Systemic anticoagulation is associated with decreased mortality and morbidity in acute pancreatitis

AbstractIn recent years there has been an increase in the incidence of acute pancreatitis worldwide. In spite of efforts to improve the treatment and care of patients with acute pancreatitis, to develop imaging investigations and interventional diagnostic and treatment techniques and to facilitate patients’ access to them, acute pancreatitis continues to be associated with significant mortality and morbidity, and the treatment of patients suffering from this disease entails significant costs for healthcare systems.Researchers are in a permanent quest to get to a global consensus for stratifying the severity of acute pancreatitis. We need this in order to offer the proper management for each patient diagnosed with this condition and to improve hospital and health system strategies.Over the years, it has been attempted to develop algorithms to support a swift assessment of patients with acute pancreatitis with a prediction of disease severity as close to reality as possible for optimal management. This has led to the development of classifications of severity and severity scores. These require a permanent updating to keep up with the technical and technological developments involved in investigating and treating the patient and encompassing the most recent studies.The goal of this paper is to go through these classifications and scores, emphasizing factors that should be taken into account, and reflecting upon their utility and upon the necessity of improving them.

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Acute Pancreatitis in Pregnancy: Maternal and Fetal Outcomes

Journal of SAFOG with DVD ◽

10.5005/jp-journals-10006-1469 ◽

2017 ◽

Vol 9 (2) ◽

pp. 106-109

Author(s):

Asha Swarup ◽

GS Jyothi ◽

Shruti R Bhoosanoor

Keyword(s):

Acute Pancreatitis ◽

Epigastric Pain ◽

Treatment Options ◽

Abdominal Cavity ◽

Age At Onset ◽

Initial Assessment ◽

Fetal Mortality ◽

Fetal Outcomes ◽

Mortality And Morbidity ◽

In Pregnancy

ABSTRACT Aim and objective To evaluate the maternal and fetal outcomes in patients with acute pancreatitis. Materials and methods It is a retrospective observational study. A total of three patients were admitted with acute pancreatitis complicating pregnancy between January 2013 and June 2015 in the Department of Obstetrics and Gynaecology, M. S. Ramaiah Medical College and Hospital, Bengaluru, India, and were followed up until after delivery. Results Incidence of acute pancreatitis in our study was 1 in 1,620. Mean age was 24 years, and 33.3% were multiparous. Mean gestational age at onset was 33 weeks. One patient (33.3%) in our study had hypertriglyceridemia (870 mg/dL), and 66.7% of patients were idiopathic. The most common complaint was epigastric pain radiating to back. All patients showed leukocytosis and elevated amylase and lipase levels. Ultrasound showed [1] enlarged pancreas with decreased peripancreatic echogenicity and [2] pelvic and abdominal cavity effusions, in all the patients. All patients were managed conservatively in the intensive care unit. Mean duration of hospital stay was 7 days; 33.3% patients developed acute respiratory distress syndrome; 33.3% patients went into preterm spontaneous vaginal delivery. Cesarean section rate was 66.7%. Perinatal mortality was 33.3%. Conclusion Acute pancreatitis in pregnancy remains a challenging clinical problem to manage. The initial assessment, severity, and the initial management of the patient are of great importance in order to support the function and to prevent maternal and fetal mortality and morbidity. Clinical significance Acute pancreatitis either in its mild or its severe form causes maternal and fetal morbidity. However, these rates are declining due to early diagnosis and greater treatment options. Multidisciplinary approach leads to good maternal and fetal outcomes. How to cite this article Jyothi GS, Bhoosanoor SR, Swarup A. Acute Pancreatitis in Pregnancy: Maternal and Fetal Outcomes. J South Asian Feder Obst Gynae 2017;9(2):100-103.

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The impact of surgery on mortality and morbidity in patients with severe acute pancreatitis and intra-abdominal hypertension

Cogent Medicine ◽

10.1080/2331205x.2017.1340078 ◽

2017 ◽

Vol 4 (1) ◽

pp. 1340078 ◽

Cited By ~ 1

Author(s):

Héctor Adrián Díaz Hernández ◽

Jesús Alejandro Gabutti Thomas ◽

Hiram Terrazas Solís ◽

Mario César Peláez Luna ◽

Luis Federico Uscanga Domínguez ◽

...

Keyword(s):

Acute Pancreatitis ◽

Severe Acute Pancreatitis ◽

Mortality And Morbidity ◽

Abdominal Hypertension ◽

The Impact

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Comparative study of the therapeutic potential of octreotide versus trimetazidine and their combination on acute pancreatitis in male rats

Journal of Contemporary Medical Sciences ◽

10.22317/jcms.v4i4.491 ◽

2018 ◽

Vol 4 (4) ◽

Keyword(s):

