A Clinically Based Classification System for Acute Pancreatitis

Bradley, Edward L.

doi:10.1001/archsurg.1993.01420170122019

Cited by 2,530 publications

(1,375 citation statements)

References 38 publications

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“…Data collected on admission included age, sex, delay from pain onset to admission, and Glasgow score [9]. A severe outcome was defined according to the Atlanta criteria [10]. AP was defined as edematous or necrotic according to the contrast-enhanced CT findings.…”

Section: Methodsmentioning

confidence: 99%

Plasma Calprotectin Levels in Patients Suffering from Acute Pancreatitis

Carroccio

Rocco²,

Rabitti³

et al. 2006

Dig Dis Sci

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Calprotectin (Cal) concentration is elevated in acute inflammatory reactions and its increase in the plasma suggests a diagnostic potential for Cal assay. This study aimed (a) to evaluate the Cal plasma levels in patients suffering from acute pancreatitis (AP) and (b) to assess whether early assay of Cal plasma levels can be helpful in assessment of the severity of AP. Forty-six consecutive patients, median age 45 years, suffering from a first attack of AP were recruited at two medical centers. Data collected on admission included age, sex, delay between pain onset and admission, and Glasgow score. A severe outcome was defined according to the Atlanta criteria. AP was defined as edematous or necrotic according to the CT findings. Plasma Cal and serum C reactive protein (CRP) were assayed in all patients within the first 24 hr after hospitalization. Sixty subjects suffering from blood hypertension were recruited as controls. Plasma Cal was measured by a commercial ELISA system. In all AP patients and in none of the controls, plasma Cal concentration was higher than the normal limit. Cal values in AP pa- tients were significantly higher than in controls (P < 0.0001). There was not a statistically significant difference in Cal values between patients with severe and patients with mild AP. Plasma Cal values did not differ in necrotizing and edematous AP. During the follow-up plasma Cal was reassayed in six of the patients with abdominal fluid collection and the values were higher in the two patients with infected necrosis. We conclude that plasma Cal is elevated in patients with AP but it is not a useful marker for early prediction of pancreatitis severity. Further studies could evaluate its usefulness in pancreatic infected necrosis.

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Section: Methodsmentioning

confidence: 99%

Plasma Calprotectin Levels in Patients Suffering from Acute Pancreatitis

Carroccio

Rocco²,

Rabitti³

et al. 2006

Dig Dis Sci

View full text Add to dashboard Cite

show abstract

“…The diagnosis of acute pancreatitis is based on clinical features (abdominal pain) and elevation of plasma concentrations of pancreatic enzymes, if indicated supplemented by imaging techniques [1-4]. Gallstone disease is reported to account for approximately half of all cases with acute pancreatitis and alcohol abuse for 20–25%[5] with great variations between regions and over time.…”

Section: Introductionmentioning

confidence: 99%

First attack of acute pancreatitis in Sweden 1988 – 2003: incidence, aetiological classification, procedures and mortality – a register study

et al. 2009

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BackgroundPopulation-based studies suggest that the incidence of first attack of acute pancreatitis (FAAP) is increasing and that old age is associated with increased mortality. Beacuse nationwide data are limited and information on standardized mortality ratio (SMR) versus age is lacking, we wanted to describe incidence and mortality of first attack acute pancreatitis (FAAP) in Sweden.MethodsHospital discharge data concerning diagnoses and surgical procedures and death certificate data were linked for patients with FAAP in Sweden. Mortality was calculated as case fatality rate (CFR), i.e. deaths per 1000 patients and SMR using age-, gender- and calendar year-specific expected survival estimates, and is given as mean with 95% confidence intervals. Data are presented as median values with 25% and 75% percentiles, means and standard deviations, or proportions. Proportions have been compared using the chi square test, Poisson-regression test or Fisher exact test. Location of two groups of ratio scale variables were compared using independent samples t-test or Mann-Whitney U-test.ResultsFrom 1988 through 2003, 43415 patients (23801 men and 19614 women) were admitted for FAAP. Age adjusted incidence rose from 27.0 to 32.0 per 100000 individuals and year. Incidence increased with age for both men and women. At index stay 19.7% of men and 35.4% of women had biliary diagnoses, and 7.1% of men and 2.1% of women alcohol-related diagnoses. Of 10072 patients who underwent cholecystectomy, 7521 (74.7%) did so after index stay within the audit period. With increasing age CFR increased and SMR decreased. For the whole period studied SMR was 11.75 (11.34–12.17) within 90 days of index admission and 2.03 (1.93–2.13) from 91 to 365 days. Alcohol-related diagnoses and young age was associated with increased SMR. Length of stay and SMR decreased significantly during the audit period.ConclusionIncidence of FAAP increased slightly from 1988 to 2003. Incidence increased and SMR declined with increasing patient age. Although the prognosis for patients with FAAP has improved it remains an important health problem. Aetiological classification at index stay and timing of cholecystectomy should be improved.

