scholarly journals Relation of Pancreatic Enzymes and Serum Transaminases Levels with Modified CT Severity Index In Acute Pancreatitis

2016 ◽  
pp. 18-24
Author(s):  
Md Mofazzal Sharif ◽  
Md Towhidur Rahman ◽  
Mahfuz Ara Ferdousi ◽  
Md Abu Taher ◽  
Farzana Shegufta ◽  
...  
Keyword(s):  
Acute Pancreatitis ◽  
Severe Acute Pancreatitis ◽  
Computer Software ◽  
Clinical Information ◽  
Severity Index ◽  
Clinical Findings ◽  
Perfect Agreement ◽  
Female Ratio ◽  
Imaging Department ◽  
Mild Acute Pancreatitis

Introduction: Diagnosis of patients with severe acute pancreatitis as soon as possible is critical for achieving optimal outcomes. Management depends largely on severity. Medical treatment of mild acute pancreatitis is relatively straightforward. Treatment of severe acute pancreatitis involves intensive care. Surgical intervention (open or minimally invasive) is indicated in selected cases.Methodology: A total number of 59 subjects were enrolled in this present prospective study in the department of Radiology and Imaging, BIRDEM during two years aim to find out the correlation between CT severity index and patient serum enzyme levels in acute pancreatitis. Patients with clinically suspected and biochemically diagnosed acute pancreatitis referred to Radiology and Imaging department from department of gastroenterology (GHPD), BIRDEM for imaging investigation were enrolled in this study. Severity of acute pancreatitis was measured by both clinical and imaging staging (Modified CT severity index) in mild, moderate and severe groups. Subjects clinical information’s and serum enzymes were recorded and analyzed by computer software SPSS (Ver. 20-IBM).Result: Mean age of the study subjects was 36.43 ± 13.85 years. The age ranged from 20-63 years and the maximum number was found in 21 to 40 years age group. Male female ratio was almost 1.56:1. It was seen that diffuse pancreatic enlargement was noted in 20.33% subjects. Pancreatic inflammation with and without peripancreatic fat involvement were observed in 22.72% and 57.62% subjects respectively. Pseudocyst formation (11.86%), ascites (23.72%), renal fascia involvement (37.28%) and pleural effusion (30.5%) were seen in CT scan. The results of the interpreter analysis was Kappa = 0.852 with p < 0.001 when association of severity by clinical scoring and CT severity scoring was compared and revealed that measure of agreement, while statistically significant, was almost perfect agreement. CT severity index in acute pancreatitis had statistically significant (p is less than 0.05) relation with serum amylase (0.738), lipase (0.638), SGOT (0.581) and SGPT (0.365) during admission which was found on simple linear regression test.Conclusion: This present study concluded that modified CT severity index correlated well with patient’s enzymes level (Amylase, lipase, SGOT, SGPT) as well as clinical findings in acute pancreatitisBirdem Med J 2015; 5(1) Supplement: 18-24

scholarly journals ACUTE PANCREATITIS

2011 ◽  
Vol 18 (03) ◽  
pp. 366-372
Author(s):  
FAISAL G. BHOPAL ◽  
FARYAL AZHAR ◽  
SHAHID MAHMOOD ◽  
Muhammed Iqbal
Keyword(s):  
Acute Pancreatitis ◽  
Severe Acute Pancreatitis ◽  
Severe Illness ◽  
Amylase Level ◽  
Systemic Complications ◽  
Female Ratio ◽  
Life Threatening Illness ◽  
Individualized Approach ◽  
Mortality Ratio ◽  
Mild Acute Pancreatitis

