Disseminated Intravascular Coagulation on Admission Predicts Complications and Poor Prognosis of Acute Pancreatitis

Hamada, Shin; Masamune, Atsushi; Kikuta, Kazuhiro; Shimosegawa, Tooru

doi:10.1097/mpa.0000000000000739

Cited by 10 publications

(14 citation statements)

References 6 publications

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“…This correlation was also confirmed in the 2011 survey data[10]. Similarly, patients with AP and disseminated intravascular coagulation or elevated D-dimer on admission were accompanied with a higher organ failure ratio and mortality rate[11,12]. We previously assessed the past nationwide survey data to identify any trends in the management of AP, and confirmed that the treatment strategy for late complications has shifted to less-invasive, step-up approaches in the last decade[13].…”

Section: Introductionmentioning

confidence: 59%

Transition of early-phase treatment for acute pancreatitis: An analysis of nationwide epidemiological survey

Hamada¹,

Masamune²,

Shimosegawa³

2017

WJG

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Treatment of acute pancreatitis (AP) is one of the critical challenges to the field of gastroenterology because of its high mortality rate and high medical costs associated with the treatment of severe cases. Early-phase treatments for AP have been optimized in Japan, and clinical guidelines have been provided. However, changes in early-phase treatments and the relationship between treatment strategy and clinical outcome remain unclear. Retrospective analysis of nationwide epidemiological data shows that time for AP diagnosis has shortened, and the amount of initial fluid resuscitation has increased over time, indicating the compliance with guidelines. In contrast, prophylactic use of broad-spectrum antibiotics has emerged. Despite the potential benefits of early enteral nutrition, its use is still limited. The roles of continuous regional arterial infusion in the improvement of prognosis and the prevention of late complications are uncertain. Furthermore, early-phase treatments have had little impact on late-phase complications, such as walled-off necrosis, surgery requirements and late (> 4 w) AP-related death. Based on these observations, early-phase treatments for AP in Japan have approached the optimal level, but late-phase complications have become concerning issues. Early-phase treatments and the therapeutic strategy for late-phase complications both need to be optimized based on firm clinical evidence and cost-effectiveness.

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Section: Introductionmentioning

confidence: 59%

Transition of early-phase treatment for acute pancreatitis: An analysis of nationwide epidemiological survey

Hamada¹,

Masamune²,

Shimosegawa³

2017

WJG

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“…14,19,24 Some reports indicate that coagulation abnormalities are associated with AP severity. 25,26 However, so far, there was scant evidence that anticoagulants are effective in treating AP. 27,28 A previous single-center retrospective study reported that rTM therapy administered to SAP patients might delay organ failure progression and reduce rates of progression to WON.…”

Section: Discussionmentioning

confidence: 99%

“…The rTM is used in Japan to treat patients with DIC who present with various underlying diseases 14,19,24 . Some reports indicate that coagulation abnormalities are associated with AP severity 25,26 . However, so far, there was scant evidence that anticoagulants are effective in treating AP 27,28 .…”

Section: Discussionmentioning

confidence: 99%

Reducing the risk of developing walled‐off necrosis in patients with acute necrotic collection using recombinant human soluble thrombomodulin

Eguchi

Tsuji

Okada

et al. 2021

J Hepato Biliary Pancreat

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“…Our results suggested that severity assessment using the four prognostic factors was equivalent to the current Japanese severity criteria employing nine factors. Accurate assessment of severity in patients with AP is still a challenge 6 . Development of a more convenient and accurate severity assessment system would contribute to improving the outcomes of this intractable disease.…”

Section: Figurementioning

confidence: 99%

“…Accurate assessment of severity in patients with AP is still a challenge. 6 Development of a more convenient and accurate severity assessment system would contribute to improving the outcomes of this intractable disease.…”

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confidence: 99%

Severity assessment of acute pancreatitis using four prognostic factors – a nationwide multicenter study of 3682 cases in Japan

et al. 2017

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read with great interest the article by Ikeura et al.1 assessing the efficacy of the prognostic factor score in the Japanese severity criteria for acute pancreatitis (AP). By analyzing 1159 patients with severe AP, they showed that the area under the curve (AUC) for the receiver-operating characteristic curve of the prognostic factor score for predicting AP-related mortality was 0.78, which was comparable to that for the wellknown acute physiology and chronic health evaluation (APACHE) II score (AUC ¼ 0.80). One weakness of their study is that mild AP cases were not included in the analysis due to the study design. In addition, severity assessment using the nine factors might be too complicated. In Japan, the Research Committee of Intractable Pancreatic Diseases, under the support of the Ministry of Health, Labor, and Welfare of Japan, has conducted nationwide epidemiological surveys of AP including both severe and mild cases every 4-5 years.2-4 We recently reported that four (base excess or shock, renal failure, systemic inflammatory response syndrome criteria and age) out of the nine prognostic factors were associated with AP-related death by multivariate analysis in the 2011 survey.5 Here, we validated the utility of the severity assessment system based on these four factors in 3682 AP cases collected for the 2003 (285 cases), 2007 (1146 cases), and 2011 (2251 cases) surveys.We performed receiver-operating characteristic curve analysis to evaluate the predictive accuracy of the prognostic factor scores for mortality. The AUC was 0.80 for the nine prognostic factors. If the cut-off point was set at score ¼ 3 as adopted currently, the sensitivity was 0.47 with a specificity of 0.93. The AUC for predicting mortality was 0.78 for the four prognostic factors, suggesting the comparable utility of these four factors in the severity assessment. The sensitivity was 0.53 with a specificity of 0.92 if the cut-off point was set at score ¼ 2. If we define the patients fulfilling at least two out of the four prognostic factors as severe, 342/3682 (9.3%) patients had severe AP. The mortality of severe AP cases was 17.3% (59/342), whereas that of mild AP cases was 1.6% (52/3340) (Figure 1). If we choose only two factors (renal failure and age) that showed a stronger association with AP-related mortality among the four factors, 5 the AUC was decreased to 0.72. The sensitivity was 0.22 with a specificity of 0.98 if the cut-off point was set at score ¼ 2.Our results suggested that severity assessment using the four prognostic factors was equivalent to the current Japanese severity criteria employing nine factors. Accurate assessment of severity in patients with AP is

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Disseminated Intravascular Coagulation on Admission Predicts Complications and Poor Prognosis of Acute Pancreatitis

Cited by 10 publications

References 6 publications

Transition of early-phase treatment for acute pancreatitis: An analysis of nationwide epidemiological survey

Transition of early-phase treatment for acute pancreatitis: An analysis of nationwide epidemiological survey

Reducing the risk of developing walled‐off necrosis in patients with acute necrotic collection using recombinant human soluble thrombomodulin

Severity assessment of acute pancreatitis using four prognostic factors – a nationwide multicenter study of 3682 cases in Japan

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