scholarly journals Association between Timing of Surgical Intervention and Mortality in 15,813 Acute Pancreatitis

2020 ◽  
Vol 2020 ◽  
pp. 1-8 ◽  
Author(s):  
Lan Lan ◽  
Jiawei Luo ◽  
Xiaoyan Yang ◽  
Dujiang Yang ◽  
Mengjiao Li ◽  
...  
Keyword(s):  
Acute Pancreatitis ◽  
Organ Failure ◽  
Surgical Intervention ◽  
Necrotizing Pancreatitis ◽  
Additive Model ◽  
Quantitative Relationship ◽  
Surgical Time ◽  
Risk Of Death ◽  
Pancreatic Debridement ◽  
The Relationship

Objective. In order to find the quantitative relationship between timing of surgical intervention and risk of death in necrotizing pancreatitis. Methods. The generalized additive model was applied to quantitate the relationship between surgical time (from the onset of acute pancreatitis to first surgical intervention) and risk of death adjusted for demographic characteristics, infection, organ failure, and important lab indicators extracted from the Electronic Medical Record of West China Hospital of Sichuan University. Results. We analyzed 1,176 inpatients who had pancreatic drainage, pancreatic debridement, or pancreatectomy experience of 15,813 acute pancreatitis retrospectively. It showed that when surgical time was either modelled alone or adjusted for infection or organ failure, an L-shaped relationship between surgical time and risk of death was presented. When surgical time was within 32.60 days, the risk of death was greater than 50%. Conclusion. There is an L-shaped relationship between timing of surgical intervention and risk of death in necrotizing pancreatitis.

scholarly journals Atlanta Classification for Acute Pancreatitis- A Study Protocol

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.

D-DIMER - AN ESSENTIAL MARKER IN SEVERITY PREDICTION OF ACUTE PANCREATITIS

2021 ◽  
pp. 78-82
Author(s):  
Mrinal Talukdar ◽  
Prashanth K R ◽  
Ratnadeep Paul
Keyword(s):  
Acute Pancreatitis ◽  
Organ Failure ◽  
Pancreatic Necrosis ◽  
Necrotizing Pancreatitis ◽  
Scoring Systems ◽  
Apache Ii ◽  
Receiver Operating Curve ◽  
Severity Prediction ◽  
Ranson Score ◽  
D Dimer

Introduction: Acute pancreatitis (AP) is characterized by a spectrum of symptoms, ranging from a local inammatory process to the more severe form (acute necrotizing pancreatitis) which is associated with a systemic inammatory response. The overall mortality rate of AP is between 5% and 15%, reaching 30 % in severe acute pancreatitis (SAP). Early optimized care may improve prognosis in patients with severe forms but it remains a challenge to identify these poor prognosis cases especially in the rst 48 hours. This study will evaluate the efcacy of serum D-Dimer in prediction of severity and outcome of acute pancreatitis. A prospective observati Methods: onal study of 60 patients presenting with AP was done at st st Silchar Medical College from 1 June 2017 to 31 May 2018. APACHE-II, Ranson criteria, and CT severity index (CTSI) of all patients were calculated,. D-Dimer was done for all patients. The patients were stratied into categories of severe pancreatitis, organ failure and pancreatic necrosis, as well as the number of deaths. The comparison of D-Dimer with other scoring systems was done by area under the receiver-operating curve (AUC) to predict severity, organ failure, necrosis, and death. Of the 60 patie Result: nts, 15 (25%) developed SAP, 12 (20%) Organ failure (OF), 22 (36.7%) pancreatic necrosis and 3 (5%) died. ROC curves were generated and following cut-off were selected for comparison of severity, organ failure, necrosis and death; Ranson ≥ 3, APACHE II ≥ 8, CTSI ≥ 4. Cut-off of D-Dimer value for severity, organ failure, necrosis and death are ≥1397µg/L, ≥1886µg/L, ≥1890µg/L and ≥5769µg/L respectively. The AUC of D-Dimer (0.914) in predicting severity of disease is similar to that of Apache 2 (0.958) and Ranson (0.899). CTSI (0.715) had lowest AUC among them. The AUC of D-Dimer (0.833) in predicting of organ failure of disease is similar to that of Ranson (0.908) and lower than Apache 2 (0.980). CTSI (0.715) had lowest AUC among them. The AUC of CTSI (0.892) in predicting the necrosis was higher than Apache 2 (0.590), Ranson score (0.578) system and D-Dimer. The AUC of D-Dimer (0.953) in predicting of mortality of disease is similar to that of Apache 2 (0.933), CTSI (0.953) and lower than Ranson score (0.816). Conclusion: D-Dimer is an easy tool for assessment of severity and prognosis of acute pancreatitis. CTSI is best for predicting pancreatic necrosis.

