Serum D-dimer is a Predictor of Severity and Outcome of Acute Pancreatitis

Background: Acute pancreatitis (AP) is characterized by a spectrum of symptoms, ranging from a local inflammatory process to the more severe form (acute necrotizing pancreatitis) which is associated with a systemic inflammatory 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 the most severe forms but it remains a challenge to identify these poor prognosis cases specially in the first 48 hours. The objective of our study is to evaluate the efficacy of serum D-dimer in the prediction of severity and outcome of acute pancreatitis. Methods: This prospective and observational study was conducted in the Department of Gastrointestinal, Hepatobiliary and Pancreatic Disorders (GHPD), BIRDEM General Hospital, Dhaka, Bangladesh from January, 2016 to September, 2017. Patients with acute pancreatitis admitted to Department of GHPD of BIRDEM General Hospital, Dhaka, were included in this study. Purposive type of non probability sampling technique was applied to enroll the patients. A predesigned structured questionnaire was used for recording the necessary information. Patients admitted with abdominal pain and fulfilling the diagnostic criteria of acute pancreatitis by clinical history, physical examination, biochemical tests and different imaging modalities and patients aged more than 18 years were included in this study. The patients were followed up on day 1, day 3 of admission and on the day before discharge. Results: Total 87 patients with acute pancreatitis, who fulfilled the inclusion criteria, were included in this study. This study found that 53(61.0%) had mild acute pancreatitis, 27(31.0%) patients had moderately severe acute pancreatitis and 7(8.0%) patients had severe acute pancreatitis. The mean serum D-dimer at day 1 of patients with mild disease was 2.31± 1.82(mean±SD) μg/ml, in patients with moderately severe disease was 4.67± 2.02(mean±SD) μg/ml and in severe acute pancreatitis it was 10.11±3.11 (mean±SD) μg/ml. The difference among the groups were statistically significant (p<0.001). The mean serum D-dimer at day 3 of patients with mild disease was 0.8±0.51 (mean±SD) μg/ml, in patients with moderately severe disease was 1.86±2.22 (mean± SD) μg/ml and in severe acute pancreatitis it was 3.62±1.9 (mean±SD) μg/ml. The difference among the groups were statistically significant (p<0.001). Thus serum D-dimer could predict disease severity early in the course of disease successfully. In the present study 55(63.2%) patients did not develop any kind of complications and serum D-dimer level at day 1 and day 3 were 2.4±1.73 and 0.81±0.49 respectively. On the other hand 32 (36.8%) patients developed complications and serum D-dimer level at day 1 and day 3 were 5.86±3.5 and 2.31±2.3 respectively. The difference among the groups were statistically significant (p<0.001).That reveals serum D-dimer is a predictor of outcome of acute pancreatitis. Sensitivity, specificity and accuracy was 77.8%, 76.5% and 77.0% respectively at day 1 (cut off value e”3.3 μg/ml) and it was 73.5%, 77.4% and 75.9% respectively at day 3 (cut off value e”1.05 μg/ml) in prediction outcome of AP. Conclusion: The difference of serum D-dimer levels between mild, moderately severe and severe acute pancreatitis was statistically significant and it was also higher in patients who developed complications following acute pancreatitis than those without complications. This simple, feasible and reproducible marker can be used in clinical practice to improve the early management of acute pancreatitis. Birdem Med J 2019; 9(1): 44-54

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Serum Procalcitonin in the Prediction of Severity and Outcome of Acute Pancreatitis

Bangladesh Critical Care Journal ◽

10.3329/bccj.v9i1.53051 ◽

2021 ◽

Vol 9 (1) ◽

pp. 16-21

Author(s):

Khan Md Nazmus Saqeb

Keyword(s):

