The Effect of Plasma Triglyceride-Lowering Therapy on the Evolution of Organ Function in Early Hypertriglyceridemia-Induced Acute Pancreatitis Patients With Worrisome Features (PERFORM Study): Rationale and Design of a Multicenter, Prospective, Observational, Cohort Study

Background: Acute pancreatitis (AP) is a potentially life-threatening inflammatory disease with multiple etiologies. The prevalence of hypertriglyceridemia-induced acute pancreatitis (HTG-AP) has been increasing in recent years. It is reported that early triglyceride (TG) levels were associated with the severity of the disease, and TG- lowering therapies, including medical treatment and blood purification, may impact the clinical outcomes. However, there is no consensus regarding the optimal TG-lowering therapy, and clinical practice varies greatly among different centers. Our objective is to evaluate the TG-lowering effects of different therapies and their impact on clinical outcomes in HTG-AP patients with worrisome features.Methods: This is a multicenter, observational, prospective cohort study. A total of approximately 300 patients with HTG-AP with worrisome features are planned to be enrolled. The primary objective of the study is to evaluate the relationship between TG decline and the evolution of organ failure, and patients will be dichotomized depending on the rate of TG decline. The primary outcome is organ failure (OF) free days to 14 days after enrollment. Secondary outcomes include new-onset organ failure, new-onset multiple-organ failure (MOF), new-onset persistent organ failure (POF), new receipt of organ support, requirement of ICU admission, ICU free days to day 14, hospital free days to day 14, 60-day mortality, AP severity grade (Based on the Revised Atlanta Classification), and incidence of systemic and local complications. Generalized linear model (GLM), Fine and Gray competing risk regression, and propensity score matching will be used for statistical analysis.Discussion: Results of this study will reveal the current practice of TG-lowering therapy in HTG-AP and provide necessary data for future trials.

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Study protocol for resolution of organ injury in acute pancreatitis (RESORP): an observational prospective cohort study

BMJ Open ◽

10.1136/bmjopen-2020-040200 ◽

2020 ◽

Vol 10 (12) ◽

pp. e040200

Author(s):

Ahmed E Sherif ◽

Rory McFadyen ◽

Julia Boyd ◽

Chiara Ventre ◽

Margaret Glenwright ◽

...

Keyword(s):

Quality Of Life ◽

Diabetes Mellitus ◽

Acute Pancreatitis ◽

Cohort Study ◽

Prospective Cohort Study ◽

Prospective Cohort ◽

Observational Prospective Cohort Study ◽

New Onset

IntroductionSurvivors of acute pancreatitis (AP) have shorter overall survival and increased incidence of new-onset cardiovascular, respiratory, liver and renal disease, diabetes mellitus and cancer compared with the general population, but the mechanisms that explain this are yet to be elucidated. Our aim is to characterise the precise nature and extent of organ dysfunction following an episode of AP.Methods and analysisThis is an observational prospective cohort study in a single centre comprising a University hospital with an acute and emergency receiving unit and clinical research facility. Participants will be adult patient admitted with AP. Participants will undergo assessment at recruitment, 3 months and 3 years. At each time point, multiple biochemical and/or physiological assessments to measure cardiovascular, respiratory, liver, renal and cognitive function, diabetes mellitus and quality of life. Recruitment was from 30 November 2017 to 31 May 2020; last follow-up measurements is due on 31 May 2023. The primary outcome measure is the incidence of new-onset type 3c diabetes mellitus during follow-up. Secondary outcome measures include: quality of life analyses (SF-36, Gastrointestinal Quality of Life Index); montreal cognitive assessment; organ system physiological performance; multiomics predictors of AP severity, detection of premature cellular senescence. In a nested cohort within the main cohort, individuals may also consent to multiparameter MRI scan, echocardiography, pulmonary function testing, cardiopulmonary exercise testing and pulse-wave analysis.Ethics and disseminationThis study has received the following approvals: UK IRAS Number 178615; South-east Scotland Research Ethics Committee number 16/SS/0065. Results will be made available to AP survivors, caregivers, funders and other researchers. Publications will be open-access.Trial registration numbersClinicalTrials.gov Registry (NCT03342716) and ISRCTN50581876; Pre-results.

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IL-6 and APACHE II predict development of organ failure in acute pancreatitis: Prospective cohort study

Pancreatology ◽

10.1016/j.pan.2017.07.212 ◽

2017 ◽

Vol 17 (4) ◽

pp. S62

Author(s):

Rajendra Kumar Jain ◽

Saransh Jain ◽

Soumya Jagannath Mahapatra ◽

Shallu Midha ◽

Baibaswata Nayak ◽

...

