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Progression Of Organ Failure In Severe Acute Pancreatitis

Tsuyoshi Takeda, Yousuke Nakai, Suguru Mizuno, Tatsunori Suzuki, Tatsuya Sato, Ryunosuke Hakuta, Kazunaga Ishigaki, Kei Saito, Tomotaka Saito, Takeo Watanabe, Naminatsu Takahara, Dai Mouri, Hirofumi Kogure, Yukiko Ito, Kenji Hirano, Minoru Tada, Hiroyuki Isayama, Kazuhiko Koike
BACKGROUND: Early identification of severe disease of acute pancreatitis (AP) is of critical importance to improve the prognosis. Fluid sequestration (FS), calculated from administrated fluid and fluid output, is a simple prognostic parameter. We examined its utility in the early phase of AP. METHODS: We retrospectively investigated AP patients between January 2009 and April 2017. We compared FS in the first 24 h (FS24) with FS in the first 48 h (FS48) and administrated fluid volume within the first 24 h (FV24)...
November 26, 2018: Journal of Gastroenterology
Xi Cao, Huai-Ming Wang, Hai Du, Er-Xia Chen, Xiu-Feng Yang, Shi-Long Wang, Ya Ding, Zhan-Fei She
The present study aimed to investigate early risk factors for hyperlipidemic acute pancreatitis (HLAP) in order to open up novel routes for its prevention and treatment. Demographics, laboratory data obtained within 48 h, enhanced computed tomography (CT) imaging data and the modified CT severity index (MCTSI) for 111 patients with HLAP who were assessed at Ordos Central Hospital (Ordos, China) between January 2015 and October 2017 were retrospectively analyzed. Of these, 17 patients progressed to infectious pancreatic necrosis (IPN) and 14 patients progressed to organ failure (OF), the occurrence of which were the study outcomes...
November 2018: Experimental and Therapeutic Medicine
N He, Y Y Yan, Y Q Ying, M Yi, G Q Yao, Q G Ge, S D Zhai
Pharmacokinetic parameters can be significantly altered for acute kidney injury (AKI), extracorporeal membrane oxygenation (ECMO) and continuous veno-venous hemofiltration therapy (CVVH). Here we reported a case of individualized vancomycin dosing for a patient diagnosed as severe acute pancreatitis treated with concurrent ECMO and CVVH. A 65 kg 32-year-old woman was admitted to hospital presented with severe acute pancreatitis (SAP), respiratory failure, metabotropic acidosis and hyperkalemia. She was admitted to intensive care unit (ICU) on hospital day 1 and was initiated on CVVH...
October 18, 2018: Beijing da Xue Xue Bao. Yi Xue Ban, Journal of Peking University. Health Sciences
Takeshi Sato, Wataru Shibata, Shin Maeda
Acute and chronic pancreatitises are gastrointestinal inflammatory diseases, the incidence of which is increasing worldwide. Most (~ 80%) acute pancreatitis (AP) patients have mild disease, and about 20% have severe disease, which causes multiple organ failure and has a high mortality rate. Chronic pancreatitis (CP) is characterized by chronic inflammation and destruction of normal pancreatic parenchyma, which leads to loss of exocrine and endocrine tissues. Patients with CP also have a higher incidence of pancreatic ductal adenocarcinoma...
August 23, 2018: Journal of Gastroenterology
Xinyue Hu, Lipeng Zhang
Severe acute pancreatitis (SAP) is still with a high incidence and mortality. Early onset is usually non-infectious inflammation caused by systemic inflammatory response syndrome (SIRS), with the further progress into pancreatic necrosis, which is the main cause of death. The occurrence of infection can induce or aggravate multiple organ failure (MOF), leading to death. Therefore, whether early use of antibiotics to prevent the occurrence of pancreatic infection and how to identify early pancreatic infection, how to choose the start of antibiotic therapy is the hot and difficult point of current study...
July 2018: Zhonghua Wei Zhong Bing Ji Jiu Yi Xue
X J N M Smeets, G Litjens, D W da Costa, W Kievit, H C van Santvoort, M G H Besselink, P Fockens, M J Bruno, J J Kolkman, J P H Drenth, T L Bollen, E J M van Geenen
BACKGROUND/OBJECTIVES: Acute pancreatitis (AP) progresses to necrotizing pancreatitis in 15% of cases. An important pathophysiological mechanism in AP is third spacing of fluids, which leads to intravascular volume depletion. This results in a reduced splanchnic circulation and reduced venous return. Non-visualisation of the portal and splenic vein on early computed tomography (CT) scan, which might be the result of smaller vein diameter due to decreased venous flow, is associated with infected necrosis and mortality in AP...
May 15, 2018: Pancreatology: Official Journal of the International Association of Pancreatology (IAP) ... [et Al.]
