age and gender to control for differences among the strata. The clinical outcomes of the patients receiving or not receiving BP therapy were compared based on the mentioned criteria. Patients with HCT0 ≥ 44%, who were treated with BP showed no significant difference in the 28-day mortality. However, a significant increase in hospital expenses and prolonged ICU stays was observed (P < 0.05). Conversely, patients with ΔBUN ≤ 0 who received BP therapy demonstrated relatively high 28-day mortality rates, prolonged ICU stays, increased hospital expenses, and low SOFA scores (P < 0.05). The analyses of MIMIC-IV database data corroborated these findings. The predictive efficacy of BP therapy in SAP patients was significantly influenced by the changes in BUN levels at 24 h post-admission compared to the initial levels of HCT on admission. Selecting SAP patients suitable for BP treatment should be based on the changes in BUN levels to enhance effective therapeutic outcomes.

Isotonic crystalloids are recommended as the first choice for fluid therapy in acute pancreatitis (AP), with normal saline (NS) and lactate Ringer's (LR) used most often. Evidence based recommendations on the type of fluid are conflicting and generally come from small single-center randomized controlled trials (RCTs). We therefore conducted a systematic review and meta-analysis to compare the effect of balanced solutions (BS) versus NS on patient-centered clinical outcomes in AP.

From four databases searched up to October 2024, we included only RCTs of adult patients with AP that compared the use of BS (including LR, acetate Ringer's, etc.) with NS. The primary outcome was the disease advances from AP to moderately severe and severe AP (MSAP/SAP). Trial sequential analyses (TSA) were conducted to control for type-I and type-II errors and Grading of Recommendations Assessment, Development, and Evaluation (GRADE) was used to assess the quality of evidence.

Six RCTs were identified and included, involving 260 patients treated with BS and 298 patients with NS. Patients who received the BS had less MSAP/SAP [odds ratio (OR) = 0.50, 95 % confidence interval (CI): 0.29 to 0.85, P = 0.01, I2 = 0 %; 5 studies, 299 patients], reduced need of ICU admission (OR = 0.60, 95 % CI: 0.39 to 0.93, P = 0.02, I2 = 0 %; 5 studies, 507 patients) and shorter length of hospital stay [mean difference (MD) = -0.88, 95 % CI:1.48 to -0.28, P = 0.004, I2 = 0 %; 6 studies, 558 patients; confirmed by TSA with high certainty] compared with those who received NS. The evidence for most of the clinical outcomes was rated as moderate to low due to the risk of bias, imprecision and inconsistency.

BS, compared with NS, was associated with improved clinical outcomes in patients with AP. However, given the moderate to low quality of evidence for most of the outcomes assessed, further trials are warranted.

Effective early diagnosis and timely intervention in acute pancreatitis (AP) are essential for improving patient outcomes. This study aims to evaluate the clinical utility of the neutrophil CD64 index (nCD64) in stratifying patients with SAP and assessing mortality risk.

A total of 302 AP patients were enrolled and divided into a training cohort (n = 226) and a validation cohort (n = 76). Venous blood samples were collected within 24 hours of admission, and the nCD64 index was measured via flow cytometry. Other clinical parameters, including C-reactive protein (CRP) and procalcitonin (PCT), were also recorded. Logistic regression and receiver operating characteristic (ROC) curve analyses were performed to assess the diagnostic value of the nCD64 index and its capacity to predict mortality risk.

ROC curve analysis identified a cutoff value of 1.45 for the nCD64 index. Patients with nCD64 > 1.45 had significantly higher risks of complications, including systemic inflammatory response syndrome (SIRS), acute respiratory distress syndrome (ARDS), multiple organ failure (MOF), and death. Over 65% of patients with acute pancreatitis (AP) can be effectively risk-stratified at a low cost, and it has been demonstrated that AP patients with an nCD64 value ≤ 1.45 have an extremely low mortality rate (no mortality in present training and validation cohort). Kaplan-Meier survival analysis revealed a significant survival difference between high-risk (nCD64 > 1.45) and low-risk groups (p < 0.001).

The nCD64 index is an effective tool for early identification of SAP patients, allowing for the classification of over 65% of cases as low-risk for mortality.

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.

Acute Pancreatitis (AP) is a prevalent clinical pancreatic disorder characterized by acute inflammation of the pancreas, frequently associated with biliary or alcoholic events. If not treated with cholecystectomy after the first episode, patients may experience a recurrence of AP, with consequent need for emergency surgery and increased risk of death. Analyzing the risk factors that may contribute to the recurrence of Biliary and Alcoholic Pancreatitis (BAP and AAP), future research can be driven toward new solutions for preventing and treating this pancreatic disease.

A systematic review was conducted selecting studies from BiomedCentral, PubMed, Scopus and Web of Science by two independent reviewers. Publications were considered only if written in English in the time interval between January 2000 and June 2024 and investigated the risk factors for the recurrence of BAP and AAP. At the end of the selection, a quality assessment phase was conducted using the PROBAST tool.

