1
|
Zerem D, Zerem O, Zerem E. Role of Clinical, Biochemical, and Imaging Parameters in predicting the Severity of Acute Pancreatitis. Euroasian J Hepatogastroenterol 2017; 7:1-5. [PMID: 29201763 PMCID: PMC5663765 DOI: 10.5005/jp-journals-10018-1202] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2016] [Accepted: 09/25/2016] [Indexed: 12/30/2022] Open
Abstract
AIM The assessment of the severity of acute pancreatitis (AP) is important for proper management of the disease and for its prognosis. The aim was to correlate clinical, biochemical, and imaging diagnostic parameters and evaluate their prognostic values in the early assessment of severity of AP. MATERIALS AND METHODS We prospectively studied 128 consecutive patients with AP. The predictors were clinical, biochemical, and imaging diagnostic parameters. The outcome measure was the occurrence of complications. Abdominal sonogram, contrast-enhanced computer tomography, and pancreatitis-specific clinical and laboratory findings were done. RESULTS According to the Atlanta classification, 84 patients (65.6%) had mild and 44 (34.4%) had severe AP. The severity markers were significantly different between the mild and the severe groups (p < 0.001). Leukocyte count, serum albumin level, C-reactive protein (CRP), Ranson, acute physiology and chronic health evaluation II (APACHE II), and Glasgow score were the factors associated with radiological severity grade. Leukocyte count, CRP, Ranson score, APACHE II, and Glasgow score were the factors associated with the number and appearance of acute fluid collections (AFCs). A significant association was found between the number of AFCs and the occurrence of complications [odds ratio 4.4; 95% confidence interval 2.5-7.6]. Hospital stay was significantly longer in the group with severe disease as compared with the group with mild disease (p < 0.001). CONCLUSION Clinical, biochemical, and imaging diagnostic parameters are related to the clinical course of AP and they can predict its severity. This allows us to determine the severity of the disease and to target the patients with high scores for close monitoring and more aggressive intervention.How to cite this article: Zerem D, Zerem O, Zerem E. Role of Clinical, Biochemical, and Imaging Parameters in predicting the Severity of Acute Pancreatitis. Euroasian J Hepato-Gastroenterol 2017;7(1):1-5.
Collapse
Affiliation(s)
- Dina Zerem
- Medical Faculty, University of Tuzla, 75000 Tuzla, Bosnia and Herzegovina
| | - Omar Zerem
- Medical Faculty, University of Tuzla, 75000 Tuzla, Bosnia and Herzegovina
| | - Enver Zerem
- Department of Medical Sciences, The Academy of Sciences and Arts of Bosnia and Herzegovina, 71000 Sarajevo, Bosnia and Herzegovina
- Department of Gastroenterology, University Clinical Center Tuzla, 75000 Tuzla, Bosnia and Herzegovina
| |
Collapse
|
2
|
Cai D, Parajuly SS, Wang H, Wang X, Ling W, Song B, Li Y, Luo Y. Accuracy of contrast-enhanced ultrasound compared with conventional ultrasound in acute pancreatitis: Diagnosis and complication monitoring. Exp Ther Med 2016; 12:3189-3194. [PMID: 27882136 PMCID: PMC5103763 DOI: 10.3892/etm.2016.3760] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2015] [Accepted: 09/01/2016] [Indexed: 02/05/2023] Open
Abstract
Contrast-enhanced ultrasound (CEUS) has been used for diagnosing acute pancreatitis (AP), particularly severe acute pancreatitis (SAP). However, the diagnostic difference between CEUS and conventional ultrasonography (CUS) for AP and SAP has not been reported. The aim of the present study was to investigate the diagnostic accuracy of CUS and CEUS for AP. A total of 196 patients clinically diagnosed with AP were selected. All patients underwent CUS, CEUS and contrast-enhanced computed tomography (CECT) within 72 h. CECT was considered the gold standard. Pancreatic size, peripancreatic fluid collection (PPFC) and splenic vessel complications were the variables observed by CUS and CEUS. The differences in the variables among the three methods were analyzed using the χ2 test and statistical analysis software. Significant differences in pancreatic size, PPFC and splenic vessel complications in AP were observed between CEUS and CUS (P<0.05). χ2 test results indicated that CEUS significantly differed from CUS in terms of having a higher diagnostic accuracy for AP and SAP (P<0.05). The results indicate that CEUS is a reliable method for the diagnosis and monitoring of AP and SAP, and may be substituted for CECT.
