Predicting Severity in Acute Pancreatitis: A Never-Ending Quest…

Leal, Carina; Almeida, Nuno

doi:10.1159/000499680

“…No laboratory test can accurately predict, on its own, the severity of acute pancreatitis. Yet, a CRP >150 mg/L measured at 48 hours is important for discriminating patients with severe acute pancreatitis [9,30,31,32].…”

Section: Discussionmentioning

confidence: 99%

Assessment of severity of acute pancreatitis over time

Cofaru

¹

,

Nica

²

,

Fierbinţeanu-Braticevici

³

2020

Romanian Journal of Internal Medicine

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AbstractIn recent years there has been an increase in the incidence of acute pancreatitis worldwide. In spite of efforts to improve the treatment and care of patients with acute pancreatitis, to develop imaging investigations and interventional diagnostic and treatment techniques and to facilitate patients’ access to them, acute pancreatitis continues to be associated with significant mortality and morbidity, and the treatment of patients suffering from this disease entails significant costs for healthcare systems.Researchers are in a permanent quest to get to a global consensus for stratifying the severity of acute pancreatitis. We need this in order to offer the proper management for each patient diagnosed with this condition and to improve hospital and health system strategies.Over the years, it has been attempted to develop algorithms to support a swift assessment of patients with acute pancreatitis with a prediction of disease severity as close to reality as possible for optimal management. This has led to the development of classifications of severity and severity scores. These require a permanent updating to keep up with the technical and technological developments involved in investigating and treating the patient and encompassing the most recent studies.The goal of this paper is to go through these classifications and scores, emphasizing factors that should be taken into account, and reflecting upon their utility and upon the necessity of improving them.

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“…Wu et al [ 21 ] pointed out that in their validation cohort, only 2.2% of cases had complete APACHE II data. Moreover, whether the APACHE II score reflects the presence of tissue necrosis remains a matter of debate [ 6 ]. Unfortunately, pancreatic parenchyma necrosis may not occur in the early stage of the disease, which restricts the early assessment of the severity of AP by MCTSI [ 10 ].…”

Section: Introductionmentioning

confidence: 99%

Establishment of Early Multi-Indicator Prediction Models of Moderately Severe Acute Pancreatitis and Severe Acute Pancreatitis

He

¹

,

Li

²

,

He

³

et al. 2022

Gastroenterology Research and Practice

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Background. It is critical to accurately identify patients with severe acute pancreatitis (SAP) and moderately SAP (MSAP) in a timely manner. The study was done to establish two early multi-indicator prediction models of MSAP and SAP. Methods. Clinical data of 469 patients with acute pancreatitis (AP) between 2015 and 2020, at the First Affiliated Hospital of Fujian Medical University, and between 2012 and 2020, at the Affiliated Union Hospital of Fujian Medical University, were retrospectively analyzed. The unweighted predictive score (unwScore) and weighted predictive score (wScore) for MSAP and SAP were derived using logistic regression analysis and were compared with four existing systems using receiver operating characteristic curves. Results. Seven prognostic indicators were selected for incorporation into models, including white blood cell count, lactate dehydrogenase, C-reactive protein, triglyceride, D-dimer, serum potassium, and serum calcium. The cut-offs of the unwScore and wScore for predicting severity were set as 3 points and 0.513 points, respectively. The unwScore ( AUC = 0.854 ) and wScore ( AUC = 0.837 ) were superior to the acute physiology and chronic health evaluation II score ( AUC = 0.526 ), the bedside index for severity in AP score ( AUC = 0.766 ), and the Ranson score ( AUC = 0.693 ) in predicting MSAP and SAP, which were equivalent to the modified computed tomography severity index score ( AUC = 0.823 ). Conclusions. The unwScore and wScore have good predictive value for MSAP and SAP, which could provide a valuable clinical reference for management and treatment.

