scholarly journals Elevated serum neopterin concentration increases mortality risk in patients with acute pancreatitis

Pteridines ◽  
2019 ◽  
Vol 30 (1) ◽  
pp. 16-20
Author(s):  
Zemin Xiang ◽  
Yijun Gu ◽  
Yuanyuan Huang ◽  
Lefeng Zhang ◽  
Xiaohong Zhang ◽  
...  
Keyword(s):  
Acute Pancreatitis ◽  
Severe Acute Pancreatitis ◽  
Mortality Risk ◽  
Elevated Serum ◽  
Multiple Organ ◽  
Control Group ◽  
Serum Neopterin ◽  
Severity Of Disease ◽  
Significant Difference ◽  
Mild Acute Pancreatitis

Abstract Background The aim of this study was to investigate serum neopterin levels in patients with acute pancreatitis (AP) and its predictive value for mortality in cases of severe acute pancreatitis (SAP). Methods Eighty-two patients with confirmed acute pancreatitis (AP) were included and divided into two groups, mild acute pancreatitis (MAP, n=51) and severe acute pancreatitis (SAP, n=31) according to severity of disease. From the SAP group, 8 cases went on to develop multiple organ dysfunction syndrome (MODS) and 6 subsequently died. Thirty healthy subjects from routine medical examination were included as the control group. The neopterin serum concentrations were determined and compared between groups. Results Serum neopterin concentrations from control, MAP, SAP, SAP_Non-MODS, MODS_survival and MODS_death groups were 6.85±2.42 (nmol/L), 0.91±4.83(nmol/L), 33.11±11.67(nmol/L), 30.39±9.97(nmol/L), 36.40±4.48(nmol/L) and 41.75±15.64(nmol/L) respectively, with statistical significant difference (p<0.05). The sensitivity and specificity for mortality risk were 66.67% (95%CI:22.28-95.67%) and 88.00%(95%CI:68.78-97.45%) respectively, with area under the ROC curve (AUC) of 0.71(95%CI:0.50-0.9), under the cut off value of 40.18. Conclusion: Serum neopterin levels in patients with acute pancreatitis were significantly elevated and correlated with the severity of disease. Neopterin may also be used a serological biomarker of mortality risk in patients with SAP.

scholarly journals Features of treatment of severe acute pancreatitis in obese patients

2021 ◽  
pp. 17-24
Author(s):  
О. V. Tkachuk ◽  
A. B. Kebkalo
Keyword(s):  
Acute Pancreatitis ◽  
Severe Acute Pancreatitis ◽  
Control Group ◽  
Comprehensive Treatment ◽  
Obese Patients ◽  
Second Stage ◽  
Significant Difference ◽  
Ringer’S Lactate ◽  
Experimental Group ◽  
Lactate Solution

The purpose of the work is to improve the results of treatment of severe acute pancreatitis in obese patients and to develop an algorithm for comprehensive treatment. Materials and methods. Patients with severe acute pancreatitis and obesity (mean BMI 37.48 ± 2.19 kg/m2) were randomized into two groups. In the experimental group (n = 18; step-up approach),early resuscitation with Ringer's lactate solution and ulinastatin in the first 5 days of the disease was used. Unilastatin was administered at a dose of 200,000IU by 1-hourintra­venous infusion TID for 5 days. The first stage of surgery was a drainage under ultrasound control, the second stage (if necessary) was laparos­copic retroperitoneal necrectomy (video-assisted­retroperitoneal debri­de­ment — VARD). Open surgery was performed in case of development of abdominal compartment syndrome. In the control group (n = 18; standard approach), resuscita­tion was performed with 0.9 % sodium chlo­ride solution without ulinastatin. The first stage of surgery was draina­ge under ultrasound control, the second stage was traditional median laparotomy with laparostomy. Results. The use of resuscitation with Ringer’s lactate solution in combination with ulinastatin for 5 days contributed to a decrease of procalcitoninlevels by 1.8 times (2.89 ± 0.88 compared with 1.8 ± 0.23 ng/mg; p = 0.001; α = 0.05). The level of CRP during the period of ulinastatin decreased by 41.68 mg/l (267.28 ± 114.11 compared with 225.6 ± 84.9 mg/l; p = 0.01; α = 0.05). There was a statistically significant difference in procalcitonin levels between groups on the 10th day (1.83 compared with 3.32 ng/mg; p = 0.001; α = 0.05), on the 15th day (1.15 compared with 1 .83 ng/mg; p = 0.001; α = 0.05) and on the 45th day (0.35 compared with 0.55 ng/mg; p = 0.001; α = 0.05). These results confirm the effect of the proposed method of treatment by reducing the risk of infection. Conclusions. The effectiveness of the proposed treatment algorithm is evidenced by a statistically significant difference in the level of CRP between groups on the 10th day (p = 0.035; α = 0.05). The use of VARD in the experimental group as a second stage of surgery is a less traumatic but effective method (p = 0.001; α = 0.05), which reduces the total number of complications (χ² = 4.012; p = 0.046). Evaluation of data «before—after» revealed the effectiveness of treatment by step-up approach (χ² = 5.4; p = 0.021). 