Acute Pancreatitis ◽

Statistical Analysis ◽

Severe Disease ◽

High Sensitivity ◽

Biochemical Tests ◽

Single Marker ◽

Predicting Outcome ◽

The Mean ◽

The Difference

Background: Different modalities are available for predicting severity and outcome of acute pancreatitis. A single marker with high sensitivity and specificity is yet to be identified. Aim: This study intends to find out the utility of serum procalcitonin in predicting the severity and outcome of acute pancreatitis. Methods: 117 patients admitted with acute pancreatitis were included.Clinical parameters and biochemical tests were recorded on admission, on day-3 & day-5 of admission. CT scan was performed in all patients. Serum procalcitonin was done on admission. Multifactorial scores were calculated using these data.Every patient was followed for identification of organ failure or other complications. Statistical analysis was done with SPSS. Result: Among 117 patients, 67(57.3%) were male. Biliary, hypertriglyceridemia, alcohol, malignancy and post-ERCP complications were found as aetiology in 25(21.4%), 23(19.7%), 8(6.8%), 3(2.6%),2(1.7%) cases respectively. In 53(45.3%) cases no definite etiology could be found. 83(70.9%) patients had mild,15(12.8%) had moderately severe and 19(16.2%) had severe acute pancreatitis. 23(19.65%) patients developed complication, whereas 94 (80.34%) developed none. The mean serum procalcitonin(pg/ml) of patients with mild, moderately severe and severe disease was 146±165.21, 1297±439.44, 4361±1493.55 respectively. The difference among the groups were statistically significant. Mean serum procalcitonin(pg/ml) in patientswho developed complications was 3744±1827.05 and in those without complication it was 301±559.97.ROC curve evaluating the role of serum procalcitonin in predicting outcome of acute pancreatitis showed AUC of 0.985. A cutoff point of 1131.28pg/ml showed highest sensitivity (95.7%) & specificity (94.7%). Conclusion: Serum procalcitonin can be a new promising marker to predict severity and outcome of acute pancreatitis. Bangladesh Crit Care J March 2021; 9(1): 16-21

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Pancreatitis in the Critical Care Setting

10.2310/gastro.8321 ◽

2017 ◽

Author(s):

Lisa M. Kodadek ◽

Pamela A. Lipsett

Keyword(s):

Acute Pancreatitis ◽

Chronic Pancreatitis ◽

Severe Acute Pancreatitis ◽

Classification System ◽

Pancreatic Necrosis ◽

Necrotizing Pancreatitis ◽

The United States ◽

Complex Spectrum ◽

Early Management ◽

Key Words Acute Pancreatitis

Pancreatitis is a complex spectrum of disease including chronic pancreatitis, acute pancreatitis, and manifestations of severe acute pancreatitis such as sterile and infected necrotizing pancreatitis. Acute pancreatitis is the leading cause of hospitalization for gastrointestinal disorders in the United States. Pancreatitis is a dynamic condition, and severity may change and evolve during the course of the disease. Although most patients with acute pancreatitis have mild disease, 10 to 15% will run a fulminant course, leading to severe acute pancreatitis, pancreatic necrosis, and multisystem organ injury. The mortality for severe acute pancreatitis is 15 to 30%; however, the overall mortality for all patients with acute pancreatitis is less than 5%. Early management of acute pancreatitis includes fluid resuscitation, pain control, and enteral nutrition. There are no specific directed therapies proven to be effective for the early treatment of acute necrotizing pancreatitis; therapy is entirely supportive. Chronic pancreatitis is a challenging disease often marked by chronic pain. Surgical intervention may help improve quality of life and relieve pain in selected patients. International consensus guidelines provide definitions and classifications to aid clinicians with diagnosis and management of pancreatitis. This review covers advances related to pancreatitis, including literature pertaining to the step-up approach for necrotizing pancreatitis first published in 2010, discussion of the revised Atlanta Classification System for severity of acute pancreatitis published in 2013, review of the current spectrum of microbial pathogens implicated in infected necrotizing pancreatitis, and the international draft consensus proposal for a new mechanistic definition for chronic pancreatitis published in 2016. Key words: acute pancreatitis, antibiotic prophylaxis, Atlanta Classification System, biliary pancreatitis, chronic pancreatitis, necrosectomy, pancreatic necrosis, pancreatitis, step-up approach, video-assisted retroperitoneal drainage (VARD)

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Pancreatitis

10.2310/7ccsp.8321 ◽

2017 ◽

Author(s):

Lisa M. Kodadek ◽

Pamela A. Lipsett

Keyword(s):

Acute Pancreatitis ◽

Chronic Pancreatitis ◽

Severe Acute Pancreatitis ◽

Classification System ◽

Pancreatic Necrosis ◽

Necrotizing Pancreatitis ◽

The United States ◽

Complex Spectrum ◽

Early Management ◽

Key Words Acute Pancreatitis

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Differences in coagulopathy indices in patients with severe versus non-severe COVID-19: a meta-analysis of 35 studies and 6427 patients

Scientific Reports ◽

10.1038/s41598-021-89967-x ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Alberto Polimeni ◽

Isabella Leo ◽

Carmen Spaccarotella ◽

Annalisa Mongiardo ◽

Sabato Sorrentino ◽

...

