Predictors of the Severity of Acute Pancreatitis in Patients with HIV Infection or AIDS

Parithivel, Vellore S.; Yousuf, Arshad M.; Albu, Eugene; Kaul, Ashutosh; Aydinalp, Nurten

doi:10.1097/00006676-199908000-00005

Cited by 9 publications

(3 citation statements)

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“…Patients may be on a variety of medications, and the role of immunodeficiency further complicates the picture, which may be reflected in the high number of idiopathic cases. 55 AP Secondary to Pancreatic Cancer AP can be caused by pancreatic cancer. 2,54 Mortality in the HIV group was also comparable to that of non-HIV populations.…”

Section: Acute Pancreatitis and Hiv Infectionmentioning

confidence: 99%

Factors Influencing Mortality in Acute Pancreatitis

Pitchumoni

Patel²,

Shah³

2005

Journal of Clinical Gastroenterology

100

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Severe acture pancreatitis (SAP), a multisystem disease, is characterized by multiple organ system failure and additionally by local pancreatic complications such as necrosis, abscess, or pseudocyst. The rate of mortality in SAP, which is about 20% of all cases of acute pancreatitis (AP), may be as high as 25%, as in infected pancreatic necrosis. The factors that influence mortality in different degrees are various. Etiology for the episode, age, sex, race, ethnicity, genetic makeup, severity on admission, and the extent and nature of pancreatic necrosis (sterile vs. infected) influence the mortality. Other factors include treatment modalities such as administration of prophylactic antibiotics, the mode of feeding (TPN vs. enteral), ERCP with sphincterotomy, and surgery in selected cases. Epidemiological studies indicate that the incidence of AP is increasing along with an increase in obesity, a bad prognostic factor. Many studies have indicated a worse prognosis in idiopathic AP compared to pancreatitis induced by alcoholism or biliary stone. The risk for SAP after ERCP is the subject of extensive study. AP after trauma, organ transplant, or coronary artery bypass surgery is rare but may be serious. Since Ranson reported early prognostic criteria, a number of attempts have been made to simplify or add new clinical or laboratory studies in the early assessment of severity. Obesity, hemoconcentration on admission, presence of pleural effusion, increased fasting blood sugar, as well as creatinine, elevated CRP in serum, and urinary trypsinogen levels are some of the well-documented factors in the literature. The role of appropriate prophylactic antibiotic therapy although still is highly controversial, in properly chosen cases appears to be beneficial and well accepted in clinical practice. Early enteral nutrition has gained much support and jejunal feeding bypassing the pancreatic stimulatory effect of it in the duodenum is desirable in selected cases. The limited role for endoscopic sphincterotomy in patients with demonstrated dilated CBD with impacted stone and evidence of impending cholangitis is well documented. Surgery in AP other than for removal of the gallbladder is often limited to infected pancreatic necrosis, pseudocysts, and pancreatic abscess and in some cases of traumatic pancreatitis with a ruptured duct system. The progress in the understanding of the role of cytokines will over us opportunities to use immunomodulatory therapies to improve the outcome in SAP.

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Section: Acute Pancreatitis and Hiv Infectionmentioning

confidence: 99%

Factors Influencing Mortality in Acute Pancreatitis

Pitchumoni

Patel²,

Shah³

2005

Journal of Clinical Gastroenterology

100

View full text Add to dashboard Cite

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“…[9] In our study, 51/82 patients (62.1%) had CD4 counts <200 cells/µL, whereas in other studies the CD4 counts were <200 cells/µL in 57.5%, [5] 32.6%, [6] 63% [7] and 89% of patients. [10] In a previous report, [8] it was also demonstrated that patients with asymptomatic HIV infection or a CD4 cell count >500 cells/µL did not develop asymptomatic hyperamylasaemia or acute pancreatitis over a 1-year period.…”

Section: Researchmentioning

confidence: 91%

“…[7] In sharp contrast, another report demonstrated Ranson's criteria to be of similar value in predicting a poor outcome as was found in other non-HIV-related series. [16] Lack of consensus on severity indices is added to by Parithivel et al's [10] report, in which 89% of patients had CD4 counts <200 cells/µL. They found that the commonly used predictors of severe disease were unhelpful because of altered hepatic and renal function and low white cell counts in HIV-infected patients.…”

Section: Researchmentioning

confidence: 99%