Keyword(s):

Acute Pancreatitis ◽

Cohort Study ◽

Organ Failure ◽

Prospective Cohort Study ◽

Prospective Cohort ◽

Apache Ii

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COVID-19 and Multiorgan Dysfunction Syndrome

10.5772/intechopen.99676 ◽

2021 ◽

Author(s):

Jitendra D. Lakhani ◽

Sajni Kapadia ◽

Rohit Choradiya ◽

Roop Preet Gill ◽

Som J. Lakhani

Keyword(s):

Organ Failure ◽

Kidney Injury ◽

Glycemic Variability ◽

Multiple Organ ◽

Organ Support ◽

Arterial Blood Gas ◽

Arterial Blood ◽

Treatment Support ◽

Laboratory Investigations ◽

Hospital Acquired

Severe acute respiratory syndrome (SARS) is the leading cause of death in COVID-19 infection, however, multi-organ dysfunction due to COVID-19 and/or because of co-morbidities is a usual accompaniment causing unfavorable outcome. Early detection of organ failure and giving appropriate organ support may improve the chances of survival. Arterial Blood Gas (ABG) analysis; electrolytes coupled with clinical picture and with organ related laboratory investigations may help in diagnosis of MODS and sepsis in COVID-19 SEVERE SYNDROME. Acute kidney injury (AKI), myocarditis, thromboembolism, acute liver de-compensation, hospital acquired infections, cardiac arrest, glycemic variability, thyroid dysfunction and other organ failure may lead to MODS.As patients having multiple organ syndrome requires ICU admission and interventions like intubation, hemodialysis and other extracorporeal treatment support knowing holistically about “COVID-19 MODS” is important for treating physicians.

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A systematic review on the timing of artificial nutrition in acute pancreatitis

British Journal Of Nutrition ◽

10.1017/s0007114508123443 ◽

2008 ◽

Vol 101 (6) ◽

pp. 787-793 ◽

Cited By ~ 63

Author(s):

Maxim S. Petrov ◽

Romana D. Pylypchuk ◽

Antonina F. Uchugina

Keyword(s):

Acute Pancreatitis ◽

Enteral Nutrition ◽

Parenteral Nutrition ◽

Multiple Organ Failure ◽

Organ Failure ◽

Infectious Complications ◽

Multiple Organ ◽

Artificial Nutrition ◽

Controlled Trials ◽

Randomised Controlled

Artificial nutrition is an inherent part of management in acute pancreatitis. However, there is no consensus regarding the optimal time of the commencement of feeding in these patients. Our aim was to compare the effect of enteral v. parenteral nutrition with regard to the time points when they were administered in the randomised controlled trials. The search was undertaken in the Cochrane Central Register of Controlled Trials, MEDLINE and Science Citation Index as well as in the proceedings of major gastroenterology meetings. The summary estimate of the effect associated with artificial nutrition was calculated using a random-effects model and presented as a risk ratio (RR) and 95 % CI. A total of eleven randomised controlled trials were included. When started within 48 h of admission, enteral nutrition, in comparison with parenteral nutrition, resulted in a statistically significant reduction in the risks of multiple organ failure (RR 0·44; 95 % CI 0·23, 0·84), pancreatic infectious complications (RR 0·46; 95 % CI 0·27, 0·77) and mortality (RR 0·46; 95 % CI 0·20, 0·99). After 48 h of admission, enteral nutrition, in comparison with parenteral nutrition, did not result in a statistically significant reduction in the risks of multiple organ failure (RR 0·73; 95 % CI 0·33, 1·63), pancreatic infectious complications (RR 0·31; 95 % CI 0·07, 1·34) and mortality (RR 0·67; 95 % CI 0·22, 2·10). Enteral nutrition is more effective than parenteral nutrition in reducing the risk of multiple organ failure, pancreatic infectious complications and mortality in patients with acute pancreatitis. The magnitude of these benefits may depend on the timing of the commencement of nutrition.

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New Predictor of Organ Failure in Acute Pancreatitis: CD4+ T Lymphocytes and CD19+ B Lymphocytes

BioMed Research International ◽

10.1155/2018/1012584 ◽

2018 ◽

Vol 2018 ◽

pp. 1-8 ◽

Cited By ~ 1

Author(s):

Chenyuan Shi ◽

Chaoqun Hou ◽

Xiaole Zhu ◽

Yunpeng Peng ◽

Feng Guo ◽

...

Keyword(s):

