The risk factors for acute respiratory distress syndrome in patients with severe acute pancreatitis

PurposeTo summarise the prognostic associations between various clinical risk factors and the development of the acute respiratory distress syndrome (ARDS) following traumatic injury.MethodsWe conducted this review in accordance with the PRISMA and CHARMS guidelines. We searched six databases from inception through December 2020. We included English language studies describing the clinical risk factors associated with the development of post-traumatic ARDS, as defined by either the American-European Consensus Conference or the Berlin definition. We pooled adjusted odds ratios for prognostic factors using the random effects method. We assessed risk of bias using the QUIPS tool and certainty of findings using GRADE methodology.ResultsWe included 39 studies involving 5 350 927 patients. We identified the amount of crystalloid resuscitation as a potentially modifiable prognostic factor associated with the development of post-traumatic ARDS (adjusted odds ratio [aOR] 1.19 for each additional liter of crystalloid administered within first 6 h after injury, 95% CI 1.15 to 1.24, high certainty). Non-modifiable prognostic factors with a moderate or high certainty of association with post-traumatic ARDS included increasing age, non-Hispanic white race, blunt mechanism of injury, presence of head injury, pulmonary contusion, or rib fracture; and increasing chest injury severity.ConclusionWe identified one important modifiable factor, the amount of crystalloid resuscitation within the first 24 h of injury, and several non-modifiable factors associated with development of post-traumatic ARDS. This information should support the judicious use of crystalloid resuscitation in trauma patients and may inform the development of a risk-stratification tools.

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Acute pancreatitis : a newly recognised potential complication of canine babesiosis

Journal of the South African Veterinary Association ◽

10.4102/jsava.v71i4.721 ◽

2000 ◽

Vol 71 (4) ◽

Cited By ~ 17

Author(s):

A.J. Möhr ◽

R.G. Lobetti ◽

J.J. Van der Lugt

Keyword(s):

Renal Failure ◽

Acute Pancreatitis ◽

Acute Respiratory Distress Syndrome ◽

Respiratory Distress Syndrome ◽

Respiratory Distress ◽

Haemolytic Anaemia ◽

Distress Syndrome ◽

Pathophysiological Mechanism ◽

Canine Babesiosis ◽

Immune Mediated

This retrospective study describes 4 cases of canine babesiosis with histologically confirmed acute pancreatitis. In addition, 16 dogs with babesiosis are reported with serum amylase (>3500 U/l ) and/or lipase (>650 U/l ) activity elevations of a magnitude that would support a diagnosis of probable acute pancreatitis, although extra-pancreatic sources of the enzymes could not be excluded in these cases. Median time of pancreatitis diagnosis was 2.5 days post-admission, with primarily young (median age 3 years), sexually intact dogs affected. The development of pancreatitis was unrelated to the degree of anaemia at time of admission. In addition to pancreatitis, 80 % of cases suffered from other babesial complications, namely icterus (13), acute respiratory distress syndrome (6), immune-mediated haemolytic anaemia (6), renal failure (3), haemoconcentration (2) and cerebral syndrome (2). Acute respiratory distress syndrome, renal failure and cerebral syndrome were associated with a poor prognosis, with 4 of the 5 dogs included in the overall 26 % mortality rate having at least 1 of these complications. Haemolytic anaemia with ischaemia-reperfusion injury to the pancreas is proposed as a possible primary pathophysiological mechanism in babesial pancreatitis. Hypotensive shock, immune-mediated haemolytic anaemia, haemoconcentration and possibly altered lipid metabolism in babesiosis may also be involved. The previously postulated pro-inflammatory cytokine milieu of complicated babesiosis may underlie the progression, if not the primary initiation, of pancreatic pathology. Acute pancreatitis may represent the previously reported 'gut' form of babesiosis.

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Nomogram for the prediction of in-hospital incidence of acute respiratory distress syndrome in patients with acute pancreatitis

10.1101/2020.02.09.20019513 ◽

2020 ◽

Author(s):

Ning Ding ◽

Cuirong Guo ◽

Yuchai Huang ◽

Changluo Li ◽

Yang Zhou ◽

...

Keyword(s):

Acute Pancreatitis ◽

Acute Respiratory Distress Syndrome ◽

Respiratory Distress Syndrome ◽

Respiratory Distress ◽

Primary Outcome ◽

Distress Syndrome ◽

Validation Cohort ◽

Predicted Probability ◽

Tertiary Hospitals ◽

Retrospective Nature

AbstractObjectiveThe aim of this study was to formulate and validate an individualized predictive nomogram for in-hospital incidence of acute respiratory distress syndrome (ARDS) in patients with acute pancreatitis(AP).DesignIt was a retrospective cohort study.SettingDepartments of Emergency Medicine of two university-affiliated tertiary hospitals, Changsha, China.ParticipantsFrom January 2017 to December 2018, 779 individuals with AP were included in this study.Primary outcome measuresThe in-hospital incidence of ARDS was assessed.ResultsAP patients were randomly distributed into primary cohort(n=560)and validation cohort(n=219). Based on the primary cohort, risk factors were identified by logistic regression model and a nomogram was performed. Five independent factors including white blood counts(WBC),prothrombin time(PT),albumin(ALB),serum creatinine(SCR) and triglyceride (TG) were associated with in-hospital incidence of ARDS in AP patients. A nomogram was constructed based on the five independent factors with primary cohort of AUC 0.821 and validation cohort of AUC 0.822. Calibration curve analysis indicated that the predicted probability was in accordance with the observed probability in both primary and validation cohorts.ConclusionsThe study developed an intuitive nomogram with easily available laboratory parameters for the prediction of in-hospital incidence of ARDS in patients with AP. The incidence of ARDS for an individual patient can be fast and conveniently evaluated by our nomogram.Strengths and limitations of this studyThis is the first study to develop a nomogram for predicting the in-hospital incidence of ARDS in AP patients.For each AP patient, our nomogram enables physicians to directly and conveniently calculate a numeric probability of ARDS.There might be patient selection biases owing to retrospective nature of our study.

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