Acute pancreatitis: predictors of mortality, pancreatic necrosis and intervention
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Several predictive scoring systems are used in the prognostication of acute pancreatitis (AP). However, the quantity of evidence of these prognostic systems in the Indian population remains sparse. The aim of our study was to evaluate the usefulness of such prognostic scores to predict mortality, incidence of pancreatic necrosis and intervention in AP.This was an observational study of patients diagnosed with AP between June 2012 and November 2013 in a tertiary referral center in India. Vital signs, biochemical tests and CT-findings were recorded to identify SIRS, Ranson's score and CT-severity index at diagnosis. Chi square test was used to compare incidence of mortality, pancreatic necrosis, and intervention between mild versus severe acute pancreatitis groups.A total of 100 patients with AP were treated during out study period. Ranson's score more than 7 and presence of pancreatic necrosis were significantly associated with increased mortality (p <0.05). SIRS, CTSI score more than 7, inotropic support, and complications were more frequently associated with patients with necrosis. Prophylactic antibiotics did not decrease mortality, but decreased intervention rate (p <0.05). Presence of systemic inflammatory response syndrome (SIRS), Ranson's score > 7, necrosis, inotropic support and presence of complications were associated with a greater rate of interventions including surgery and percutaneous procedures (p <0.05).We validate SIRS, Ranson's, and CTSI score as prognostic markers for AP in the Indian population. These predictors, when used in combination, can direct early monitoring and aggressive management in order to decrease mortality associated with severe AP.Acute necrotising pancreatitis is the most serious form of acute pancreatitis and accounts for the majority of complications. Treatment of patients with pancreatic necrosis is still controversial. There is a well-established definition for acute pancreatitis and consequent pancreatic fluid collections. However, it has been identified a group of patients who represent a separate entity and whose collections may prompt additional change from the definition of acute pancreatitis. Imaging investigations in these patients have well defined subacute collections that evolve from severe acute necrotising pancreatitis involving greater than 30% of the gland. Although these collections are not completely liquefied, they do not meet criteria for pseudocysts, however, at the same time, they are morphologically different from acute pancreatic necrosis seen during initial presentation of acute pancreatitis. It has been used to call "subacute" these collections of necrotic pancreatic tissue or "subacute pancreatic necrosis". The purpose of this review is to summarise the subacute collections of necrotic pancreatic tissue and its complications, discussing treatment options of the complex pancreatic and peripancreatic collections found in these patients, focusing on the management of subacute pancreatic necrosis.
Pancreatic pseudocyst
Presentation (obstetrics)
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The clinical usefulness of the APACHE II and SAPS systems in the early prognostic classification of patients with acute pancreatitis has been evaluated in a prospective multicenter study. We aimed to identify early those patients with acute pancreatitis who should be monitored closely to expedite the detection and treatment of complications. One hundred eighty-two patients with acute pancreatitis were included; 28 were classified as severe, having developed at least one major complication of the disease. The scores obtained through the APACHE II and SAPS systems in these severe cases were significantly higher than the scores in the mild cases of acute pancreatitis (p < 0.001). The sensitivity of these systems in the prognostic classification of acute pancreatitis was 70.4% for APACHE II and 66.7% for SAPS, and the specificity was 79.1% for both. When applying APACHE II and SAPS systems in the early phase of acute pancreatitis, the possibility of misdiagnosing the severity exists, thus limiting the application of these systems in the initial assessment of prognostic classification. In conclusion, APACHE II and SAPS systems are of limited clinical utility in the early prognostic evaluation of acute pancreatitis because of their low positive predictive value.
SAPS II
Limiting
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Acute pancreatitis (AP) is an inflammatory disease of the pancreas that causes local damage and systemic inflammatory response. Some of the numerical scoring systems used in the intensive care unit for the assessment of critically ill patients such as APACHE II and MEWS score could be used for AP, beside the scoring systems specific to AP (Ranson score, Pancreas score, BISAP). Therefore, the aim of this study was to examine the significance of inflammatory biomarkers and scoring systems in the evaluation of the severity of AP and outcomes. The study was conducted as a cohort prospective study, examining patients with AP, of both sexes. Laboratory analyses, as well as the scoring systems: Ranson, Pancreas score, Bedside Index of Severity in Acute Pancreatitis (BISAP), and Acute Physiology and Chronic Health Evaluation II (APACHE II) were collected on day zero and 48h after admission. The study included 50 patients of whom 8 died. The most reliable score for predicting AP severity was APACHE II0 and 48AUROC (0.753; 0.768) in relation to the inflammatory biomarkers. For initial prediction of the treatment outcome, APACHE II0, BISAP0, and CRP0 AUROC (0.813; 0.807; 0.753) had the highest discrimination rates and after 48h, APACHE II48, Ranson48, BISAP48, and Pancreas48 AUROC (0.917; 0.856; 0.789; 0.729). There was a statistically significant correlation between CRP0 and BISAP0 (p=0.006) and between PCT and all day-zero scores. All tested screening systems showed reliability in predicting AP severity and treatment outcomes. The best predictive power was demonstrated by the APACHE II score.