Acute pancreatitis represents a spectrum of disease ranging from a mild, self-limited course to a rapidly progressive, severe illness. The mortality rate of severe acute pancreatitis exceeds 20%, and some patients diagnosed as mild to moderate acute pancreatitis at the onset of the disease may progress to a severe, life-threatening illness within 2-3 days1. Setting: A study was conducted in RGH (Now BBH). Period: January, 1997 to January, 2001. All patients with abdominal pain and having a serum amylase level of five times the normal range, were included in the study. 72 patients were admitted. 29 (40.2%) were males and 42 (59.7%) were females. Male to female ratio was 2:3. The age of the patients ranged from 7 years to 85 years (average age 40 years). Disease severity was assessed according to Ranson’s criteria. They were managed in a general surgical ward or intensive care unit when indicated. Development of complications and their management done were recorded. Patients stayed in the hospital from 1-21 days with an average period of 8.59 days. 32 (44.44%) recovered uneventfully without any complication while 40 (55.55%) patients developed either local or systemic complications. Overall 10 (13.88%) patients died early in the course of disease i.e. within one week. All of them were above 55 years of age, 6 of them were females and 4 of them were males, mortality ratio for female to male was 3:2. Purpose of study: (1) To study the morbidity and mortality in patients of acute pancreatitis. (2) To evaluate the management of acute pancreatitis in a general surgical unit. Conclusions: Management of mild acute pancreatitis is simple, it needs only supportive treatment. However, the management of severe acute pancreatitis is complex. Mortality is high and the treatment requires individualized approach regarding timing of surgery and choice of technique.

scholarly journals Role of Computed Tomography In The Evaluation of Severity of Acute Pancreatitis

KYAMC Journal ◽  
2017 ◽  
Vol 7 (2) ◽  
pp. 738-744
Author(s):  
Md Mofazzal Sharif ◽  
Mahfuz Ara Ferdousi ◽  
Md Towhidur Rahman ◽  
Nayeema Rahman ◽  
Md Nayeem Ullah ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Acute Pancreatitis ◽  
Clinical Outcome ◽  
Surgical Intervention ◽  
Gall Stone ◽  
Severity Index ◽  
Clinical Findings ◽  
Time Period ◽  
Mild Acute Pancreatitis

Title: Role of computed tomography in the evaluation of severity of acute pancreatitis.Introduction: Early diagnosis and determination of severity of acute pancreatitis is important for management and it depends largely on severity of disease. Medical treatment of mild acute pancreatitis includes conservative management while severe acute pancreatitis requires intensive care to surgical intervention (open or minimally invasive) in selected cases.Methodology: This prospective study was carried out to find out the correlation between modified CT severity index and patient's clinical outcome in acute pancreatitis enrolling 96 subjects in the department of Radiology and Imaging, BIRDEM during two years time period. Severity of acute pancreatitis was assessed by both clinical and imaging staging (Modified CT severity index) in mild, moderate and severe groups.Result: Mean age ( ± SD) of the study subjects was 35.48 ± 14.59 years and number of male was 60 (62.50%) and female was 36 (37.50%). Acute pancreatitis was associated with hypertriglyceridemia (19.79%), gall stone (12.5%), post ERCP (6.25%) and alcoholism (2.08%). Aetiology was unidentified in 59.73% subjects. Majority of the subjects with acute pancreatitis presented with abdominal pain, fever (20.08%), vomiting (54.41%) and oedema (25%). On imaging, diffuse pancreatic enlargement was noted in 29.16% subjects. Pancreatic inflammation with and without peripancreatic fat involvement were observed in 27.08% and 72.91% subjects respectively. Pseudocyst formation (13.54%), ascites (30.20%), renal fascia involvement (46.87%) and pleural effusion (37.5%) were seen in CT scan. Severity of acute pancreatitis was evaluated by clinical findings and CT severity index and the measure of agreement between clinical and imaging staging was almost perfect. CT severity index in acute pancreatitis had statically significant relation with clinical outcome (0.573), organ failure (0.674), need for surgical intervention (0.463) and hospital stay (0.235).Conclusion: Modified CT severity index in acute pancreatitis correlates with patient outcome. During reporting if this simple scoring system is applied then we can easily measure the severity and determine whether patient need medical or surgical intervention.KYAMC Journal Vol. 7, No.-2, Jan 2017, Page 738-744

scholarly journals Comparison of bedside index for severity in acute pancreatitis(BISAP) and modified CT severity index(MCTSI) for predicting the severity of hyperlipidemic acute pancreatitis(HLAP)

