Gastrointestinal bleeding in acute pancreatitis: etiology, clinical features, risk factors and outcome

Background Inability to advance to an oral diet, or oral feeding intolerance, is a common complication in patients with acute pancreatitis associated with worse clinical outcomes. The factors related to oral feeding intolerance are not well studied. Objective We aimed to determine the incidence and risk factors of oral feeding intolerance in acute pancreatitis. Methods Patients were prospectively enrolled in the Acute Pancreatitis Patient Registry to Examine Novel Therapies in Clinical Experience (APPRENTICE), an international acute pancreatitis registry, between 2015 and 2018. Oral feeding intolerance was defined as worsening abdominal pain and/or vomiting after resumption of oral diet. The timing of the initial feeding attempt was stratified based on the day of hospitalization. Multivariable logistic regression was performed to assess for independent risk factors/predictors of oral feeding intolerance. Results Of 1233 acute pancreatitis patients included in the study, 160 (13%) experienced oral feeding intolerance. The incidence of oral feeding intolerance was similar irrespective of the timing of the initial feeding attempt relative to hospital admission day ( P = 0.41). Patients with oral feeding intolerance were more likely to be younger (45 vs. 50 years of age), men (61% vs. 49%) and active alcohol users (44% vs. 36%). They also had higher blood urea nitrogen (20 vs. 15 mg/dL; P<0.001) and hematocrit levels (41.7% vs. 40.5%; P = 0.017) on admission; were more likely to have a non-biliary acute pancreatitis etiology (69% vs. 51%), systemic inflammatory response syndrome of 2 or greater on admission (49% vs. 35%) and at 48 hours (50% vs. 26%;), develop pancreatic necrosis (29% vs. 13%), moderate to severe acute pancreatitis (41% vs. 24%) and have a longer hospital stay (10 vs. 6 days; all P<0.04). The adjusted analysis showed that systemic inflammatory response syndrome of 2 or greater at 48 hours (odds ratio 3.10; 95% confidence interval 1.83–5.25) and a non-biliary acute pancreatitis etiology (odds ratio 1.65; 95% confidence interval 1.01–2.69) were independent risk factors for oral feeding intolerance. Conclusion Oral feeding intolerance occurs in 13% of acute pancreatitis patients and is independently associated with systemic inflammatory response syndrome at 48 hours and a non-biliary etiology.

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Faculty Opinions recommendation of Acanthamoeba, fungal, and bacterial keratitis: a comparison of risk factors and clinical features.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.718169867.793489642 ◽

2014 ◽

Author(s):

Natalie Afshari ◽

Maria Eugenia Vola

Keyword(s):

Risk Factors ◽

Clinical Features ◽

Bacterial Keratitis

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SAT0029 Clinical Features and Risk Factors of Infection in Patients with Systemic Lupus Erythematosus: Experience from A Single Institute of Southern China

Annals of the Rheumatic Diseases ◽

10.1136/annrheumdis-2014-eular.3052 ◽

2014 ◽

Vol 73 (Suppl 2) ◽

pp. 599.2-599

Author(s):

D. Chen ◽

Z. Zhan

Keyword(s):

Risk Factors ◽

Systemic Lupus Erythematosus ◽

Clinical Features ◽

Lupus Erythematosus ◽

Southern China ◽

Systemic Lupus

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When Uncontrolled Diabetes Mellitus and Severe COVID-19 Converge: The Perfect Storm for Mucormycosis

Journal of Fungi ◽

10.3390/jof7040298 ◽

2021 ◽

Vol 7 (4) ◽

pp. 298

Author(s):

Teny M. John ◽

Ceena N. Jacob ◽

Dimitrios P. Kontoyiannis

Keyword(s):

Diabetes Mellitus ◽

Risk Factors ◽

Clinical Features ◽

The Other ◽

Diabetic Patients ◽

Epidemiological Factors ◽

Uncontrolled Diabetes ◽

Diagnostic Certainty ◽

Patients With Diabetes ◽

Perfect Storm

Mucormycosis (MCR) has been increasingly described in patients with coronavirus disease 2019 (COVID-19) but the epidemiological factors, presentation, diagnostic certainty, and outcome of such patients are not well described. We review the published COVID-19-associated mucormycosis (CAMCR) cases (total 41) to identify risk factors, clinical features, and outcomes. CAMCR was typically seen in patients with diabetes mellitus (DM) (94%) especially the ones with poorly controlled DM (67%) and severe or critical COVID-19 (95%). Its presentation was typical of MCR seen in diabetic patients (mostly rhino-orbital and rhino-orbital-cerebral presentation). In sharp contrast to reported COVID-associated aspergillosis (CAPA) cases, nearly all CAMCR infections were proven (93%). Treating physicians should have a high suspicion for CAMCR in patients with uncontrolled diabetes mellitus and severe COVID-19 presenting with rhino-orbital or rhino-cerebral syndromes. CAMR is the convergence of two storms, one of DM and the other of COVID-19.

