scholarly journals Evaluation of the Prognosis and Severity of Severe Acute Pancreatitis by APACHE-II Score Associated with CT Classification

2014 ◽  
Vol 04 (04) ◽  
pp. 91-94
Author(s):  
敏 薛
Keyword(s):  
Acute Pancreatitis ◽  
Severe Acute Pancreatitis ◽  
Apache Ii ◽  
Apache Ii Score ◽  
Ct Classification

Plasma ADAMTS13 activity parallels the APACHE II score, reflecting an early prognostic indicator for patients with severe acute pancreatitis

2008 ◽  
Vol 43 (11) ◽  
pp. 1387-1396 ◽  
Author(s):  
Chie Morioka ◽  
Masahito Uemura ◽  
Tomomi Matsuyama ◽  
Masanori Matsumoto ◽  
Seiji Kato ◽  
...  
Keyword(s):  
Acute Pancreatitis ◽  
Severe Acute Pancreatitis ◽  
Prognostic Indicator ◽  
Apache Ii ◽  
Apache Ii Score ◽  
Adamts13 Activity

scholarly journals Prognostic Indicator in Severe Acute Pancreatitis

2018 ◽  
Vol 3 (05) ◽  
Author(s):  
Dr. Ajay Khanolkar ◽  
Dr. Manish Khare
Keyword(s):  
Acute Pancreatitis ◽  
Severe Acute Pancreatitis ◽  
Surgical Intervention ◽  
Financial Burden ◽  
Fluid Collection ◽  
Prognostic Indicator ◽  
Apache Ii ◽  
Management Decision ◽  
Apache Ii Score ◽  
Local Complication

Aim of study: - To assess the utility of each as prognostic indicator in Severe Acute Pancreatitis. Material and Methods: This prospective study entitled “To assess the utility of each as prognostic indicator in Severe Acute Pancreatitis” was carried out on patients hospitalized for acute pancreatitis in the surgery department at Chandulal Chandrakar Memorial Medical College and CM Hospital, Bhilai from March 2015 to October 2017.50 patients with the diagnosis of first attack of acute pancreatitis of both sexes and all age groups were selected for the study. Conclusion:- On the basis of observation and result of the study, it can be safely stated that APACHE II Scoring is quick, safe, reproducible, ongoing and cost effective. It can be done by resident or intelligent nursing staff. Give an idea regarding improving or worsening of patients. APACHE II Scoring system when complimented by high quality CECT abdomen can further refine the results and give an idea of likelihood of patients developing local complication. Thus it can also be used along with CECT abdomen for Risk Stratification of subset of patients who are likely to develop local complication who might need surgical intervention. CECT on 3rd day adds nothing to management. It has a tendency to over predict the regional complication, which are in anyway apart of natural course of history of disease (acute fluid collection). Management decision could not be based on CECT abdomen on 3rd day alone, since it is not needed to make a diagnosis of acute pancreatitis it should be abundant, thus reducing the financial burden of patients and institute. CECT abdomen done after 2nd week in the course of illness along with APACHE II Score and clinical finding are better guide for management and surgical intervention.

scholarly journals Clinical Profile and Outcome of Patients with Severe Acute Pancreatitis

2020 ◽  
Vol 9 (3) ◽  
pp. 8-11
Author(s):  
Rishabh Sehgal ◽  
Inder Pal Singh ◽  
Jyotisterna Mittal
Keyword(s):  
Acute Pancreatitis ◽  
Alcohol Consumption ◽  
Severe Acute Pancreatitis ◽  
Sofa Score ◽  
Clinical Profile ◽  
Etiological Factor ◽  
Clinical Severity ◽  
Apache Ii ◽  
Apache Ii Score ◽  
Marshall Score

