Trends and recent developments in pharmacotherapy of acute pancreatitis

Hey-Hadavi, Judith; Velisetty, Prasad; Mhatre, Swapnali

doi:10.1080/00325481.2022.2136390

Cited by 12 publications

(18 citation statements)

References 92 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Explanation for the shortcomings of the NUTRIC score is that mortality was the only consideration in the study design when it was first developed (13). Some experts claim that mortality is not the only outcome that should be assessed when determining the efficacy of a nutritional intervention, considering the numerous factors influencing ICU mortality (16). Long-term functional tests might better reflect the benefit of a nutritional intervention and should be included in the screening tools (32).…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Prognostic performance of the NRS2002, NUTRIC, and modified NUTRIC to identify high nutritional risk in severe acute pancreatitis patients

Chen

Zhao²,

Wang³

et al. 2023

Front. Nutr.

View full text Add to dashboard Cite

BackgroundAcute pancreatitis (AP) is the most common gastrointestinal disease requiring hospital admission. AP patients are categorized as mild, moderately severe, and severe AP (SAP). For SAP patients, malnutrition increases susceptibility to infection and mortality. The Nutritional Risk Screening 2002 (NRS 2002), the Nutrition Risk in Critically Ill (NUTRIC) score and modified Nutrition Risk in Critically Ill (mNUTRIC) are nutritional risk screening tools of critically ill patients and have not been validated in patients with SAP. It is essential to evaluate the prognostic performance of these nutritional risk screening tools.Materials and methodsA retrospective study was designed to validate the NRS 2002, NUTRIC, and mNUTRIC when applied to SAP patients. Receiver operating characteristic curves were plotted to investigate the predictive ability of clinical outcomes by comparing areas under the curve (AUC). Appropriate cut-offs were calculated by using Youden’s index. Patients were identified as being at high nutritional risk according to the calculated cut-off values. The effects of different scoring systems on mortalities were calculated using the Cox proportional hazards model. Logistic regression was used to assess the association between the energy provision and 28-day mortality.ResultsFrom January 2013 to December 2019, 234 SAP patients were included and analyzed. Patients categorized as high nutritional risk by the NRS 2002 (12.6% versus 1.9% for 28-day and 20.5% versus 3.7% for 90-day), NUTRIC (16.2% versus 0.0% for 28-day and 27.0% versus 0.0% for 90-day), and mNUTRIC (16.4% versus 0.0% for 28-day and 26.4% versus 0.8% for 90-day) had significant higher mortality than those categorized as low nutritional risk. The NUTRIC (AUC: 0.861 for 28-day mortality and 0.871 for 90-day mortality, both cut-off value ≥3) and mNUTRIC (AUC: 0.838 for 28-day and 0.828 for 90-day mortality, both cut-off value ≥3) showed better predictive ability of the 28- and 90-day mortality than the NRS 2002 (AUC: 0.706 for 28-day mortality and 0.695 for 90-day mortality, both cut-off value ≥5).ConclusionThe NRS 2002, NUTRIC, and mNUTRIC scores were predictors for the 28- and 90-day mortalities. The NUTRIC and mNUTRIC showed better predictive ability compared with the NRS 2002 when applied to SAP patients.

show abstract

Section: Discussionmentioning

confidence: 99%

“…The average calorie and protein intakes were calculated. The total calorie requirements were calculated as 25-30 kcal/kg/day and 1.2-1.5 g/kg/day protein as in the current guidelines (12,16). Ideal body weight was used for obese patients with BMI > 25 kg/m 2 .…”

Section: Outcome Measures and Data Collectionmentioning

confidence: 99%

Prognostic performance of the NRS2002, NUTRIC, and modified NUTRIC to identify high nutritional risk in severe acute pancreatitis patients

Chen

Zhao²,

Wang³

et al. 2023

Front. Nutr.