A case report of severe acute pancreatitis with infected necrosis and concomitant Coronavirus Disease‑19 (COVID‑19): a nosocomial infection or delayed respiratory manifestation of viral disease?

2021 ◽  
Author(s):  
Y. Susak ◽  
O. Tkachenko ◽  
O. Lobanova ◽  
L. Skivka
Keyword(s):  
Intensive Care Unit ◽  
Acute Pancreatitis ◽  
Intensive Care ◽  
Case Report ◽  
Hospital Stay ◽  
Necrotizing Pancreatitis ◽  
Treatment Protocol ◽  
Symptom Improvement ◽  
Infected Necrosis ◽  
Pancreatic Debridement

The association between COVID‑19 and acute pancreatitis (AP) has been extensively analyzed in recent research and review papers worldwide. It should be noted that most studies have focused on AP as a COVID‑19 complication and/or an extra‑pulmonary manifestation of the disease, although the investigation reports on the cases of prior pancreatitis and subsequent COVID‑19 infection are limited. The aim of this case report is to describe the treatment protocol and clinical outcome of a patient with acute necrotizing pancreatitis who developed nosocomial COVID‑19.. Case presentation. The data were collected from patient S., a 42‑year‑old male admitted with AP to the intensive care unit of Kyiv City Clinical Emergency Hospital, in October 2020. This study was reviewed and approved by the local Ethics Committee (Protocol No 25‑15‑60). The patient signed written informed consent to participate in the study, after having been informed of all relevant aspects that could influence his decision. The patient, primarily diagnosed with AP, was admitted to the hospital without a PCR test for detecting SARS‑CoV‑2. 21 days after his admission to the hospital, the patient developed COVID‑19. AP progression to severe AP with infected necrosis, the development of systemic inflammatory response syndrome and multiple organ failure necessitated operative pancreatic debridement, which was postponed due to severe acute respiratory failure. Operative pancreatic debridement was performed on the 45th day of hospital stay after the resolution of COVID‑19‑associated pneumonia. The postoperative period was typical for the disease severity and the extent of the surgery, and was complicated by external pancreatic and colonic fistulas. The length of hospital stay for this patient was 115 days which included 20 days of treatment and monitoring in the intensive care unit due to pneumonia. He was discharged after clinical symptom improvement. Conclusions. It is imperative to screen patients presenting with AP for SARS‑CoV‑2 in order to avoid misdiagnosis and inappropriate treatment strategy. Further detailed investigation of mechanisms of pancreatic injury in patients with SARS‑CoV‑2 is necessary.  

scholarly journals Severe acute pancreatitis: surgical indications and treatment

2020 ◽  
Author(s):  
Max Heckler ◽  
Thilo Hackert ◽  
Kai Hu ◽  
Cristopher M. Halloran ◽  
Markus W. Büchler ◽  
...  
Keyword(s):  
Acute Pancreatitis ◽  
Minimally Invasive ◽  
Organ Failure ◽  
Severe Disease ◽  
Intensive Therapy ◽  
Necrotizing Pancreatitis ◽  
Pancreatic Pseudocysts ◽  
Second Phase ◽  
Accurate Identification ◽  
Multi Organ Failure