Multiple organ dysfunction associated with severe acute pancreatitis (SAP)

2001 ◽  
Vol 120 (5) ◽  
pp. A644-A645
Author(s):  
Kimmo I. Halonen ◽  
Ville Pettila ◽  
Ari K. Leppaniemi ◽  
Esko A. Kemppainen ◽  
Pauli A. Puolakkainen ◽  
...  
Keyword(s):  
Acute Pancreatitis ◽  
Organ Dysfunction ◽  
Severe Acute Pancreatitis ◽  
Multiple Organ ◽  
Multiple Organ Dysfunction

scholarly journals Clinical and therapeutic correlations in patients with slight acute pancreatitis

2015 ◽  
Vol 28 (1) ◽  
pp. 24-27 ◽  
Author(s):  
Clewis Henri MUNHOZ-FILHO ◽  
Fernando BATIGÁLIA ◽  
Hamilton Luiz Xavier FUNES
Keyword(s):  
Acute Pancreatitis ◽  
Intensive Care ◽  
Vital Signs ◽  
Positive Association ◽  
Multiple Organ ◽  
Glutamic Oxaloacetic Transaminase ◽  
Serum Glutamic Oxaloacetic Transaminase ◽  
Early Return ◽  
Lower Spectrum ◽  
Mild Acute Pancreatitis

BACKGROUND: Acute pancreatitis is an inflammatory disease of the pancreas due to enzymatic autodigestion which can cause necrosis or multiple organ failure; its pathophysiology is not fully known yet. AIM: To evaluate the correlation between clinical and therapeutic data in patients with mild acute pancreatitis. METHODS: A retrospective study in 55 medical records of patients admitted with acute mild pancreatitis was realized to analyze the association between age, leukocytosis, serum glutamic-oxaloacetic transaminase and lactate dehydrogenase, glucose, antibiotics, time admission and Ranson´s scores. RESULTS: There was a positive association between less intensive care (strict hydration, analgesia and monitoring of vital signs), early antibiotic therapy (monotherapy), early return to diet after 48 hours and laboratory control of the serum amylase and lipase (high in the first week and decreasing after 10 days, without any prognostic value). CONCLUSIONS: Changes in the management of patients with mild acute pancreatitis, such as enteral nutrition, rational use of lower spectrum antibiotics and intensive care, have contributed significantly to the reduction of hospitalization time and mortality.

Exosomes Derived from Human Umbilical Cord Mesenchymal Stem Cells (huMSCs) Carrying MicroRNA-342 Relieve Protect Severe Acute Pancreatitis Injury (SAP)

2021 ◽  
Vol 11 (9) ◽  
pp. 1838-1843
Author(s):  
Xiaohong Zhou ◽  
Xuzhong Hao ◽  
Feifei He
Keyword(s):  
Stem Cells ◽  
Acute Pancreatitis ◽  
Mesenchymal Stem Cells ◽  
Umbilical Cord ◽  
Severe Acute Pancreatitis ◽  
Pancreatic Tissue ◽  
Inflammatory Factors ◽  
Control Group ◽  
Human Umbilical Cord Blood ◽  
Human Umbilical Cord

To investigate whether exosomes (exo) derived from human umbilical cord mesenchymal stem cells (huMSCs) and microRNA (miRNA)-342 have a protective effect on severe acute pancreatitis (SAP). Human umbilical cord blood was collected to extract huMSC-exo. With sham-operated mice as control group (n = 10), the other mice were induced to SAP model (n = 20), while 10 of the SAP mice received treatment with huMSC-exo. ELISA was performed to determine amylase and TAP level as well as inflammatory factors and HE staining to evaluate pathological changes of pancreatic tissue. The expression of miR-342 and Shh, Ptchl, and Smo in the Hh signal pathway was detected using RT-qPCR. The expression of miR-342 and the mRNA expression of Shh, Ptchl, and Smo was higher than that in model group (p < 0.05). The level of serum amylase, trypsinogen, and IFN-γ,Fasl, and IL-6 was upregulated in pancreas tissues of SAP mice relative to healthy mice, but their levels were decreased upon treatment with huMSC-exo and slightly higher than those of the control group, just not significantly. Collectively, the huMSC-exo may activate the Hh signaling pathway by regulating the expression of miR-342 increasing the expression of Shh, Ptchl, and Smo, and thereby healing of damaged pancreatic tissues in SAP.