View full text Add to dashboard Cite

show abstract

“…AP is frequently accompanied by intestinal barrier dysfunction, acute lung injury (ALI), and systemic in ammatory response syndrome (SIRS) (Gao et al,2020;Li et al,2020). Although the mortality rate of acute pancreatitis is 5%, the mortality rate of severe acute pancreatitis (SAP) is as high as 25% (Hey-Hadavi et al,2022).…”

Section: Discussionmentioning

confidence: 99%

Dachengqi Decoction alleviates acute pancreatitis by down-regulating autophagy related protein Beclin1

Liu

Huang

et al. 2023

Preprint

View full text Add to dashboard Cite

Objective: Acute pancreatitis (AP) is a common acute abdominal disease characterized by pancreatic acinar cell death and inflammation. Excessive autophagy of acinar cells will aggravate AP, further develop into SAP, and even endanger life. Dachengqi Decoction (DCQD) is a commonly used drug in clinic for acute pancreatitis. Beclin1 is a vital autophagy-related molecule in disease. We investigated DCQD treat acute pancreatitis by intervening Beclin1 to regulate the autophagy of acinar cells.Methods: Wistar rats were injected intraperitoneally with 20% L-arginine to reproduce AP rat model. AP rat were treated with DCQD and 3-Methyladenine (3-MA) and compared to AP rats pre-treated with 20% L-arginine. we examined the levels of serum TNF-α, Beclin1 and Reactive Oxygen Species (ROS) by ELISA; stained the pancreas tissues of rats with Hematoxylin-eosin staining (HE); observed the autophagy formation in pancreas tissues by transmission electron microscopy; and detected the expression of Beclin1 and light chain 3-Ⅱ(LC3-II) protein level in pancreas tissues by Western blot and immunohistochemistry.Result: The levels of serum Amylase, Beclin1, ROS, TNF-α and pathological scores of pancreas were significantly elevated by injected intraperitoneally with 20% L-arginine. The results of electron microscopy showed that the autophagy of pancreatic tissue increased significantly in AP rats, but decreased in rats treated with DCQD or 3-MA. DCQD and 3-MA could significantly reduce the levels of serum Amylase, Beclin1, ROS and TNF-α in rats. Western blot and immunohistochemical results showed that DCQD and 3-MA significantly reduced Beclin1 and LC3-II proteins.Conclusion: Our studies showed that Beclin1 is closely related to acute pancreatitis, and DCQD could inhabited Beclin1 and excessive autophagy.

show abstract

“… 25 , 26 Even though further approaches have been tested in the past years, specific therapies are still not approved for the treatment of AP, and its management is primarily based on supportive care, involving nutritional therapy and avoidance of pancreatic complications. 27 , 28 A recent, multicenter trial, organized by experts in the field, also failed to establish clear benefits of a specific treatment, which is early aggressive hydration, in AP. 29 …”

Section: Therapeutic Considerations In Acute Pancreatitis (Ap)mentioning

confidence: 99%

Precision Medicine in Pancreatitis: The Future of Acute Pancreatitis Care

Garami

Hegyi

2023

Function

View full text Add to dashboard Cite

Acute pancreatitis (AP) continues to present a substantial burden to patients and healthcare personnel. Despite its occasionally severe progression and high mortality rate, there is no specific therapy that could be routinely applied in patients with AP. Here, we review treatment possibilities in AP, describe how the treatment approaches have changed in pancreatic cancer as an analogy, and point out potential causes for the failure of clinical trials on AP. We highlight that instead of attempting to discover generalized treatment options that could be used in any AP patient, it is time for a paradigm shift in the treatment of AP, which would help to focus more on individual patients or specific patient subpopulations when designing clinical trials and therapeutic approaches (similarly as in pancreatic cancer). Since the recruitment of specific patient subpopulations with AP could take excessive time if clinical centers work separately, the development of precision medicine in AP would require to establish an expert committee, e.g., Pancreatitis Precision Medicine Interest Group, which could organize and coordinate the activities of the joined centers. With the joined forces of expert clinicians and leading centers, a new era could start in the treatment of AP, in which personalized treatment options could be discovered and introduced to efficiently reduce the burden of the disease on patients and healthcare workers.

show abstract

Trends and recent developments in pharmacotherapy of acute pancreatitis

Cited by 12 publications

References 92 publications

Prognostic performance of the NRS2002, NUTRIC, and modified NUTRIC to identify high nutritional risk in severe acute pancreatitis patients

Prognostic performance of the NRS2002, NUTRIC, and modified NUTRIC to identify high nutritional risk in severe acute pancreatitis patients

Dachengqi Decoction alleviates acute pancreatitis by down-regulating autophagy related protein Beclin1

Precision Medicine in Pancreatitis: The Future of Acute Pancreatitis Care

Contact Info

Product

Resources

About