Prior Exposure to Nonsteroidal Anti-inflammatory Drugs Reduces the Rate of Organ Failure and In-Hospital Mortality in Acute Pancreatitis

Ladd, Antonio Mendoza; Conwell, Darwin L.; Burroughs, Thomas E.; Munigala, Satish

doi:10.1016/j.amjmed.2021.10.020

Cited by 7 publications

(4 citation statements)

References 38 publications

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“…A retrospective study published in the American Journal of Medicine in 2021, including a total of 31,340 acute pancreatitis patients, found that prior exposure to non-steroidal anti-inflammatory drugs reduces the rate of organ failure and in-hospital mortality in acute pancreatitis ( Ladd et al, 2022 ). Therefore, treatment with NSAIDs before and during the early stages of AKI decreased the chance of developing AKI, which might be related to NSAIDs preventing organ failure.…”

Section: Discussionmentioning

confidence: 99%

“…NSAIDs were best known for inhibiting cyclooxygenases, which produce prostaglandins and thromboxanes. Its anti-inflammatory effects extend far beyond cyclooxygenase inhibition, including the inhibition of the pivotal nuclear factor kappa-light-chain-enhancer of activated B cells (NF-B) and the induction of certain types of eicosanoids, which reduced pro-inflammatory mediators such as TNF-, IL-1, and IL-6 ( Deligiannidou et al, 2021 ; Pekacar et al, 2021 ; Ladd et al, 2022 ).…”

Section: Discussionmentioning

confidence: 99%

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NSAID Treatment Before and on the Early Onset of Acute Kidney Injury Had an Opposite Effect on the Outcome of Patients With AKI

Wang

Liu

et al. 2022

Front. Pharmacol.

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Background: NSAIDs are one of the most frequently used medications and a risk factor for AKI. However, the optimal time of NSAIDs in patients with AKI is unknown.Methods: A secondary analysis of a multicenter, randomized clinical trial including adult inpatients with acute kidney injury was performed. Univariate, multivariate, and subgroup analyses were used to explore the impact of NSAIDs during the early onset of AKI on the outcome of patients with AKI.Results: A total of 6,030 patients with AKI were enrolled in the study. Following are the findings of the multi-factor analysis: NSAID treatments within 72 and 24 h before the onset of AKI were not associated with AKI progression, dialysis, or discharge from dialysis; only NSAID treatment within the 24-h onset of AKI was associated with these outcomes, and their OR values were independently 1.50 (95% CI: 1.02–2.19, p = 0.037), 4.20 (95% CI: 1.47–11.97, p = 0.007), and 0.71 (95% CI: 0.54–0.92, p = 0.011); only NSAID treatment within the 24-h onset of AKI would decrease the 14-day mortality, and the OR value was 0.52 (95% CI: 0.33–0.82, p = 0.005). The subgroup analysis revealed that in patients with age ≥65 years, CKD (chronic kidney disease), congestive heart failure, hypertension, and liver disease, NSAID treatments within the 24-h onset of AKI would deteriorate the outcome of patients with AKI.Conclusion: Before an early onset of AKI, NSAID treatment might be safe, but during the onset of AKI, even early NSAID treatment would deteriorate the outcome of patients with AKI.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

NSAID Treatment Before and on the Early Onset of Acute Kidney Injury Had an Opposite Effect on the Outcome of Patients With AKI

Wang

Liu

et al. 2022

Front. Pharmacol.

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“…The presumed working mechanism, reduction of the proinflammatory response through cyclooxygenase (COX) inhibition, may also be a viable option in patients with acute pancreatitis who have a high risk of developing organ failure. A large US retrospective study based on ICD-9 codes suggests that any prior NSAID use is inversely associated with organ failure [41]. A US RCT has randomized 42 patients with SIRS but without organ failure between a 100 mg loading dose of rectal indomethacin, followed by five doses of 50 mg every 8 h, or placebo [42].…”

