Intravenous methylprednisolone induced acute pancreatitis

Yahiaoui, Nassima; Roche, Mélodie; Aissaoui-Hoffmann, N; Keita, B; Mallaret, Michel

doi:10.1007/s00228-017-2207-5

Cited by 11 publications

(5 citation statements)

References 5 publications

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“…On the other hand, there are several randomized controlled trials, and a meta-analysis showed no statistically significant benefit of prophylactic GCs for the prevention of post-endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis, one sort of AP [ 31 ]. Meanwhile, GCs are also thought to potentially trigger AP [ 32 ].…”

Section: Discussionmentioning

confidence: 99%

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Glucocorticoids in acute pancreatitis: a propensity score matching analysis

2021

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Background There are few reports about the effect of glucocorticoids in the treatment of acute pancreatitis in humans. This study aims to evaluate the effect of glucocorticoids in the treatment of acute pancreatitis by propensity score matching analysis. Results Acute pancreatitis patients admitted between 2014 and 2019 were collected from the database and analyzed. Included patients were divided into the glucocorticoids-used group (GC group) and the non-glucocorticoids-used group (NGC group) according to whether glucocorticoids were used. A total of 818 eligible patients were included in the final analysis. Seventy-six patients were treated with glucocorticoids, and 742 patients were treated without glucocorticoids. Before propensity score matching, the triglyceride levels (38.2 ± 18.5 vs. 20.2 ± 16.8, P < 0.05) and Acute Physiology and Chronic Health Evaluation II (APACHE II) scores (7.1 ± 2.5 vs. 4.5 ± 2.1, P < 0.05) at admission were significantly higher in the GC group than in the NGC group. The incidence of multi-organ failure (33.3% vs. 11.9%, P < 0.05) was significantly higher in the GC group than in the NGC group. Patients in the GC group showed a positive balance of fluid intake and output over 72 h. After 1:1 propensity score matching, 59 patients from each group (GC and NGC) were included in the analysis. There were no significant differences in age, sex, body mass index, triglycerides, or APACHE II scores between the two groups (P > 0.05), and the patients’ clinical outcomes were reversed. The proportion of patients with organ failure (40.7% vs. 52.5%, p < 0.05) and multi-organ failure (35.0% vs. 67.7%, P < 0.05) was significantly lower in the GC group than in the NGC group. Furthermore, patients in the GC group had significantly shorter lengths of hospital stay (12.9 ± 5.5 vs. 16.3 ± 7.7, P < 0.05) and costs (25,348.4 ± 2512.6vs. 32,421.7 ± 2813.3, P < 0.05) than those in the NGC group. Conclusions This study presents preliminary confirmation of the beneficial effect of glucocorticoids in the treatment of acute pancreatitis. More high-quality prospective studies are needed in the future.

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Section: Discussionmentioning

confidence: 99%

“…However, GC-induced pancreatitis has only been reported in individual cases [ 32 , 50 ]. There is a lack of large-scale, high-quality evidence studies, and the mechanism of GC-induced pancreatitis remains unclear.…”

Section: Discussionmentioning

confidence: 99%

Glucocorticoids in acute pancreatitis: a propensity score matching analysis

2021

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“…Similarly, steroids have been reported as one of the causative agents of drug-induced acute pancreatitis. A study reported that the risk of developing acute pancreatitis was highest between 4 and 14 days after the start of oral glucocorticoid administration [14], whereas another study reported that acute pancreatitis developed after 3 days of intravenous administration of mPSL (1000 mg/day) [18]. Stimulation of pancreatic acinar cells by steroid-induced toxic or allergic mechanisms [18,19] and increased viscosity of pancreatic secretions [20] are believed to be parts of the mechanisms by which steroids damage the pancreas.…”

Section: Discussionmentioning

confidence: 99%

Effective improvement of minimal change nephrotic syndrome with uncontrollable high low-density lipoprotein cholesterol level using evolocumab accompanied by the development of acute pancreatitis