In this systematic review, 8 articles were selected out of 6.945, involving a total sample of 11.271 patients of which 38.77% developed recurrence episodes. 37.5% of the included studies focus on recurrent acute biliary pancreatitis (RBAP), while 62.5% are dedicated to recurrent acute alcoholic pancreatitis (RAAP). The risk factors for the recurrence of AP showed a clear differentiation between the alcoholic and biliary etiology. Most of the considered studies adopted a retrospective design, characterized by a susceptibility to potential methodological biases. However, the trend indicated a more recent increase in prospective studies, together with a greater focus on identifying and understanding the possible risk factors associated with the recurrence of acute pancreatitis (RAP). This result highlighted the progress in the scientific approach toward a more rigorous and systematic assessment of the causes and dynamics that influence the recurrence of the disease.

Studies highlighted the importance of lifestyle factors, clinical complications, and surgical interventions that can impact the risk of biliary or alcoholic recurrent acute pancreatitis. Increased and systematic adoption of artificial intelligence-based tools could significantly impact future knowledge relating to the risks of recurrence and relative possibilities of prevention.

Acute pancreatitis (AP) is an inflammatory disease that can represent a challenge for clinicians, in fact, the early determination of its severity in the first 72 h is crucial for prognosis, recognizing the etiology and carrying out risk stratification to determine a more specific therapy. No accurate early prognostic scores for disease severity have been published, so the severity of AP often cannot be properly defined in the first few hours of the disease. This initial phase represents a "no man's land", in which there is no certainty in the stratification of the damage, prognosis is difficult to establish, therapy must be started promptly, although there is still no effective medical therapy against pancreatic enzymatic activation. Therefore, it is very difficult at this stage to make the correct decisions to achieve the best outcome for the patient with AP. Literature search was carried out using the PubMed database by entering early management of acute pancreatitis [title] or therapy of acute pancreatitis [title] and selecting the most relevant articles for the diagnosis and therapy of acute pancreatitis in clinical practice. This document provides suggestions on managing the key clinical decisions for patients suffering from AP before disease severity is defined, to achieve the best outcomes for patients with AP.

Background: Alcohol use and hypertriglyceridemia are the second and third common causes of acute pancreatitis after choledocholithiasis. Still, few studies directly compare the severity and outcomes of these two groups, which share pathophysiology pathways. Methods: In our study, we compared the biologic profile, severity according to the Atlanta classification and Balthazar index, intensive care unit admissions, and mortality between patients with hypertriglyceridemia-induced pancreatitis (HTGP) and alcohol-induced acute pancreatitis (AAP). A total of 78 patients were included in this study, 37.17% of which had HTGP, and 62.82% had AAP. Results: HTGP was more severe in terms of the Atlanta revised classification severity assessment (82.76% vs. 46%, p = 0.014), led to more extended hospitalizations (p = 0.024), and resulted in similar serum CRP levels among patients, with a significant difference regarding median serum fibrinogen values (739 vs. 563 mg/dL, p = 0.030) and necrotizing forms (24.13% vs. 10.20%). Hyponatremia was more significant in HTGP patients compared with AAP patients (130 vs. 137 mmol/L, p < 0.000). No differences were found in other inflammation indexes such as NLR (neutrophil count/lymphocyte count), PLR (platelet count/lymphocyte count), MLR (monocyte/lymphocyte count), SII (systemic immune-inflammation index), or SIRI (systemic inflammation response index). Conclusions: The pattern of acute pancreatitis is related to its etiology and may have different grades of severity. In our study, we found that hypertriglyceridemia-induced pancreatitis required twice as many admissions to the intensive care unit and was associated with lower serum sodium levels, and almost twice as many patients with HTGP had moderate or severe forms of acute pancreatitis compared to alcohol-induced pancreatitis cases.

Acute on chronic pancreatitis (ACP) shares a similar clinical presentation with acute pancreatitis (AP) and is often diagnosed and treated in the same way. However, these two conditions may have distinct clinical risk profiles and prognoses. There is currently limited evidence available regarding the specific characteristics of ACP.

This retrospective cohort study included all adult patients admitted with a diagnosis of AP or ACP between 2017 and 2019 at two tertiary referral centers. The primary outcome was disease severity as defined by the Atlanta classification. Secondary outcomes included the presence of local and systemic complications, organ failure, ICU admission, and mortality. Differences in outcomes between ACP and AP were compared using multivariate logistic regression models, with results presented as odds ratios (ORs).

We included 1163 patients, 90% of whom had AP and 10% had ACP. ACP patients were predominantly male (81 vs. 46%; P  < 0.001), whereas AP patients were older (mean age 62.6 vs. 56.5 years, P  < 0.001). ACP patients had lower amylase and lipase levels ( P  < 0.001). Multivariate analysis showed no difference in the risk of moderate or severe pancreatitis (OR, 1.15; 95% CI, 0.66-1.98; P  = 0.615). ACP patients had a higher risk of local complications (predominantly pseudocysts) (OR, 1.71; 95% CI, 1.00-2.92; P  = 0.049) and a lower risk of organ failure ( P  = 0.019) and ICU admission ( P  = 0.005).