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Risk Factors, and Clinical and Etiological Characteristics of Ischemic Strokes in COVID-19-Infected Patients: A Systematic Review of Literature

Cerebrovascular Diseases ◽

10.1159/000514267 ◽

2021 ◽

pp. 1-4

Author(s):

Simone Vidale

Keyword(s):

Risk Factors ◽

Systematic Review ◽

Clinical Features ◽

Case Reports ◽

Clinical Severity ◽

Large Artery ◽

Causal Association ◽

Review Of Literature ◽

Increased Risk ◽

Long Time

Background and Purpose: Coronavirus disease 2019 (COVID-19) infection is an ongoing pandemic and worldwide health emergency that has caused important changes in healthcare systems. Previous studies reported an increased risk of thromboembolic events, including stroke. This systematic review aims to describe the clinical features and etiological characteristics of ischemic stroke patients with COVID-19 infection. Method: A literature search was performed in principal databases for studies and case reports containing data concerning risk factors, clinical features, and etiological characteristics of patients infected with COVID-19 and suffering from stroke. Descriptive and analytical statistics were applied. Results: Overall, 14 articles were included for a total of 93 patients. Median age was 65 (IQR: 55–75) years with prevalence in males. Stroke occurred after a median of 6 days from COVID-19 infection diagnosis. Median National of Institute of Health Stroke Scale (NIHSS) score was 19. Cryptogenic (Cry) strokes were more frequent (51.8%), followed by cardioembolic etiology, and they occurred a long time after COVID-19 diagnosis compared with large-artery atherosclerosis strokes (ptrend: 0.03). The clinical severity of stroke was significantly associated with the severity grade of COVID-19 infection (ptrend: 0.03). Conclusions: Ischemic strokes in COVID-19-infected patients were clinically severe, affecting younger patients mainly with Cry and cardioembolic etiologies. Further multicenter prospective registries are needed to better describe the causal association and the effect of COVID-19 infection on stroke.

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Venous thromboembolic events in T-cell lymphoma patients: Incidence, risk factors and clinical features

Leukemia Research ◽

10.1016/j.leukres.2021.106537 ◽

2021 ◽

Vol 103 ◽

pp. 106537

Author(s):

Yingxia Lan ◽

Jinqiu Guan ◽

Jia Zhu ◽

Juan Wang ◽

Mengzhen Li ◽

...

Keyword(s):

Risk Factors ◽

T Cell ◽

Clinical Features ◽

Cell Lymphoma ◽

T Cell Lymphoma ◽

Thromboembolic Events ◽

Venous Thromboembolic Events ◽

Venous Thromboembolic ◽

Incidence Risk

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Early prediction of in-hospital mortality in acute pancreatitis: a retrospective observational cohort study based on a large multicentre critical care database

BMJ Open ◽

10.1136/bmjopen-2020-041893 ◽

2020 ◽

Vol 10 (12) ◽

pp. e041893

Author(s):

Caifeng Li ◽

Qian Ren ◽

Zhiqiang Wang ◽

Guolin Wang

Keyword(s):

Risk Factors ◽

Acute Pancreatitis ◽

Multivariate Analysis ◽

Hospital Mortality ◽

Observational Cohort Study ◽

Calibration Plot ◽

Observational Cohort ◽

Care Database ◽

Retrospective Observational Cohort Study ◽

Apache Iv

ObjectiveTo develop and validate a prediction model for predicting in-hospital mortality in patients with acute pancreatitis (AP).DesignA retrospective observational cohort study based on a large multicentre critical care database.SettingAll subject data were collected from the eICU Collaborative Research Database (eICU-CRD), which covers 200 859 intensive care unit admissions of 139 367 patients in 208 US hospitals between 2014 and 2015.ParticipantsA total of 746 patients with AP were drawn from eICU-CRD. Due to loss to follow-up (four patients) or incomplete data (364 patients), 378 patients were enrolled in the primary cohort to establish a nomogram model and to conduct internal validation.Primary and secondary outcome measuresThe outcome of the prediction model was in-hospital mortality. All risk factors found significant in the univariate analysis were considered for multivariate analysis to adjust for confounding factors. Then a nomogram model was established. The performance of the nomogram model was evaluated by the concordance index (C-index) and the calibration plot. The nomogram model was internally validated using the bootstrap resampling method. The predictive accuracy of the nomogram model was compared with that of Acute Physiology, Age, and Chronic Health Evaluation (APACHE) IV. Decision curve analysis (DCA) was performed to evaluate and compare the potential net benefit using of different predictive models.ResultsThe overall in-hospital mortality rate is 4.447%. Age, BUN (blood urea nitrogen) and lactate (ABL) were the independent risk factors determined by multivariate analysis. The C-index of nomogram model ABL (0.896 (95% CI 0.825 to 0.967)) was similar to that of APACHE IV (p=0.086), showing a comparable discriminating power. Calibration plot demonstrated good agreement between the predicted and the actual in-hospital mortality. DCA showed that the nomogram model ABL was clinically useful.ConclusionsNomogram model ABL, which used readily available data, exhibited high predictive value for predicting in-hospital mortality in AP.

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