Collapse
Affiliation(s)
- Diming Cai
- Department of Ultrasound, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P.R. China
| | - Shyam Sundar Parajuly
- Department of Ultrasound, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P.R. China
| | - Huiyao Wang
- Training Department of Resident Doctor, West China School of Medicine, Sichuan University, Chengdu, Sichuan 610041, P.R. China
| | - Xiaoling Wang
- Department of Operations Management, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P.R. China
| | - Wenwu Ling
- Department of Ultrasound, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P.R. China
| | - Bin Song
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P.R. China
| | - Yongzhong Li
- Department of Ultrasound, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P.R. China
| | - Yan Luo
- Department of Ultrasound, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P.R. China
- Correspondence to: Dr Yan Luo, Department of Ultrasound, West China Hospital, Sichuan University, 37 Guoxue Lane, Chengdu, Sichuan 610041, P.R. China, E-mail:
| |
Collapse
|
3
|
Zerem E, Imamović G, Latić F, Mavija Z. Prognostic value of acute fluid collections diagnosed by ultrasound in the early assessment of severity of acute pancreatitis. JOURNAL OF CLINICAL ULTRASOUND : JCU 2013; 41:203-209. [PMID: 22987623 DOI: 10.1002/jcu.21995] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/13/2012] [Accepted: 08/13/2012] [Indexed: 06/01/2023]
Abstract
PURPOSE To evaluate the prognostic value of acute fluid collections (AFC) diagnosed by conventional transabdominal ultrasound in the early assessment of severity acute pancreatitis (AP). METHODS We studied 128 consecutive patients with AP between March 2006 and March 2011. The predictor was the number of AFC. Outcome measure was the occurrence of complications. Abdominal sonogram, contrast-enhanced CT, and pancreatitis-specific clinical and laboratory findings were performed. RESULTS AFC were associated with complications (p < 0.0001), Balthazar grade (p = 0.004), Ranson score (p < 0.0001), and the majority of clinical, radiologic, and biochemical parameters for predicting complications of AP (p < 0.05). Univariate logistic regression also revealed significant association between the number of AFC and the occurrence of complications (OR 4.4; 95% CI 2.5-7.6). After the adjustment for covariates, AFC remained prognostic for complications and a cutoff point of >1 AFC was prognostic of their occurrence with 88% sensitivity and 82% specificity. CONCLUSIONS AFC are related to the clinical course of AP and can predict its severity
Collapse
Affiliation(s)
- Enver Zerem
- Department of Gastroenterology, University Clinical Center Tuzla, Tuzla, Bosnia and Herzegovina
| | | | | | | |
Collapse
|
4
|
Lu Q, Zhong Y, Wen XR, Huang ZW, Fan YT, Xia Q, Luo Y. Can contrast-enhanced ultrasound evaluate the severity of acute pancreatitis? Dig Dis Sci 2011; 56:1578-84. [PMID: 21113802 DOI: 10.1007/s10620-010-1460-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2010] [Accepted: 10/06/2010] [Indexed: 02/05/2023]
Abstract
OBJECTIVES To investigate the ability of contrast-enhanced ultrasound (CEUS) in the assessment of acute pancreatitis (AP), as well as its diagnostic accuracy in the evaluation of the severity of pancreatitis. METHODS A prospective double-blind study was carried out in 33 AP patients from May 2007 to January 2008. Each patient underwent both CEUS and contrast-enhanced computed tomography (CECT) with the time interval between two examinations less than 72 h. Using CECT as gold standard, the ability of CEUS to diagnose pancreatic necrosis as well as peripancreatic effusion and/or complications, and its diagnostic value in the evaluation of the severity of pancreatitis, were investigated. Balthazar's grading system was used to measure CT and ultrasound severity indices (CTSI and USSI), and the correlation between CTSI and USSI was tested by Spearman's rank correlation coefficient. RESULTS A strong correlation between CTSI and USSI was found (r = 0.92, P < 0.01).The sensitivity, specificity, accuracy, positive and negative predictive value of CEUS in the diagnosis of pancreatic parenchyma necrosis were 90, 95, 94, 90 and 95%, in the diagnosis of peripancreatic effusion and/or complications were 83, 100, 93, 100 and 91%, and in the diagnosis of severe pancreatitis were 97, 67, 94, 97 and 67%, respectively. CONCLUSIONS CEUS has shown to be of clinical value in the assessment of pancreatic necrosis as well as peripancreatic complications in AP and has a high diagnostic accuracy in the evaluation of the severity of pancreatitis. Further studies are needed to add it to the diagnostic algorithm for acute pancreatitis.
