Splenectomy Correlates With Increased Risk of Acute Pancreatitis: A Case-Control Study in Taiwan

Lai, Shih‐Wei; Lin, Cheng‐Li; Liao, Kuan‐Fu

doi:10.2188/jea.je20150214

Cited by 9 publications

(7 citation statements)

References 17 publications

(18 reference statements)

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“…Some studies have reported that splenectomy is associated with an increased risk of diseases. Lai et al compared between splenectomy patients and non-splenectomy patients and found that for postsplenectomy patients, the adjusted OR of acute pancreatitis was 2.90 (95% CI 1.39 to 6.05), 12 the adjusted HR of renal and perinephric abscesses was 2.24 (95% CI 1.30 to 3.88), 11 the adjusted HR of pyogenic liver abscess was 3.89 (95% CI 3.20 to 4.72) 10 and the OR of pulmonary tuberculosis were 1.91 (95% CI 1.06 to 3.44). 8 …”

Section: Discussionmentioning

confidence: 99%

Population-based cohort study examining the association between splenectomy and empyema in adults in Taiwan

et al. 2017

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ObjectiveThis study aimed to investigate the association between splenectomy and empyema in Taiwan.MethodsA population-based cohort study was conducted using the hospitalisation dataset of the Taiwan National Health Insurance Program. A total of 13 193 subjects aged 20–84 years who were newly diagnosed with splenectomy from 2000 to 2010 were enrolled in the splenectomy group and 52 464 randomly selected subjects without splenectomy were enrolled in the non-splenectomy group. Both groups were matched by sex, age, comorbidities and the index year of undergoing splenectomy. The incidence of empyema at the end of 2011 was calculated. A multivariable Cox proportional hazards regression model was used to estimate the HR with 95% CI of empyema associated with splenectomy and other comorbidities.ResultsThe overall incidence rate of empyema was 2.56-fold higher in the splenectomy group than in the non-splenectomy group (8.85 vs 3.46 per 1000 person-years). The Kaplan-Meier analysis revealed a higher cumulative incidence of empyema in the splenectomy group than in the non-splenectomy group (6.99% vs 3.37% at the end of follow-up). After adjusting for confounding variables, the adjusted HR of empyema was 2.89 for the splenectomy group compared with that for the non-splenectomy group. Further analysis revealed that HR of empyema was 4.52 for subjects with splenectomy alone.ConclusionThe incidence rate ratio between the splenectomy and non-splenectomy groups reduced from 2.87 in the first 5 years of follow-up to 1.73 in the period following the 5 years. Future studies are required to confirm whether a longer follow-up period would further reduce this average ratio. For the splenectomy group, the overall HR of developing empyema was 2.89 after adjusting for age, sex and comorbidities, which was identified from previous literature. The risk of empyema following splenectomy remains high despite the absence of these comorbidities.

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Section: Discussionmentioning

confidence: 99%

Population-based cohort study examining the association between splenectomy and empyema in adults in Taiwan

et al. 2017

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“…Lai et al reported that splenectomy could be a risk factor for acute pancreatitis (OR 3.57) (41). Even though the pancreas might be at risk for developing an infection after splenectomy which would lead to pancreatic inflammation, the pathogeny of acute pancreatitis is much more complex.…”