Keyword(s):

Platelet Count ◽

Meta Analysis ◽

Severe Disease ◽

Coagulation Factors ◽

Primary Analysis ◽

Severe Group ◽

Intravascular Coagulopathy ◽

The Difference ◽

D Dimer

AbstractCoronavirus disease 2019 (COVID-19) is a highly contagious disease that appeared in China in December 2019 and spread rapidly around the world. Several patients with severe COVID-19 infection can develop a coagulopathy according to the ISTH criteria for disseminated intravascular coagulopathy (DIC) with fulminant activation of coagulation, resulting in widespread microvascular thrombosis and consumption of coagulation factors. We conducted a meta-analysis in order to explore differences in coagulopathy indices in patients with severe and non-severe COVID-19. An electronic search was performed within PubMed, Google Scholar and Scopus electronic databases between December 2019 (first confirmed Covid-19 case) up to April 6th, 2020. The primary endpoint was the difference of D-dimer values between Non-Severe vs Severe disease and Survivors vs Non-Survivors. Furthermore, results on additional coagulation parameters (platelet count, prothrombin time, activated partial thromboplastin time) were also analyzed. The primary analysis showed that mean d-dimer was significantly lower in COVID-19 patients with non-severe disease than in those with severe (SMD − 2.15 [− 2.73 to − 1.56], I2 98%, P < 0.0001). Similarly, we found a lower mean d-dimer in Survivors compared to Non-Survivors (SMD − 2.91 [− 3.87 to − 1.96], I2 98%, P < 0.0001). Additional analysis of platelet count showed higher levels of mean PLT in Non-Severe patients than those observed in the Severe group (SMD 0.77 [0.32 to 1.22], I2 96%, P < 0.001). Of note, a similar result was observed even when Survivors were compared to Non-Survivors (SMD 1.84 [1.16 to 2.53], I2 97%, P < 0.0001). Interestingly, shorter mean PT was found in both Non-Severe (SMD − 1.34 [− 2.06 to − 0.62], I2 98%, P < 0.0002) and Survivors groups (SMD − 1.61 [− 2.69 to − 0.54], I2 98%, P < 0.003) compared to Severe and Non-Survivor patients. In conclusion, the results of the present meta-analysis demonstrate that Severe COVID-19 infection is associated with higher D-dimer values, lower platelet count and prolonged PT. This data suggests a possible role of disseminated intravascular coagulation in the pathogenesis of COVID-19 disease complications.

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The burden of acute pancreatitis and early experience of step-up approach for acute necrotizing pancreatitis at Military Hospital

Journal of Society of Surgeons of Nepal ◽

10.3126/jssn.v22i2.28723 ◽

2019 ◽

Vol 22 (2) ◽

pp. 11-17

Author(s):

Sushil Bahadur Rawal ◽

Uttam Laudari ◽

Basanta Khatiwada ◽

Anup Thapa ◽

Manoj Kumar Jha ◽

...

Keyword(s):

