Organ Dysfunction in the Course of Severe Acute Pancreatitis

Wang, Min; Lei, Ruo-qing

doi:10.1097/mpa.0000000000000450

Cited by 7 publications

(9 citation statements)

References 6 publications

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“…Approximately 20%–30% of the patients with acute pancreatitis exhibit progression to severe acute pancreatitis (SAP), which is characterized by local complications or distant organ dysfunctions and is associated with high morbidity and mortality rates 3 . Lung injury is the most common extra pancreatic organ dysfunction induced by SAP 4 , 5 , 6 , 7 , and approximately one in three patients with SAP will develop acute lung injury (ALI) or even the acute respiratory distress syndrome (ARDS) 8 , 9 . The mortality rate of AP with complications of ALI is 30%–40% 10 , 11 .…”

Section: Introductionmentioning

confidence: 99%

Emodin attenuates severe acute pancreatitis-associated acute lung injury by suppressing pancreatic exosome-mediated alveolar macrophage activation

Yao

et al. 2022

Acta Pharmaceutica Sinica B

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Section: Introductionmentioning

confidence: 99%

Emodin attenuates severe acute pancreatitis-associated acute lung injury by suppressing pancreatic exosome-mediated alveolar macrophage activation

Yao

et al. 2022

Acta Pharmaceutica Sinica B

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“…This, in turn, leads to increased cytokines, systemic inflammatory response syndrome (SIRS), shock, loss of internal dynamic homeostasis, and organ dysfunction. 10 Therefore, preventing and blocking the occurrence and progression of SIRS is the key to the treatment of SAP.…”

Section: Introductionmentioning

confidence: 99%

“…Via a list of signal transduction, the entire activated TLR4 and nuclear factor kappa B (NF‐κB) pathway finally promotes cell synthesis, secreting pro‐inflammatory cytokines like tumor necrosis factor alpha (TNF‐α), cytokine interleukin‐1β (IL‐1β), and cytokine interleukin 6 (IL‐6). This, in turn, leads to increased cytokines, systemic inflammatory response syndrome (SIRS), shock, loss of internal dynamic homeostasis, and organ dysfunction 10 . Therefore, preventing and blocking the occurrence and progression of SIRS is the key to the treatment of SAP.…”

Section: Introductionmentioning

confidence: 99%

Early continuous blood purification affects TNF‐α, IL‐1β, and IL‐6 in patients with severe acute pancreatitis via inhibiting TLR4 signaling pathway

Chen

Huang

et al. 2022

The Kaohsiung J of Med Scie

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To exploit whether early continuous blood purification (CBP) inhibits the Toll‐like receptors 4 (TLR4) signaling pathway in the peripheral blood of patients with severe acute pancreatitis (SAP) and whether it affects the abundance of inflammatory factors; 130 SAP patients were randomly selected and divided into Groups B and C. Both groups received conventional treatment. Among them, Group C was given early CBP treatment. Another 60 healthy cases in physical examination at the same time were selected as Group A. The abundances of TLR4 and inflammatory factors were detected before and after treatment. Compared with Group B, (1) the symptoms in Group C improved more markedly; (2) protein contents of TLR4 and nuclear factor kappa B (NF‐κB) in Group C diminished more signally; (3) the abundances of tumor necrosis factor alpha (TNF‐α), cytokine interleukin‐1β (IL‐1β), and cytokine interleukin 6 (IL‐6) in Group C decreased (p < 0.05); and (4) the abundance of TLR4 in Group C was positively correlated with those of TNF‐α, IL‐1β, and IL‐6 after treatment (all p < 0.001). Early CBP inhibits TLR4 signaling pathway in SAP patients and attenuates the abundance of inflammatory factors to a certain extent, which may provide a new clinical treatment strategy for SAP.

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“…Given its importance, multiple studies have looked at the influence of the onset, duration, organ type, and the number of organs affected during POF. 3,5,[8][9][10][11][12][13][14] Overall, these studies have consistently reported that multiple organ failure (MOF) is associated with higher mortality than single POF 5,8,10,11,14 ; although, previous studies did not systematically adjust for confounding. Furthermore, in critically ill patients with MOF the sequence of organ dysfunction and the first organ failing have been recognized as important determinants of mortality; however, this aspect has not been studied in AP.…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2021

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Background Persistent organ failure (POF) is the strongest determinant of mortality in acute pancreatitis (AP). There is a paucity of data regarding the impact of different POF attributes on mortality and the role of different characteristics of systemic inflammatory response syndrome (SIRS) in the risk of developing POF. Objective We aimed to assess the association of POF dynamic features with mortality and SIRS characteristics with POF. Methods We studied 1544 AP subjects prospectively enrolled at 22 international centers (APPRENTICE consortium). First, we estimated the association of onset, duration, and maximal score of SIRS with POF. Then, we evaluated the risk of mortality based on POF onset, duration, number, type, and sequence of organs affected. Analyses were adjusted for potential confounders. Results 58% had SIRS, 11% developed POF, and 2.5% died. Early SIRS, persistent SIRS, and maximal SIRS score ≥ 3 were independently associated with higher risk of POF (p < 0.05). Mortality risk in POF was higher with two (33%, odds ratio [OR] = 10.8, 3.3–34.9) and three (48%, OR = 20.2, 5.9–68.6) organs failing, in comparison to single POF (4%). In subjects with multiple POF, mortality was higher when the cardiovascular and respiratory systems failed first or concurrently as compared to when the renal system failed first or concurrently with other organ (p < 0.05). In multivariate regression model, the number and sequence of organs affected in POF were associated with mortality (p < 0.05). Onset and duration of POF had no impact mortality. Conclusion In AP patients with POF, the risk of mortality is influenced by the number, type, and sequence of organs affected. These results are useful for future revisions of AP severity classification systems.

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Organ Dysfunction in the Course of Severe Acute Pancreatitis

Cited by 7 publications

References 6 publications

Emodin attenuates severe acute pancreatitis-associated acute lung injury by suppressing pancreatic exosome-mediated alveolar macrophage activation

Emodin attenuates severe acute pancreatitis-associated acute lung injury by suppressing pancreatic exosome-mediated alveolar macrophage activation

Early continuous blood purification affects TNF‐α, IL‐1β, and IL‐6 in patients with severe acute pancreatitis via inhibiting TLR4 signaling pathway

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

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