Background: Acute pancreatitis (AP) is an acute inflammatory condition of the pancreas leading to pancreatic autodigestion. The present study was conducted to study the clinical profile and outcome of patients with severe acute pancreatitis. Subjects & Methods: The study was conducted on 40 patients of acute pancreatitis. Clinical profile including history, examination findings, etiology of pancreatitis, clinical severity (according to Modified Marshall Score, BISAP score, APACHE II, HAPS score, SOFA score) was recorded. Results: Severe Acute Pancreatitis (SAP) among patients. Majority of the patients i.e. 22 (55%) had alcohol consumption as etiological factor causing SAP followed by biliary 10 (25%) & idiopathic 5 (12.5%). Hypertriglyceridemia and drug-induced (herbal medication) pancreatitis was present in 1 (2.5%) patient each. Out of all 1 (2.5%), patients had a history of both alcohol consumption and the presence of gallstone as an etiological factor. 22 patients (55%) out of 40 patients only conservative management was used while 18(45%) patients underwent USG guided percutaneous drainage was done. Out of these 18 patients, 3(7.5%) patients required Laparoscopic Necrosectomy & 2(5%) patients required open necrosectomy in addition to ultrasound-guided PCD. Patients who improved had a mean BISAP SCORE of 2.15   0.54, Modified Marshall score of 3.65    1.44, APACHE II score of 9.77  4.45, SOFA score 5.54  2.49, RANSON’s score 3.85   1.80 and HAP score of 0.65   0.63. Conclusion: Most common   etiology of severe acute pancreatitis is alcohol followed by biliary etiology. Out of severity scores (BISAP, APACHE-II, SOFA, HAPS), only BISAP score ≥3 is predictive of poor outcome in patients with severe acute pancreatitis.

Decreased Activity of Plasma ADAMTS13 Parallels Enhanced Endotoxemia in Patients with Severe Acute Pancreatitis: Relationship to Multiorgan Failure

Blood ◽  
2008 ◽  
Vol 112 (11) ◽  
pp. 4541-4541
Author(s):  
Chie Morioka ◽  
Masahito Uemura ◽  
Tomomi Matsuyama ◽  
Masanori Matsumoto ◽  
Masao Fujimoto ◽  
...  
Keyword(s):  
Acute Pancreatitis ◽  
Severe Acute Pancreatitis ◽  
Sofa Score ◽  
Multiorgan Failure ◽  
Prognostic Indicator ◽  
Apache Ii ◽  
Apache Ii Score ◽  
Healthy Controls ◽  
Endotoxin Concentration ◽  
Plasma Endotoxin

