Endotoxemia Predicts Outcome in Acute Pancreatitis

Abstract

The incidence of complications of acute pancreatitis is high in patients with endotoxemia, and so we determined the endotoxin levels in the blood and peritoneal fluid of patients with acute severe pancreatitis to correlate the levels with any sequelae. Fourteen patients with acute severe pancreatitis were examined with regard to clinical features, biochemical tests, and laparotomy (n = 9). In all coagulation profiles, blood gas analysis, chest and abdominal x-rays, ultrasound, and abdominal computed tomography scan (n = 10) were performed. Qualitative estimation of endotoxin levels was done in peripheral blood and peritoneal and peripancreatic fluid. Ten (71.42%) of 14 patients had endotoxin in the blood, and 9 (64.28%) had it in the peritoneal fluid. Twelve (85.7%) had pulmonary involvement, with hypoxia being the most common (85.7%); among them endotoxin was found in the blood of 10 (83.32%) and in the peritoneal fluid of 8 (66.66%) patients. Renal dysfunction was found in 4 (28.57%) patients; endotoxin was present in the blood of all 4 patients and in the peritoneal fluid of 3 (75%) patients. Cardiovascular abnormality was detected in 8 (57.14%) patients, and endotoxin was present in the blood and peritoneal fluid of all patients. Metabolic abnormality was present in 8 (57.14%) patients; endotoxin was present in the blood of all 8 patients and in the peritoneal fluid of 7 (87.6%) patients. Eight (88.88%) of the 9 patients who required surgery had endotoxemia. Three (30%) patients with endotoxemia survived, whereas all 4 patients without endotoxemia survived. Mean hospital stay was 61.2 days and 46.7 days for endotoxin-positive and endotoxin-negative patients, respectively. We conclude that the presence of endotoxin in blood and peritoneal fluid correlates with the severity, systemic complications, and mortality rates of acute pancreatitis. Endotoxin estimation can identify patients at risk in the early stages of acute pancreatitis.

Protective roles of redox-active protein thioredoxin-1 for severe acute pancreatitis

“…As expected, the survival rate inversely correlated with the concentration of LPS administered. These results are consistent with a previous report in which serum endotoxin levels correlated with the severity, systemic complications, and mortality rates of AP patients (48).…”

A Study of Intestinal Permeability in Relation to the Inflammatory Response and Plasma Endocab IgM Levels in Patients with Acute Pancreatitis

“…Our results are similar to those described in the literature. 42, 46 We did not observe significant differences in Endocab IgM between MAP and SAP at admission, but a significant increment of values were observed on day 15 in patients with SAP. In concordance with previous studies, we did not observe any significant correlation between Endocab IgM levels and IP at admission, and this fact likely supports the contention that translocation of endotoxin and IP represent 2 different, and not necessarily related processes, that may be present in patients with AP in different moments of the clinical evolution.…”

Surgical Treatment of Severe Acute Pancreatitis: Timing of Operation is Crucial for Survival

“…Corresponding to the surgical literature dealing with the prediction of mortality by APACHE II scores, the expected mortality rates referring to a mean APACHE II score of 16 range from 35% to 50% [19,20]. The mortality rate of 39% in our patients corresponds to the surgical literature, when a patient cohort, requiring operative treatment and suffering from single or multiple organ failure, is taken into account [21,22].…”