Acute respiratory distress-syndrome in the general complications of severe acute pancreatitis

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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