scholarly journals Assessment of Prophylactic Carbapenem Antibiotics Administration for Severe Acute Pancreatitis: An Updated Systematic Review and Meta-Analysis

Digestion ◽  
2022 ◽  
pp. 1-9
Author(s):  
Daxin Guo ◽  
Wei Dai ◽  
Jingyi Shen ◽  
Mengting Zhang ◽  
Yetan Shi ◽  
...  
Keyword(s):  
Acute Pancreatitis ◽  
Organ Failure ◽  
Severe Acute Pancreatitis ◽  
Pancreatic Pseudocyst ◽  
Meta Analysis ◽  
Fluid Collection ◽  
Cochrane Library ◽  
Intensive Care Unit Treatment ◽  
Significant Difference ◽  
And Control

<b><i>Background:</i></b> The effectiveness of prophylactic antibiotics in severe acute pancreatitis (SAP) remains a debatable issue. This meta-analysis aimed to determine the efficacy of prophylactic carbapenem antibiotics in SAP. <b><i>Methods:</i></b> This meta-analysis of prophylactic carbapenem antibiotics for SAP was conducted in PubMed, EMBASE, Web of Science, MEDLINE, and Cochrane Library up to February 2021. The related bibliographies were manually searched. The primary outcomes involved infected pancreatic or peripancreatic necrosis, mortality, complications, infections, and organ failure. <b><i>Results:</i></b> Seven articles comprised 5 randomized controlled trials and 2 retrospective observational studies, including 3,864 SAP participants. Prophylactic carbapenem antibiotics in SAP were associated with a statistically significant reduction in the incidence of infections (odds ratio [OR]: 0.27; <i>p</i> = 0.03) and complications (OR: 0.48; <i>p</i> = 0.009). Nevertheless, no statistically significant difference was demonstrated in the incidence of infected pancreatic or peripancreatic necrosis (OR: 0.74; <i>p</i> = 0.24), mortality (OR: 0.69; <i>p</i> = 0.17), extrapancreatic infection (OR: 0.64, <i>p</i> = 0.54), pulmonary infection (OR: 1.23; <i>p</i> = 0.69), blood infection (OR: 0.60; <i>p</i> = 0.35), urinary tract infection (OR: 0.97; <i>p</i> = 0.97), pancreatic pseudocyst (OR: 0.59; <i>p</i> = 0.28), fluid collection (OR: 0.91; <i>p</i> = 0.76), organ failure (OR: 0.63; <i>p</i> = 0.19), acute respiratory distress syndrome (OR: 0.80; <i>p</i> = 0.61), surgical intervention (OR: 0.97; <i>p</i> = 0.93), dialysis (OR: 2.34; <i>p</i> = 0.57), use of respirator or ventilator (OR: 1.90; <i>p</i> = 0.40), intensive care unit treatment (OR: 2.97; <i>p</i> = 0.18), and additional antibiotics (OR: 0.59; <i>p</i> = 0.28) between the experimental and control groups. <b><i>Conclusions:</i></b> It is not recommended to administer routine prophylactic carbapenem antibiotics in SAP.

Evaluation of Renal Function and Plasma Osmolality among Covid-19 Patients in Sudan

2021 ◽  
Vol 15 (12) ◽  
pp. 3576-3578
Author(s):  
Shomos A. Mubarak ◽  
Alneel A. A. Alameen ◽  
Husham O. Elzein ◽  
Mohamed Siddig Ibrahim ◽  
Maha B. Hassan ◽  
...  
Keyword(s):  
Renal Function ◽  
Elevated Serum ◽  
Plasma Osmolality ◽  
Serum Osmolality ◽  
Control Group ◽  
Plasma Urea ◽  
Significant Difference ◽  
The Mean ◽  
Serious Disease ◽  
Sodium And Potassium