Our study confirms previous observations that ACP has a more favorable in-hospital prognosis than AP and extends these findings to a modern European setting.

This review addresses oxidative stress and redox signaling in the pancreas under healthy physiological conditions as well as in acute pancreatitis, chronic pancreatitis, pancreatic cancer, and diabetes. Physiological redox homeodynamics is maintained mainly by NRF2/KEAP1, NF-κB, protein tyrosine phosphatases, peroxisome proliferator-activated receptor-γ coactivator 1α (PGC1α), and normal autophagy. Depletion of reduced glutathione (GSH) in the pancreas is a hallmark of acute pancreatitis and is initially accompanied by disulfide stress, which is characterized by protein cysteinylation without increased glutathione oxidation. A cross talk between oxidative stress, MAPKs, and NF-κB amplifies the inflammatory cascade, with PP2A and PGC1α as key redox regulatory nodes. In acute pancreatitis, nitration of cystathionine-β synthase causes blockade of the transsulfuration pathway leading to increased homocysteine levels, whereas p53 triggers necroptosis in the pancreas through downregulation of sulfiredoxin, PGC1α, and peroxiredoxin 3. Chronic pancreatitis exhibits oxidative distress mediated by NADPH oxidase 1 and/or CYP2E1, which promotes cell death, fibrosis, and inflammation. Oxidative stress cooperates with mutant KRAS to initiate and promote pancreatic adenocarcinoma. Mutant KRAS increases mitochondrial reactive oxygen species (ROS), which trigger acinar-to-ductal metaplasia and progression to pancreatic intraepithelial neoplasia (PanIN). ROS are maintained at a sufficient level to promote cell proliferation, while avoiding cell death or senescence through formation of NADPH and GSH and activation of NRF2, HIF-1/2α, and CREB. Redox signaling also plays a fundamental role in differentiation, proliferation, and insulin secretion of β-cells. However, ROS overproduction promotes β-cell dysfunction and apoptosis in type 1 and type 2 diabetes.

Infected pancreatic necrosis (IPN) is a dreaded complication of acute necrotizing pancreatitis and is linked to persistent organ failure, sepsis, and increased morbidity and mortality. Clinical indicators of IPN include fever, clinical deterioration, and worsening inflammatory markers. The diagnosis of IPN is based on clinical signs, microbiological confirmation, and radiological evidence, with contrast-enhanced CT being the preferred imaging modality. In the absence of tests with high sensitivity, a high clinical suspicion is required for early recognition and treatment. Although there is no way to prevent IPN, a systematic management approach with parenteral antibiotics, nutritional management, and minimally invasive procedures has become the cornerstone of the treatment. The step-up approach includes minimally invasive procedures that minimize procedure-related complications and are associated with improved outcomes. The percutaneous route remains the most common route for drainage, while endoscopic interventions are preferred for perigastric or periduodenal encapsulated collections. The use of lumen-apposing metal stents is associated with excellent outcomes in cases of infected walled-off necrosis. Patients with significant quantities of infected necrosis may benefit from direct or percutaneous endoscopic necrosectomy. Minimally invasive surgical techniques followed by open surgeries are reserved for patients who do not improve with percutaneous or endoscopic necrosectomies. The outcome can be maximized through a multidisciplinary approach by a team of interventional radiologists, advanced therapeutic endoscopists, and surgeons.

Acute pancreatitis is a commonly encountered pathology in the emergency department. We presented a clinical review summarizing the contemporary emergency medicine approach to managing acute pancreatitis. Although the diagnostic criteria for acute pancreatitis are straightforward, it has many possible causes, several treatment options, and both short- and long-term sequelae. We discussed diagnostic, intervention, and disposition considerations relevant to emergency clinicians and considered risk assessment using available clinical decision tools. We also discussed changes to traditional treatments and ongoing investigational therapies, including steroids, monoclonal antibodies, and calcium release-activated calcium channel inhibitors.

Subtotal cholecystectomy is one of the most frequent bail-out procedures performed during difficult cholecystectomy. A common complication to this procedure is bile leak, and thus multiple strategies have been created to avoid its appearance. This study aims to evaluate the effectivity of using an omental patch as bile leak prevention in patients undergoing subtotal cholecystectomy. A retrospective cohort study including patients who underwent subtotal cholecystectomy between 2014 and 2022 was performed. 17 patients had an omental patch, while 378 did not; the latter were included to evaluate surgical outcomes with bile leak as a primary outcome using a propensity score matching analysis (PSM). Patients' median age in both groups after PSM was 71.00 (IQR: 59.00-81.00) and 69.00 (IQR: 61.75-80.25) years, respectively. The dominant sex in both groups was male. In most cases surgical procedure indication was cholecystitis. Patients who had an omental patch did not present statistically significant differences for bile leak rates compared to patients who did not (29.4% versus 17.6%, p = 0.456, respectively). Similar results were observed when evaluating the need for postoperative ERCP for bile leak management (23.5 versus 5.9%, p = 0.078). A statistically significant higher proportion of major complications were observed in patients who had an omental patch (47.1% versus 19.1%, p = 0.038). Pedicled omental patch was not an effective measure for preventing bile leak, and it even presented a higher rate of complications. It is thus imperative to continue evaluating other strategies for the prevention of bile leak during subtotal cholecystectomy.