2019 ◽  
Author(s):  
Lan Nie ◽  
Yi Cheng ◽  
Fei Yao ◽  
Ru Shuo Wu ◽  
Ming Li ◽  
...  
Keyword(s):  
Acute Pancreatitis ◽  
Severe Acute Pancreatitis ◽  
Predictive Value ◽  
Early Stage ◽  
Area Under The Curve ◽  
Severity Index ◽  
Local Complications ◽  
Type2 Diabetes ◽  
Clinical Worker ◽  
Mild Acute Pancreatitis

Abstract Background: In recent years,the incidence of hyperlipidemic acute pancreatitis(HLAP) is rapidly increasing.It is important for Clinical worker to identify the severity at early stage of HLAP. AIMS: The goal of this paper was to compare bedside index for severity in acute pancreatitis(BISAP) and modified CT severity index(MCTSI) for predicting the severity and local complications of HLAP.Methods: We collected 167 patients with HLAP, including 133 cases of Mild acute pancreatitis(MAP), 34 cases of Moderately severe acute pancreatitis(MSAP) and Severe acute pancreatitis(SAP). The study retrospectively analyzed the clinical characteristics of two groups(MAP group,MSAP and SAP group) of patients.Correlation analysis was demonstrated by Spearman,s test. In addition,the accuracy was investigated through the study of the receiver operating characteristic(ROC) curve to predict the severity of HLAP by BISAP and MCTSI score.Results:There are significantly statistical differences(P<0.05) in Triglycerides(TG), Total cholesterols(TC),Hospitalization days,Fatty liver,and Local complications between two groups,While no statistical differences in Gender, Age,Serum amylase,Alanine aminotransferase(ALT),Aspertate aminotransferase(AST),Hypertension,Type2 diabetes,and Hyperuricemia. Positive relevance was established between BISAP and TG with r of 0.55. The Area Under the Curve(AUC) of BISAP and MCTSI in predicting the severity of HLAP respectively were0.89、0.78，sensitivity were 73.5%、79.4%, specificity were95.5%、60.2%, positive predictive value(PPV) were 80.6%、33.8%, negative predictive value(NPV) were 93.4%、92.0%.In predictionig local complications,the AUC respectively were 0.73、0.87, sensitivity were 37.5%、90.1%, specificity were 93.2%、78.6%, PPV were 77.4%、72.5%, NPV were 70.6%、93.1%.Conclusion: BISAP score has a meaningful prognostic value for predicting the severity of HLAP and higher AUC than MCTSI.In particular,there are significant association between BISAP and TG.Keywords:Hyperlipidemic acute pancreatitis；Triglycerides;BISAP score；MCTSI score; Severe acute pancreatitis

scholarly journals Comparison of bedside index for severity in acute pancreatitis(BISAP) and modified CT severity index(MCTSI) for predicting the severity of hyperlipidemic acute pancreatitis(HLAP)

2020 ◽  
Author(s):  
Lan Nie ◽  
Yi Cheng ◽  
Fei Yao ◽  
Ru Shuo Wu ◽  
Ming Li ◽  
...  
Keyword(s):  
Acute Pancreatitis ◽  
Severe Acute Pancreatitis ◽  
Predictive Value ◽  
Operating Characteristic ◽  
Early Stage ◽  
Area Under The Curve ◽  
Severity Index ◽  
Local Complications ◽  
Type2 Diabetes ◽  
Mild Acute Pancreatitis