Yu-San Tee, Hsin-Yueh Fang, I-Ming Kuo, Yann-Sheng Lin, Song-Fong Huang, Ming-Chin Yu
Acute severe pancreatitis caused high mortality, and several scoring systems for predicting mortality are available. We evaluated the effectiveness of serial measurement of several scoring systems in patients with acute severe pancreatitis.We retrospectively obtained serial measurements of Ranson, Acute Physiology and Chronic Health Assessment (APACHE) II, and Sequential Organ Failure Assessment (SOFA) scores of 159 patients with acute severe pancreatitis.The overall mortality rate was 20%, and early mortality (in the first 2 weeks) occurred in 10 (7...
February 2018: Medicine (Baltimore)
Deepesh Sharma, Aparna Jakkampudi, Ratnakar Reddy, Panyala Balakumar Reddy, Aasish Patil, H V V Murthy, G Venkat Rao, D Nageshwar Reddy, Rupjyoti Talukdar
INTRODUCTION: This paper reports preliminary data of an ongoing study that evaluates the association of systemic inflammatory response (SIRS) with early severe acute pancreatitis (ESAP) and compensatory anti-inflammatory response syndrome (characterized by HLA-DR down-regulation) with infected pancreatic necrosis (IPN). METHODS: Consecutive patients presenting within 72 h of symptom onset with organ dysfunction and/or local complications were included. Following parameters were recorded: demographics, etiology, SIRS, APACHE II, creatinine, BUN...
December 2017: Digestive Diseases and Sciences
Shilpa A Rao, Aditya R Kunte
BACKGROUND AND AIMS: Interleukin (IL)-6, IL-8, IL-10, and C-reactive protein (CRP) have been evaluated for predicting outcomes of acute pancreatitis. However, there is considerable variation in their performance among different studies. We evaluate their accuracy in predicting progression to severe pancreatitis. MATERIALS AND METHODS: Serum IL-6, IL-8, IL-10, and CRP levels were measured within 24 h of admission in forty patients of clinically predicted severe acute pancreatitis (SAP)...
July 2017: Indian Journal of Critical Care Medicine
Sapna Iyer, Min-Jung Park, David Moons, Raymond Kwan, Jian Liao, Li Liu, M Bishr Omary
Acute pancreatitis has several underlying etiologies, and results in consequences ranging from mild to complex multi-organ failure. The wide range of pathology suggests a genetic predisposition for progression. We compared the susceptibility to acute pancreatitis in BALB/c and FVB/N mice, coupled with proteomic analysis, in order to identify potential protein associations with pancreatitis progression. METHODS: Pancreatitis was induced in BALB/c and FVB/N mice by administration of cerulein or feeding a choline-deficient, ethionine-supplemented (CDE) diet...
January 22, 2017: Biochemical and Biophysical Research Communications
Michal Lipinski, Alicja Rydzewska-Rosolowska, Andrzej Rydzewski, Malgorzata Cicha, Grazyna Rydzewska
BACKGROUND: Soluble urokinase-type plasminogen activator receptor (suPAR) is a glycoprotein secreted during inflammation and infections. Moreover, increased levels of suPAR are observed after hypoxia and ischaemia. The aim of the study was to assess whether suPAR could represent a useful marker of acute pancreatitis (AP) severity. PATIENTS AND METHODS: We have observed a cohort of 126 prospectively enrolled patients. Based on the presence of persistent organ failure (more than 48 h) and local complications (diagnosis of moderate AP [MSAP]), patients were classified into three groups: mild AP (MAP), moderate and severe AP (SAP)...
January 2017: Pancreatology: Official Journal of the International Association of Pancreatology (IAP) ... [et Al.]
(no author information available yet)
OBJECTIVE: To observe the occurrence rate of elevated serum amylase and lipase in critically ill children, to explore the relationship between elevated pancreatic enzymes and pancreatic injury, and the effect of elevated pancreatic enzymes on state of illness and the prognosis. METHOD: The data of cases treated in pediatric intensive care unit(ICU) of 17 children's hospitals were collected prospectively from January 2012 to March 2014 according to the inclusion and exclusion criteria...
September 2016: Zhonghua Er Ke za Zhi. Chinese Journal of Pediatrics
Geltrude Mingrone, David E Cummings
Type 2 diabetes (T2D) is classically characterized by failure of pancreatic β-cell function and insulin secretion to compensate for a prevailing level of insulin resistance, typically associated with visceral obesity. Although this is usually a chronic, progressive disease in which delay of end-organ complications is the primary therapeutic goal for medical and behavioral approaches, several types of bariatric surgery, especially those that include intestinal bypass components, exert powerful antidiabetes effects to yield remission of T2D in most cases...
July 2016: Surgery for Obesity and related Diseases: Official Journal of the American Society for Bariatric Surgery
Aparna Jakkampudi, Ramaiah Jangala, B Ratnakar Reddy, Sasikala Mitnala, D Nageshwar Reddy, Rupjyoti Talukdar
The incidence of acute pancreatitis (AP) is increasing globally and mortality could be high among patients with organ failure and infected necrosis. The predominant factors responsible for the morbidity and mortality of AP are systemic inflammatory response syndrome and multiorgan dysfunction. Even though preclinical studies have shown antisecretory agents (somatostatin), antioxidants (S-adenosyl methionine [SAM], selenium), protease inhibitors, platelet activating factor inhibitor (Lexipafant), and anti-inflammatory immunomodulators (eg...