Background and Objectives: Severe acute pancreatitis carries a substantial risk of complications and death. Prompt identification of prognostic factors is crucial to optimize management and reduce mortality. This study aims to compare inflammatory scores, laboratory markers, and clinical outcomes between survivors and non-survivors with severe acute pancreatitis, drawing on data from 179 patients admitted between 2017 and 2024. Methods: We conducted a retrospective cohort study of 179 patients diagnosed with severe acute pancreatitis. Of these, 55 patient records were extracted from an existing database, and an additional 124 were included from hospital archives (2017-2024). We divided participants into survivors (n = 121) and non-survivors (n = 58). Clinical data were obtained from medical records, including demographic information, comorbidities, laboratory markers (neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR)), and severity scores (Acute Physiology and Chronic Health Evaluation (APACHE), Computed Tomography Severity Index (CTSI), and Ranson). Results: Non-survivors had significantly higher ages (mean of 66.4 vs. 52.7 years, p = 0.002), elevated inflammatory markers (median NLR of 14.2 vs. 10.3, p = 0.031), and more frequent multiorgan failure (75.9% vs. 31.4%, p < 0.001). The timing of intervention before 28 days was associated with higher mortality (p = 0.004). Chronic kidney disease and advanced cardiovascular comorbidities independently predicted worse survival (p = 0.009). The mortality rate in this cohort was 32.4%. Logistic regression identified age >60 years with an odds ratio (OR = 2.9), multiple organ failure (OR = 4.1), and high severity scores as primary contributors to mortality. Conclusions: Advanced age, comorbidities, elevated inflammatory markers, and multiple organ failure significantly impact mortality in severe acute pancreatitis. Delaying major interventions when feasible, optimizing perioperative care, and early recognition of high-risk patients may improve outcomes. Further research should explore targeted management strategies for high-risk groups and refine the role of delayed or minimally invasive approaches in severe acute pancreatitis management.

Background/Objectives: Acute pancreatitis (AP) is an inflammatory condition with diverse origins, often resulting in significant morbidity and mortality due to systemic inflammatory response syndrome (SIRS) and multiorgan failure. Fluid resuscitation is pivotal in early management, and it is aimed at preventing hypovolemia-induced ischemia and necrosis. This review evaluates fluid therapy strategies in AP, including fluid types, resuscitation rates, and clinical outcomes. Methods: This systematic review was conducted in January 2025 using databases such as PubMed, Medline, and Google Scholar, focusing on studies published between 2010 and 2024. Search terms included "acute pancreatitis", "fluid resuscitation", and related keywords. Studies involving adults with AP were analyzed to compare the outcomes of crystalloid and colloid use, aggressive vs. moderate fluid resuscitation, and administration timings. The primary outcomes were mortality and severe complications, while secondary outcomes included organ failure, SIRS, and length of hospital stay. Results: Crystalloids, particularly Ringer's lactate (RL), are superior to normal saline in reducing SIRS, organ failure, and intensive care unit stays without significantly affecting mortality rates. Colloids were associated with adverse events such as renal impairment and coagulopathy, limiting their use. Aggressive fluid resuscitation increased the risk of fluid overload, respiratory failure, and acute kidney injury, particularly in severe AP, while moderate hydration protocols achieved comparable clinical outcomes with fewer complications. Conclusions: Moderate fluid resuscitation using RL is recommended for managing AP, balancing efficacy with safety. Further research is needed to establish optimal endpoints and protocols for fluid therapy, ensuring improved patient outcomes while minimizing complications.

