Validation of Modified Determinant-Based Classification of severity for acute pancreatitis in a tertiary teaching hospital

Wu, Dong; Lü, Bo; Xue, Huadan; Hong, Yang; Qian, Jiaming; Lee, Peter; Windsor, John A.

doi:10.1016/j.pan.2019.01.003

Cited by 27 publications

(47 citation statements)

References 34 publications

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“…The included patients were followed up by various methods (including hospital notes, telephone, WeChat and/or e-mail) from date of tumor diagnosis until death, or 1 December 2019, depending on which occurred first. AP without tumor (controls) were selected from the AP database, which had been described elsewhere (11,12), using stratified random sampling. Controls were matched to each study subject by gender and length of stay at a 1:4 ratio.…”

Section: Patients and Settingsmentioning

confidence: 99%

Clinical characteristics and outcome of tumor-associated acute pancreatitis: a single-center cohort study

Xiong¹,

Zhao²,

Han³

et al. 2021

Ann Transl Med

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Background: What features should alert clinicians to suspect underlying tumors in patients with acute pancreatitis (AP) was largely unknown. This study aimed to assess the clinical characteristics and outcome in patients with tumor-associated AP.Methods: Patients who presented with AP and were diagnosed with tumor after admission were included according to the inclusion and exclusion criteria and followed up by hospital notes, telephone, WeChat and/ or e-mail. The clinical characteristics and outcome were analyzed with multivariable logistic regression and were compared with AP patients without tumor.Results: Out of a cohort of 1,792 AP patients we identified 103 who had a neoplastic etiology. The 103 patients had a median age of 57 (range, 13-81) and 65 were males. AP was mild in 92 patients, moderately severe in 7 and severe in 4. The three most common tumors included pancreatic cancer (PC) (40), periampullary carcinoma (PAC) (25), and neoplastic pancreatic cysts (NPC) (22). The following ranked features were predictive of a tumor etiology: dilation of main pancreatic duct (MPD) (

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Section: Patients and Settingsmentioning

confidence: 99%

Clinical characteristics and outcome of tumor-associated acute pancreatitis: a single-center cohort study

Xiong¹,

Zhao²,

Han³

et al. 2021

Ann Transl Med

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“…Rather than use the nomenclature of Groups 1–4, and exclude those with mild AP, a working nomenclature has been proposed as follows: “mild”, “moderate” (Group 1), “moderately severe” (Group 2), “severe,” (Group 3) and “critical” (Group 4) (Fig. ) …”

Section: Determinants Of Severity and Outcome As Targets For Treatmentmentioning

confidence: 99%

“…The modification of the Determinants‐Based Classification of acute pancreatitis severity, based on the multicentre prospective study with the proposed nomenclature: mild, moderate, moderately severe, severe, and critical acute pancreatitis, based on organ failure (none, transient, or persistent) and local complications (none, sterile, and infected) …”

Section: Determinants Of Severity and Outcome As Targets For Treatmentmentioning

confidence: 99%

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Novel strategies for the treatment of acute pancreatitis based on the determinants of severity

Windsor

Escott

Brown

et al. 2017

J of Gastro and Hepatol

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Acute pancreatitis (AP) is a common disease for which a specific treatment remains elusive. The key determinants of the outcome from AP are persistent organ failure and infected pancreatic necrosis. The prevention and treatment of these determinants provides a framework for the development of specific treatment strategies. The gut-lymph concept provides a common mechanism for systemic inflammation and organ dysfunction. Acute and critical illness, including AP, is associated with intestinal ischemia and drastic changes in the composition of gut lymph, which bypasses the liver to drain into the systemic circulation immediately proximal to the major organ systems which fail. The external diversion of gut lymph and the targeting of treatments to counter the toxic elements in gut lymph offers novel approaches to the prevention and treatment of persistent organ failure. Infected pancreatic necrosis is increasingly treated with less invasive techniques, the mainstay of which is drainage, both endoscopic and percutaneous. Further improvements will occur with the strategies to accelerate liquefaction and through a fundamental redesign of drains, both of which will increase drainage efficacy. The determinants of severity and outcome in patients admitted with AP provide the basis for innovative treatment strategies. The priorities are to translate the gut-lymph concept to clinical practice and to improve the design and active use of drains for infected complications of AP.

