Early Risk Stratification in Acute Pancreatitis: The Role of Biochemical and Hematological Parameters

AbstractAcute pancreatitis (AP) represents an inflammatory condition,-with a wide spectrum of local and systemic complications. Early stratification of severity of pancreatitis is an important step in guiding the management of the disease and improving outcomes. Throughout the years many researchers have looked at various risk stratification parameters which could be used from the admission of patients, however current available scores are cumbersome.Our aim was to evaluate the role of biochemical and hematological parameters in the early stratification of severity of AP, regarding the length of hospitalization.We conducted an observational study which included 100 patients with AP admitted to the Gastroenterology Department over a period 18 months. AP diagnosis was set according to 2013 ACG criteria. Demographic, clinical and imaging data related to the pancreatitis flare were collected from their charts. Length of hospital stay was used as surrogate marker for severity of AP. We evaluated different biochemical and hematological parameters which influenced the length of hospitalization.Several hematological parameters and ratio did not correlate with length of hospital stay in our study cohort, however there was a significant relation of hyperglycemia and alkaline phosphatase levels with hospitalization duration.Early risk stratification in AP remains difficult with routine blood work done at admission. Glycemic control and serum level of alkaline phosphatase seems to be correlated with length of hospital stay.

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Role of early enteral feeding in mild and moderate acute pancreatitis

International Surgery Journal ◽

10.18203/2349-2902.isj20214376 ◽

2021 ◽

Vol 8 (11) ◽

pp. 3387

Author(s):

Aswin George Roy ◽

Haridas T. V.

Keyword(s):

Acute Pancreatitis ◽

Hospital Stay ◽

Enteral Feeding ◽

Significant Risk ◽

Length Of Hospital Stay ◽

Advantages And Disadvantages ◽

Early Enteral Feeding ◽

Systemic Complication ◽

Infective Complications

Background: Timing of enteral feeding in acute pancreatitis was always a matter of controversy. Increasing evidence suggests that early enteral feeding reduces systemic and local complications of pancreatitis and thereby hospital stay. Hence the study has been undertaken to determine the feasibility, advantages and disadvantages of early enteral feeding in mild and moderate acute pancreatitis. Methods: Patients admitted with symptoms and signs suggestive of mild and moderate acute pancreatitis who were started on early enteral feeding (within 48 hours of admission) were included in study. Blood investigation results are used to classify patients accordingly to mild and moderate acute pancreatitis based on Ransons’s score. Patients were followed up and categorized based on development of complications, length of hospital stay.Results: Majority of the patients who were started on early enteral feeding showed significant decrease in complications and hospital stay. Study also suggested that age is a significant risk in development of complications. Gender is not significant in the development of complications.Conclusions: There is significant decrease in rate of systemic complication, local infective and non-infective complications, length of hospital stay among acute pancreatitis patients who were started on early enteral feeding (within 48 hours).

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

Gut ◽

10.1136/gutjnl-2020-323364 ◽

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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Role of Pancreatic Stone Protein as an Early Biomarker for Risk Stratification of Acute Pancreatitis

Digestive Diseases and Sciences ◽

10.1007/s10620-021-07152-6 ◽

2021 ◽

Author(s):

Carlos Rodríguez Rojas ◽

Luis García de Guadiana-Romualdo ◽

Senador Morán Sánchez ◽

Josef Prazak ◽

Virginia Algara Soriano ◽

...

Keyword(s):

Acute Pancreatitis ◽

Risk Stratification ◽

Pancreatic Stone Protein ◽

Pancreatic Stone ◽

Early Biomarker

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P0032 VARIABLES AFFECTING LENGTH OF HOSPITAL STAY AND MORTALITY IN PATIENTS WITH ACUTE PANCREATITIS

European Journal of Internal Medicine ◽

10.1016/s0953-6205(09)60052-2 ◽

2009 ◽

Vol 20 ◽

pp. S19-S20

Author(s):

José Antonio Díaz-Peromingo ◽

Paula María Pesqueira-Fontán ◽

Marina Iglesias-Gallego ◽

Sonia Molinos-Castro ◽

Juan Saborido-Froján ◽

...

