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Hidalgo NJ, Pando E, Mata R, Fernandes N, Villasante S, Barros M, Herms D, Blanco L, Balsells J, Charco R. Impact of comorbidities on hospital mortality in patients with acute pancreatitis: a population-based study of 110,021 patients. BMC Gastroenterol 2023; 23:81. [PMID: 36949385 PMCID: PMC10035222 DOI: 10.1186/s12876-023-02730-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Accepted: 03/16/2023] [Indexed: 03/24/2023] Open
Abstract
BACKGROUND The impact of pre-existing comorbidities on acute pancreatitis (AP) mortality is not clearly defined. Our study aims to determine the trend in AP hospital mortality and the role of comorbidities as a predictor of hospital mortality. METHODS We analyzed patients aged ≥ 18 years hospitalized with AP diagnosis between 2016 and 2019. The data have been extracted from the Spanish National Hospital Discharge Database of the Spanish Ministry of Health. We performed a univariate and multivariable analysis of the association of age, sex, and comorbidities with hospital mortality in patients with AP. The role of the Charlson and Elixhauser comorbidity indices as predictors of mortality was evaluated. RESULTS A total of 110,021 patients diagnosed with AP were hospitalized during the analyzed period. Hospital mortality was 3.8%, with a progressive decrease observed in the years evaluated. In multivariable analysis, age ≥ 65 years (OR: 4.11, p < 0.001), heart disease (OR: 1.73, p < 0.001), renal disease (OR: 1.99, p < 0.001), moderate-severe liver disease (OR: 2.86, p < 0.001), peripheral vascular disease (OR: 1.43, p < 0.001), and cerebrovascular disease (OR: 1.63, p < 0.001) were independent risk factors for mortality. The Charlson > 1.5 (OR: 2.03, p < 0.001) and Elixhauser > 1.5 (OR: 2.71, p < 0.001) comorbidity indices were also independently associated with mortality, and ROC curve analysis showed that they are useful for predicting hospital mortality. CONCLUSIONS Advanced age, heart disease, renal disease, moderate-severe liver disease, peripheral vascular disease, and cerebrovascular disease before admission were independently associated with hospital mortality. The Charlson and Elixhauser comorbidity indices are useful for predicting hospital mortality in AP patients.
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Affiliation(s)
- Nils Jimmy Hidalgo
- Universitat Autonoma de Barcelona, Barcelona, Spain
- Department of Hepato-Pancreato-Biliary and Transplant Surgery, Hospital Universitari Vall d'Hebron, Passeig de La Vall d'Hebron, 119-129. 08035, Barcelona, Spain
| | - Elizabeth Pando
- Universitat Autonoma de Barcelona, Barcelona, Spain.
- Department of Hepato-Pancreato-Biliary and Transplant Surgery, Hospital Universitari Vall d'Hebron, Passeig de La Vall d'Hebron, 119-129. 08035, Barcelona, Spain.