Objective: COVID-19 is a very serious disease and is considered a pandemic by the WHO. The aim of this study is to determine the renal function and serum osmolality among COVID-19 patients in Khartoum state, Sudan. Method: This is retrospective study was conducted in Gebra Hospital, Khartoum state, Sudan from April 2021 to August 2021. The study enrolled 50 patients with Covid-19 and 50 healthy individuals as a control group. After all the enrolled participants signed the informed consent the samples were analyzed for Creatinine, Urea, Sodium, and potassium. By using an A25 fully automated chemistry analyzer, and serum Osmolality (mOsm / kg) was calculated according to Smithline and Gardner formula. Results: The study revealed a significant increase of the mean of Urea (P.value = 0.001), Creatinine (P.value = 0.001), however significant decrease in the mean of e GFR (P.value<0.05) on the first day of the admission. There was a significant increase in the mean of plasma Urea, Creatinine, and eGFR on the 7th day of admission when compared with the first day, P.value = (0.0001), (0.001), (0.001), respectively. The study revealed a significant difference in plasma Osmolality in COVID-19 patients (280.73 ±16.10 mOsm/kg) when compared with the control group (288.13 ±3.42 mOsm/kg), P.value = 0.0. Conclusion: COVID-19 does not affect only the lungs; it can also affect the kidney. This study concluded that there were an elevated serum creatinine, blood urea, and low glomerular filtration, and there was a significant difference in serum osmolality in COVID- 19 than in the healthy group. Keywords: COVID -19; Serum Osmolality; eGFR; Renal function; Sudan.

scholarly journals NLRP3 Deficiency Alleviates Severe Acute Pancreatitis and Pancreatitis-Associated Lung Injury in a Mouse Model

2018 ◽  
Vol 2018 ◽  
pp. 1-10 ◽  
Author(s):  
Qiang Fu ◽  
Zhensheng Zhai ◽  
Yuzhu Wang ◽  
Lixia Xu ◽  
Pengchong Jia ◽  
...  
Keyword(s):  
Acute Pancreatitis ◽  
Lung Injury ◽  
Severe Acute Pancreatitis ◽  
Nlrp3 Inflammasome ◽  
Early Death ◽  
Neutrophil Infiltration ◽  
Multiple Organ ◽  
Dependent Manner ◽  
Dose Dependent ◽  
Nlrp3 Expression

The rapid production and release of a large number of inflammatory cytokines can cause excessive local and systemic inflammation in severe acute pancreatitis (SAP) and multiple organ dysfunction syndrome (MODS), especially pancreatitis-associated acute lung injury (P-ALI), which is the main cause of early death in patients with SAP. The NLRP3 inflammasome plays an important role in the maturation of IL-1β and the inflammatory cascade. Here, we established a model of SAP using wild-type (NLRP3+/+) and NLRP3 knockout (NLRP3-/-) mice by intraperitoneal injections of caerulein (Cae) and lipopolysaccharide (LPS). Pathological injury to the pancreas and lungs, the inflammatory response, and neutrophil infiltration were significantly mitigated in NLRP3-/- mice. Furthermore, INF-39, an NLRP3 inflammasome inhibitor, could reduce the severity of SAP and P-ALI in a dose-dependent manner. Our results suggested that SAP and P-ALI were alleviated by NLRP3 deficiency in mice, and thus, reducing NLRP3 expression may mitigate SAP-associated inflammation and P-ALI.

scholarly journals Minimally invasive drainage versus open surgical debridement in SAP/SMAP – a network meta-analysis

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Kai Zhang ◽  
Xiaole Zhu ◽  
Chaoqun Hou ◽  
Chenyuan Shi ◽  
Yi Miao ◽  
...  
Keyword(s):  
Acute Pancreatitis ◽  
Minimally Invasive ◽  
Severe Acute Pancreatitis ◽  
Meta Analysis ◽  
Multiple Organ ◽  
Surgical Debridement ◽  
Percutaneous Catheter Drainage ◽  
Endoscopic Drainage ◽  
Percutaneous Catheter ◽  
Study Participants

Abstract Background The efficacy of some therapeutic methods (open surgical debridement (OSD), conservative treatment (CST) and minimally invasive drainage (MID)) for severe acute pancreatitis (SAP) and moderately severe acute pancreatitis (MSAP) has been widely evaluated. However, the results remained controversial. We performed this study to illuminate whether any difference in incidence exists on patients with SAP/MSAP treated with OSD and MID. Methods Eligible articles were collected base of a comprehensive review of PUBMED, EMBASE, COCHRANE, CKNI and WANGFANG for published randomized controlled trials. Two steps of meta-analysis were performed, routine pair-wise meta-analysis and network meta-analysis. Results Thirteen studies were included in this study. Participants were classed as 5 groups, CST, early MID (EMID), late MID (LMID), early OSD (EOSD) and late OSD (LOSD). And MID contains endoscopic drainage (ESD), percutaneous catheter drainage (PCD) and minimally invasive surgery (MIS). Compared with CST, MID could decrease both mortality and multiple organ dysfunction syndrome (MODS) rate but OSD couldn’t. Both EMID and MID can significantly decrease the mortality and MODS rate compared to CST. PCD might be most likely to have a benefit compared to CST. Conclusion Existing evidence for the use of MID in SAP/MSAP is reliable and it can be used as early treatment. OSD, if necessary, should be avoided or delayed as long as possible.

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