Keyword(s):

Acute Pancreatitis ◽

Hospital Stay ◽

Length Of Hospital Stay

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Tu1144 Comparison of Length of Hospital Stay of Children Admitted With Acute Pancreatitis Among Hospital Services At a Single Pediatric Tertiary Care Center

Gastroenterology ◽

10.1016/s0016-5085(14)62765-7 ◽

2014 ◽

Vol 146 (5) ◽

pp. S-765 ◽

Cited By ~ 1

Author(s):

Flora K. Szabo ◽

Joseph J. Palermo ◽

Tom K. Lin ◽

Maisam Abu-El-Haija

Keyword(s):

Acute Pancreatitis ◽

Hospital Stay ◽

Care Center ◽

Tertiary Care ◽

Length Of Hospital Stay ◽

Tertiary Care Center ◽

Hospital Services

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Advanced Endoscopic Tools

Digestive Disease Interventions ◽

10.1055/s-0041-1729765 ◽

2021 ◽

Author(s):

Eleanor C. Fung

Keyword(s):

Gastrointestinal Bleeding ◽

Hospital Stay ◽

Surgical Intervention ◽

Length Of Hospital Stay ◽

Therapeutic Endoscopy ◽

Full Thickness ◽

Evolution And Development ◽

Improved Outcomes ◽

Endoscopic Clips

AbstractThe advent and success of therapeutic endoscopy has expanded the utilization of endoscopy as an effective alternative to surgical intervention in some cases with decreased morbidity, improved outcomes, and shortened length of hospital stay. Gastrointestinal bleeding, perforations, leaks, fistulas, and strictures have become increasingly managed by endoscopy with the evolution and development of endoscopic tools for effective closure of full-thickness gastrointestinal defects, dilation, and hemostasis. This article reviews the characteristics and role of endoscopic clips, stents, dilation balloons, endoscopic knives, and suturing devices.

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Repeat Local Treatment of Recurrent Colorectal Liver Metastases, the Role of Neoadjuvant Chemotherapy: An Amsterdam Colorectal Liver Met Registry (AmCORE) Based Study

Cancers ◽

10.3390/cancers13194997 ◽

2021 ◽

Vol 13 (19) ◽

pp. 4997

Author(s):

Madelon Dijkstra ◽

Sanne Nieuwenhuizen ◽

Robbert S. Puijk ◽

Florentine E. F. Timmer ◽

Bart Geboers ◽

...

Keyword(s):

Neoadjuvant Chemotherapy ◽

Hospital Stay ◽

Colorectal Liver Metastases ◽

Local Treatment ◽

Length Of Hospital Stay ◽

Progression Free Survival ◽

Free Survival ◽

Significant Difference ◽

Subgroup Analyses

This cohort study aimed to evaluate efficacy, safety, and survival outcomes of neoadjuvant chemotherapy (NAC) followed by repeat local treatment compared to upfront repeat local treatment of recurrent colorectal liver metastases (CRLM). A total of 152 patients with 267 tumors from the prospective Amsterdam Colorectal Liver Met Registry (AmCORE) met the inclusion criteria. Two cohorts of patients with recurrent CRLM were compared: patients who received chemotherapy prior to repeat local treatment (32 patients) versus upfront repeat local treatment (120 patients). Data from May 2002 to December 2020 were collected. Results on the primary endpoint overall survival (OS) and secondary endpoints local tumor progression-free survival (LTPFS) and distant progression-free survival (DPFS) were reviewed using the Kaplan–Meier method. Subsequently, uni- and multivariable Cox proportional hazard regression models, accounting for potential confounders, were estimated. Additionally, subgroup analyses, according to patient, initial and repeat local treatment characteristics, were conducted. Procedure-related complications and length of hospital stay were compared using chi-square test and Fisher’s exact test. The 1-, 3-, and 5-year OS from date of diagnosis of recurrent disease was 98.6%, 72.5%, and 47.7% for both cohorts combined. The crude survival analysis did not reveal a significant difference in OS between the two cohorts (p = 0.834), with 1-, 3-, and 5-year OS of 100.0%, 73.2%, and 57.5% for the NAC group and 98.2%, 72.3%, and 45.3% for the upfront repeat local treatment group, respectively. After adjusting for two confounders, comorbidities (p = 0.010) and primary tumor location (p = 0.023), the corrected HR in multivariable analysis was 0.839 (95% CI, 0.416–1.691; p = 0.624). No differences between the two cohorts were found with regards to LTPFS (HR = 0.662; 95% CI, 0.249–1.756; p = 0.407) and DPFS (HR = 0.798; 95% CI, 0.483–1.318; p = 0.378). No heterogeneous treatment effects were detected in subgroup analyses according to patient, disease, and treatment characteristics. No significant difference was found in periprocedural complications (p = 0.843) and median length of hospital stay (p = 0.600) between the two cohorts. Chemotherapy-related toxicity was reported in 46.7% of patients. Adding NAC prior to repeat local treatment did not improve OS, LTPFS, or DPFS, nor did it affect periprocedural morbidity or length of hospital stay. The results of this comparative assessment do not substantiate the routine use of NAC prior to repeat local treatment of CRLM. Because the exact role of NAC (in different subgroups) remains inconclusive, we are currently designing a phase III randomized controlled trial (RCT), COLLISION RELAPSE trial, directly comparing upfront repeat local treatment (control) to neoadjuvant systemic therapy followed by repeat local treatment (intervention).