Abstract Background: In recent years, the incidence of hyperlipidemic acute pancreatitis(HLAP) is rapidly increasing. It is important for clinicians to identify the severity at early stage of HLAP. AIMS: The goal of this paper was to compare bedside index for severity in acute pancreatitis(BISAP) and modified CT severity index(MCTSI) for predicting the severity and local complications of HLAP. Methods: We collected 167 patients with HLAP, including 133 cases of Mild acute pancreatitis(MAP), 34 cases of Moderately severe acute pancreatitis(MSAP) and Severe acute pancreatitis(SAP). The study retrospectively analyzed the clinical characteristics of two groups(MAP group,MSAP and SAP group) of patients. Correlation analysis was demonstrated by Spearman,s test. In addition,the accuracy was investigated through the study of the receiver operating characteristic(ROC) curve to predict the severity of HLAP by BISAP and MCTSI score. Results：There are significantly statistical differences(P<0.05) in Triglycerides(TG), Total cholesterols(TC), Hospitalization days, Fatty liver and Local complications between two groups. However, there are no statistical differences(P>0.05) in Gender, Age,Serum amylase, Alanine aminotransferase(ALT), Aspertate aminotransferase(AST), Hypertension, Type2 diabetes and Hyperuricemia. The Area Under the Curve(AUC) of BISAP and MCTSI in predicting the severity of HLAP respectively were 0.89、0.78, sensitivity were 73.5%、79.4%, specificity were95.5%、60.2%, positive predictive value(PPV) were 80.6%、33.8%, negative predictive value(NPV) were 93.4%、92.0%. Furthermore, the AUC respectively were 0.73、0.87, sensitivity were 37.5%、90.1%, specificity were 93.2%、78.6%, PPV were 77.4%、72.5%, NPV were 70.6%、93.1% in predictionig local complications. Conclusion：Compared to MCTSI score, BISAP score may be a better prognostic scoring system for predicting the severity of HLAP in view of accuracy and easiness. Keywords: Hyperlipidemic acute pancreatitis; Triglycerides; BISAP score; MCTSI score; Severe acute pancreatitis

Clinical Profile and Outcomes in Patients with Acute Pancreatitis attending a Teaching Hospital at Gandaki Province, Nepal

2020 ◽  
Vol 16 (3) ◽  
Author(s):  
Subash Bhattarai ◽  
Merina Gyawali
Keyword(s):  
Acute Pancreatitis ◽  
Severe Acute Pancreatitis ◽  
Age Groups ◽  
Data Entry ◽  
Kidney Injury ◽  
Severity Index ◽  
Clinical Profile ◽  
Cross Sectional ◽  
Systemic Complications ◽  
Keywords Alcohol

Background: Acute pancreatitis (AP) is inflammatory process of pancreas presenting with acute abdominal pain.The majority of patients have mild disease. Some patients develop local and systemic complications with increased morbidity and mortality. This study was undertaken to describe the clinical profile and outcomes in patients with acute pancreatitis.   Methods:  A cross-sectional hospital based study comprising of 62 consecutive patients with acute pancreatitis were enrolled between Jan 2019 to August 2020. Clinical profile at admission, complications and clinical outcomes including mortality were studied. Patients were classified into mild, moderately severe and severe acute pancreatitis based on revised Atlanta classification and modified CT severity index.  Data entry was done in Statistical Packages for the Social Sciences version 20. Results: The mean age of study subjects was 44±10.87 years with 43 (56%) males and 19 (44%) females (M:F=2.1:1). The commonest etiology of pancreatitis was alcohol (53.2%) followed by biliary pancreatitis (37.1%)  The most common presentation was abdominal pain (100%). The most common complication was pancreatic necrosis (21%) followed by acute kidney injury (19.4%) and pleural effusion (17.3%). Majority( 72.6%) was mild and 17.7% had severe acute pancreatitis. Mortality was seen in 6.5% patients. Mortality was observed in patients with persistent complications, organ failure, low serum calcium and high modified CT severity index.   Conclusions: Alcohol and gallstones were the two main etiologies of acute pancreatitis and were common in males, and in middle age groups. Majority presented with mild severity. Mortality was observed in some patients with severe acute pancreatitis.   Keywords: alcohol; biliary; CT severity index; mortality; outcome; pancreatitis          

scholarly journals Rhinocerebral mucormycosis secondary to severe acute pancreatitis and diabetic ketoacidosis: a case report