Acute Pancreatitis ◽

Therapeutic Potential ◽

Serum Levels ◽

Male Rats ◽

Combination Group ◽

Mortality And Morbidity ◽

Tnf Α ◽

Total Antioxidant ◽

Factor Α ◽

Necrosis Factor

Objective Acute pancreatitis continues to be associated with significant rates of mortality and morbidity, and therapeutic options are stillvery limited. Various theories have been suggested regarding the pathophysiology of acute pancreatitis, lot of research into differentmedical treatments for the treatment of acute pancreatitis, but it is not clear what benefits each treatment has, or indeed if any medicaltreatment is beneficial apart from supportive treatment.Aim To clarify the potential therapeutic effect of octreotide, trimetazidine, and their combination in acute pancreatitis.Methods Acute pancreatitis was induced by L-arginine and treated with octreotide subcutaneously, trimetazidine intraperitoneally andcombination therapy by octreotide and trimetazidine. The rats were followed for 24 h. At the 24th hour we determined serum levels oftumor necrosis factor-α (TNF-α), interleukin-1β (IL-1β), total antioxidant capacity (TAC), lipase, and amylase, and the pancreatic tissues wereanalyzed histopathologically.Results TNF-α (P < 0.001), IL-1β (P < 0.001), TAC (P < 0.001), lipase (P < 0.001), and amylase (P < 0.001) serum levels and scores ofhistopathological changes (P < 0.05) were significantly lower in combination group as compared with both octreotide and trimetazidinegroups.Conclusion Combination treatment markedly decreases biochemical and histopathological changes in acute pancreatitis, thus amelioratepancreatic injury in l-arginine induced acute pancreatitis.

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A Rare Complication during Salmonella sp. Infection in a 4-Year-Old Child: Acute Pancreatitis

Journal of Pediatric Infectious Diseases ◽

10.1055/s-0040-1714711 ◽

2020 ◽

Author(s):

Ahmet O. Kılıç ◽

Fatih Akın ◽

Abdullah Yazar ◽

Abdülkerim Çokbiçer ◽

Metin Doğan ◽

...

Keyword(s):

Acute Pancreatitis ◽

Abdominal Pain ◽

Inflammatory Process ◽

Rare Complication ◽

Contaminated Water ◽

Limited Data ◽

Salmonella Infection ◽

Pediatric Case ◽

Mortality And Morbidity

Abstract Objective We aimed to report a rare complication of acute pancreatitis which developed during Salmonella infection. Methods We report a 4-year-old girl with pancreatitis that occurred after salmonella gastroenteritis. Discussion Salmonella sp. infections cause serious mortality and morbidity worldwide. Salmonella transmission is mostly fecal oral from contaminated water and foods. Acute pancreatitis expresses the acute inflammatory process of the pancreas. Inflammation of the pancreas associated with bacterial, viral, and fungal agents can lead to acute pancreatitis. There are limited data regarding the frequency of infections leading to pancreatitis. Here, a pediatric case with pancreatitis that occurred after salmonella gastroenteritis is reported. Conclusion Acute pancreatitis due to S. sp. infection is very rare in children. Pancreatitis should be considered in patients with gastroenteritis with typical abdominal pain.

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The triad of diabetes ketoacidosis, hypertriglyceridemia and acute pancreatitis. How does it affect mortality and morbidity?

Medicine ◽

10.1097/md.0000000000014378 ◽

2019 ◽

Vol 98 (7) ◽

pp. e14378 ◽

Cited By ~ 8

Author(s):

C. Roberto Simons-Linares ◽

Sunguk Jang ◽

Madhusudan Sanaka ◽

Amit Bhatt ◽

Rocio Lopez ◽

...

Keyword(s):

Acute Pancreatitis ◽

Mortality And Morbidity

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Derivation and validation of the ED-SAS score for very early prediction of mortality and morbidity with acute pancreatitis: a retrospective observational study

BMC Emergency Medicine ◽

10.1186/s12873-021-00410-w ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Joseph Miller ◽

Yiyang Wu ◽

Rawan Safa ◽

Georgiana Marusca ◽

Sandeep Bhatti ◽

...

Keyword(s):

Acute Pancreatitis ◽

Observational Study ◽

Primary Outcome ◽

Validation Cohort ◽

Scoring Systems ◽

Retrospective Observational Study ◽

Mortality And Morbidity ◽

Derivation Cohort ◽

C Statistic ◽

Prediction Of Mortality

Abstract Background Existing scoring systems to predict mortality in acute pancreatitis may not be directly applicable to the emergency department (ED). The objective of this study was to derive and validate the ED-SAS, a simple scoring score using variables readily available in the ED to predict mortality in patients with acute pancreatitis. Methods This retrospective observational study was performed based on patient data collected from electronic health records across 2 independent health systems; 1 was used for the derivation cohort and the other for the validation cohort. Adult patients who were eligible presented to the ED, required hospital admission, and had a confirmed diagnosis of acute pancreatitis. Patients with chronic or recurrent episodes of pancreatitis were excluded. The primary outcome was 30-day mortality. Analyses tested and derived candidate variables to establish a prediction score, which was subsequently applied to the validation cohort to assess odds ratios for the primary and secondary outcomes. Results The derivation cohort included 599 patients, and the validation cohort 2011 patients. Thirty-day mortality was 4.2 and 3.9%, respectively. From the derivation cohort, 3 variables were established for use in the predictive scoring score: ≥2 systemic inflammatory response syndrome (SIRS) criteria, age > 60 years, and SpO2 < 96%. Summing the presence or absence of each variable yielded an ED-SAS score ranging from 0 to 3. In the validation cohort, the odds of 30-day mortality increased with each subsequent ED-SAS point: 4.4 (95% CI 1.8–10.8) for 1 point, 12.0 (95% CI 4.9–29.4) for 2 points, and 41.7 (95% CI 15.8–110.1) for 3 points (c-statistic = 0.77). Conclusion An ED-SAS score that incorporates SpO2, age, and SIRS measurements, all of which are available in the ED, provides a rapid method for predicting 30-day mortality in acute pancreatitis.