Collapse
Affiliation(s)
- Qiang Lu
- Department of Sonography, West China Hospital, Sichuan University, 610041, Chengdu, China
| | | | | | | | | | | | | |
Collapse
|
5
|
Schütte K, Malfertheiner P. Markers for predicting severity and progression of acute pancreatitis. Best Pract Res Clin Gastroenterol 2008; 22:75-90. [PMID: 18206814 DOI: 10.1016/j.bpg.2007.10.013] [Citation(s) in RCA: 65] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Several tools have been developed for severity stratification in acute pancreatitis. They include single biochemical markers, imaging methods, and complex scoring systems, all of which aim at an early detection of severe acute pancreatitis to optimise monitoring and treatment of patients as early as possible. Among single biochemical markers, C-reactive protein (CRP) remains the most useful. Despite its delayed increase, peaking not earlier than 72 h after the onset of symptoms, it is accurate and widely available. Many other markers have been evaluated for their usefulness, and for some of them very promising data could be shown. Among them interleukin 6 seems to be the most promising parameter for use in clinical routine. For the detection of pancreatic infection, procalcitonin is the most sensitive, and can be used as an indicator for the need for fine-needle aspiration of pancreatic necrosis. Regarding imaging, contrast-enhanced computed tomography is still the reference method for the detection of necrotising acute pancreatitis. Pancreatitis-specific scoring systems have been shown to be of value for the prediction of severity and progression of acute pancreatitis, but cannot be applied any earlier than 48 h after admission to hospital. The APACHE-II score has not been developed specifically for acute pancreatitis and is rather complex to assess, but has been proven to be an early and reliable tool. Indication, timing and consequences of the methods applied need to be carefully considered and incorporated into clinical assessments to avoid costs and harm to the patient.
Collapse
Affiliation(s)
- Kerstin Schütte
- Department of Gastroenterology, Hepatology and Infectious Diseases, Otto-von-Guericke University, Leipziger Str. 44, 39120 Magdeburg, Germany
| | | |
Collapse
|
6
|
Shaheen MA, Akhtar AJ. Organ failure associated with acute pancreatitis in African-American and Hispanic patients. J Natl Med Assoc 2007; 99:1402-1406. [PMID: 18229777 PMCID: PMC2575932] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
OBJECTIVE We studied the relationship between acute pancreatitis and organ failure in African-American and Hispanic patients. METHODS The medical records of 760 (417 African-American and 343 Hispanic) patients aged 19-85 years diagnosed with acute pancreatitis over 15 years were reviewed retrospectively. We abstracted and analyzed data related to demographics, etiology, type of pancreatitis, organ failure and mortality. RESULTS Of the 760 patients, 24% had organ failure. Of the 182 patients with organ failure, 125 patients (69%) had multiple organ failure, whereas 57 patients (31%) had single type. Cardiovascular system failure was the common organ dysfunction (28%). Of the 760 patients, 14% died. Patients with organ failure had a higher mortality (40%) compared with those without it (6%) (OR=9.6, 95% CI: 6.0-15.3) (P=0.001). Mortality was higher among those with multiple organ failure (46%) compared with those with single type (25%). Mortality was highest among those with pulmonary failure (57%). CONCLUSION The prevalence of organ failure in our study was slightly higher than the general population (20%). Mortality from single type was higher than that reported in previous studies (8-11%), especially mortality from pulmonary failure (18%). Prevention, early diagnosis and prompt treatment of organ failure may improve the clinical outcome.