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Jinjing Wang ◽  
Yao Li ◽  
Shuai Luo ◽  
Hong Zheng
Keyword(s):  
Acute Pancreatitis ◽  
Diabetic Ketoacidosis ◽  
Severe Acute Pancreatitis ◽  
Clinical Findings ◽  
Severe Form ◽  
Optimal Treatment ◽  
Diabetic Patients ◽  
Rhinocerebral Mucormycosis ◽  
Patient Prognosis ◽  
Treatment Window

Abstract Introduction Rhinocerebral mucormycosis is a rare and severe form of opportunistic fungal infection that can develop rapidly and cause significant mortality, particularly among diabetic patients suffering from ketoacidosis. Diagnosing rhinocerebral mucormycosis during the early stages of infection is challenging. Case presentation We describe a case of rhinocerebral mucormycosis secondary to severe acute pancreatitis in a patient suffering from diabetic ketoacidosis. In this case, the condition was not diagnosed during the optimal treatment window. we therefore provide a thorough overview of related clinical findings and histopathological characteristics, and we discuss potential differential diagnoses. Conclusions In summary, we described a case of rhinocerebral mucormycosis secondary to severe acute pancreatitis in a patient suffering from diabetic ketoacidosis, with the optimal treatment window for this condition having been missed. This report suggests that a definitive mucormycosis diagnosis can be made based upon tissue biopsy that reveals the presence of characteristic hyphae. Early diagnosis and treatment are essential in order to improve patient prognosis.

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.

Effects of Micro-Ecological Enteral Nutrition on Systemic Inflammatory Response, Bacterial Translocation, and Immune Function in Patients with Severe Acute Pancreatitis

2020 ◽  
Vol 19 (3) ◽  
pp. 240-247
Author(s):  
Yilan Wang ◽  
Hongwei Ye ◽  
Feng Zheng ◽  
Xinsen Zou ◽  
Xianbin Wu ◽  
...  
Keyword(s):  
Acute Pancreatitis ◽  
Enteral Nutrition ◽  
Inflammatory Response ◽  
Immune Function ◽  
Severe Acute Pancreatitis ◽  
Bacterial Translocation ◽  
Severity Index ◽  
Systemic Inflammatory Response ◽  
Mucosal Barrier ◽  
Control Group

We have evaluated the effect of early and late micro-ecological enteral nutrition on systemic inflammatory response, bacterial translocation, and immune function in patients with severe acute pancreatitis. Two weeks after treatment, experimental group receiving early nutritional intervention exhibited a significant increase in intestinal lactobacilli and bifidobacteria, fewer staphylococci, and E. coli, and lower levels of serum endotoxin, D-lactic acid, and diamine oxidase than the group receiving late intervention (control group) (P < 0.05). Also, the serum levels of CD3+ and CD4+ and CD4+/CD8+ ratio significantly increase after 2 weeks of intervention. On the other hand, the level of CD8+ and the Acute Physiology and Chronic Health Evaluation II and Modified Computed Tomography Severity Index scores significantly decreased after 2 weeks of treatment (P < 0.05). The early intervention also led to a significant shortening of time needed for abdominal pain relief, anal exhaustion, resumption of peristaltic sound, and hospitalization. Furthermore, there was a significant increase in overall response rate, and decrease in the incidence rate of complications (P < 0.05). Early micro-ecological enteral nutrition therapy can effectively relieve systemic inflammatory response, prevent intestinal bacterial translocation, restore the function of intestinal mucosal barrier, and alleviate nutritional imbalance in severe acute pancreatitis patients leading to improved immune function, mitigation of the disease, and reduced complications benefiting the recovery of patients.

