Pancreatic injury in patients with septic shock: A literature review

Chaari, Anis; Hakim, Karim Abdel; Bousselmi, K; Etman, M.; Bahr, M. El; Saka, Ahmed; Hamza, Eman; Ismail, Mohamed Saleh; Khalil, Elsayed Mahmoud; Kauts, Vipin; Casey, William

doi:10.4251/wjgo.v8.i7.526

Cited by 27 publications

(30 citation statements)

References 64 publications

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“…Possible reasons for this conclusion extrapolated from human medicine include inflammation secondary to the underlying disorder causing renal injury, multiorgan failure, and ischemia or hypoperfusion because of changes in plasma volume. 4,9,39 Other primary nonpancreatic disorders frequently associated with significantly increased DGGR-lipase activities in our study were endocrinopathies, immune-mediated disorders, and upper airway obstruction. Diabetes mellitus and AP are common comorbidities; a previous study found diabetes mellitus in 36% of dogs diagnosed with AP, 40 and another identified cPL concentrations >400 μg/L in 73% of dogs with DKA.…”

Section: Discussionmentioning

confidence: 58%

Hyperlipasemia in critically ill dogs with and without acute pancreatitis: Prevalence, underlying diseases, predictors, and outcome

Prümmer

Howard

Grandt

et al. 2020

Veterinary Internal Medicne

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Background: Hyperlipasemia is frequent in critically ill people without evidence of acute pancreatitis (AP), and has been associated with increased morbidity and mortality. Objective: To evaluate the prevalence of hyperlipasemia at admission and development of hyperlipasemia during hospitalization in critically ill dogs, explore factors associated with hyperlipasemia, and evaluate association with outcome. Animals: Critically ill, client owned dogs (n = 1360), presented on emergency and admitted to the intensive care unit, that had 1,2-o-dilauryl-rac-glycero-3-glutaric acid-(6 0-methylresorufin) ester (DGGR) lipase activity measured within 24 hours of admission. Methods: Retrospective cross-sectional study of clinical and laboratory records. Results: The DGGR lipase activity was increased >3× the upper reference limit at admission in 216/1360 (16%) dogs, of which 70/216 (32%) had a clinical diagnosis of AP. Other primary conditions associated with hyperlipasemia were renal, endocrine, and immune-mediated diseases, and upper airway obstruction. Predictors of hyperlipasemia at admission were prior glucocorticoid administration, vomiting and abdominal pain, increased age, plasma bilirubin and creatinine concentrations, and decreased hematocrit. Of dogs with repeat measurements, 78/345 (23%) had significantly increased lipase during hospitalization, of which 13/78 (17%) had a clinical diagnosis of AP. Other primary conditions associated with in-hospital hyperlipasemia were renal and immune-mediated disorders.

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Section: Discussionmentioning

confidence: 58%

Hyperlipasemia in critically ill dogs with and without acute pancreatitis: Prevalence, underlying diseases, predictors, and outcome

Prümmer

Howard

Grandt

et al. 2020

Veterinary Internal Medicne

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“…Sepsis and septic shock is an extremely life threatening, and can lead to high mortality rates in critically-ill patients. It is mostly associated with insufficiency between demand of cells and the delivery of oxygen, which caused the beginning of multi-organ dysfunction [ 1 ]. Sepsis is characterized by an overwhelming host response and development of remote organ failure [ 2 ].…”

Section: Introductionmentioning

confidence: 99%

MiR-6835 promoted LPS-induced inflammation of HUVECs associated with the interaction between TLR-4 and AdipoR1 in lipid rafts

