Clinical Prediction Score for Early Diagnosis of Acute Pancreatitis in Emergency Departments

Emergency patients with mild elevations of serum lipase and acute pancreatitis

OBJECTIVES

To estimate the incidence of AP and determine potential predictors and the outcomes. Elevated lipase level of <3 times the upper limit of normal (ULN) cause diagnostic confusion for acute pancreatitis (AP).

METHODS

A multicenter, 6-year retrospective study enrolled adult patients who were detected with lipase level of 80-240 IU/L in the Emergency Department (ED). The Revised Atlanta Classification was used to identify AP within 72 hour (hr) from the first ED visit.

RESULTS

Of 1082 patients, 68 (6.3%) had AP, 393 (36.3%) were hospitalized, 64 (6%) required intensive care unit admission, and 2 (0.2%) died. Most AP cases were confirmed using computed tomography CT; 47 (69.1%), followed by repeated lipase level 15 (22.1%) and ultrasound 14 (20.6%). Alcohol exhibited the highest adjusted odds ratio of predicting AP (3.9-45.6), followed by white blood cell count (1.340-6.222), male gender (1.451-4.308), and higher lipase level (1.009-1.02). Among AP cases, 11.8% required ICU admission and 1 died within 72 hr. Chronic heart disease, obesity, fever, and tachycardia were associated with these critical outcomes.

CONCLUSION

Among the study sample, 6.3% were diagnosed with AP. Most of the cases confirmed by CT and alcohol was the strongest risk factor in predicting AP. A prediction score system to stratify AP risk when lipase is <3 ULN is warranted.

Could we use PD-1 and PD-L1 expression on lymphocytes and monocytes as predictive markers for prognosis of acute biliary pancreatitis?

PURPOSE

This study aimed to assess the significance of immunophenotyping and serum cytokines in predicting the clinical progression of acute biliary pancreatitis (ABP).

MATERIALS AND METHODS

Cytokine levels, T-helper, cytotoxic T, natural killer (NK) cells, monocytes, HLA-DR, and PD-1, as well as PDL-1 immune checkpoints, were measured in ABP patients at the time of diagnosis and compared with results from healthy volunteers. The study also compared leukocyte counts, hematocrit, immunophenotyping results, cytokine statuses, and PD-1, PDL-1 expression between healthy volunteers and ABP subgroups categorized by pancreatitis severity.

RESULTS

The study included 65 ABP patients and 20 healthy volunteers. Significant differences were observed between groups in hematocrit, leukocyte counts, total monocytes, lymphocytes, CD3+ total T cells, CD4+ Th cells, PD-1 expression on CD4+ and CD8+T lymphocytes, HLA-DR expression on CD14+ monocytes, NK cells, PD-L1 expression on CD14+ monocytes, classical and intermediate monocytes, as well as levels of IL-6, IL-8, IL-10, IL-18, and IL-33 cytokines. Moderate correlations were found with lymphocyte counts, PD-1+CD4+ cells, PD-L1+CD14+ cells, and strong correlations with HLA-DR+CD14+ cells. Hematocrit, CD3+ total T cells, NK cells, CD4+PD-1 + T cells, and CD8+PD-1 + T cells showed independent associations with the severity of ABP. Lymphocyte counts, CD14+HLA-DR+ cells, CD14+PD-L1+ cells, CD4+PD-1 + T cells, classical, and intermediate monocytes exhibited the highest Area Under the Curve rates in determining organ failure.

CONCLUSIONS

Hematocrit, lymphocyte counts, CD14+HLA-DR+ cells, CD14+PD-L1+ cells, and intermediate monocytes emerged as parameters most closely associated with the severity and these parameters could be useful in predicting the severity of ABP.