Mortality in acute pancreatitis with persistent organ failure is determined by the number, type, and sequence of organ systems affected

Machicado, Jorge D.; Gougol, Amir; Tan, Xiaoqing; Gao, Xiang; Paragomi, Pedram; Pothoulakis, Ioannis; Talukdar, Rupjyoti; Kochhar, Rakesh; Goenka, Mahesh Kumar; Gulla, Aistė; Gonzalez, Jose A.; Singh, Vikesh K.; Ferreira, Miguel Godinho; Stevens, Tyler; Barbu, Sorin T.; Nawaz, Haq; Gutiérrez, Sílvia; Zarnescu, Narcis; Capurso, Gabriele; Easler, Jeffrey J.; Triantafyllou, Konstantinos; Peláez-Luna, Mario; Thakkar, Shyam; Ocampo, Carlos; de-Madaria, Enriqué; Coté, Gregory A.; Wu, Bechien U.; Conwell, Darwin L.; Hart, Phil A.; Tang, Gong; Papachristou, Georgios I.

doi:10.1002/ueg2.12057

Cited by 20 publications

(19 citation statements)

References 31 publications

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“…15 However, organ failure remains to be a stronger predictor of mortality than local complications (peri-pancreatic fluid collections and necrosis) and influences the length of hospital stay. 15,21,22 Multiple scoring systems have been developed based on clinical, biochemical, and imaging assessments in an attempt to predict the severity and prognosis of AP. 20,23,24 Most of the models are based on data available from two points in time (i.e., at admission and 48 h), which makes them impractical to use in a triage setting.…”

Section: Discussionmentioning

confidence: 99%

Correlation between BISAP score and D-dimer level on their predictive ability to determine the severity of acute pancreatitis at 24-hours of hospital admission: an observational study

et al. 2023

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Background: Early prediction of severity of acute pancreatitis (AP) is important for management of AP patients with escalation of care and aggressive therapy which can reduce complications. Bedside index of severity in AP (BISAP) score is helpful in early diagnosis of severe AP. D-dimer, a biomarker of secondary fibrinolysis may be helpful in predicting the severity of pancreatitis. Aims and Objectives: The objective of this study was to evaluate the two scoring systems - the BISAP score and D-dimer in early prediction (within 24 h) on the severity of AP and to analyze how D-dimer correlates with BISAP score. Materials and Methods: Seventy-five patients, aged 18–70 years, suffering from AP due to any cause were included for this prospective, observational study. Within 24 h of admission D-dimer was estimated and BISAP score was calculated. The severity was assessed based on D-dimer level and BISAP scoring systems within 24 h of hospital admission and data were tabulated for analysis. The D-dimer level >2.5 mg/L was considered to be suggestive of severe pancreatitis. The BISAP score >2 in first 24 h was defined as predictive of severe pancreatitis. Spearman rank correlation was used for an analysis of the association between two set of data (BISAP scores and d-dimer levels) and thus to measure the strength and direction of the relationship between the two variables. Results: In the present study, 37.3% of the patients had D-dimer ≤2.5 mg/L and 62.7% had D-dimer>2.5 mg/L’ on calculating the Pearson’s correlation on the ranked values of the data (BISAP scores and D-dimer levels), the correlation coefficient (Spearman’s Rho, designated as “rs”) was found to be 0.406 which indicates about moderate positive correlation. Conclusion: D-dimer testing can be used as an alternative test to predict the severity of AP. It shows a moderate correlation with BISAP scoring.

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Section: Discussionmentioning

confidence: 99%

Correlation between BISAP score and D-dimer level on their predictive ability to determine the severity of acute pancreatitis at 24-hours of hospital admission: an observational study

et al. 2023

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“…The main causes of death in the early phase of severe AP are systemic inflammation and organ failure. In patients with persistent multiple organ failure, the mortality rate will be > 30% [ 30 ]. Although the difference between the two groups was not statistically significant at α = 0.05, it is still intriguing.…”

Section: Discussionmentioning

confidence: 99%

Stenting of the pancreatic duct in the early phase of acute pancreatitis: a retrospective study