Abstract Background Acute pancreatitis (AP) is defined as an acute inflammatory attack of the pancreas of sudden onset. Around 25% of patients have either moderately severe or severe disease with a mortality rate of 15–20%. Purpose The aim of this article was to summarize the advances being made in the understanding of this disease and the important role of surgery. Results and conclusions An accurate diagnosis should be made a soon as possible, initiating resuscitation with large volume intravenous fluids and oxygen by mask. Predicted severe disease will require intensive monitoring. Most deaths within the first week are due to multi-organ failure; thus, these patients will require intensive therapy unit management. During the second phase of the disease, death is due to local complications arising from the pancreatic inflammation, requiring accurate identification to determine the correct form of treatment. Acute peripancreatic fluid collections arise < 4 weeks after onset of interstitial edematous pancreatitis, not requiring any treatment. Most pancreatic pseudocysts arise > 4 weeks and largely resolve on conservative management. Necrotizing pancreatitis causing acute necrotic collections and later walled-off necrosis will require treatment if symptomatic or infected. Initial endoscopic transgastric or percutaneous drainage will resolve less serious collections but necrosectomy using minimally invasive approaches will be needed for more serious collections. To prevent recurrent attacks of AP, causative factors need to be removed where possible such as cholecystectomy and cessation of alcohol. Future progress requires improved management of multi-organ failure and more effective minimally invasive techniques for the removal of necrosis.

scholarly journals Minimally invasive endoscopic treatment of necrotizing pancreatitis: A case report with images and review of the literature

2017 ◽  
Vol 63 (3) ◽  
pp. 207-209
Author(s):  
Cassia Lemos Moura ◽  
Priscila Pulita Azevedo Barros ◽  
Cristiane Mota Oliveira ◽  
Rogerio Colaiácovo ◽  
Juliana Marques Drigo ◽  
...  
Keyword(s):  
Acute Pancreatitis ◽  
Intensive Care ◽  
Pancreatic Necrosis ◽  
Surgical Intervention ◽  
Necrotizing Pancreatitis ◽  
Severe Case ◽  
Treatment Modalities ◽  
Endoscopic Drainage ◽  
Review Of The Literature ◽  
Fluid Collections

Summary Necrotizing pancreatitis with fluid collections can occur as a complication of acute pancreatitis. The management of these patients depends on the severity and involves multiple medical treatment modalities, as clinical intensive care and surgical intervention. In this article, we show a severe case of walled-off pancreatic necrosis that was conducted by endoscopic drainage with great clinical outcome.

scholarly journals Serum Albumin Is Independently Associated with Persistent Organ Failure in Acute Pancreatitis

2017 ◽  
Vol 2017 ◽  
pp. 1-10 ◽  
Author(s):  
Wandong Hong ◽  
Suhan Lin ◽  
Maddalena Zippi ◽  
Wujun Geng ◽  
Simon Stock ◽  
...  
Keyword(s):  
Acute Pancreatitis ◽  
Serum Albumin ◽  
Organ Failure ◽  
Blood Urea Nitrogen ◽  
Serum Albumin Level ◽  
Roc Curves ◽  
Albumin Level ◽  
Urea Nitrogen ◽  
Risk Of Death ◽  
Persistent Organ Failure

Background and Aims. To investigate the association between serum albumin levels within 24 hrs of patient admission and the development of persistent organ failure in acute pancreatitis.Methods. A total of 700 patients with acute pancreatitis were enrolled. Multivariate logistic regression and subgroup analysis determined whether decreased albumin was independently associated with persistent organ failure and mortality. The diagnostic performance of serum albumin was evaluated by the area under Receiver Operating Characteristic (ROC) curves.Results. As levels of serum albumin decrease, the risk of persistent organ failure significantly increases (Ptrend<0.001). The incidence of organ failure was 3.5%, 10.6%, and 41.6% in patients with normal albumin and mild and severe hypoalbuminaemia, respectively. Decreased albumin levels were also proportionally associated with prolonged hospital stay (Ptrend<0.001) and the risk of death (Ptrend<0.001). Multivariate analysis suggested that biliary etiology, chronic concomitant diseases, hematocrit, blood urea nitrogen, and the serum albumin level were independently associated with persistent organ failure. Blood urea nitrogen and the serum albumin level were also independently associated with mortality. The area under ROC curves of albumin for predicting organ failure and mortality were 0.78 and 0.87, respectively.Conclusion. A low serum albumin is independently associated with an increased risk of developing of persistent organ failure and death in acute pancreatitis. It may also be useful for the prediction of the severity of acute pancreatitis.