Section: Other Complicationsmentioning

confidence: 99%

Patients After Splenectomy: Old Risks and New Perspectives

Dragomir¹,

Petrescu²,

Manga³

et al. 2016

chr

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Rezumat Pacienåii post-splenectomie: complicaåii cunoscute aei perspective noiComplicaåiile care survin în urma splenectomiei pot fi împãråite în infecåioase aei non-infecåioase. Legãtura dintre splenectomie aei aceste riscuri este doar paråial înåeleasã. Rãspunsul imun al gazdei împotriva infecåiei este profund modificat post-splenectomie, iar aceaeti indivizi sunt mai susceptibili sã dezvolte sepsis aei infecåia are o evoluåie fulminantã. Splenectomia este de asemenea un potenåial factor de risc pentru numeroase complicaåii vasculare care rezultã în urma obstrucåiei paråiale sau totale ale unei artere sau vene. În plus, hipertensiunea pulmonarã poate fi o complicaåie severã aei uneori fatalã a splenectomiei. Unii autori includ aei neoplaziile, diabetul zaharat aei pancreatita acutã în categoria complicaåiilor non-infecåioase post-splenectomie. Cea mai de temut complicaåie pentru pacienåii splenectomizaåi rãmâne sepsisul. Fiziopatologia sepsisului încã este controversatã. Decesul în sepsis poate surveni fie în urma hiperinflamaåiei, fie în urma imunosupresiei. Multiple dovezi experimentale au dovedit implicarea microRNA-urilor celulare aei virale în sepsis. Considerãm faptul cã microRNA-urile sunt de asemenea asociate cu imunosupresia pacientului asplenic, ceea ce determinã o creaetere a riscului de sepsis fatal. Studierea nivelului expresiei plasmatice a microRNA-urilor circulante la pacienåii asplenici, ar putea conduce la o mai bunã înåelegere a imunosupresiei post-splenectomie aei la dezvoltarea unor noi metode diagnostice aei terapeutice.Cuvinte cheie: splenectomie, microRNA, sepsis, microRNA-uri virale, OPSI AbstractThe risks that arise after splenectomy can be divided in infectious and non-infectious. The link between splenectomy and these hazards remains partially unknown. Host defense against infection is altered after splenectomy and such individuals develop sepsis more easily and the infection has a fulminant course. Splenectomy is also a potential risk factor for several vascular complications that result from partial or total obstruction of an arterial or venous blood vessel. Furthermore, pulmonary hypertensioncan be a severe and sometimes fatal complication following splenectomy. Some authors also consider that malignancies, diabetes mellitus and acute pancreatitis are non-infectious complications after splenectomy. The most feared complication for splenectomized patients remains sepsis. The pathophysiology of sepsis is still controversial. Death in sepsis can occur due to either hyper-inflammation or "immune paralysis". Multiple experimental evidences link cellular and viral microRNAs with sepsis. We presume that General ReportChirurgia (2016)

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“…In general, the spleen takes on a substantial proportion of the organic metabolism and removal of the spleen would obliterate most of the invaluable gifted functions, predisposing to different diseases [ 7 – 15 ]. Apart from the afore-mentioned OPSI and thrombocytosis, asplenism is meanwhile associated with a high risk of vascular events especially as atherosclerosis (AS) and coronary artery disease, diabetes mellitus [ 16 ], as well as acute pancreatitis [ 17 ] and cancers [ 18 ].…”

Section: Introductionmentioning

confidence: 99%

The role of splenectomy in lipid metabolism and atherosclerosis (AS)

Han

et al. 2018

Lipids Health Dis

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The extensive performance of splenectomy worldwide for patients suffered from splenic trauma has given rise to high risks of postoperative complications, which has been attracting increasing attention in recent years. Nowadays the spleen is regarded as a versatile organ of the human body, invested with various excellent properties. The spleen has been recognized to take a great part in lipid metabolism. While removal of the spleen intends to alter lipid values, especially with an elevated LDL, splenic autotransplantation is able to normalize these lipid alterations. What is more, conservative surgical procedures like subtotal or partial splenectomy, could as well, afford a correction of dyslipidemia. At the same time, clinically, splenectomy demonstrates a high rate of atherosclerosis (AS), whereas non-surgical treatment after splenic trauma shows unchanged propagation of AS. Based on the intimate relationship between serum lipids and AS, the lipid changes modulated by splenectomy are believed to be responsible for the development of AS. Therefore, a “splenic factor” is most likely present in the regulation of lipidation and AS. Several theories have been postulated to elucidate the possible mechanism involved, among which most are primarily based on its forceful natural immune function, that is to say, the mononuclear phagocytic system.However, the accurate mechanisms behind this mysterious phenomenon still remain unclear so far. Of importance, lipid fractions should be monitored consecutively in case of inevitable splenectomy.

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Splenectomy Correlates With Increased Risk of Acute Pancreatitis: A Case-Control Study in Taiwan

Cited by 9 publications

References 17 publications

Population-based cohort study examining the association between splenectomy and empyema in adults in Taiwan

Population-based cohort study examining the association between splenectomy and empyema in adults in Taiwan

Patients After Splenectomy: Old Risks and New Perspectives

The role of splenectomy in lipid metabolism and atherosclerosis (AS)

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