Yao

Wang

et al. 2022

BMC Gastroenterol

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Background The effectiveness of pancreatic duct (PD) stenting in the early stages of acute pancreatitis (AP) remains controversial. This study aimed to investigate the efficacy and safety of PD stenting in the early stages of AP. Methods This is a retrospective cohort study. The clinical data of 131 patients with AP from 2018 to 2019 were analysed and divided into two groups: the study group (n = 46, PD stenting) and the control group (n = 85, standard treatment). Results There was a statistically significant reduction in pain relief, oral refeeding, hospitalization, and intensive care unit (ICU) stay in the study group compared with that of the control group (P < 0.05). There were no significant differences in the incidence of complications between the two groups. Further multivariate analysis of risk factors for new-onset organ failure showed that the control group (odds ratio [OR] (95% confidence interval [CI]): 6.533 (1.104–70.181)) and a higher level of haematocrit (HCT) at admission (HCT > 46.1%, OR (95%CI): 8.728 (1.264–116.767)) were independent risk factors. Conclusions In the early phase of AP, PD stenting has the potential to reduce pain relief time, oral refeeding time, ICU stay time, and overall hospital stay time. This finding highlights a new route for the treatment of AP.

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“…3 Specifically, multisystem organ failure ([MSOF]; organ failure involving two or more vital organs) represents the most terminal stage of systemic complications and is the main driver of mortality in AP. 2,4 Obesity and alcoholic etiology-present in 30%-50% of AP cohorts-have been examined as potential risk factors for MSOF in a few studies. 5,6 However, previous studies have generated conflicting results: some even suggested the "obesity paradox," implying that obesity has protective effects in severe AP, 7 while others found that obesity does not increase the risk of organ failure.…”

Section: Introductionmentioning

confidence: 99%

“…While there has been substantial progress in the management of local complications, such as acute fluid and necrotic collections in AP, there is currently no effective treatment to mitigate organ failure, a potentially fatal systemic complication of AP 3 . Specifically, multisystem organ failure ([MSOF]; organ failure involving two or more vital organs) represents the most terminal stage of systemic complications and is the main driver of mortality in AP 2,4 …”

Section: Introductionmentioning

confidence: 99%

Obesity and alcoholic etiology as risk factors for multisystem organ failure in acute pancreatitis: Multinational study

et al. 2023

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Background: Multisystem organ failure (MSOF) is the most important determinant of mortality in acute pancreatitis (AP). Obesity and alcoholic etiology have been examined as potential risk factors for MSOF, but prior studies have not adequately elucidated their independent effects on the risk of MSOF.Objective: We aimed to determine the adjusted effects of body mass index (BMI) and alcoholic etiology on the risk of MSOF in subjects with AP. Methods:A prospective observational study of 22 centers from 10 countries was conducted. Patients admitted to an APPRENTICE consortium center with AP between August 2015 and January 2018 were enrolled. Multivariable logistic regression was used to estimate the adjusted effects of BMI, etiology, and other relevant covariates on the risk of MSOF. Models were stratified by sex.Results: Among 1544 AP subjects, there was a sex-dependent association between BMI and the risk of MSOF. Increasing BMI was associated with increased odds of MSOF in males (OR 1.10, 95% confidence interval [CI] 1.04-1.15) but not in females (OR 0.98, 95% CI 0.90-1.1). Male subjects with AP, whose BMIs were 30-34 and >35 kg/m 2 , had odds ratios of 3.78 (95% CI 1.62-8.83) and 3.44 (95% CI 1.08-9.99), respectively. In females, neither higher grades of obesity nor increasing age increased the risk of MSOF. Alcoholic etiology was independently associated with Peter J. Lee and Ali Lahooti are co-first authors.

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Mortality in acute pancreatitis with persistent organ failure is determined by the number, type, and sequence of organ systems affected

Cited by 20 publications

References 31 publications

Correlation between BISAP score and D-dimer level on their predictive ability to determine the severity of acute pancreatitis at 24-hours of hospital admission: an observational study

Correlation between BISAP score and D-dimer level on their predictive ability to determine the severity of acute pancreatitis at 24-hours of hospital admission: an observational study

Stenting of the pancreatic duct in the early phase of acute pancreatitis: a retrospective study

Obesity and alcoholic etiology as risk factors for multisystem organ failure in acute pancreatitis: Multinational study

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