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B and NK Cells Closely Correlate with the Condition of Patients with Acute Pancreatitis

Gastroenterology Research and Practice ◽

10.1155/2019/7568410 ◽

2019 ◽

Vol 2019 ◽

pp. 1-13 ◽

Cited By ~ 1

Author(s):

Xin Wei ◽

Weifeng Yao ◽

Huiping Li ◽

Jingjing Qian ◽

Yaosheng Xie ◽

...

Keyword(s):

Acute Pancreatitis ◽

B Cells ◽

Hospital Stay ◽

B Cell ◽

Nk Cells ◽

Length Of Hospital Stay ◽

Absolute Number ◽

Frequency Change ◽

Short Term Treatment ◽

Cell Frequency

Purpose. Pancreatitis can lead to systemic inflammatory response, but the relationship between lymphocyte changes and patients with pancreatitis remains unclear. In this study, we evaluated the feedback function of changes in peripheral lymphocyte subsets on the condition of patients with pancreatitis. Materials and Methods. 131 acute pancreatitis (AP) patients and 11 chronic pancreatitis (CP) patients constituted the patients’ group; 20 healthy individuals were enrolled as healthy controls (HC). Serum concentration of C-reactive protein (CRP), amylase, and lipase and the frequency and absolute number of many types of peripheral lymphocytes (including T, B, NK, CD16+/CD56+ T, CD4+ T, CD8+ T, CD4+CD8+ T, and CD4−CD8− T cells) were detected on admission and the seventh day of standard treatment. Besides, the length of hospital stay was recorded. Results. The absolute number of all lymphocytes we studied decreased in patients with CP and in patients with almost all types of AP. The frequency change of lymphocytes varies among the different types of AP. During disease onset, B cell frequency correlated positively with CRP concentration and NK cell frequency correlated positively with amylase and lipase concentration. B cell frequency and CD4+ T cell absolute number were recovering towards normal after short-term treatment. The frequency of B cells and NK cells correlated positively with the length of hospital stay. Conclusions. B cells and NK cells closely correlate with patients’ condition and may help to diagnose AP more accurately and reflect treatment effect of AP in time, affecting the recovery speed of patients with M-AP, which may help physicians to better understand the pathophysiology of pancreatitis.

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A monoclonal anti-interleukin 8 antibody (WS-4) inhibits cytokine response and acute lung injury in experimental severe acute necrotising pancreatitis in rabbits

Gut ◽

10.1136/gut.43.2.232 ◽

1998 ◽

Vol 43 (2) ◽

pp. 232-239 ◽

Cited By ~ 75

Author(s):

M O Osman ◽

J U Kristensen ◽

N O Jacobsen ◽

S B Lausten ◽

B Deleuran ◽

...

Keyword(s):

Acute Pancreatitis ◽

Acute Lung Injury ◽

Lung Injury ◽

Severe Acute Pancreatitis ◽

Pancreatic Necrosis ◽

Interleukin 8 ◽

Systemic Complications ◽

Duct Ligation ◽

Tnf Α

Background—Interleukin 8 (IL-8) has recently been proposed to have an important role in mediating the development of the systemic sequelae associated with severe acute pancreatitis.Aims—To define the role of IL-8 in acute pancreatitis by neutralising its effects with a monoclonal anti-IL-8 antibody (WS-4), in a rabbit model of severe acute pancreatitis.Methods—Acute pancreatitis was induced by retrograde injection of 5% chenodeoxycholic acid into the pancreatic duct and duct ligation. Twenty rabbits were divided equally into two groups: acute pancreatitis controls received physiological saline and the treated group received WS-4, 30 minutes before induction of acute pancreatitis.Results—Pretreatment of animals with WS-4 resulted in significant down regulation of serum IL-8 and tumour necrosis factor α (TNF-α) from three to six hours after induction of acute pancreatitis (p=0.011 and 0.047 for IL-8 and 0.033 and 0.022 for TNF-α, respectively). In addition, a significant reduction in the CD11b and CD18 positive cells and the amount of interstitial neutrophil infiltration in the lungs from WS-4 treated animals was seen. In contrast, WS-4 did not alter the amount of pancreatic necrosis and the serum concentrations of amylase, lipase, calcium, and glucose.Conclusion—WS-4 cannot change the amount of pancreatic necrosis induced by injection of 5% bile acid, but does reduce the acute lung injury, presumably through inhibition of circulating IL-8 and TNF-α, and CD11b/CD18 in lung tissue. Therefore, a role of IL-8 in the progression of acute pancreatitis and the development of its systemic complications is suggested.

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