A study of clinical profile of patients with acute pancreatitis at a tertiary health care centre

2021 ◽  
Vol 19 (1) ◽  
pp. 10-12
Author(s):  
Deepak Ramakant Patil ◽  
Keyword(s):  
Health Care ◽  
Acute Pancreatitis ◽  
Epigastric Pain ◽  
Biliary Tract Disease ◽  
Clinical History ◽  
Clinical Profile ◽  
Care Centre ◽  
Health Care Centre ◽  
Female Ratio ◽  
Mild Acute Pancreatitis

Background: Acute pancreatitis is one of the most common diseases affecting the exocrine pancreas. The incidence of acute pancreatitis has increased during the past 20 years. The overall mortality rate of acute pancreatitis ranges from 1% in mild acute pancreatitis to 30% in severe acute pancreatitis. Aim and objective: To study the clinical profile of patients with acute pancreatitis at a tertiary health care centre Methodology: Present study was a prospective study carried out on patients with acute pancreatitis admitted in department of surgery. Data collected was sociodemographic data, clinical history and clinical examination. All patients underwent biochemical investigations, Radiological investigations. All the patients were treated with conservative treatment. Results: Most commonly affected age group was 21-40 year males. Male to female ratio was 5:1. Most common etiological factor was alcohol 21(70%). 5(16.67%) patients had history of biliary tract disease. Epigastric pain (100%) was most common followed by Nausea vomiting (83.33%).

scholarly journals Underestimation of acute pancreatitis: patients with only a small increase in amylase/lipase levels can also have or develop severe acute pancreatitis

Gut ◽  
1999 ◽  
Vol 44 (4) ◽  
pp. 542-544 ◽  
Author(s):  
P G Lankisch ◽  
S Burchard-Reckert ◽  
D Lehnick
Keyword(s):  
Acute Pancreatitis ◽  
Severe Acute Pancreatitis ◽  
Serum Amylase ◽  
Artificial Ventilation ◽  
Enzyme Level ◽  
Serum Enzyme ◽  
Results Of Treatment ◽  
Upper Limit ◽  
High Enzyme ◽  
Mild Acute Pancreatitis

BACKGROUNDIn most treatment studies on acute pancreatitis, pancreatologists base their diagnosis on amylase/lipase levels more than three times above the upper limit of normal (>3n) and thus exclude patients with smaller enzyme level increases. The recommendations derived from the results of treatment studies do not take into account such patients. Non-pancreatologists frequently believe that only patients with high enzyme levels have a serious prognosis.AIMSTo question the assumption that high enzyme levels indicate severe, and conversely low enzyme levels indicate mild, acute pancreatitis.PATIENTS/METHODSThis retrospective study includes 284 consecutive patients with a first attack of acute pancreatitis. The cause was biliary in 114 (40%) patients, alcoholism in 83 (29%), other in 21 (7%), and unknown in 66 (23%). Patients were divided into two groups according to their serum enzyme levels (amylase: ⩽3n, n = 88; >3n, n = 196; lipase: ⩽3n, n = 51; >3n, n = 233). Renal impairment, indication for dialysis and artificial ventilation, development of pseudocysts, necessity for surgery, and mortality were taken as parameters of severity.RESULTSThe incidence of severity was the same for both the ⩽3n and >3n groups.CONCLUSIONSThe severity of acute pancreatitis is independent of the elevation in serum amylase/lipase level (⩽3n or >3n) on admission. Patients with only a slight increase can also have or develop severe acute pancreatitis. Patients with ⩽3n elevated enzyme levels on admission represent a substantial group that treatment studies have frequently overlooked. This is especially true for patients with alcohol induced acute pancreatitis whose amylase levels are lower than in other aetiological groups.

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