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Atlanta Classification for Acute Pancreatitis- A Study Protocol

Journal of Pharmaceutical Research International ◽

10.9734/jpri/2021/v33i31b31691 ◽

2021 ◽

pp. 61-68

Author(s):

Varun Singh ◽

Rajasbala Pradeep Dhande ◽

Gaurav Mishra

Keyword(s):

Acute Pancreatitis ◽

Organ Failure ◽

Scoring System ◽

Necrotizing Pancreatitis ◽

Classification Systems ◽

Mortality And Morbidity ◽

The Past ◽

Edematous Pancreatitis ◽

Acute Necrotic Collection

Background: Acute pancreatitis is one of the most common abdominal pathologies having variable outcome ranging from self limiting abdominal pain to high mortality and morbidity due to organ failure, over the past five decades, various classification systems have emerged to classify pancreatitis according to its severity , and the associated complications have emerged to classify acute pancreatitis and its various complications, such as Apache Scoring , Ct Severity , Modified Ct Severity ,Ransen and Atlanta Classification. Objectives: We in our study will be classifying patients suffering from acute pancreatitis according to the revised Atlanta classification to divide them into interstitial edematous pancreatitis and necrotizing pancreatitis. The local complications will be classified according to CT imaging findings into acute necrotic collection, psuedocyst, acute necrotic collection and walled of necrosis. Organ failure will be assessed according to modified marshal scoring system into transient or persistent organ failure. Methodology: We will be carrying forward our study on Siemens 16 slice computer tomography machine over a sample of 140 patients coming to the outpatient department of our hospital which will be followed by a routine clinical follow up of the patient to find out their prognosis. Results: Will be tabulated at the end of the study using SPSS version 26 software. Conclusion: The revised Atlanta classification for acute pancreatitis, in conjunction with the Modified Marshall Scoring System for organ failure, if found useful, in our series in improving the prognosis of the patients, then it can be incorporated in management.

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Derivation and Validation of the ED-SAS Score for Very Early Prediction of Mortality and Morbidity with Acute Pancreatitis: A Retrospective Observational Study

10.21203/rs.3.rs-76144/v1 ◽

2020 ◽

Author(s):

Joseph Miller ◽

Yiyang Wu ◽

Rawan Safa ◽

Georgiana Marusca ◽

Sandeep Bhatti ◽

...

Keyword(s):

Acute Pancreatitis ◽

Observational Study ◽

Validation Cohort ◽

Scoring Systems ◽

Retrospective Observational Study ◽

Mortality And Morbidity ◽

Derivation Cohort ◽

C Statistic ◽

Prediction Of Mortality ◽

Level Data

Abstract Background: Existing scoring systems to predict mortality in acute pancreatitis may not be directly applicable to the emergency department (ED). The objective of this study was to derive and validate the ED-SAS, a simple scoring score using variables readily available in the ED to predict mortality in patients with acute pancreatitis. Methods: This retrospective observational study was performed based on patient level data collected from electronic health records across 2 independent health systems, one used for the derivation cohort and one for the validation cohort. Adult patients who were eligible presented to the ED, required hospital admission, and had a confirmed diagnosis of acute pancreatitis. Patients with chronic or recurrent episodes of pancreatitis were excluded. The primary outcome was 30-day mortality. Analyses tested and derived candidate variables to establish a prediction score and that was subsequently applied to the validation cohort to assess odds ratio for the primary and secondary outcomes. Results: The derivation cohort included 599 patients, and the validation cohort 2011 patients. Thirty-day mortality was 4.2% and 3.9% respectively. From the derivation cohort, 3 variables were established for use in the predictive scoring score: ≥2 systemic inflammatory response syndrome (SIRS) criteria, age >60 years, and SpO2 <96%. Summing the presence or absence of each variable yielded an ED-SAS score ranging from 0 to 3. In the validation cohort, the odds of 30-day mortality increased with each subsequent ED-SAS point: 4.4 (95% CI 1.8 – 10.8) for 1 point, 12.0 (95% CI 4.9 – 29.4) for 2 points, and 41.7 (95% CI 15.8 – 110.1) for 3 points (c-statistic = 0.77).Conclusion: An ED-SAS score that incorporates SpO2, age, and SIRS measurements provides a rapid method for predicting 30-day mortality in acute pancreatitis.

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