Acute Pancreatitis ◽

T Lymphocytes ◽

Organ Failure ◽

Clinical Outcomes ◽

B Lymphocytes ◽

T Lymphocyte ◽

Roc Curve ◽

Scoring Systems ◽

Gallstone Pancreatitis ◽

Effector Cells

Objective. Lymphocytes are one of the main effector cells in the inflammatory response of acute pancreatitis (AP). The purpose of the study was to evaluate whether peripheral blood lymphocyte (PBL) subsets at admission change during AP based on clinical outcomes and to explore whether these changes vary by aetiology of AP. Hence, we performed a prospective study to find a predictor in lymphocyte subsets that might allow easier, earlier, and more accurate prediction of clinical outcomes. Methods. Patients with AP were enrolled from December 2017 to June 2018 at the First Affiliated Hospital of Nanjing Medical University. Age, sex, clinical and biochemical parameters, and aetiology of AP were obtained at admission. PBL counts were assessed within 24 hours after admission. Clinical outcomes were observed as endpoints. The areas under the curve (AUCs) of different predictors were calculated using the receiver operating characteristic (ROC) curve. Results. Overall, 133 patients were included. Patients (n=24) with organ failure (OF) had significantly lower CD4+ T lymphocyte levels than those (n=109) with No OF (NOF) (39.60 (33.94-46.13) vs. 32.41 (26.51-38.00), P=0.004). The OF group exhibited significantly higher CD19+ B lymphocytes than the NOF group (16.07 (10.67-21.06) vs. 23.78 (17.84-29.45), P=0.001). Of the AP cases, 68.8% were caused by gallstones; 10.1% were attributed to alcohol; 16.5% were due to hyperlipidaemia; and 4.6% had other causes. Across all aetiologies, a lower CD4+ T lymphocyte level was significantly related to OF (P<0.05). However, CD19+ B lymphocytes were significant only in gallstone pancreatitis (P<0.05). The ROC curve results showed that the AUC values of CD4+T lymphocytes, CD19+ B lymphocytes, and combined CD4+T lymphocytes and CD19+ B lymphocytes were similar to those of traditional scoring systems, such as APACHEII and Ranson. Conclusions. CD4+ T and CD19+ B lymphocytes during the early phase of AP can predict OF.

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Discrepancy Between the Extent of Pancreatic Necrosis and Multiple Organ Failure Score in Severe Acute Pancreatitis

World Journal of Surgery ◽

10.1007/s00268-009-0161-9 ◽

2009 ◽

Vol 33 (11) ◽

pp. 2427-2432 ◽

Cited By ~ 10

Author(s):

Damian J. Mole ◽

Katie L. McClymont ◽

Sarah Lau ◽

Rosamund Mills ◽

Christopher Stamp-Vincent ◽

...

Keyword(s):

Acute Pancreatitis ◽

Multiple Organ Failure ◽

Organ Failure ◽

Severe Acute Pancreatitis ◽

Pancreatic Necrosis ◽

Multiple Organ ◽

Organ Failure Score

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Kynurenine-3-monooxygenase inhibition prevents multiple organ failure in rodent models of acute pancreatitis

Nature Medicine ◽

10.1038/nm.4020 ◽

2016 ◽

Vol 22 (2) ◽

pp. 202-209 ◽

Cited By ~ 69

Author(s):

Damian J Mole ◽

Scott P Webster ◽

Iain Uings ◽

Xiaozhong Zheng ◽

Margaret Binnie ◽

...

Keyword(s):

Acute Pancreatitis ◽

Multiple Organ Failure ◽

Organ Failure ◽

Multiple Organ ◽

Rodent Models

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Pancreatic and gut hormones as predictors of new-onset prediabetes after non-necrotising acute pancreatitis: a prospective longitudinal cohort study

Endocrine Connections ◽

10.1530/ec-21-0229 ◽

2021 ◽

Author(s):

Sakina H Bharmal ◽

Wandia Kimita ◽

Juyeon Ko ◽

Maxim S Petrov

Keyword(s):

Acute Pancreatitis ◽

Cohort Study ◽

Odds Ratio ◽

Adjusted Odds Ratio ◽

Gut Hormones ◽

Study Groups ◽

Prospective Longitudinal ◽

Prospective Longitudinal Cohort ◽

New Onset

Objective: Early identification of individuals at a high risk for metabolic derangements after an attack of acute pancreatitis (AP) is critical with a view to tertiary preventing of this disease. The aim was to investigate whether fasting pancreatic and gut hormones at baseline were predictive of future risk of new-onset prediabetes after acute pancreatitis (NOPAP) in individuals with non-necrotising AP. Methods: This was a prospective longitudinal cohort study that included 69 consecutive non-diabetic participants with AP, of whom 55% (n=38) had normoglycaemia both at baseline and during follow-up, 25% (n=17) had prediabetes both at baseline and during follow-up, and 20% (n=14) were normoglycaemic at baseline but developed NOPAP during follow-up. The associations between the study groups and circulating fasting levels of pancreatic and gut hormones (insulin, C-peptide, glucose-dependent insulinotropic peptide, glucagon-like peptide-1, pancreatic polypeptide, and peptide YY) were studied using multinomial regression in both unadjusted and adjusted analyses. Results: Elevated plasma insulin and glucagon at baseline were significantly associated with NOPAP (adjusted odds ratio 1.99, 95% confidence interval 1.01 to 3.92; and adjusted odds ratio 3.44, 95% confidence interval 1.06 to 11.19, respectively). The same hormones had no significant association with antecedent prediabetes in AP. The other studied hormones were not significantly associated with the study groups. Conclusions: Normoglycaemic AP individuals with elevated fasting levels of insulin and glucagon at baseline constitute a high-risk group for future NOPAP.

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