Collapse
Affiliation(s)
- Magda A Shaheen
- Charles R. Drew University of Medicine and Science, 2594 Industry Way, Lynwood, CA 90262, USA.
| | | |
Collapse
|
7
|
Szentkereszty Z, Sápy P. The role of percutaneous external drainage in the treatment of fluid collections associated with severe acute pancreatitis. What, when and how to drain? Orv Hetil 2007; 148:1395-9. [PMID: 17631476 DOI: 10.1556/oh.2007.27999] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
A súlyos akut pancreatitist kísérő folyadékgyülem-képződéssel járó lokális szövődmények perkután drenázskezelése, főleg steril esetekben, nem széles körben alkalmazott eljárás. Jelen közlemény célja a perkután drenázs indikációjának, technikájának, korlátjainak és eredményének elemzése az irodalom alapján. A perkután drenázskezelés a súlyos akut pancreatitist kísérő akut folyadékgyülem, az akut pseudocysta és a hasnyálmirigytályog, valamint az elfolyósodott nekrózis kezelésében jelentős szerepet játszik. A fertőzött folyadékgyülemek kezelésére a perkután drenázs mint első kezelés ajánlható. A steril akut folyadékgyülem és pseudocysta kezelésében a drenázskezelés, a sterilitás szabályainak fokozott betartása mellett, a iatrogén fertőzés relatív gyakorisága miatt csak komoly panaszokat okozó esetekben ajánlott. Az elfolyósodott steril és szeptikus nekrózis kezelésében a legjobb eredménnyel a 20–30F vastagságú katéterekkel végzett drenázskezelés, a „sinus tract endoscopy” és a laparoszkóppal asszisztált necrectomia kecsegtet. Az esetek több mint 25%-ában a drenázs a konzervatív kezelés mellett a beteg végleges gyógyulásához vezet. Más esetekben a műtét időpontjának prolongálására, a „korai” műtét elkerülésére hasznos eljárás.
Collapse
Affiliation(s)
- Zsolt Szentkereszty
- Debreceni Egyetem, Orvos- és Egészségtudományi Centrum, Orvostudományi Kar Sebészeti Intézet, Auguszta Sebészeti Központ Debrecen.
| | | |
Collapse
|
8
|
Abstract
AIM: To investigate the relationship between severe acute pancreatitis (SAP) and organ failure.
METHODS: Clinical data of 74 cases of SAP from Jan. 1993 to Dec. 2002 were retrospectively reviewed, and the relationship between organ failure and age, gender, etiology, extent of necrosis, infection of necrosis and mortality was analyzed.
RESULTS: A total of 47 patients (63.5%) showed organ failure, 20 patients (27.0%) multiple organ failure, whereas 27 patients (36.5%) with dysfunction of a single organ system. Pulmonary failure was the most common organ dysfunction (23.0%) among single organ failures. There were no significant differences in age, gender and gallstone pancreatitis among patients with or without organ failure (P > 0.05). The incidence of organ failure in infected necrosis was not higher compared with sterile necrosis, and patients with increased amount of necrosis did not have an increased prevalence of organ failure (P > 0.05). Patients with organ failure had a higher mortality rate compared with those without organ failure (P < 0.05). The death of SAP was associated with multiple organ failure (P < 0.005), pulmonary failure (P < 0.005), cardiovascular dysfunction (P < 0.05) and gastrointestinal dysfunction (P < 0.05).
CONCLUSION: Organ failure is common in patients with SAP, and patients with multiple organ failure and pulmonary failure have a higher mortality rate. Prevention and active treatment of organ failure can improve the outcome of patients with SAP.
Collapse
Affiliation(s)
- Ai-Jun Zhu
- Department of General surgery, The First Hospital of Xi'an Jiaotong University, Xi'an 710061, Shaanxi Province, China.
| | | | | |
Collapse
|
9
|
Ding SP, Li JC, Jin C. A mouse model of severe acute pancreatitis induced with caerulein and lipopolysaccharide. World J Gastroenterol 2003; 9:584-9. [PMID: 12632523 PMCID: PMC4621587 DOI: 10.3748/wjg.v9.i3.584] [Citation(s) in RCA: 89] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM: To establish a non-traumatic, easy to induce and reproducible mouse model of severe acute pancreatitis (SAP) induced with caerulein and lipopolyasccharide (LPS).
METHODS: Thirty-two healthy mature NIH female mice were selected and divided at random into four groups (each of 8 mice), i.e., the control group (NS group), the caerulein group (Cn group), the lipopolysaccharide group (LPS group), and the caerulein+LPS group (Cn + LPS group). Mice were injected intraperitoneally with caerulein only, or LPS only, and caerulein and LPS in combination. All the animals were then killed by neck dislocation three hours after the last intraperitoneal injection. The pancreas and exo-pancreatic organs were then carefully removed for microscopic examination. And the pancreatic acinus was further observed under transmission electron microscope (TEM). Pancreatic weight, serum amylase, serum nitric oxide (NO) concentration, superoxide dismutase (SOD) and malondialdehyde (MDA) concentration of the pancreas were assayed respectively.