| | - Rodrigo Mata
- Department of Hepato-Pancreato-Biliary and Transplant Surgery, Hospital Universitari Vall d'Hebron, Passeig de La Vall d'Hebron, 119-129. 08035, Barcelona, Spain
| | - Nair Fernandes
- Department of Hepato-Pancreato-Biliary and Transplant Surgery, Hospital Universitari Vall d'Hebron, Passeig de La Vall d'Hebron, 119-129. 08035, Barcelona, Spain
| | - Sara Villasante
- Department of Hepato-Pancreato-Biliary and Transplant Surgery, Hospital Universitari Vall d'Hebron, Passeig de La Vall d'Hebron, 119-129. 08035, Barcelona, Spain
| | - Marta Barros
- Department of Hepato-Pancreato-Biliary and Transplant Surgery, Hospital Universitari Vall d'Hebron, Passeig de La Vall d'Hebron, 119-129. 08035, Barcelona, Spain
| | - Daniel Herms
- Department of Hepato-Pancreato-Biliary and Transplant Surgery, Hospital Universitari Vall d'Hebron, Passeig de La Vall d'Hebron, 119-129. 08035, Barcelona, Spain
| | - Laia Blanco
- Department of Hepato-Pancreato-Biliary and Transplant Surgery, Hospital Universitari Vall d'Hebron, Passeig de La Vall d'Hebron, 119-129. 08035, Barcelona, Spain
| | - Joaquim Balsells
- Department of Hepato-Pancreato-Biliary and Transplant Surgery, Hospital Universitari Vall d'Hebron, Passeig de La Vall d'Hebron, 119-129. 08035, Barcelona, Spain
| | - Ramon Charco
- Department of Hepato-Pancreato-Biliary and Transplant Surgery, Hospital Universitari Vall d'Hebron, Passeig de La Vall d'Hebron, 119-129. 08035, Barcelona, Spain
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Hidalgo NJ, Pando E, Alberti P, Mata R, Fernandes N, Adell M, Villasante S, Blanco L, Balsells J, Charco R. The role of high serum triglyceride levels on pancreatic necrosis development and related complications. BMC Gastroenterol 2023; 23:51. [PMID: 36829113 PMCID: PMC9955530 DOI: 10.1186/s12876-023-02684-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Accepted: 02/17/2023] [Indexed: 02/26/2023] Open
Abstract
BACKGROUND The relevance of elevated serum triglyceride (TG) levels in the early stages of acute pancreatitis (AP) not induced by hypertriglyceridemia (HTG) remains unclear. Our study aims to determine the role of elevated serum TG levels at admission in developing pancreatic necrosis. METHODS We analyzed the clinical data collected prospectively from patients with AP. According to TG levels measured in the first 24 h after admission, we stratified patients into four groups: Normal TG (< 150 mg/dL), Borderline-high TG (150-199 mg/dL), High TG (200-499 mg/dL) and Very high TG (≥ 500 mg/dL). We analyzed the association of TG levels and other risk factors with the development of pancreatic necrosis. RESULTS A total of 211 patients were included. In the Normal TG group: 122, in Borderline-high TG group: 38, in High TG group: 44, and in Very high TG group: 7. Pancreatic necrosis developed in 29.5% of the patients in the Normal TG group, 26.3% in the Borderline-high TG group, 52.3% in the High TG group, and 85.7% in the Very high TG group. The trend analysis observed a significant association between higher TG levels and pancreatic necrosis (p = 0.001). A multivariable analysis using logistic regression showed that elevated TG levels ≥ 200 mg/dL (High TG and Very high TG groups) were independently associated with pancreatic necrosis (OR: 3.27, 95% CI - 6.27, p < 0.001). CONCLUSIONS An elevated TG level at admission ≥ 200 mg/dl is independently associated with the development of pancreatic necrosis. The incidence of pancreatic necrosis increases proportionally with the severity of HTG.
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Affiliation(s)
- Nils Jimmy Hidalgo
- grid.7080.f0000 0001 2296 0625Universitat Autonoma de Barcelona, Bellaterra, Spain ,grid.411083.f0000 0001 0675 8654Department of Hepato-Pancreato-Biliary and Transplant Surgery, Hospital Universitari Vall d’Hebron, 119 Passeig de la Vall d’Hebron, 08035 Barcelona, Spain
| | - Elizabeth Pando
- Universitat Autonoma de Barcelona, Bellaterra, Spain. .,Department of Hepato-Pancreato-Biliary and Transplant Surgery, Hospital Universitari Vall d'Hebron, 119 Passeig de la Vall d'Hebron, 08035, Barcelona, Spain.