Liu

Chen

et al. 2017

PLoS ONE

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BackgroundHigh mortality rate of critically-ill patients could be induced by sepsis and septic shock, which is the extremely life threatening. The purpose of this work is to identify and evaluate the potential regulatory mechanism of LPS-induced inflammation associated with miR-6835 and lipid rafts in HUVECs.MethodsThe 3’ UTR luciferase activity of AdipoR1 was detected, which was predicted the potential target gene of miR-6835. Moreover, the treated HUVECs with or without inhibitors or mimics of miR-6835 were used. Furthermore, the bio-functions of HUVECs were explored. The protein expression levels of SIRT-1, AMPK, and AdipoR1 were assessed, which were involved in the AdipoR1 signaling pathway. Then, the interaction between TLR-4 and AdipoR1 in lipid rafts and its mediation role on LPS-induced inflammation was investigated in HUVECs.ResultsMiR-6835 targeted directly on AdipoR1, and suppressed its expression in mRNA (mimics of miR-6835: 0.731±0.016 vs control: 1.527±0.015, P<0.001) and proteins levels, then regulated protein expression of SIRT-1 and AMPK, which were the downstream target genes of AdipoR1 signaling pathway. MiR-6835 enhanced LPS-induced inflammation process in HUVECs (TNF-α: LPS+mimics of miR-6835: 1638.51±78.43 vs LPS: 918.73±39.73, P<0.001; IL-6: LPS+mimics of miR-6835: 1249.35±69.51 vs LPS: 687.52±43.64, P<0.001), which was associated with the interaction between TLR-4 and AdipoR1 in lipid rafts.ConclusionsMiR-6835 is the key regulator of LPS-induced inflammation process in HUVECs. The interaction between TLR-4 and AdipoR1 mediated by lipid rafts at membrane of HUVECs with inflammation process induced by miR-6835. Our results demonstrated a hopeful strategy for treatment on sepsis by aiming at lipid rafts and miR-6835.

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“…Therefore, the involvement of these factors in the physiopathology of pancreatic insult may explain the occurrence of this complication in patients without significant hemodynamic compromise [6, 17]. Our study also showed that the impairment of renal function was significantly associated with sepsis-related increase of pancreatic enzymes.…”

Section: Discussionmentioning

confidence: 51%

“…The APACHE (II) score calculated within the first 24 h was 26 [20–31]. Median SOFA score on admission was 7 [6–10]. Thirty patients (60%) were diabetic, and 32 patients (64%) have previous history of hypertension.…”

Section: Resultsmentioning

confidence: 99%

Factors associated with increased pancreatic enzymes in septic patients: a prospective study

et al. 2017

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BackgroundThe perfusion of splanchnic organs is deeply altered in patients with septic shock. The aim of the study is to identify the predictive factors of septic shock-induced increase of serum lipase and amylase and to assess and evaluate its prognostic impact.MethodsWe conducted a prospective observational study. All adult patients admitted with septic shock were eligible for our study. Serum lipase and amylase were measured on admission. Patients with and those without increased pancreatic enzymes were compared. Predictive factors of pancreatic insult identified by the univariate analysis were integrated in a stepwise multivariate analysis. Odds ratios (OR) with the 95% confidence interval (CI) were calculated accordingly. Second, the sensitivity and the specificity of amylase and lipase to predict intensive care unit (ICU) mortality were identified through the Receiver Operator Curve.ResultsFifty patients were included. Median [quartiles] age was 68.5 [58–81] years. The APACHE II score was 26 [20–31]. Twenty-three patients (46%) had increased serum amylase and/or serum lipase. Diabetes mellitus (OR = 16; 95% CI [1.7–153.5]; p = 0.016), increased blood urea nitrogen (OR = 1.12; 95% CI [1.02–1.20], p = 0.016), and decreased C-reactive protein (OR = 0.97; 95% CI [0.96–0.99]; p = 0.027) were identified as independent factors predicting increased pancreatic enzymes. Twenty patients (40%) died in the ICU. Neither serum amylase level nor serum lipase level was significantly different between survivors and non-survivors (respectively 49 [27.7–106] versus 85.1 [20.1–165] UI/L; p = 0.7 and 165 [88–316] versus 120 [65.5–592] UI/L; p = 0.952).ConclusionIncrease of pancreatic enzymes is common in patients with septic shock. Diabetes and impaired renal function are predictive of increased pancreatic enzymes. Such finding does not carry any negative prognostic value.

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Pancreatic injury in patients with septic shock: A literature review

Cited by 27 publications

References 64 publications

Hyperlipasemia in critically ill dogs with and without acute pancreatitis: Prevalence, underlying diseases, predictors, and outcome

Hyperlipasemia in critically ill dogs with and without acute pancreatitis: Prevalence, underlying diseases, predictors, and outcome

MiR-6835 promoted LPS-induced inflammation of HUVECs associated with the interaction between TLR-4 and AdipoR1 in lipid rafts

Factors associated with increased pancreatic enzymes in septic patients: a prospective study

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