Mews
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Background: Acute pancreatitis is an inflammatory process with a highly variable clinical course. The present study was conducted to assess severity of acute pancreatitis.Methods: The present study was conducted on 53 patients of acute pancreatitis of both genders. A thorough clinical examination was performed. Ranson’s score (RS), Glasgow score (GS), acute physiology and chronic health evaluation (APACHE-II) score, APACHE-O score and Balthazar’s computed tomography severity index (CTSI) score was recorded.Results: Out of 53 patients, males were 47 and females were 6. Patients were divided into acute pancreatitis (32) and severe pancreatitis (21). Results of the bivariate analysis of Ranson scoring system in mild periodontitis was 0.84 in severe was 2.95, Glasgow score was 0.66 in mild and 2.48 in severe, APACHE-II had 6.94 in mild and 10.33 in severe, APACHE-O had 7.34 in mild and 11 in severe and CTSI had 1.9 in mild and 6.15 in severe.Conclusions: Authors found that all the scoring systems are useful in assessing the severity of acute pancreatitis.
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BACKGROUND Acute pancreatitis (AP) is an inflammatory disease of the pancreas, that results from intrapancreatic activation, release, and digestion of the organ by its own enzymes. The diagnosis of acute pancreatitis can be made when a patient presents with threefold elevated serum levels of amylase or lipase, abdominal pain and vomiting. In this study, we wanted to assess the severity of acute pancreatitis by using BISAP (Bedside index for severity in acute pancreatitis) and APACHE-II (Acute physiology and chronic health evaluation) scoring systems and compare the accuracy of BISAP scores with APACHE-II scores. METHODS A prospective study including 201 patients was conducted from April 2018 to March 2020 in Victoria Hospital, affiliated to BMCRI. RESULTS Among 201 AP patients, 129 were found to have mild acute pancreatitis (MAP), 72 were of severe acute pancreatitis (SAP), 192 survival cases, and 9 death cases. The larger the rating score, the higher the proportion of severe pancreatitis and mortality risk. Two kinds of scoring criteria; BISAP score points and Apache II score points compared in patients with MAP and SAP, In Apache II score to predict severity of organ failure, the sensitivity, specificity, positive predictive value, negative predictive value was 84.72 %, 93.02 %, 87.14 %, 91.60 % and area under the curve was 0.958 (P < 0.0001). In BISAP, the sensitivity, specificity, positive predictive value, negative predictive value was 90.28 %, 80.62 %, 72.22 %, 93.69 % and area under the curve was 0.917 (P < 0.0001). CONCLUSIONS Ability of APACHE II score prediction of AP in severity of organ failure and mortality are stronger than BISAP score, But APACHE II scoring system indicators were cumbersome, complicated assessment. BISAP scoring system is simple, economical, rapid and reliable, and it can effectively predict the severity and mortality of acute pancreatitis, and can be used as a preliminary screening method in accurate risk stratification and initiation of management accordingly at community health care, secondary health care and tertiary health care Hospitals. KEYWORDS Pancreatitis, Severity, Prediction, APACHE II and BISAP
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As a result of the early amplification of the inflammatory response in the acute pancreatitis, systemic inflammatory response syndrome (SIRS) is a main cause of acute pancreatitis-associated lung injury (APALI), while early combined acute lung injury or acute respiratory distress syndrome causes a high mortality of acute pancreatitis. A series of inflammatory mediators and cytokines play important roles in the process of SIRS and APALI, therefore, inflammatory reaction restoring a balance becomes a key point of the treatment of pancreatitis lung injury.
Key words:
Acute pancreatitis; Acute lung injury; Systemic inflammatory response syndrome
Inflammatory response
Diffuse alveolar damage
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Our aim was to prospectively compare the Accuracy of Acute Physiology and Chronic Health Evaluation (APACHE) II, Bedside Index of Severity in Acute Pancreatitis (BISAP), Ranson's score and modified Computed Tomography Severity Index (CTSI) in predicting the severity of acute pancreatitis based on Atlanta 2012 definitions in a tertiary care hospital in northern India.
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Objective To study the onset, duration and severity of systemic inflammatory response syndrome (SIRS) in early stage of acute pancreatitis (AP) ,and to explore the role of cytokines in the progression of acute pancreatitis. Methods The subjects were 86 patients who were diagnosed as having acute pancreatitis in this hospital from 2000 to 2002, and 30 healthy volunteers (15 male and 15 female) as control group. The overall morbidity of SIRS in AP was calculated and compared with that in acute edematous pancreatitis (AEP) and in severe acute pancreatitis (SAP). Based on the presence or abgsence'of SIRS in the course, the AP patients were grouped as non-SIRS and SIRS based to compare the onset,duration and severity of SIRS in AP. Plasma TNF-α, IL-1β, IL-6 and IL-8 were determined by ELISA in AP patients. TNF-α, IL-1β, IL-6 and IL-8 were determined on alternative days in SAP patients to study the role of cytokines in the progression of acute pancreatitis. Results The morbidity of SIRS in SAP was higher than that in the mild form of AP(P0. 05). The mortality in AP patients increased with the severity of SIRS (P0. 01). The plasma levels of TNF-a, IL-1(3, IL-6 and IL-8 in AP patients were significantly higher than those in control group(P0. 05), and these changes were corresponding to the clinical symptoms. Conclusions The prognosis of AP is highly related to the morbidity of SIRS and the severity of SIRS. Cytokines are involved in the pathological progression of acute pancreatitis and are important factors of tissue injury.
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