Background/Objectives: Pancreatitis is the most frequent and serious complication of endoscopic retrograde cholangiopancreatography (ERCP), with an incidence between 2 and 10% and a mortality rate of 1 in 500 patients. Etiopathogenesis remains poorly understood. The aim of this study was to analyze the incidence of post-ERCP pancreatitis (PEP) and to identify potential patient- and procedure-related risk factors (RF) in a cohort of patients from a tertiary referral center in Romania. Methods: We conducted a retrospective, observational, single-center study in which we analyzed ERCP procedures performed in the Gastroenterology Department of Colentina Clinical Hospital, Bucharest, Romania, between January 2019 and September 2024. All patients received intrarectal diclofenac before the ERCP and were hydrated with at least 1500 mL of Ringer's solution after the procedure in the absence of contraindications, according to the latest international recommendations. Results: In total, 2743 ERCPs were performed in the given time period, while 2350 procedures were analyzed in the study. PEP occurred in 350 cases (14.9%). Of these, 191 (54.6%) occurred in males with a mean age of 66.5 years. Procedural RF with adjusted odds ratios (OR) were as follows: difficult cannulation of the common bile duct, OR = 3.734, p < 0.001, main pancreatic duct catheterization, OR = 1.454, p = 0.022, and endoscopic papillary balloon dilatation, with an OR of 3.258, p < 0.001. Pancreatic duct stent placement was shown to prevent PEP in this study group (p < 0.001). Conclusions: PEP remains a serious complication of ERCP, associated with significant morbidity and occasional mortality. While some proven risk factors, such as age, gender, or comorbidities, are unmodifiable, avoiding Wirsung duct cannulation and pancreatography, or prophylactic pancreatic duct stent placement, could play a significant role in PEP prevention.

This study explores the association between the need for open necrosectomy (ON) during infected necrotizing pancreatitis (INP) treatment and the development of postoperative pancreatic fistula (POPF) following definitive surgery (DS) for transverse colonic fistulas.

This study was conducted at two tertiary hospitals and included patients who underwent DS for colonic fistula secondary to INP from January 2009 to December 2023. Patients were followed until hospital discharge. The primary outcome was the incidence of POPF.

A total of 135 patients were included. The median age was 38 years (interquartile range [IQR]: 32-44 years), with 85 (62.9%) being male. ON was required in 52 patients (38.5%), with 24 patients developing POPF post-DS. The need for ON (odds ratio [OR] = 2.78, 95% confidence interval [CI]: 1.03-7.58, p = 0.040) and the interval from INP resolution to DS (OR = 0.82, 95% CI: 0.68-0.92, p = 0.011) were associated with POPF.

The need for ON during INP treatment is significantly associated with an increased risk of POPF following DS for transverse colonic fistulas.

Mild acute biliary pancreatitis (MABP) presents significant clinical and economic challenges due to its potential for relapse. Current guidelines advocate for early cholecystectomy (EC) during the same hospital admission to prevent recurrent acute pancreatitis (RAP). Despite these recommendations, implementation in clinical practice varies, highlighting the need for reliable and accessible predictive tools. The MINERVA study aims to develop and validate a machine learning (ML) model to predict the risk of RAP (at 30, 60, 90 days, and at 1-year) in MABP patients, enhancing decision-making processes.

The MINERVA study will be conducted across multiple academic and community hospitals in Italy. Adult patients with a clinical diagnosis of MABP, in accordance with the revised Atlanta Criteria, who have not undergone EC during index admission will be included. Exclusion criteria encompass non-biliary aetiology, severe pancreatitis, and the inability to provide informed consent. The study involves both retrospective data from the MANCTRA-1 study and prospective data collection. Data will be captured using REDCap. The ML model will utilise convolutional neural networks (CNN) for feature extraction and risk prediction. The model includes the following steps: the spatial transformation of variables using kernel Principal Component Analysis (kPCA), the creation of 2D images from transformed data, the application of convolutional filters, max-pooling, flattening, and final risk prediction via a fully connected layer. Performance metrics such as accuracy, precision, recall, and area under the ROC curve (AUC) will be used to evaluate the model.

The MINERVA study aims to address the specific gap in predicting RAP risk in MABP patients by leveraging advanced ML techniques. By incorporating a wide range of clinical and demographic variables, the MINERVA score aims to provide a reliable, cost-effective, and accessible tool for healthcare professionals. The project emphasises the practical application of AI in clinical settings, potentially reducing the incidence of RAP and associated healthcare costs.

ClinicalTrials.gov ID: NCT06124989.

Current prediction models are suboptimal for determining mortality risk in patients with acute pancreatitis (AP); this might be improved by using a machine learning (ML) model. In this study, we aimed to construct an explainable ML model to calculate the risk of mortality in patients with AP admitted in intensive care unit (ICU) and compared it with existing scoring systems.

A gradient-boosting ML (XGBoost) model was developed and externally validated based on two public databases: Medical Information Mart for Intensive Care (MIMIC, training cohort) and the eICU Collaborative Research Database (eICU-CRD, validation cohort). We compared the performance of the XGBoost model with validated clinical risk scoring systems (the APACHE IV, SOFA, and Bedside Index for Severity in Acute Pancreatitis [BISAP]) by area under receiver operating characteristic curve (AUC) analysis. SHAP (SHapley Additive exPlanations) method was applied to provide the explanation behind the prediction outcome.

The XGBoost model performed better than the clinical scoring systems in correctly predicting mortality risk of AP patients, achieving an AUC of 0.89 (95% CI: 0.84-0.94). When set the sensitivity at 100% for death prediction, the model had a specificity of 38%, much higher than the APACHE IV, SOFA and BISAP score, which had a specificity of 1%, 16% and 1% respectively.