RESULTS: (1) NS animals displayed normal pancreatic structure both in the exocrine and endocrine. In the LPS group, the pancreas was slightly edematous, with the infiltration of a few inflammatory cells and the necrosis of the adjacent fat tissues. All the animals of the Cn group showed distinct signs of a mild edematous pancreatitis characterized by interstitial edema, infiltration of neutrophil and mononuclear cells, but without obvious parenchyma necrosis and hemorrhage. In contrast, the Cn + LPS group showed more diffuse focal areas of nonviable pancreatic and hemorrhage as well as systemic organ dysfunction. According to Schmidt’s criteria, the pancreatic histologic score showed that there existed significant difference in the Cn + LPS group in the interstitial edema, inflammatory infiltration, parenchyma necrosis and parenchyma homorrhage in comparison with those of the Cn group, LPS group and NS group (P < 0.01 or P < 0.05). (2) The ultrasturcture of acinar cells was seriously damaged in the Cn + LPS group. Chromatin margination of nuclei was present, the number and volume of vacuoles greatly increased. Zymogen granules (ZGs) were greatly decreased in number and endoplasmic reticulum exhibited whorls. The swollen mitochondria appeared, the crista of which was decreased in number or disappeared. (3) Pancreatic weight and serum amylase levels in the Cn +LPS was significantly higher than those of the NS group and the LPS group respectively (P < 0.01 or P < 0.05). However, the pancreatic wet weight and serum amylase concentration showed no significant difference between the Cn + LPS group and the Cn group. (4) NO concentration in the Cn + LPS group was significantly higher than that of NS group, LPS group and Cn group(P < 0.05 or P < 0.01). 5) The SOD and MDA concentration of the pancreas in the Cn + LPS group were significantly higher than those of NS, LPS and Cn groups (P < 0.05 or P < 0.01).
CONCLUSION: The mouse model of severe acute pancreatitis could be induced with caerulein and LPS, which could be non-traumatic and easy to induce, reproducible with the same pathological characteristics as those of SAP in human, and could be used in the research on the mechanism of human SAP.
Collapse
Affiliation(s)
- Shi-Ping Ding
- Department of Lymphology, Department of Histology and Embryology, Medical College of Zhejiang University, Hangzhou 310031, Zhejiang Province, China.
| | | | | |
Collapse
|
10
|
Zhou ZG, Chen YD, Sun W, Chen Z. Pancreatic microcirculatory impairment in experimental acute pancreatitis in rats. World J Gastroenterol 2002; 8:933-6. [PMID: 12378645 PMCID: PMC4656590 DOI: 10.3748/wjg.v8.i5.933] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM: To study the feature of pancreatic microcirculatory impairment, especially the initial changes, in caerulein-induced experimental acute pancreatitis (AP).
METHODS: The pancreatic microcirculation of caerulein-induced AP model was studied by intravital fluorescence microscopy with FITC-labeled erythrocytes (FITC-RBC), scanning electron microscopy of vascular corrosion casts, and light microscopy of Chinese ink-injected/cleared tissues.
RESULTS: Animals in caerulein-treated group showed hyperamylemia (× 2), pancreatic oedema, infiltration of inflammatory cells in pancreas. Constrictions of intralobular arteriolar sphincters, presence of vacuoles in all layers of sphincter, and gross irregularity in capillary network of acini were found in the AP specimens. The decrease of pancreatic capillary blood flow (0.34 ± 0.10 nL·min-1vs 0.91 ± 0.06 nL·min-1 of control, P < 0.001), reduction of functional capillary density (277 ± 13 cm-1vs 349 ± 8 cm-1 of control, P < 0.001), and irregular intermittent perfusion were observed in caerulein-induced groups.
CONCLUSION: Impairment and constriction of pancreatic intralobular arteriolar sphincter are the initial microcirculatory lesions in the early phase of acute pancreatitis, and play a key role in the pancreatic ischaemia and pancreatic microvascular failure in acute pancreatitis.
Collapse
Affiliation(s)
- Zong-Guang Zhou
- III Department of General Surgery (Gastroenteric Surgery), West China Hospital, Sichuan University, Chengdu 610041, Sichuan, China.
| | | | | | | |
Collapse
|