Early infection is an independent risk factor for increased mortality in patients with culture-confirmed infected pancreatic necrosis

Moran, Robert A.; Halloran, Christopher; Guo, Qiang; Umapathy, Chandra; Jalaly, Niloofar Y; Jain, Saransh; Cowzer, Darren; Pérez-Cuadrado-Robles, Enrique; Quesada-Vázquez, Noé; Szentesi, Andrea; Papp, Mária; Chua, Tiffany; Korbonits, M; Sampath, Kartik; Jin, David X.; Sahebally, Shaheel Mohammad; Kuschnereit, Tobias Philipp; Khashab, Mouen A.; Rock, Clare; Darvasi, Erika; Saunders, Rebecca; García-Rayado, Guillermo; Torrijos, Yolanda Sánchez; Coady, Laoise; Papachristou, Georgios I.; Mayerle, Julia; Geoghegan, Justin; Banks, Peter A.; Gardner, Timothy B.; Szabó, Anikó; Stevens, Tyler; Tornai, Tamás; Tóth, Emese; McEntee, Gerry; de-Madaria, Enriqué; Garg, Pramod Kumar; Hegyi, Péter; Yadav, Dhiraj; Hu, Weiming; Neoptolemos, John P.; Singh, Vikesh K.

doi:10.1016/j.pan.2021.11.003

Cited by 5 publications

(5 citation statements)

References 24 publications

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“…3.1), bacterial translocation across the injured gut and a defective gastrointestinal permeability barrier is a consequence of the systemic inflammatory response. Despite enteral nutrition, bacterial translocation may still occur, an important although not the only route of infective complications, notably infecting necrosis; early infection is associated with increased mortality [200]. Prompt recognition, for example gas bubbles in necrosis on CECT, source control that may necessitate percutaneous drainage, appropriate antibiotics, physiological stabilisation, and optimal further interventional approaches are fundamental [201].…”

Section: Treatment Of Infectionmentioning

confidence: 99%

Acute Pancreatitis: Diagnosis and Treatment

Szatmary

Grammatikopoulos

Cai

et al. 2022

Drugs

130

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Acute pancreatitis is a common indication for hospital admission, increasing in incidence, including in children, pregnancy and the elderly. Moderately severe acute pancreatitis with fluid and/or necrotic collections causes substantial morbidity, and severe disease with persistent organ failure causes significant mortality. The diagnosis requires two of upper abdominal pain, amylase/lipase ≥ 3 ×upper limit of normal, and/or cross-sectional imaging findings. Gallstones and ethanol predominate while hypertriglyceridaemia and drugs are notable among many causes. Serum triglycerides, full blood count, renal and liver function tests, glucose, calcium, transabdominal ultrasound, and chest imaging are indicated, with abdominal crosssectional imaging if there is diagnostic uncertainty. Subsequent imaging is undertaken to detect complications, for example, if C-reactive protein exceeds 150 mg/L, or rarer aetiologies. Pancreatic intracellular calcium overload, mitochondrial impairment, and inflammatory responses are critical in pathogenesis, targeted in current treatment trials, which are crucially important as there is no internationally licenced drug to treat acute pancreatitis and prevent complications. Initial priorities are intravenous fluid resuscitation, analgesia, and enteral nutrition, and when necessary, critical care and organ support, parenteral nutrition, antibiotics, pancreatic exocrine and endocrine replacement therapy; all may have adverse effects. Patients with local complications should be referred to specialist tertiary centres to guide further management, which may include drainage and/or necrosectomy. The impact of acute pancreatitis can be devastating, so prevention or reduction of the risk of recurrence and progression to chronic pancreatitis with an increased risk of pancreas cancer requires proactive management that should be long term for some patients.

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Section: Treatment Of Infectionmentioning

confidence: 99%

Acute Pancreatitis: Diagnosis and Treatment

Szatmary

Grammatikopoulos

Cai

et al. 2022

Drugs

130

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“…3,6 Mortality in AP is spread over two periods: during the early phase (first 2 weeks), indicative of rampant disease, or during the late phase (third week and later) following progressive deterioration. [7][8][9] Early identification of those patients who are at a greater risk for developing complications is necessary to reduce the risk of adverse disease outcomes and death. Several prediction scores and biochemical markers have been evaluated and compared in the past.…”

Section: Introductionmentioning

confidence: 99%

“…In the case of severe AP, organ failure is persistent (more than 48 h), with a mortality rate up to 50% 3,6 . Mortality in AP is spread over two periods: during the early phase (first 2 weeks), indicative of rampant disease, or during the late phase (third week and later) following progressive deterioration 7–9 …”

Section: Introductionmentioning

confidence: 99%

EASY‐APP: An artificial intelligence model and application for early and easy prediction of severity in acute pancreatitis

Kui

Pintér

Molontay

et al. 2022

Clinical & Translational Med

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The EASY prediction score is a practical tool for identifying patients at a greater risk for severe acute pancreatitis shortly after hospital admission. • The explanation of the impact of features on the prediction helps physicians understand the decision of the machine learning model.• The easy-to-use web application is available for clinicians and contributes to the improvement of the model.

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“…The main reason for the same results was that MSAP patients with transient organ dysfunction had a potential risk of evolving into SAP. Moran et al [ 28 ] reported that early pancreatic infection is associated with increased mortality. Thus, both extrapancreatic and pancreatic infections are associated with increased mortality in patients with acute pancreatitis.…”

Section: Discussionmentioning

confidence: 99%