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“…For instance, patients with MAP only need supportive care such as uid and analgesia and recover within a few days. But in the non-mild form of AP, an in ammatory cascade usually leads to local and systemic complications, claims remarkable morbidity and mortality, and makes the management of AP challenging [4]. The pathogenetic mechanism underlying the progression of AP severity is yet to be elucidated [5].Gut microbiota plays an essential role in maintaining immune homeostasis and the biological barrier of the intestine [6].…”

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confidence: 99%

Shotgun metagenomics reveals significant gut microbiome features in different grades of acute pancreatitis

Xiong

et al. 2021

Microbial Pathogenesis

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Background: Acute pancreatitis (AP) has a broad spectrum of severity and is associated with considerable morbidity and mortality. We aimed to evaluate the composition and functional effects of gut microbiota in different grades of AP severity.Results: Gut microbiota in AP patients was characterized by decreased species richness. The most representative gut microbiota in mild acute pancreatitis (MAP), moderately severe acute pancreatitis (MSAP), and severe acute pancreatitis (SAP) was Streptococcus, Escherichia-coli, and Enterococcus, respectively. Each of the three AP-associated genera could differentiate AP from healthy control population. Representative pathways associated with the glutathione metabolism, lipopolysaccharide biosynthesis, and amino acid metabolism (valine, leucine and isoleucine degradation) were enriched in MAP, MSAP, and SAP, respectively.Conclusions: Our ndings indicate that in patients with AP, the gut microbiome composition and function are correlated with different severity of AP from a whole-genome perspective, and new changes are observed. BackgroundAcute pancreatitis (AP) is the most common gastrointestinal disease that requires acute admission and causes tremendous pain and socioeconomic burden [1]. The worldwide incidence of AP ranges from 4.9 to 80 cases per 100,000 individuals annually [2]. According to the Revised Atlanta Classi cation, AP is strati ed into mild acute pancreatitis (MAP), moderately severe acute pancreatitis (MSAP), and severe acute pancreatitis (SAP) [3]. The outcome of AP patients with different severity is widely divergent. For instance, patients with MAP only need supportive care such as uid and analgesia and recover within a few days. But in the non-mild form of AP, an in ammatory cascade usually leads to local and systemic complications, claims remarkable morbidity and mortality, and makes the management of AP challenging [4]. The pathogenetic mechanism underlying the progression of AP severity is yet to be elucidated [5].Gut microbiota plays an essential role in maintaining immune homeostasis and the biological barrier of the intestine [6]. Under pathological conditions such as AP, perturbations to the gut microbiota could disrupt gut barrier, increase the intestinal permeability, and lead to bacterial translocation, which in turn triggers secondary infectious complications [7]. Several bacteria, including Escherichia, Shigella, Enterococcus, and Enterobacteriaceae family, have been found in the pancreas, indicating that their translocation from the gut could lead to infected pancreatic necrosis in non-mild AP [8]. Our previous work revealed different gut bacteria composition in AP patients with varying grades of severity. To be speci c, Bacteroides, Escherichis-Shigella, and Enterococcus was the dominant gut microbiota species in MAP, MSAP, and SAP, respectively. Besides, Anaerococcus and Enterococcus were signi cantly increased and Eubacterium hallii decreased in non-mild AP patients [9]. Similar ndings were also reported by Zhu Y et al. [7]. These studies ...

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Validation of Modified Determinant-Based Classification of severity for acute pancreatitis in a tertiary teaching hospital

Cited by 27 publications

References 34 publications

Clinical characteristics and outcome of tumor-associated acute pancreatitis: a single-center cohort study

Clinical characteristics and outcome of tumor-associated acute pancreatitis: a single-center cohort study

Novel strategies for the treatment of acute pancreatitis based on the determinants of severity

Shotgun metagenomics reveals significant gut microbiome features in different grades of acute pancreatitis

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