Abstract Background: Severe acute pancreatitis (SAP) frequently progresses to pancreatitis-associated multiorgan failure (MOF) with high mortality. Decreased plasma ADAMTS13 activity (ADAMTS13:AC) results in the accumulation of unusually large von Willebrand factor multimers (UL-VWFM) and the formation of platelet thrombi, ultimately leading to MOF. We demonstrated that the imbalance between decreased ADAMTS13:AC and increased UL-VWFM could contribute to SAP pathogenesis through enhanced thrombogenesis, and serve as an early prognostic indicator for SAP patients (Scand J Gastroenterol, 2008, 26:1). Endotoxin has been considered to be the principle activator of the systemic inflammatory response syndrome, which predisposes patients for MOF and/or pancreatic necrosis, ultimately leading to SAP. We investigated the relationship of endotoxin to ADAMTS13:AC and its related parameters, and tried to explore their potential role on the development of MOF in patients with SAP. Methods: We sequentially determined plasma endotoxin concentration, ADAMTS13:AC and its related parameters in 13 SAP patients (APACHE-II score mean 6.6 ± 2.7), who were admitted into intensive care unit of our hospital between 2004 and 2006. Eleven patients were survivors and two were non-survivors whose APACHE II scores were 10 and 12 died of MOF, respectively. The degree of MOF was evaluated according to the SOFA score. Endotoxin concentration was determined by a chromogenic substrate assay (Toxicolor LS –M Set, Seikagaku Kogyo Co.) with kinetic analysis after pretreatment with detergent, Triton X-100, and heating at 70 °C for 10 min. Plasma ADAMTS13:AC was determined by a sensitive chromogenic ELISA (ADAMTS13-act-ELISA: Kainos Inc.). Plasma UL-VWFM was analyzed by a vertical SDS-1.0% agarose gel electrophoresis. Plasma VWF antigen (VWF:AG), interleukin 6 (IL-6), interleukin 8 (IL-8), and tumor necrosis factor -α (TNF-α) were measured by ELISA. Results: In normal healthy controls (n=20), plasma endotoxin concentration was 7.9±1.7 pg/ml (mean ± SD). The concentration in the SAP patients significantly increased at day 1 (means 65 pg/ml, p<0.001) and at day 2 (88 pg/ml, p<0.001) as compared to healthy controls. The values, thereafter, gradually decreased in 8 survivors (55 pg/ml at day 5, 53 pg/ml at day 7, 27 pg/ml at day 14), while in remaining 3 survivors needing necrosectomy, the concentration further increased (98 pg/ml at day 5, 178 pg/ml at day 7), and decreased to 20 pg/ml at day 14 at the recovery phase. In two non-survivors, the endotoxin levels increased from 37 pg/ml at day 1 to 462 pg/ml at day 2 in one needing necrosectomy, and showed 51 pg/ml at day 1 in another at the age of 91. Within 1 or 2 days after admission, the ADAMTS13:AC was lower in SAP patients (mean 29%, p<0.001) than in healthy controls (99%), and gradually recovered in the 11 survivors but further decreased in the 2 non-survivors. On admission, VWF:Ag was higher (402%, p<0.001) in SAP patients than controls (100%). VWF:Ag gradually decreased in the survivors, except in the 3 survivors needing a necrosectomy, but remained high in the non-survivors. UL-VWFM positive patients showed lower ADAMTS13:AC (25% vs. 42%, p<0.05) and higher VWF:Ag ( 481% vs. 332%, p<0.05), resulting in higher ratio of VWF:Ag to ADAMTS13:AC (25.2 vs. 9.1, p<0.02), as compared to UL-VWFM negative ones. Patients with higher endotoxin concentration more than 50 pg/ml showed lower ADAMTS13:AC than those without (22% vs. 43%, p<0.05). Plasma endotoxin concentration positively correlated with the ratio of VWF:Ag to ADAMTS13:AC (r=0.732, p<0.005). The SOFA score correlated positively with plasma endotoxin concentration (r=0.604, p<0.03), IL-8 (r=0.843, p<0.001), and the ratio of VWF:Ag to ADAMTS13:AC (r=0.700, p<0.01), and inversely with the ADAMTS13:AC (r= − 0.601, p<0.03). Conclusion. The imbalance between decreased ADAMTS13:AC and increased UL-VWFM is closely related to enhanced endotoxemia, which may contribute to the development of SAP and subsequent MOF through enhanced thrombogenesis.

scholarly journals Soluble B7-H5 Is a Novel Diagnostic, Severity, and Prognosis Marker in Acute Pancreatitis

2021 ◽  
Vol 2021 ◽  
pp. 1-8
Author(s):  
Ruoxin Xu ◽  
Ju Gong ◽  
Wei Chen ◽  
Yakang Jin ◽  
Jian Huang
Keyword(s):  
Acute Pancreatitis ◽  
Abdominal Pain ◽  
Severe Acute Pancreatitis ◽  
Apache Ii ◽  
Apache Ii Score ◽  
Prognosis Marker ◽  
Score Apache ◽  
Marshall Score ◽  
Pain Patients ◽  
Ranson Score