Acute Pancreatitis ◽

Severe Acute Pancreatitis ◽

Necrotizing Pancreatitis ◽

Early Experience ◽

Acute Necrotizing Pancreatitis ◽

Military Hospital ◽

Army Hospital ◽

Acute Necrotizing ◽

Hospital Resources ◽

Open Necrosectomy

Introduction: Twenty-five percent of acute pancreatitis develops severe acute pancreatitis (SAP). SAP patients have prolonged hospitalization and require a substantial amount of manpower and hospital resources. The aim of this study was to give an insight into the burden of acute pancreatitis at a tertiary level military hospital and to share the experience of managing pancreatic necrosis with the application of the step-up approach. Methods: A prospective descriptive study of consecutive patients was conducted at Shree Birendra Army Hospital from 2017 June to 2017 November. Patients with a diagnosis of acute pancreatitis admitted were stratified according to severity as per Revised Atlanta classification 2012. Patients with acute necrotizing pancreatitis were enrolled for the step-up approach. Patient’s demography, baseline investigations, radiology, prognostic scoring scales and type of intervention were analyzed. The burden of severe acute pancreatitis at our center and the early experience of the step-up approach at our centre within the study period were studied. Results: Out of 35 five patients with acute pancreatitis, 7 (20%) subsequently developed severe acute pancreatitis. Among them, five patients subsequently developed necrotizing pancreatitis who were managed according to the step-up approach. Out of them, three patients subsequently underwent operative intervention in the form of minimally invasive procedures like percutaneous drain placement, laparoscopic necrosectomy, video-assisted retroperitoneal debridement, and open necrosectomy. Conclusion: Acute pancreatitis is a common presentation at our centre. The step-up approach in the management of acute necrotizing pancreatitis is a safe and feasible approach.

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Surgery in the Treatment of Acute Pancreatitis — Open Pancreatic Necrosectomy

Scandinavian Journal of Surgery ◽

10.1177/145749690509400209 ◽

2005 ◽

Vol 94 (2) ◽

pp. 130-134 ◽

Cited By ~ 47

Author(s):

J. Werner ◽

W. Hartwig ◽

T. Hackert ◽

M. W. Büchler

Keyword(s):

Acute Pancreatitis ◽

Late Phase ◽

Necrotizing Pancreatitis ◽

Surgical Techniques ◽

Interventional Therapy ◽

Minimal Invasive ◽

Infected Necrosis ◽

Early Management ◽

Pancreatic Infection ◽

The Past

Management of acute necrotizing pancreatitis has changed significantly over the past years. Early management is non-surgically and solely supportive. Today, more patients survive the early phase of severe pancreatitis due to improvements of intensive-care-medicine. Pancreatic infection is the major risk factor with regard to morbidity and mortality in the late phase of severe acute pancreatitis. Whereas early surgery and surgery for sterile necrosis can only be recommended in selected cases, pancreatic infection is a well accepted indication for surgical treatment. Surgery should ideally be postponed until four weeks after the onset of symptoms as necrosis is well demarcated at that time. Four surgical techniques can be performed with comparable results regarding mortality: necrosectomy combined with (1) open packing, (2) planned staged relaparotomies with repeated lavage, (3) closed continuous lavage of the retroperitoneum, and (4) closed packing. However, closed continuous lavage of the retroperitoneum, and closed packing seem to be associated with a lower morbidity compared to the other two approaches. Advances in radiologic imaging, new developments of interventional radiology and other minimal access interventions have revolutionized the management of many surgical conditions over the past decades. However, minimal invasive surgery and interventional therapy for infected necrosis should be limited to specific indications in patients who are critically ill and otherwise unfit for conventional surgery. Open surgical debridement is the “gold standard” for treatment of infected pancreatic and peripancreatic necrosis.

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Severe Acute Pancreatitis and Necrotizing Pancreatitis

Critical Care Clinics ◽

10.1016/j.ccc.2015.12.006 ◽

2016 ◽

Vol 32 (2) ◽

pp. 279-290 ◽

Cited By ~ 29

Author(s):

Rahul Maheshwari ◽

Ram M. Subramanian

Keyword(s):

Acute Pancreatitis ◽

Severe Acute Pancreatitis ◽

Necrotizing Pancreatitis

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Impact Of Undesirable Effects Of The Parenteral Nutrition On The Nutritional Support And The Disease Progression

European Medical Health and Pharmaceutical Journal ◽

10.12955/emhpj.v4i0.366 ◽

2012 ◽

Vol 4 ◽

Author(s):

Shpata Vjollca ◽

Kuneshka Loreta ◽

Kurti Floreta ◽

Ohri Ilir

Keyword(s):

Acute Pancreatitis ◽

Case Report ◽

Parenteral Nutrition ◽

Disease Progression ◽

Severe Acute Pancreatitis ◽

Nutritional Support ◽

Negative Impact ◽

Necrotizing Pancreatitis ◽

Negative Energy ◽

Protein Catabolism

We report the case of a 52-year old man with severe acute pancreatitis. In this case report we discuss the undesirable effects of parenteral nutrition and the importance of nutritional support at patients with severe necrotizing pancreatitis. Severe acute pancreatitis is usually accompanied by systemic inflammatory response syndrome, which results in hypermetabolism with prominent protein catabolism. Providing nutrition to these patients is of paramount importance. An adequate nutritional support is crucial in patients with severe and complicated pancreatitis. A negative energy balance has a negative impact on the nutritional status and the disease progression.