This model might increase identification of very low-risk patients who can be safely monitored in a general ward for management. By making the model explainable, physicians would be able to better understand the reasoning behind the prediction.

Postpartum acute pancreatitis (PAP) is a rare but potentially life-threatening condition that can occur following childbirth. The incidence of PAP is estimated to be between 1 in 1,000 and 1 in 10,000 deliveries, with a significant proportion of cases linked to biliary causes, particularly gallstones and biliary sludge. Prompt diagnosis and comprehensive management are essential to prevent severe complications such as septic shock and peritonitis.

We report the case of a 25-year-old white woman who presented with severe abdominal pain and septic shock 18 days after a cesarean section. Initial management included aggressive fluid resuscitation, broad-spectrum antibiotics, and pain control. Diagnostic imaging and laboratory tests confirmed the presence of biliary obstruction due to gallstones and biliary sludge, leading to acute pancreatitis. An endoscopic retrograde cholangiopancreatography (ERCP) was performed to remove the biliary obstructions, followed by a laparoscopic cholecystectomy to prevent recurrence.

PAP, while rare, poses significant risks and can lead to serious side effects such as septic shock. Early diagnosis by laboratory workup and imaging is essential. In this instance, gallstones and biliary sludge were found to be the culprit, requiring cholecystectomy and ERCP. ERCP was effective in this patient, despite its controversy in septic patients. The effective management of PAP requires a multidisciplinary approach involving obstetricians, gastroenterologists, surgeons, and critical care specialists.

PAP must be identified and treated as soon as possible. Bile obstruction is a common problem that necessitates prompt imaging and, if necessary, endoscopic or surgical intervention. Delays can be fatal; timing is crucial. To prevent deadly consequences, doctors must be extremely suspicious of postpartum patients presenting with abdominal pain.

Acute pancreatitis (AP) represents one of the most common reasons for hospital admission and intensive care treatment in internal medicine. The incidence of AP is increasing, posing significant financial burden on healthcare systems due to the necessity for frequent medical interventions. Severe acute pancreatitis (SAP) is a potentially life-threatening condition with substantial morbidity and mortality. The management of SAP requires prolonged hospitalization and the expertise of a multidisciplinary team, comprising emergency physicians, intensivists, internists, gastroenterologists, visceral surgeons, and experts in nutrition, infectious disease, endoscopy, as well as diagnostic and interventional radiology. Effective management and beneficial patient outcomes depend on continuous interdisciplinary collaboration. This review synthesizes recent evidence guiding the practical management of SAP, with a particular focus on emergency and intensive care settings. Both established as well as new diagnostic and therapeutic paradigms are highlighted, including workup, risk stratification, fluid management, analgesia, nutrition, organ support, imaging modalities and their timing, along with anti-infective strategies. Furthermore, the review explores interventions for local and vascular complications of SAP, with particular attention to the indications, timing and selection between endoscopic (both endoscopic retrograde cholangiopancreatography (ERCP) and endoscopic ultrasound (EUS)), percutaneous and surgical approaches. Similarly, the management of biliary AP due to obstructive gallstones, including the imaging, timing of ERCP and cholecystectomy, are discussed. By integrating new evidence with relevant guidance for everyday clinical practice, this review aims to enhance the interdisciplinary approach essential for improving outcomes in SAP management.

There is currently a lack of nomograms specifically designed for predicting the risk of death in diabetic patients with severe acute pancreatitis (SAP). The objective of this study was to develop a nomogram tailored to diabetic patients with SAP to predict overall survival.

Diabetic patients diagnosed with SAP between January 1, 2018 and December 31, 2023 were included in the study. Risk factors were identified through least absolute shrinkage and selection operator regression analysis. Subsequently, a novel nomogram model was developed through multivariable logistic regression analysis. The predictive performance of the nomogram was evaluated using metrics such as the receiver operating characteristic curve, calibration curve, and decision curve analysis (DCA).

A total of 206 patients were included in the analysis, with 171 in the survival group and 35 in the deceased group. Multivariate logistic regression indicated that age, platelet, total bilirubin, and potassium were independent prognostic factors for the survival of diabetic patients with SAP. The nomogram demonstrated a performance comparable to sequential organ failure assessment ( P = 0.570). Additionally, the calibration curve showed satisfactory predictive accuracy, and the DCA highlighted the clinical application value of the nomogram.

We have identified key demographic and laboratory parameters that are associated with the survival of diabetic patients with SAP. These parameters have been utilized to create a precise and user-friendly nomogram, which could be an effective and valuable clinical tool for clinicians.

To provide a comprehensive assessment of the efficacy and safety of pharmacological interventions for AP.

This was an overview of systematic reviews based on randomized controlled trials comparing pharmacological interventions with placebo or blank control in adults with AP. We searched PubMed, Embase, and the Cochrane Database of Systematic Reviews from inception to January 13, 2024, with an update on February 4, 2025. The effect value of each medication on each outcome of interest defined as a "combo" was assessed. Findings were categorized as efficacious, not efficacious, or inconclusive.