As an important ligand in T lymphocyte costimulatory pathways, B7-H5 is involved deeply in the immune response in various diseases. However, its clinical usefulness as an early indicator in acute pancreatitis (AP) remains unclear. In this study, the levels of sB7-H5 and cytokines in plasma samples of 75 AP patients, 20 abdominal pain patients without AP, and 20 healthy volunteers were determined. Then, the correlation of sB7-H5 and clinical features, cytokines, the Ranson score, APACHE II score, Marshall score, and BISAP score was analysed, and the value of sB7-H5 for diagnostic, severity, and prognosis of AP was evaluated. We found that the levels of sB7-H5 were specifically upregulated in AP patients. Receiver operating characteristic (ROC) analysis revealed that sB7-H5 can identify AP patients from healthy or abdominal pain patients with 78.9% or 86.4% sensitivity and 93.3% or 90.0% specificity. Further analysis showed that the levels of sB7-H5 were significantly correlated with WBC ( p = 0.004 ), GLU ( p = 0.008 ), LDH ( p < 0.001 ), Ca2+ ( p = 0.006 ), AST ( p = 0.009 ), PLT ( p = 0.041 ), IL-6 ( p < 0.001 ), IL-10 ( p < 0.001 ), and TNF-α ( p < 0.001 ). And levels of sB7-H5 were gradually increased among patients with mildly acute pancreatitis (MAP), moderately severe acute pancreatitis (MSAP), and severe acute pancreatitis (SAP). It can distinguish the severity of AP with good sensitivity and specificity. Moreover, when dividing the patients into two groups according to the median level of sB7-H5, the local complication and length of stay of low levels of the sB7-H5 group were significantly less than those in high levels of the sB7-H5 group. And the levels of sB7-H5 in AP patients were significantly correlated with the Ranson score ( p < 0.001 ), APACHE II score ( p < 0.001 ), Marshall score ( p < 0.001 ), and BISAP score ( p < 0.001 ). The AUCs of assessing local complications of sB7-H5 at day 1 and day 3 were 0.704 ( p = 0.0024 ) and 0.727 ( p = 0.0373 ). These results showed the potential value of sB7-H5 as a diagnostic, severity, and prognosis marker of AP.

scholarly journals Dynamic Changes in Plasma Mitochondrial DNA Concentration in Patients with Severe Acute Pancreatitis

2020 ◽  
Author(s):  
Zepeng Duan ◽  
Yujing Wang ◽  
Hua Ling ◽  
Qiong Li ◽  
Xingui Dai
Keyword(s):  
Acute Pancreatitis ◽  
Mitochondrial Dna ◽  
Severe Acute Pancreatitis ◽  
Sofa Score ◽  
Early Stage ◽  
Dynamic Change ◽  
Apache Ii ◽  
Apache Ii Score ◽  
Reactive Protein ◽  
Failure Assessment

Abstract Background: The elevated plasma mitochondrial DNA (mtDNA) is associated with prognosis in patients with severe acute pancreatitis (SAP). However, it is not clear that the dynamic process of plasma mtDNA during the early stage of SAP and the correction between mtDNA and clinical features.Methods: Twenty-six eligible patients with SAP in the general intensive care unit of our institution were enrolled in this study. The mtDNA concentration were assessed at admission and on days 3, 5, and 7.Results: The mtDNA concentration of the patients with SAP was elevated at each time point compared with that in the healthy controls. The mtDNA levels increased rapidly, peaking on day 3 after admission, and began to decrease on day 5. The trend remained statistically consistent among the acute physiology and chronic health evaluation (APACHE II) score, the sequential organ failure assessment (SOFA) score, C-reactive protein (CRP) levels and mtDNA levels. Contrastingly, the changes were not statistically consistent among the procalcitonin (PCT), calciumion (Ca2+) and mtDNA concentrations. The mtDNA level correlated significantly with the APACHE II score, SOFA score, and Ranson score, but not with the CRP, PCT, and Ca2+ concentrations. Conclusions: The dynamic change of plasma mtDNA correlated significantly with SAP development. The elevated mtDNA levels could be used as a biomarker for the early stage of SAP.Trial registration: NCT: 04079777. Registered 4 September 2019 - Retrospectively registered, https://register.clinicaltrials.gov/prs/app/action/SelectProtocol?sid=S00096E5&selectaction=Edit&uid=U0002O5I&ts=2&cx=-e6bci8

Plasma ADAMTS13 Activity Markedly Decreases in Patients with Severe Acute Pancreatitis: Its Potential Role on the Development of Multiorgan Failure.

