scholarly journals Abdominal free fluid in acute pancreatitis predicts necrotizing pancreatitis and organ failure

2021 ◽  
Author(s):  
Edward Yang
Keyword(s):  
Acute Pancreatitis ◽  
Organ Failure ◽  
Necrotizing Pancreatitis ◽  
Free Fluid

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.

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 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 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.

scholarly journals Necroptosis protects against exacerbation of acute pancreatitis

2021 ◽  
Vol 12 (6) ◽  
Author(s):  
Michittra Boonchan ◽  
Hideki Arimochi ◽  
Kunihiro Otsuka ◽  
Tomoko Kobayashi ◽  
Hisanori Uehara ◽  
...  
Keyword(s):  
Acute Pancreatitis ◽  
Necrotizing Pancreatitis ◽  
Neutrophil Infiltration ◽  
Dependent Manner ◽  
Protective Effects ◽  
Interacting Protein ◽  
Inflammatory Conditions ◽  
Edematous Pancreatitis ◽  
Genetic Deletion ◽  
Dose Dependent

AbstractThe sensing of various extrinsic stimuli triggers the receptor-interacting protein kinase-3 (RIPK3)-mediated signaling pathway, which leads to mixed-lineage kinase-like (MLKL) phosphorylation followed by necroptosis. Although necroptosis is a form of cell death and is involved in inflammatory conditions, the roles of necroptosis in acute pancreatitis (AP) remain unclear. In the current study, we administered caerulein to Ripk3- or Mlkl-deficient mice (Ripk3−/− or Mlkl−/− mice, respectively) and assessed the roles of necroptosis in AP. We found that Ripk3−/− mice had significantly more severe pancreatic edema and inflammation associated with macrophage and neutrophil infiltration than control mice. Consistently, Mlkl−/− mice were more susceptible to caerulein-induced AP, which occurred in a time- and dose-dependent manner, than control mice. Mlkl−/− mice exhibit weight loss, edematous pancreatitis, necrotizing pancreatitis, and acinar cell dedifferentiation in response to tissue damage. Genetic deletion of Mlkl resulted in downregulation of the antiapoptotic genes Bclxl and Cflar in association with increases in the numbers of apoptotic cells, as detected by TUNEL assay. These findings suggest that RIPK3 and MLKL-mediated necroptosis exerts protective effects in AP and caution against the use of necroptosis inhibitors for AP treatment.

scholarly journals Accuracy of angiopoietin-2 for predicting organ failure in patients with acute pancreatitis: a systematic review and meta-analysis

2021 ◽  
Vol 49 (2) ◽  
pp. 030006052098670
Author(s):  
Yongcai Lv ◽  
Yanhua Yao ◽  
Qi Liu ◽  
Jingjing Lei
Keyword(s):  
Acute Pancreatitis ◽  
Organ Failure ◽  
Meta Analysis ◽  
Characteristic Curve ◽  
Diagnostic Odds Ratio ◽  
Cochrane Library ◽  
Case Control Studies ◽  
Likelihood Ratios ◽  
Summary Receiver Operating Characteristic ◽  
Angiopoietin 2

Objective Our aim was to assess the accuracy of angiopoietin-2 (Ang-2) as a prognostic marker for acute pancreatitis (AP) with organ failure (OF). Methods We undertook a systematic search of the PubMed, Cochrane Library, Embase, Chinese Journals Full-text, Wanfang, China Biology Medicine disc, and Weipu databases to identify eligible cohort studies on the predictive value of Ang-2 for AP with OF. The main outcome measures were sensitivity and specificity. The effects were pooled using a bivariate mixed-effects model. Results Six articles with seven case-control studies (n = 650) were included. Pooled sensitivity, specificity, and positive and negative likelihood ratios with 95% confidence intervals (CI) for AP with OF were 0.93 (95%CI: 0.75–0.99), 0.85 (95%CI: 0.75–0.92), 6.40 (95%CI: 3.36–12.19), and 0.08 (95%CI: 0.02–0.36), respectively. The area under the summary receiver operating characteristic curve was 0.95 (95%CI: 0.92–0.96), and the diagnostic odds ratio was 83.18 (95%CI: 11.50–623.17). Subgroup analysis showed that admission time of AP onset (< or ≥24 hours) was a source of overall heterogeneity. Sensitivity analysis supported this finding. Conclusion Ang-2 had high diagnostic accuracy for AP with OF; the best prediction of Ang-2 may be 24 to 72 hours after onset of AP.

scholarly journals SARS-CoV-2 infection in acute pancreatitis increases disease severity and 30-day mortality: COVID PAN collaborative study

Gut ◽  
2021 ◽  
pp. gutjnl-2020-323364
Author(s):  
Sanjay Pandanaboyana ◽  
John Moir ◽  
John S Leeds ◽  
Kofi Oppong ◽  
Aditya Kanwar ◽  
...  
Keyword(s):  
Acute Pancreatitis ◽  
Hospital Stay ◽  
Organ Failure ◽  
Collaborative Study ◽  
Length Of Hospital Stay ◽  
Secondary Outcome ◽  
Icu Admission ◽  
Local Complications ◽  
Persistent Organ Failure ◽  
Increased Risk

ObjectiveThere is emerging evidence that the pancreas may be a target organ of SARS-CoV-2 infection. This aim of this study was to investigate the outcome of patients with acute pancreatitis (AP) and coexistent SARS-CoV-2 infection.DesignA prospective international multicentre cohort study including consecutive patients admitted with AP during the current pandemic was undertaken. Primary outcome measure was severity of AP. Secondary outcome measures were aetiology of AP, intensive care unit (ICU) admission, length of hospital stay, local complications, acute respiratory distress syndrome (ARDS), persistent organ failure and 30-day mortality. Multilevel logistic regression was used to compare the two groups.Results1777 patients with AP were included during the study period from 1 March to 23 July 2020. 149 patients (8.3%) had concomitant SARS-CoV-2 infection. Overall, SARS-CoV-2-positive patients were older male patients and more likely to develop severe AP and ARDS (p<0.001). Unadjusted analysis showed that SARS-CoV-2-positive patients with AP were more likely to require ICU admission (OR 5.21, p<0.001), local complications (OR 2.91, p<0.001), persistent organ failure (OR 7.32, p<0.001), prolonged hospital stay (OR 1.89, p<0.001) and a higher 30-day mortality (OR 6.56, p<0.001). Adjusted analysis showed length of stay (OR 1.32, p<0.001), persistent organ failure (OR 2.77, p<0.003) and 30-day mortality (OR 2.41, p<0.04) were significantly higher in SARS-CoV-2 co-infection.ConclusionPatients with AP and coexistent SARS-CoV-2 infection are at increased risk of severe AP, worse clinical outcomes, prolonged length of hospital stay and high 30-day mortality.

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