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Prognostic Impact of Coagulopathy in Patients with COVID-19: a Meta-analysis of 35 Studies and 6427 Patients

10.21203/rs.3.rs-31142/v1 ◽

2020 ◽

Author(s):

Alberto Polimeni ◽

Isabella Leo ◽

Carmen Spaccarotella ◽

Annalisa Mongiardo ◽

Sabato Sorrentino ◽

...

Keyword(s):

Platelet Count ◽

Meta Analysis ◽

Severe Disease ◽

Severe Illness ◽

Prognostic Impact ◽

Primary Analysis ◽

Severe Group ◽

The Difference ◽

The Impact ◽

D Dimer

Abstract Coronavirus Disease 2019 (COVID-19) is a highly contagious disease that appeared in China in December 2019. Several patients with severe COVID-19 infection can develop a coagulopathy according to the ISTH-criteria for disseminated intravascular coagulopathy (DIC). We conducted a meta-analysis of all available studies on COVID-19 to explore the impact of coagulopathy on severe illness and mortality. An electronic search was performed within PubMed, Google Scholar and Scopus electronic databases. The primary endpoint was the difference of D-dimer values between Non-Severe vs Severe disease and Survivors vs Non-Survivors. The primary analysis showed that mean d-dimer is significantly higher in COVID-19 patients with severe disease than in those without (SMD -2.15 [-2.73 to -1.56], I2 98%, P <0.0001). Additional analysis of platelet count showed lower levels of mean PLT in Severe patients than those observed in the Non-Severe patients (SMD 0.77 [0.32 to 1.22], I2 96%, P <0.001). Interestingly, longer mean PT was found in Severe group (SMD -1.34 [-2.06 to -0.62], I2 98%, P <0.0002) compared to Non-Severe group. In conclusion, the results of the present meta-analysis, the largest and most comprehensive to date, demonstrate that Severe COVID-19 infection is associated with higher D-dimer values, lower platelet count and prolonged PT.

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Experience of managing first fifty COVID-19 positive peripartum women in a tertiary care centre in North India

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20210730 ◽

2021 ◽

Vol 10 (3) ◽

pp. 1036

Author(s):

Vijay Zutshi ◽

Neha Mohit Bhagwati ◽

Alka .

Keyword(s):

Pregnant Women ◽

Severe Disease ◽

Tertiary Care ◽

Birth Asphyxia ◽

Fetal Distress ◽

North India ◽

Tertiary Care Centre ◽

Mild Disease ◽

Qrt Pcr ◽

The Mean

Background: SARS-CoV-2 has caused significant morbidity and mortality worldwide. Analysis of the clinical profile of COVID-19 positive pregnant women is important to understand the pathophysiology, transmission and outcome of the disease in Indian population.Methods: It is a retrospective observational study of first fifty pregnant patients tested positive for COVID-19 by qRT PCR admitted for delivery in our hospital.Results: In this audit, first fifty COVID-19 pregnant women were studied and the mean age of the patients in this study was 26 years. 98% of these women were admitted for obstetric indications. Seventy two percent of these women were admitted with spontaneous onset of labour. Based on disease severity, 49 (98%) were either asymptomatic or exhibited mild disease and only 1 (2%) had severe disease who succumbed to her illness. Forty six percent patients delivered vaginally and 54% required cesarean delivery. The most common indication for LSCS was fetal distress (43%). Eighteen percent had preterm delivery. Among the newborn babies, one died due to severe birth asphyxia. Sixteen percent babies required NICU stay. Five babies tested positive for COVID-19 of which one baby was positive on day one of life.Conclusions: As per our results, majority of the COVID-19 positive pregnant women had mild disease. There has been increase in cesarean section rate as compared to the previous hospital figures. Only one baby tested positive within 24 hours of delivery so the possibility vertical transmission can not be commented upon as of today.

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