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“…It is generally accepted that the premature release or activation by trypsin of proenzymes (including trypsinogen) is the initial trigger of pancreatitis[ 11 ]. Under normal conditions, trypsin and other proteolytic enzymes are blocked from activation by serine protease inhibitor, Kazal type 1, which is secreted by acinar cells[ 11 ].…”

Section: Introductionmentioning

confidence: 99%

“…It is generally accepted that the premature release or activation by trypsin of proenzymes (including trypsinogen) is the initial trigger of pancreatitis[ 11 ]. Under normal conditions, trypsin and other proteolytic enzymes are blocked from activation by serine protease inhibitor, Kazal type 1, which is secreted by acinar cells[ 11 ]. AP is characterized by the activation of trypsin and other events such as obstruction and passage of gallstones in the bile duct (in the case of acute biliary pancreatitis), which in turn blocks the transport of trypsin to the small intestine[ 7 , 12 ].…”

Section: Introductionmentioning

confidence: 99%

“…CRP, an acute-phase reactant produced by the liver and induced by IL-6, is well described as an inflammatory marker for the disease. It has been demonstrated as an effective prognostic marker of AP severity at 48 h after admission, although other studies found that its strength as a prognostic marker is prominent only at 72 h after admission[ 11 , 14 - 15 ]. NF-κB, on the other hand, is a transcription factor involved in cell proliferation[ 13 ].…”

Section: Introductionmentioning

confidence: 99%

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Chemokine receptor 8 expression may be linked to disease severity and elevated interleukin 6 secretion in acute pancreatitis

Nalisa¹,

Nweke²,

Omoshoro-Jones³

et al. 2021

WJGP

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BACKGROUND Acute pancreatitis (AP) is an inflammatory disease, which presents with epigastric pain and is clinically diagnosed by amylase and lipase three times the upper limit of normal. The 2012 Atlanta classification stratifies the severity of AP as one of three risk categories namely, mild AP (MAP), moderately severe AP (MSAP), and severe AP (SAP). Challenges in stratifying AP upon diagnosis suggest that a better understanding of the underlying complex pathophysiology may be beneficial. AIM To identify the role of the chemokine receptor 8 ( CCR8 ), expressed by T-helper type-2 Lymphocytes and peritoneal macrophages, and its possible association to Interleukin (IL)-6 and AP stratification. METHODS This study was a prospective case-control study. A total of 40 patients were recruited from the Chris Hani Baragwanath Academic Hospital and the Charlotte Maxeke Johannesburg Academic Hospital. Bioassays were performed on 29 patients (14 MAP, 11 MSAP, and 4 SAP) and 6 healthy controls as part of a preliminary study. A total of 12 mL of blood samples were collected at Day (D) 1, 3, 5, and 7 post epigastric pain. Using multiplex immunoassay panels, real-time polymerase chain reaction (qRT-PCR) arrays, and multicolour flow cytometry analysis, immune response-related proteins, genes, and cells were profiled respectively. GraphPad Prism™ software and fold change (FC) analysis was used to determine differences between the groups. P <0.05 was considered significant. RESULTS The concentration of IL-6 was significantly different at D3 post epigastric pain in both the MAP group and MSAP group with P = 0.001 and P = 0.013 respectively, in a multiplex assay. When a FC of 2 was applied to identify differentially expressed genes using RT 2 Profiler, CCR8 was shown to increase steadily with disease severity from MAP (1.33), MSAP (38.28) to SAP (1172.45) median FC. Further verification studies using RT-PCR showed fold change increases of CCR8 in MSAP and SAP ranging from 1000 to 1000000 times when represented as Log 10 , compared to healthy control respectively at D3. The findings also showed differing lymphocyte and monocyte cell frequency between the groups. With monocyte population frequency as high as 70% in MSAP at D3. CONCLUSION The higher levels of CCR8 and IL-6 in the severe patients and immune cell differences compared to MAP and controls provide an avenue for exploring AP stratification to improve management.

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Predicting Severity in Acute Pancreatitis: A Never-Ending Quest…

Cited by 9 publications

References 19 publications

Assessment of severity of acute pancreatitis over time

Assessment of severity of acute pancreatitis over time

Establishment of Early Multi-Indicator Prediction Models of Moderately Severe Acute Pancreatitis and Severe Acute Pancreatitis

Chemokine receptor 8 expression may be linked to disease severity and elevated interleukin 6 secretion in acute pancreatitis

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