Fifteen reviews (167 unique trials, 12,930 participants) reported the efficacy of 14 medications on 5 outcomes, yielding 35 distinct combos. Seven combos showed efficacy with low certainty evidence: low molecular weight heparin (risk ratio 0.31, 95% confidence interval, 0.18-0.51), omega-3 fatty acids (0.30, 0.14-0.65), and antioxidants (0.69, 0.49-0.98) for mortality; low molecular weight heparin (0.38, 0.22-0.65), chengqi-series decoctions (0.48, 0.36-0.63), and ulinastatin (0.43, 0.24-0.78) for multiple organ failure; and neostigmine (mean difference -2.81, 95 % confidence interval -3.75 to -1.87) for length of intensive care unit stay. Half of the remaining combos showed no efficacy, while the other half was inconclusive for very low certainty evidence. Safety data were limited, with one review reporting no significant adverse events for neostigmine.

Some pharmacological interventions exhibited potential efficacy for specific AP outcomes, albeit with low certainty evidence. Further verifying those medications is crucial in advancing the treatment landscape for AP.

Opioid administration in acute pancreatitis (AP) exacerbates its severity, prompting concerns regarding the increased requirement for intensive care and its potential impact on patient survival. We aimed to elucidate the influence of analgesic patterns on mortality among patients with AP hospitalized in the ICU.

We included 784 patients (198 receiving opioid monotherapy and 586 receiving opioid polytherapy) from the Medical Information Mart for Intensive Care database. The primary outcome was in-hospital mortality. Propensity score matching was used to account for baseline differences. We used Kaplan-Meier survival curves and multivariate regression models to indicate survival discrepancies and potential associations.

Polytherapy group exhibited prolonged hospital survival (79.8 vs. 57.3 days, P < 0.001); polytherapy was associated with decreasing in-hospital mortality adjusted for confounders (HR = 0.49, 95% CI: 0.26-0.92; P = 0.027). Stratification analysis indicated that patients receiving adjunctive acetaminophen had prolonged hospital survival (opioid vs. opioid + acetaminophen, P < 0.001; opioid vs. opioid + NSAIDs + acetaminophen, P = 0.026). Opioid polytherapy benefited patients with APACHE III scores >83 and those with mean oral morphine equivalent >60 mg/day (HR = 0.17, 95% CI: 0.1-0.3, P < 0.001 and HR = 0.32, 95% CI: 0.2-0.52, P < 0.001, respectively).

Our findings suggest that an opioid-based analgesic regimen offers a survival advantage for patients with AP, particularly those in critical condition or with concerns about opioid use. This approach provides a viable clinical strategy for pain management. Further randomized clinical trials are warranted to validate these results.

Percutaneous cholecystostomy (PC) can be used as a bridging therapy for moderately severe acute biliary pancreatitis (MSABP). Currently, there are only a limited number of reports of MSABP using PCs.

To assess the short-term outcomes of early PC in MSABP and factors associated with recurrence and death in MSABP.

Patients who received conservative treatment or PC for acute biliary pancreatitis (ABP) in Liaoning Provincial People's Hospital from January 2017 to July 2022 were collected. A total of 54 patients with MSABP who received early-stage PC and 29 patients who received conservative treatment. The short-term efficacy of PC was evaluated. Depending on whether there is a recurrence, compare the characteristics of the pre-PC and explore the factors of recurrence. Pre-PC features were compared and predictors were discussed, depending on the outcome.

After 3 days of PC treatment, patients experienced a reduction in inflammatory markers compared to the conservative group. After PC, patients were divided into non-recurrence (n = 37) and recurrence (n = 10) groups, and the results showed that age was an independent correlation affecting ABP recurrence [odds ratio (OR) = 0.937, 95% confidence interval (CI): 0.878-0.999; P = 0.047 < 0.05]. Patient outcomes were divided into non-lethal (n = 47) and lethal (n = 7) groups, and Charlson Comorbidity Index (CCI) was a risk factor for mortality (OR = 2.397, 95%CI: 1.139-5.047; P = 0.021 < 0.05). CCI was highly accurate in predicting death in MSABP (area under the curve = 0.86 > 0.7). When the Youden index maximum was 0.565, the cut-off value was 5.5, the sensitivity was 71.4%, and the specificity was 85.1%.

PC is an important method in the early years (< 72 hours) of MSABP. Age is a protective factor against recurrence of ABP. High pre-PC CCI is significantly associated with mortality.