| | - Piero Alberti
- grid.411083.f0000 0001 0675 8654Department of Hepato-Pancreato-Biliary and Transplant Surgery, Hospital Universitari Vall d’Hebron, 119 Passeig de la Vall d’Hebron, 08035 Barcelona, Spain
| | - Rodrigo Mata
- grid.411083.f0000 0001 0675 8654Department of Hepato-Pancreato-Biliary and Transplant Surgery, Hospital Universitari Vall d’Hebron, 119 Passeig de la Vall d’Hebron, 08035 Barcelona, Spain
| | - Nair Fernandes
- grid.411083.f0000 0001 0675 8654Department of Hepato-Pancreato-Biliary and Transplant Surgery, Hospital Universitari Vall d’Hebron, 119 Passeig de la Vall d’Hebron, 08035 Barcelona, Spain
| | - Montse Adell
- grid.411083.f0000 0001 0675 8654Department of Hepato-Pancreato-Biliary and Transplant Surgery, Hospital Universitari Vall d’Hebron, 119 Passeig de la Vall d’Hebron, 08035 Barcelona, Spain
| | - Sara Villasante
- grid.411083.f0000 0001 0675 8654Department of Hepato-Pancreato-Biliary and Transplant Surgery, Hospital Universitari Vall d’Hebron, 119 Passeig de la Vall d’Hebron, 08035 Barcelona, Spain
| | - Laia Blanco
- grid.411083.f0000 0001 0675 8654Department of Hepato-Pancreato-Biliary and Transplant Surgery, Hospital Universitari Vall d’Hebron, 119 Passeig de la Vall d’Hebron, 08035 Barcelona, Spain
| | - Joaquim Balsells
- grid.411083.f0000 0001 0675 8654Department of Hepato-Pancreato-Biliary and Transplant Surgery, Hospital Universitari Vall d’Hebron, 119 Passeig de la Vall d’Hebron, 08035 Barcelona, Spain
| | - Ramon Charco
- grid.411083.f0000 0001 0675 8654Department of Hepato-Pancreato-Biliary and Transplant Surgery, Hospital Universitari Vall d’Hebron, 119 Passeig de la Vall d’Hebron, 08035 Barcelona, Spain
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Lopes PFM, Mendes L, Fonseca V, Villasante S. Tourism as a driver of conflicts and changes in fisheries value chains in Marine Protected Areas. J Environ Manage 2017; 200:123-134. [PMID: 28575780 DOI: 10.1016/j.jenvman.2017.05.080] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/24/2016] [Revised: 05/17/2017] [Accepted: 05/26/2017] [Indexed: 06/07/2023]
Abstract
Although critical tools for protecting ocean habitats, Marine Protected Areas (MPAs) are sometimes challenged for social impacts and conflicts they may generate. Some conflicts have an economic base, which, once understood, can be used to resolve associated socioenvironmental problems. We addressed how the fish trade in an MPA that combines no-take zones and tourist or resident zones creates incentives for increased fisheries. We performed a value chain analysis following the fish supply and trade through interviews that assessed consumer demand and preference. The results showed a simple and closed value chain driven by tourism (70% of the consumption). Both tourists and local consumers preferred high trophic level species (predators), but the former preferred large pelagics (tuna and dolphinfish) and the latter preferred reef species (barracuda and snapper). Pelagic predators are caught with fresh sardines, which are sometimes located only in the no-take zone. Pelagic species are mainly served as fillet, and the leftover fish parts end up as waste, an issue that, if properly addressed, can help reduce fishing pressure. Whereas some of the target species may be sustainable (e.g., dolphinfish), others are more vulnerable (e.g., wahoo) and should not be intensively fished. We advise setting stricter limits to the number of tourists visiting MPAs, according to their own capacity and peculiarities, in order to avoid conflicts with conservations goals through incentives for increased resource use.
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Affiliation(s)
- P F M Lopes
- Department of Ecology, Federal University of Rio Grande do Norte, Natal, Brazil; Fisheries and Food Institute, Santos, SP, Brazil; Fishing Ecology, Management and Economics (FEME), Natal, Brazil.
| | - L Mendes
- Department of Ecology, Federal University of Rio Grande do Norte, Natal, Brazil
| | - V Fonseca
- Graduate Program in Ecology, Federal University of Rio Grande do Norte, Natal, Brazil
| | - S Villasante
- Faculty of Political and Social Sciences, University of Santiago de Compostela, A Coruña, Spain
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Villasante S, Arreguín-Sánchez F, Heymans J, Libralato S, Piroddi C, Christensen V, Coll M. Modelling marine ecosystems using the Ecopath with Ecosim food web approach: New insights to address complex dynamics after 30 years of developments. Ecol Modell 2016. [DOI: 10.1016/j.ecolmodel.2016.04.017] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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