scholarly journals Improving the Outcome of Acute Pancreatitis

2016 ◽  
Vol 34 (5) ◽  
pp. 540-545 ◽  
Author(s):  
Marco J. Bruno ◽  
Keyword(s):  
Acute Pancreatitis ◽  
Randomized Trial ◽  
Organ Failure ◽  
Large Scale ◽  
Randomized Study ◽  
Necrotizing Pancreatitis ◽  
Tube Feeding ◽  
Percutaneous Catheter Drainage ◽  
Endoscopic Necrosectomy ◽  
Multicenter Randomized Trial

Acute pancreatitis (AP) is the most common indication for hospital admission and its incidence is rising. It has a variable prognosis, which is mainly dependent upon the development of persistent organ failure and infected necrotizing pancreatitis. In the past few years, based on large-scale multicenter randomized trials, some novel insights regarding clinical management have emerged. In patients with infected pancreatic necrosis, a step-up approach of percutaneous catheter drainage followed by necrosectomy only when the patient does not improve, reduces new-onset organ failure and prevents the need for necrosectomy in about a third of patients. A randomized pilot study comparing surgical to endoscopic necrosectomy in patients with infected necrotizing pancreatitis showed a striking reduction of the pro-inflammatory response following endoscopic necrosectomy. These promising results have recently been tested in a large multicenter randomized trial whose results are eagerly awaited. Contrary to earlier data from uncontrolled studies, a large multicenter randomized trial comparing early (within 24 h) nasoenteric tube feeding compared with an oral diet after 72 h, did not show that early nasoenteric tube feeding was superior in reducing the rate of infection or death in patients with AP at high risk for complications. Although early ERCP does not have a role in the treatment of predicted mild pancreatitis, except in the case of concomitant cholangitis, it may ameliorate the disease course in patients with predicted severe pancreatitis. Currently, a large-scale randomized study is underway and results are expected in 2017.

Plasma Level of IL-1β in Disseminated Intravascular Goagulation

1991 ◽  
Vol 65 (04) ◽  
pp. 364-368 ◽  
Author(s):  
Hideo Wada ◽  
Shigehisa Tamaki ◽  
Motoaki Tanigawa ◽  
Mikio Takagi ◽  
Yoshitaka Mori ◽  
...  
Keyword(s):  
Endothelial Cells ◽  
Tumor Necrosis Factor ◽  
Plasma Level ◽  
Organ Failure ◽  
Tumor Necrosis ◽  
Mononuclear Cells ◽  
Solid Cancer ◽  
Normal Individuals ◽  
The Relationship ◽  
Necrosis Factor

SummaryThe plasma level of interleukin-1β (IL-1β) was determined in normal individuals, patients with disseminated intravascular coagulation (DIC), patients in the pre-DIC period (within 7 days before the onset of DIC), and non-DIC patients to examine the relationship between DIC and the plasma ILlp level. The plasma IL-1β level was 0-0.085 ng/ml in normal individuals, with little difference being seen according to related age. It was significantly higher in the DIC group (0.19 ± 0.19 ng/ml) than in the pre-DIC group (0.05 ± 0.08 ng/ml) or the non-DIC group (0.09 ± 0.01 ng/ml). The plasma IL-1β level was not markedly elevated in leukemia patients, even in the DIC group, but it was significantly increased in the DIC group of solid cancer patients and was generally elevated in patients with sepsis. It was markedly elevated to 0.39 ± 0.26 ng/ml in patients with organ failure. When mononuclear cells were incubated with lipopolysaccharide, it was found that IL-1β, tumor necrosis factor, and tissue factor (TF) were released into the medium, and there was an increase of TF release from endothelial cells incubated with this medium. These results suggest that the increase in IL-Iβ reflected the activation of monocytes and may be an important factor in DIC and its associated organ failure.

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