July 2016: Pancreatology: Official Journal of the International Association of Pancreatology (IAP) ... [et Al.]
Takaaki Eguchi, Yoshihisa Tsuji, Hiroshi Yamashita, Takumi Fukuchi, Atsushi Kanamori, Kei Matsumoto, Takashi Hasegawa, Akio Koizumi, Ryuki Kitada, Masahiro Tsujimae, Taro Iwatsubo, Shintaro Koyama, Satoshi Ubukata, Mikio Fujita, Akihiko Okada
OBJECTIVE: To investigate the efficacy of recombinant human soluble thrombomodulin (rTM) in preventing the development of walled-off necrosis (WON) in severe acute pancreatitis (SAP) patients. METHODS: We retrospectively analyzed 54 SAP patients divided into two groups: SAP patients treated by rTM (rTM group, 24 patients) and not treated by rTM (control group, 30 patients). rTM was administered to patients with disseminated intravascular coagulation (DIC). Initially, on the admission day, we recorded patient severity and pancreatic necrosis/ischemia positive or negative...
September 2015: Pancreatology: Official Journal of the International Association of Pancreatology (IAP) ... [et Al.]
Kazuhiro Kikuta, Atsushi Masamune, Tooru Shimosegawa
Acute pancreatitis (AP) is an acute inflammatory disease of the exocrine pancreas. In spite of the pivotal role of the endocrine pancreas in glucose metabolism, the impact of impaired glucose tolerance on AP has not been fully elucidated. A meta-analysis of seven observational studies showed that type 2 diabetes mellitus (DM) was associated with an increased risk of AP. The increased risk of AP shown in the meta-analysis was independent of hyperlipidemia, alcohol use and gallstones. Anti-diabetic drugs including incretins might increase the risk of AP, but no intervention trials have confirmed this...
June 28, 2015: World Journal of Gastroenterology: WJG
Georgi A Minkov, Krasimira S Halacheva, Yovcho P Yovtchev, Maya V Gulubova
Development of acute pancreatitis illustrates the need to understand the basic mechanisms of disease progression to drive the exploration of therapeutic options. Cytokines play a major role in the pathogenesis of acute pancreatitis as underlying systemic inflammatory response, tissue damage, and organ dysfunction. However, little is known about circulating concentrations of these inflammatory markers and their real impact on clinical practice. Experimental studies have suggested that the prognosis for acute pancreatitis depends on the degree of pancreatic necrosis and the intensity of multisystem organ failure generated by the systemic inflammatory response...
July 2015: Pancreas
Chaochao Tan, Zongxin Ling, Ying Huang, Youde Cao, Qiang Liu, Tao Cai, Hao Yuan, Changjun Liu, Yunfeng Li, Keqian Xu
OBJECTIVES: To evaluate alterations of the intestinal bacteria and its associations with the inflammation in acute pancreatitis (AP). METHODS: A multihospital prospective clinical study was conducted, and a total of 108 participants were enrolled in our study, including 44 with severe AP (SAP), 32 with mild AP (MAP), and 32 healthy volunteers. The structure of intestinal microbiota, 10 predominant bacteria, plasma endotoxin, and serum cytokines were investigated by polymerase chain reaction-denaturing gradient gel electrophoresis, real-time quantitative polymerase chain reaction, Limulus amebocyte lysate tests, and enzyme-linked immunosorbent assays, respectively...
August 2015: Pancreas
Sara Bertilsson, Per Swärd, Evangelos Kalaitzakis
BACKGROUND & AIMS: Little is known about recurrence of pancreatitis after an initial episode, and little is known about how the disease progresses or what factors affect progression. We performed a population-based study of patients with acute pancreatitis (AP) to determine their outcomes and associated factors. METHODS: We performed a retrospective study of patients with first-time AP from 2003 through 2012 in a well-defined area of Sweden. Data were collected from medical records on disease etiology, severity (according to the Atlanta classification), recurrence of AP, subsequent chronic pancreatitis, and mortality...
September 2015: Clinical Gastroenterology and Hepatology
Guntars Pupelis, Vladimir Fokin, Kaspars Zeiza, Ita Kazaka, Jelizaveta Pereca, Vita Skuja, Viesturs Boka
CONTEXT: The surgical treatment of necrotizing pancreatitis includes percutaneous drainage of acute necrotic collections and sequestrectomy in the late phase of the disease. OBJECTIVE: The aim of the study was to compare the conventional open necrosectomy (CON) approach with the alternative focused open necrosectomy (FON) approach in patients with infected necrosis and progression of sepsis. METHODS: Patients with acute necrotizing pancreatitis were included in the study prospectively from January 2004 to July 2014...
March 2015: JOP: Journal of the Pancreas
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