Prediction of severe acute pancreatitis: Current knowledge and novel insights

Papachristou, Georgios I.

doi:10.3748/wjg.14.6273

Cited by 81 publications

(52 citation statements)

References 15 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Many clinicians have investigated its role in predicting severity of AP. [25,26] Unfortunately, outcomes of these studies are not very promising. As result of its rapid clearance, TNF-α is less useful than other cytokines in prediction of severity.…”

Section: Discussionmentioning

confidence: 99%

Correlation between ranson score and red cell distribution width (RDW) in acute pancreatitis

Kılıç

Çelik²,

Yüksel³

et al. 2016

Ulus Travma Acil Cerrahi Derg

View full text Add to dashboard Cite

show abstract

Section: Discussionmentioning

confidence: 99%

Correlation between ranson score and red cell distribution width (RDW) in acute pancreatitis

Kılıç

Çelik²,

Yüksel³

et al. 2016

Ulus Travma Acil Cerrahi Derg

View full text Add to dashboard Cite

show abstract

“…Therefore, in recent years, a novel concept evolved suggesting that systemic complications during AP result from uncontrolled activation of the immune system (5). In an attempt to identify surrogate parameters as predictors for complicated AP, several association studies linking cytokines and chemokines with AP severity have been conducted (11). Among these, serum levels of IL-6 and the IL-6-dependent acute phase protein C-reactive protein (CRP) were identified as the most reliable parameters for SAP (12,13).…”

Section: Introductionmentioning

confidence: 99%

IL-6 trans-signaling promotes pancreatitis-associated lung injury and lethality

et al. 2013

View full text Add to dashboard Cite

Acute lung injury (ALI) is an inflammatory disease with a high mortality rate. Although typically seen in individuals with sepsis, ALI is also a major complication in severe acute pancreatitis (SAP). The pathophysiology of SAP-associated ALI is poorly understood, but elevated serum levels of IL-6 is a reliable marker for disease severity. Here, we used a mouse model of acute pancreatitis-associated (AP-associated) ALI to determine the role of IL-6 in ALI lethality. Il6-deficient mice had a lower death rate compared with wild-type mice with AP, while mice injected with IL-6 were more likely to develop lethal ALI. We found that inflammation-associated NF-κB induced myeloid cell secretion of IL-6, and the effects of secreted IL-6 were mediated by complexation with soluble IL-6 receptor, a process known as trans-signaling. IL-6 trans-signaling stimulated phosphorylation of STAT3 and production of the neutrophil attractant CXCL1 in pancreatic acinar cells. Examination of human samples revealed expression of IL-6 in combination with soluble IL-6 receptor was a reliable predictor of ALI in SAP. These results demonstrate that IL-6 trans-signaling is an essential mediator of ALI in SAP across species and suggest that therapeutic inhibition of IL-6 may prevent SAP-associated ALI. IntroductionAcute pancreatitis (AP) accounts for more than 220,000 hospital admissions in the United States each year. Risk factors for AP include gallstones and excessive alcohol use. Interestingly, 70%-80% of AP patients develop mild and uncomplicated AP, while 20%-30% will develop more severe symptoms with concomitant multiple organ failure (MOF) (1). MOF is a consequence of the systemic activation of the immune system, known as systemic inflammatory response syndrome (SIRS). The clinical and pathological features of SIRS mimic those of sepsis; however, efforts to identify any infecting organisms in many patients with SIRS have failed (2-4). Although this syndrome is typically seen in individuals with sepsis, SIRS also occurs in patients with severe AP (SAP), blunt trauma, aseptic burns, and widespread surgical manipulations (5, 6). A major complication during SAP is acute lung injury (ALI). Nevertheless, the clinical course of ALI in SAP is still unpredictable and has a mortality rate of up to 50%. Current therapeutic approaches in SAP and associated ALI are symptomatically based (1, 7).The pathophysiology of SAP with ALI is poorly understood. Researchers have long hypothesized that SAP results from activation of digestive enzymes within the pancreas, a process called autodigestion (8). Indeed, inherited mutations in genes encoding for digestive enzymes have been found in patients with a hereditary form of pancreatitis. However, all these patients develop chronic pancreatitis, rather than SAP with ALI (9, 10). Therefore,

show abstract

“…Its wide diversity involving local tissues to spreading inflammation involving systemic involvement increases the mortality many fold. (8)(9)(10) It may run a totally benign course in more than 80% of cases but in 10-20% it has a wildfire like course which may proceed fast as to reach to a point of no return in a very short span having great emotional, physical and a drastic financial burden over the entire family. (11) Many such elderly patients with pain in abdomen are treated as acute MI or duodenal ulcers and eventually this misdiagnosis loses the initial period where patients could be effectively treated and saved.…”

Section: Introductionmentioning

confidence: 99%

Biliary Pancreatitis : Deadly Threat to the Elderly : Is It a Real Threat ?

Malik¹

2015

IJHS

View full text Add to dashboard Cite

Abstract:Objective/Introduction: Gallstone pancreatitis is a deadly disease and especially so in the elderly. This study highlights the incidence, pattern and management of acute biliary pancreatitis in the elderly patients to find out the outcome of management.Methods: All patients of acute abdomen regardless of the age and gender of the patients were admitted in our unit at Liaquat University of Medical and Health Sciences and different private hospitals in Hyderabad during 3 years commencing from June 2009 to June 2011. The data was collected on a proforma by the author as soon as the patients were received from the emergency. After admission the patients with the diagnosis of acute biliary pancreatitis on initial workup were inducted in this study. The variables studied included the incidence, severity and management outcome in patients 55 years and above compared to younger patients below 55 years.Results: A total number of 650 patients regardless of gender with acute severe abdominal pain were brought to the emergency of which 131(20.15%) were diagnosed as acute biliary pancreatitis after initial work up. Out of the total patients diagnosed as acute pancreatitis, 63(48.09%) patients were <55 years of age and remaining 68(51.90%) patients were >55 years of age. The overall mortality in this study was 20.63 %( n=13) in elderly patients (> 55 years of age) in both the sexes despite all possible treatment measures. Conclusion:Elderly people respond poorly to the acute insult to pancreatitis.

show abstract

Prediction of severe acute pancreatitis: Current knowledge and novel insights

Cited by 81 publications

References 15 publications

Correlation between ranson score and red cell distribution width (RDW) in acute pancreatitis

Correlation between ranson score and red cell distribution width (RDW) in acute pancreatitis

IL-6 trans-signaling promotes pancreatitis-associated lung injury and lethality

Biliary Pancreatitis : Deadly Threat to the Elderly : Is It a Real Threat ?

Contact Info

Product

Resources

About