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“…The clinical course of acute pancreatitis may vary from a mild self-limiting disease to a life-threatening illness (1,2). Patients whose condition progresses to severe disease may require intensive therapy, which may include surgery, and such treatment may require admission to a specialized center.…”

Section: Discussionmentioning

confidence: 99%

Outcome Analysis of Patients with Acute Pancreatitis by Using an Artificial Neural Network

Keogan

Freed

et al. 2002

Academic Radiology

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Rationale and Objectives. The authors performed this study to evaluate the ability of an artificial neural network (ANN) that uses radiologic and laboratory data to predict the outcome in patients with acute pancreatitis. Materials andMethods. An ANN was constructed with data from 92 patients with acute pancreatitis who underwent computed tomography (CT). Input nodes included clinical, laboratory, and CT data. The ANN was trained and tested by using a round-robin technique, and the performance of the ANN was compared with that of linear discriminant analysis and Ranson and Balthazar grading systems by using receiver operating characteristic analysis. The length of hospital stay was used as an outcome measure.Results. Hospital stay ranged from 0 to 45 days, with a mean of 8.4 days. The hospital stay was shorter than the mean for 62 patients and longer than the mean for 30. The 23 input features were reduced by using stepwise linear discriminant analysis, and an ANN was developed with the six most statistically significant parameters (blood pressure, extent of inflammation, fluid aspiration, serum creatinine level, serum calcium level, and the presence of concurrent severe illness). With these features, the ANN successfully predicted whether the patient would exceed the mean length of stay (A z ϭ 0.83 Ϯ 0.05). Although the A z performance of the ANN was statistically significantly better than that of the Ranson (A z ϭ 0.68 Ϯ 0.06, P Ͻ .02) and Balthazar (A z ϭ 0.62 Ϯ 0.06, P Ͻ .003) grades, it was not significantly better than that of linear discriminant analysis (A z ϭ 0.82 Ϯ 0.05, P ϭ .53).Conclusion. An ANN may be useful for predicting outcome in patients with acute pancreatitis. Key Words. Computers, diagnostic aid; computers, ANN; pancreatitis. © AUR, 2002An episode of acute pancreatitis may run a variable and unpredictable course (1,2). Prediction of the likely severity of an episode in an individual patient is difficult but has implications for the institution of therapy and for patient information. For this reason, several predictive systems have been devised. Some of these systems are based on clinical criteria (eg, the Ranson and the acute physiology and chronic health evaluation [APACHE] scoring systems [2-4]), whereas others, such as the Balthazar system (5,6), are based on radiologic features at computed tomography (CT) (Fig 1). To our knowledge, no system has been devised in which both clinical and radiologic indicators are combined to predict severity or outcome. In this study, this task was investigated by using two multivariate decision model approaches: an artificial neural network (ANN) and linear discriminant analysis.ANNs are computer models composed of parallel, nonlinear computational elements arranged in layers with a

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A Clinically Based Classification System for Acute Pancreatitis

Cited by 2,530 publications

References 38 publications

Plasma Calprotectin Levels in Patients Suffering from Acute Pancreatitis

Plasma Calprotectin Levels in Patients Suffering from Acute Pancreatitis

First attack of acute pancreatitis in Sweden 1988 – 2003: incidence, aetiological classification, procedures and mortality – a register study

Outcome Analysis of Patients with Acute Pancreatitis by Using an Artificial Neural Network

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