Blood ◽  
2007 ◽  
Vol 110 (11) ◽  
pp. 2160-2160
Author(s):  
Chie Morioka ◽  
Masahito Uemura ◽  
Tomomi Matsuyama ◽  
Masanori Matsumoto ◽  
Seiji Kato ◽  
...  
Keyword(s):  
Acute Pancreatitis ◽  
Severe Acute Pancreatitis ◽  
Healthy Subjects ◽  
Potential Role ◽  
Multiorgan Failure ◽  
Common Bile Duct Stones ◽  
Severe Form ◽  
Apache Ii ◽  
Apache Ii Score ◽  
Adamts13 Activity

Abstract Background: A severe form of acute pancreatitis, severe acute pancreatitis (SAP), frequently develops pancreatitis-associated multiorgan failure (MOF) followed by systemic microcirculatory disturbance with a high mortality. ADAMTS13 has been focused on the occurrence of thrombotic thrombocytopenic purpura (TTP). TTP has been reported to cause acute pancreatitis in a few percents, and recent study indicates that some acute pancreatitis may be a triggering event for TTP. We sequentially determined plasma ADAMTS13 activity (ADAMTS13:AC) and its related parameters in patients with SAP, and thereby, tried to explore their potential role on the development of MOF. Methods: Subjects studied were 13 patients with SAP, who were admitted into the department of emergency and critical care medicine of our hospital. The etiology was alcohol in 7, idiopathic in 3, common bile duct stones in 2, and post endoscopic retrograde cholangiopancreatography in 1. Eleven patients were survivors and two were non-survivors. Two of 4 patients with MOF were non-survivors. The severity was scored according to APACHE-II system. ADAMTS13:AC was determined using a commercially available ADAMTS13-act-ELISA (Kainos Inc., Tokyo). Plasma levels of VWF antigen (VWF:AG), interleukin 6 (IL-6), interleukin 8 (IL-8), and tumor necrosis-α (TNF-α) were measured by ELISA. Unusually large VWF multimer (UL-VWFM) was analyzed by a vertical SDS -1.0% agarose gel electrophoresis system. Results: ADAMTS13:AC significantly decreased at day 1 (mean 39%, p<0.001) and at day 2 (33%, p<0.001) as compared to healthy subjects (99%). The activity, thereafter, gradually recovered (49% at day 5, 58% at day 7, and 70% at day 10) in survivors, whereas in non-survivors, it decreased from 22% at day 1 to 10% at day 2 in one and showed 15% at day 1 in another. The inhibitor against ADAMTS13 was not detected. The VWF:AG increased to 402% at day 1 (p<0.001) and 333% at day 2 (p<0.001) as compared to healthy subjects (100%), and the value, thereafter, remained high (395% at day 5, 428% at day 7, and 382% at day 10). The UL-VWFM could be detected in 7 cases for 3 to 35 days immediately after admission. On admission, patients with detectable UL-VWFM tended to be lower ADAMTS13:AC and higher VWF:Ag than those without, resulting in higher VWF/ADAMTS13 ratio (19.9 vs. 8.9, p<0.01). Patients with MOF showed lower ADAMTS13:AC (20% vs. 40%, p<0.05) and higher VWF:Ag (448% vs. 391%, p<0.05) than those without, resulting in higher VWF/ADAMTS13 ratio (22.9 vs. 11.2, p<0.02). The concentrations of IL-6, IL-8, and TNFα increased, and ADAMTS13:AC correlated with those of IL-6 (r= − 0.51, p<0.05) and IL-8 (r= − 0.66, p<0.02). Furthermore, ADAMTS13:AC negatively correlated with APACHE-II score (r= − 0.67, p<0.02). Conclusion: Markedly decreased ADAMTS13:AC together with increased amounts of UL-VWFM was closely related to the severity of pancreatitis, an intense systemic inflammatory response, and prognosis in patients with SAP. These results indicate that the imbalance between the enzyme and its substrate may involve in the development of acute pancreatitis and subsequent MOF through enhanced thrombogenesis.

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