Reduction in mortality in severe acute pancreatitis: A time trend analysis over 16 years

Agarwal, Samagra; George, John E.; Padhan, Rajesh; Vadiraja, Padmaprakash K.; Behera, Sanatan; Hasan, Ajmal; Dhingra, Rajan; Shalimar, S.; Garg, Pramod Kumar

doi:10.1016/j.pan.2016.01.012

Cited by 41 publications

(27 citation statements)

References 22 publications

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“…With the changing management strategy, the outcome of AP is improving. We have previously shown a reduction in severity adjusted mortality over a time period of 16 years 12 . The major changes in the management of AP have been in the treatment approach to IPN.…”

Section: Discussionmentioning

confidence: 93%

“…However, the management of AP has evolved over the past decades with primary conservative and minimally invasive approaches preferred over open surgical necrosectomy 9 – 11 . We have shown that severity adjusted mortality has decreased over time with a change in management approach 12 . Whether or not the predictors of outcome have changed in view of the evolving treatment strategies is, however, not clear.…”

Section: Introductionmentioning

confidence: 91%

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Infected Pancreatic Necrosis due to Multidrug-Resistant Organisms and Persistent Organ failure Predict Mortality in Acute Pancreatitis

Jain

Mahapatra

Gupta

et al. 2018

Clinical and Translational Gastroenterology

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BackgroundOrgan failure determines outcome in acute pancreatitis (AP). It is controversial if infected pancreatic necrosis (IPN) is also an independent determinant of mortality. We hypothesized that the predictors of mortality in AP might have changed with advances in management and consequent decline in mortality over the past decades. Our objective was to study the predictors of mortality in patients with AP.MethodsConsecutive patients with a first episode of AP hospitalized from January 2015 to December 2016 were included in an observational study. Patients with IPN were treated with a conservative first approach followed by intervention. Necrosectomy, if required, was delayed beyond 4 weeks and done primarily employing minimally invasive techniques. The primary outcome measure was independent predictors of in-hospital mortality.ResultsOf 209 patients with AP, 81 (39%) had persistent organ failure (OF) and 108 (52%) developed IPN. Overall, 46/209 (22%) patients died. Independent predictors of mortality were OF (odds ratio [OR]19; 95% CI: 6.1–58.8), and IPN due to infection with multidrug resistant (MDR) organisms (OR: 8.4; 95% CI:3.1–22.5). Infected pancreatic necrosis by itself was not found to be a significant predictor of mortality (OR 2; 95% CI: 0.4–9.5).ConclusionPersistent OF and complicated IPN due to MDR infection were independent predictors of mortality in patients with AP. Renewed efforts to prevent MDR infection with antibiotic stewardship and strategies for early control of sepsis are urgently required.

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Section: Discussionmentioning

confidence: 93%

Section: Introductionmentioning

confidence: 91%

Infected Pancreatic Necrosis due to Multidrug-Resistant Organisms and Persistent Organ failure Predict Mortality in Acute Pancreatitis

Jain

Mahapatra

Gupta

et al. 2018

Clinical and Translational Gastroenterology

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“…Acute pancreatitis (AP) is a trypsin-activated sudden inflammatory response in the pancreas and autodigestion of the pancreas caused by various etiological factors such as gallstones, craputence, hyperlipemia, virus, sepsis and shock (1,2). Currently, AP is divided the mild AP, moderately severe AP (MSAP) and severe AP (SAP) in the clinic according to disease severity and prognosis (3).…”

Section: Introductionmentioning

confidence: 99%

Resveratrol protects against L-arginine-induced acute necrotizing pancreatitis in mice by enhancing SIRT1-mediated deacetylation of p53 and heat shock factor 1

Wang

Zhang

Liu

et al. 2017

International Journal of Molecular Medicine

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Acute necrotizing pancreatitis (ANP) is a common severe critical illness with a high mortality rate. Resveratrol, a polyphenol compound derived from various plants such as grape skin, peanut, berry and veratrum, exhibits multiple biological activities, especially potent anti-inflammatory activity, but its effect on ANP has not yet been fully elucidated. The present study aimed to investigate the effects of resveratrol on L-arginine-induced ANP and the possible mechanisms. A mouse model of ANP was established by 2 hourly intraperitoneal injections of 8% L-arginine (4 g/kg). Then the mice were treated by intragastric administration of resveratrol (80 mg/kg) every 12 h immediately after the second injection of L-arginine. Mice with ANP showed increased apoptosis of pancreatic acinar cells, pancreatic myeloperoxidase activity, serum lactate dehydrogenase activity, amylase, tumor necrosis factor-α (TNF-α), interleukin-6 (IL-6) levels as well as decreased serum IL-10 level, pancreatic expression of heat shock factor 1 (HSF1), sirtuin 1 (SIRT1) and p53, but the ratio of acetylated HSF1 and p53 was markedly increased. Resveratrol enhanced the survival rate of mice with ANP from 47.8 to 71.4% and obviously restored the changes in mice with ANP as mentioned above. Additionally, interactions between SIRT1 and p53 and between SIRT1 and HSF1 in the pancreas of the mice were confirmed by co-immunoprecipitation. These data suggest that resveratrol protects against L-arginine-induced ANP, which may be related to the enhancement of SIRT1-mediated deacetylation of p53 and HSF1.

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“…In support of the possibility that improved management is responsible for decreased mortality, a retrospective study by Agarwal et al . demonstrated a decrease in mortality at a tertiary care center in India, despite referral of an increased proportion of patients with organ failure and infected pancreatic necrosis 16 .…”

Section: Recent Advances In Epidemiology and Evaluation Of Acute Pancmentioning

confidence: 99%

Recent advances in understanding and managing acute pancreatitis

Mandalia¹,

Wamsteker²,

DiMagno³

2018

F1000Res

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This review highlights advances made in recent years in the diagnosis and management of acute pancreatitis (AP). We focus on epidemiological, clinical, and management aspects of AP. Additionally, we discuss the role of using risk stratification tools to guide clinical decision making. The majority of patients suffer from mild AP, and only a subset develop moderately severe AP, defined as a pancreatic local complication, or severe AP, defined as persistent organ failure. In mild AP, management typically involves diagnostic evaluation and supportive care resulting usually in a short hospital length of stay (LOS). In severe AP, a multidisciplinary approach is warranted to minimize morbidity and mortality over the course of a protracted hospital LOS. Based on evidence from guideline recommendations, we discuss five treatment interventions, including intravenous fluid resuscitation, feeding, prophylactic antibiotics, probiotics, and timing of endoscopic retrograde cholangiopancreatography (ERCP) in acute biliary pancreatitis. This review also highlights the importance of preventive interventions to reduce hospital readmission or prevent pancreatitis, including alcohol and smoking cessation, same-admission cholecystectomy for acute biliary pancreatitis, and chemoprevention and fluid administration for post-ERCP pancreatitis. Our review aims to consolidate guideline recommendations and high-quality studies published in recent years to guide the management of AP and highlight areas in need of research.

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Reduction in mortality in severe acute pancreatitis: A time trend analysis over 16 years

Cited by 41 publications

References 22 publications

Infected Pancreatic Necrosis due to Multidrug-Resistant Organisms and Persistent Organ failure Predict Mortality in Acute Pancreatitis

Infected Pancreatic Necrosis due to Multidrug-Resistant Organisms and Persistent Organ failure Predict Mortality in Acute Pancreatitis

Resveratrol protects against L-arginine-induced acute necrotizing pancreatitis in mice by enhancing SIRT1-mediated deacetylation of p53 and heat shock factor 1

Recent advances in understanding and managing acute pancreatitis

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