Section: Immunomodulationmentioning

confidence: 99%

Update on the management of acute pancreatitis

Berg

Boermeester

2023

Current Opinion in Critical Care

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Purpose of reviewThis review provides insight into the recent advancements in the management of acute pancreatitis.Recent findingsModerate fluid resuscitation and Ringer's lactate has advantages above aggressive fluid resuscitation and normal saline, respectively. A normal “on-demand” diet has a positive effect on recovery from acute pancreatitis and length of hospital stay. A multimodal pain management approach including epidural analgesia might reduce unwarranted effects of opiate use. A more targeted use of antibiotics is starting to emerge. Markers such as procalcitonin may be used to limit unwarranted antibiotic use. Conversely, many patients with infected necrotizing pancreatitis can be treated with only antibiotics, although the optimal choice and duration is unclear. Delay of drainage as much as is possible is advised since it is associated with less procedures. If drainage is required, clinicians have an expanding arsenal of interventional options to their disposal such as the lumen-apposing metal stent for transgastric drainage and (repeated) necrosectomy. Immunomodulation using removal of systemic cytokines or anti-inflammatory drugs is an attractive idea, but up to now the results of clinical trials are disappointing. No additional preventive measures beside non-steroidal anti-inflammatory drugs (NSAIDs) can be recommended for post-endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis.SummaryMore treatment modalities that are less invasive became available and a trend towards less aggressive treatments (fluids, starvation, interventions, opiates) of acute pancreatitis is again emerging. Despite recent advancements, the pathophysiology of specific subgroup phenotypes is still poorly understood which reflects the disappointing results of pharmacological and immunomodulatory trials.

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“…Unfortunately, the other 20% of patients with AP would develop lethal severe acute pancreatitis (SAP) that requires intensive care ( 2 , 3 ). Despite improvements in treatment measurements and supportive care, SAP remains one of the important causes of death during the past decade ( 4 ). Therefore, identification of patients with SAP from patients with AP is urgently needed to help determine therapeutic interventions as early as possible.…”

Section: Introductionmentioning

confidence: 99%

Alteration of Peripheral Resistin and the Severity of Acute Pancreatitis: A Meta-Analysis

et al. 2022

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IntroductionResistin is a small secretory adipokine which is implicated to obesity and associated diseases. Recently, plenty of research papers have been conducted to explore the association between peripheral resistin and the severity of acute pancreatitis (AP). However, the results were controversial. In this study, we aimed to confirm the effect of peripheral resistin and the development of acute pancreatitis.MethodsA comprehensive online search was performed using the PubMed, Embase, Web of Science, CNKI, and Wanfang databases up through January 20, 2022. The retrieved records and their references were screened to identify additional studies. Data were extracted to calculate the pooled Hedges' g and its 95% CI, which were selected to assess peripheral resistin levels and the severity of acute pancreatitis. Subgroup analyses, sensitivity analyses, meta-regression, and publication bias tests were also undertaken based on obtained information.ResultsA total of eleven studies with 892 acute pancreatitis patients were enrolled in the study. Peripheral resistin levels were significantly increased in severe acute pancreatitis compared with mild acute pancreatitis (Hedges' g = 2.092, 95% CI: 0.994–3.190, P < 0.001). Subgroup analyses based on sample types and ethnicity also showed similar results. A single study did not affect our results, which was verified by sensitivity analysis. Meta-regression analyses revealed that age, gender of the included subjects, sample size, and publication year did not moderate effects on the present results.ConclusionIn our study, peripheral resistin levels were significantly elevated in patients with severe AP compared with patients with mild AP. Abnormal resistin levels may provide us some new insights in predicting the severity of AP.

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Prior Exposure to Nonsteroidal Anti-inflammatory Drugs Reduces the Rate of Organ Failure and In-Hospital Mortality in Acute Pancreatitis

Cited by 7 publications

References 38 publications

NSAID Treatment Before and on the Early Onset of Acute Kidney Injury Had an Opposite Effect on the Outcome of Patients With AKI

NSAID Treatment Before and on the Early Onset of Acute Kidney Injury Had an Opposite Effect on the Outcome of Patients With AKI

Update on the management of acute pancreatitis

Alteration of Peripheral Resistin and the Severity of Acute Pancreatitis: A Meta-Analysis

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