Soluble dietary fiber, notably as an adjunct to early enteral nutrition (EEN), is gaining prominence in clinical therapy. This study evaluates the effect of fructooligosaccharides (FOS), a new soluble dietary fiber, on the prognosis of patients with severe acute pancreatitis (SAP). In a retrospective cohort study at the Third Xiangya Hospital of Central South University from July 2017 to July 2023, 110 SAP patients were analyzed. TPF (enteral nutritional suspension of total protein)-normal and TPF-FOS groups both received standard EEN solutions; the latter additionally received FOS. Outcomes were compared between the groups. The study included 37 patients in the TPF-FOS group and 73 patients in the TPF-normal group. Mortality was 13.50% in the TPF-FOS group and 34.20% in the TPF-normal group (P < 0.05). FOS was identified as an independent protective factor (OR: 0.826, P = 0.041). The TPF-FOS group showed lower rates of intra-abdominal infection and decreased the level of inflammation (P < 0.05). FOS potentially acts as an independent protective factor against death in SAP. Additionally, the supplementation of EEN with FOS may contribute to reducing mortality and improving the prognosis of SAP patients.

Acute pancreatitis (AP) is an acute inflammatory disease resulting from abnormal digestion of itself and surrounding organs by pancreatic enzymes caused by a variety of pathogenic factors. When the tissue of a biological organism is afflicted with pancreatitis and experiences swelling, bleeding, and necrotic injuries, the abnormal expression of β-galactosidase (β-Gal) activity becomes one of the main indicators for assisting in the diagnosis of pancreatitis. In this study, a highly specific red fluorescent probe designed for the detection of β-Gal activity has been developed. β-galactoside is used as the enzyme activating group, and the long-wavelength luminescent water-soluble organic molecule NBDOH is used as the luminophore to construct the fluorescent probe NBD-gal. NBD-gal is activated by abnormally overexpressed β-Gal, releasing a strong red fluorescent signal. The new fluorescent probe developed in this study is used to assist in the diagnosis of pancreatitis by detecting abnormal expression of β-Gal activity in vivo. In in vivo imaging experiments, NBD-gal can effectively differentiate between normal nude mice and pancreatitis nude mice. In addition, NBD-gal can be effectively localized in real-time to the pancreas and intestines, which are rich in β-Gal in nude mice. Therefore, NBD-gal exerts great potential in the early diagnosis, treatment, and prevention of biomedical clinical pancreatitis.

Renal replacement therapy (RRT) plays a crucial role in managing acute pancreatitis (AP). This study aimed to develop and evaluate predictive models for determining the need for RRT among patients with AP in the intensive care unit (ICU).

A retrospective selection of patients with AP was made from the Medical Information Mart for Intensive Care IV (MIMIC-IV, version V2.0). The cohort was randomly divided into a training set (447 patients) and a validation set (150 patients). The least absolute shrinkage and selection operator (LASSO) regression cross-validation method was utilized to identify key features for model construction. Using these features, four machine learning (ML) algorithms were developed. The optimal model was visualized and clarified using SHapley Additive exPlanations (SHAP) and presented as a nomogram.

The mean age of the cohort was 59.17 years, with an average Acute Physiology and Chronic Health Evaluation II (APACHE II) score of 17.55. Acute kidney injury (AKI) was observed in 52.43% of patients with AP, and 9.05% required RRT. After feature selection, four of 41 clinical factors were ultimately chosen for use in model construction. The Lasso-Logistic Regression (Lasso-LR) model showed a high discriminative ability to predict RRT risk in patients with AP, with an area under the receiver operating characteristic (AUROC) of 0.955 (95% CI 0.924-0.987) in the training set. In the validation set, it maintained its discriminative performance, achieving an AUROC of 0.985 (95% CI 0.970-1.000). Calibration curves indicated an excellent fit in both sets (Brier scores: 0.039 and 0.032, respectively), suggesting high consistency. Decision curve analysis (DCA) highlighted the Lasso-LR model's significant clinical utility in predicting RRT likelihood in patients with AP.

Developed via the LASSO regression cross-validation method, the Lasso-LR model significantly excels in predicting the requirement for RRT in patients with AP, demonstrating its potential for clinical application.

Acute pancreatitis (AP), a condition marked by its swift progression, substantial individual discrepancies, and profound concealment, poses a formidable challenge. Within its severe form, known as severe acute pancreatitis (SAP), the disease assumes an even more prevalent status, often entwined with dire complications such as pancreatic abscess, circulatory shock, and the direst of all, multiple organ failure. Regrettably, the conjunction of SAP with gastric mucosal exfoliation culminating in massive hemorrhage remains an exceptionally rare phenomenon within the clinical realm. This study delves into a retrospective analysis of a singular, yet remarkable clinical case, where SAP's therapeutic odyssey unexpectedly led to gastric mucosa stripping and catastrophic gastrointestinal bleeding. This paper endeavors to unravel the diagnostic intricacies, explore the treatment modalities, and prognosticate the outcome, all with the ultimate aim of fostering a heightened clinical vigilance and fostering a novel, nuanced understanding of SAP's exceptional complications within the intensive care arena. Furthermore, this study aspires to serve as a beacon of reference, illuminating the path for clinical practitioners confronted with such elusive yet critical scenarios.