et al. 2020

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Nephrotic syndrome is sometimes refractory; however, it is rarely accompanied by acute pancreatitis. A 47-year-old Japanese woman complaining of limb edema was diagnosed with nephrotic syndrome. Blood and urine examinations suggested minimal change nephrotic syndrome (MCNS), and pulse intravenous methylprednisolone was administered, followed by oral prednisolone. Although proteinuria improved, the patient's condition remained unchanged, and diuresis was insufficient. As in patients with other nephrotic syndromes, this patient showed significant dyslipidemia. Atorvastatin was started for remarkable dyslipidemia since her admission, but her low-density lipoprotein cholesterol (LDL-C) level did not improve significantly. During the clinical course, she developed acute pancreatitis, and large-volume fluid replacement was performed. Although diuretic levels were increased in response to the increased fluid volume, diuresis was not enough, and lung edema developed. Extracorporeal ultrafiltration was started to ameliorate the lung edema. With the onset of pancreatitis, oral intake, including atorvastatin, was discontinued, and prednisolone was administered intravenously. To treat the high-LDL cholesterolemia, 140 mg of evolocumab was injected subcutaneously. Nausea slightly decreased on the following day, and the administration of 150 mg cyclosporine was initiated. LDL-C levels, proteinuria, and renal function promptly ameliorated. The results of a renal biopsy suggested MCNS. On the 44th day of hospitalization, she had complete remission. Evolocumab is potentially effective for severe nephrotic syndrome with uncontrollable dyslipidemia.

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“…Whether subgroups exist and how they should possibly influence recommendations on the dosage, treatment initiation and duration needs further investigation. When considering corticosteroid dosage and treatment duration, practitioners should keep in mind that studies have found evidence of corticosteroids causing or increasing the risk of acute pancreatitis [ 21 , 22 ].…”

Section: Limitationsmentioning

confidence: 99%

“…Corticosteroids are generally contraindicated because of the risk of gastric ulcerations and reduced reticuloendothelial activity [ 19 ]. Recent human case studies have indicated that corticosteroids may even induce acute pancreatitis [ 21 , 22 ]. In dogs with hyperadrenocorticism, one study reported increases in canine pancreatic-specific lipase (Spec-cPL) concentrations without any obvious clinical evidence of pancreatitis [ 23 ].…”

Section: Introductionmentioning

confidence: 99%

Corticosteroid treatment for acute/acute-on-chronic experimental and naturally occurring pancreatitis in several species: a scoping review to inform possible use in dogs

Bjørnkjær-Nielsen

Bjørnvad

2021

Acta Vet Scand

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Acute pancreatitis in dogs is a prevalent disease characterised by mild to severe inflammation. Treatment with anti-inflammatory corticosteroids has been widely debated but is not generally recommended in veterinary medicine. The objective of the present study was to present current evidence on the effect of corticosteroid treatment for acute/acute-on-chronic pancreatitis across species. These findings were then used to evaluate if and how corticosteroid treatment could influence disease outcome in canine acute/acute-on-chronic pancreatitis. A scoping review was performed by searching the Agricola, CAB Abstracts, MEDLINE and Embase databases to identify relevant articles published before June 24, 2021. The inclusion criteria were English language, original research published in a peer-reviewed journal, and investigation of corticosteroid treatment effects on acute/acute-on-chronic pancreatitis by the outcome parameters clinical score, circulating CRP level, hospitalisation duration, mortality and pancreas histopathology. Research on any species was considered. Studies were rated based on the level of evidence, and methodological quality was evaluated based on similarity between groups at baseline, risk of bias and study group size. The reporting method was based on the PRISMA extension for scoping reviews. One thousand nine hundred fifty-four studies were identified, and 31 met the inclusion criteria. Five were canine studies, with 4 investigating experimentally induced pancreatitis; 5 were human clinical studies; and 21 were rodent studies of experimentally induced pancreatitis. The level of evidence ranged between randomised controlled trials and case series, the estimated risk of bias ranged from low to high, and the sample sizes ranged from very small to moderate. Evidence indicates that adding corticosteroid to symptomatic treatment of acute/acute-on-chronic canine pancreatitis could have a positive influence on disease outcome. However, the analysed evidence was based on several species, including both naturally occurring and experimentally induced pancreatitis; thus, the authors suggest that large randomised controlled studies should be performed in dogs with spontaneously occurring acute/acute-on-chronic pancreatitis to further elucidate a potential benefit of corticosteroid treatment.

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Intravenous methylprednisolone induced acute pancreatitis

Cited by 11 publications

References 5 publications

Glucocorticoids in acute pancreatitis: a propensity score matching analysis

Glucocorticoids in acute pancreatitis: a propensity score matching analysis

Effective improvement of minimal change nephrotic syndrome with uncontrollable high low-density lipoprotein cholesterol level using evolocumab accompanied by the development of acute pancreatitis

Corticosteroid treatment for acute/acute-on-chronic experimental and naturally occurring pancreatitis in several species: a scoping review to inform possible use in dogs

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