Assessment of severity of acute pancreatitis over time

Cofaru, F; Nica, Silvia; Fierbinţeanu-Braticevici, Carmen

doi:10.2478/rjim-2020-0003

Cited by 12 publications

(7 citation statements)

References 26 publications

(29 reference statements)

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“…Moreover, the genetic aspect seems to be correlated with chronic pancreatitis [ 54 ], an important risk factor for PC [ 55 ], leading to endocrine and exocrine dysfunction [ 56 ]. Pancreatitis pathology is characterized by malabsorption, steatorrhea, fat-soluble vitamin deficiency, osteoporosis, and diabetes [ 56 , 57 ]. Patients diagnosed with chronic pancreatitis have a 14-fold risk of developing PC [ 58 ].…”

Section: Pancreatic Cancer Risk Factorsmentioning

confidence: 99%

Targeting PI3K/AKT/mTOR Signaling Pathway in Pancreatic Cancer: From Molecular to Clinical Aspects

Stanciu¹,

Ioniţă-Radu²,

Ştefani³

et al. 2022

IJMS

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Although pancreatic cancer (PC) was considered in the past an orphan cancer type due to its low incidence, it may become in the future one of the leading causes of cancer death. Pancreatic ductal adenocarcinoma (PDAC) is the most frequent type of PC, being a highly aggressive malignancy and having a 5-year survival rate of less than 10%. Non-modifiable (family history, age, genetic susceptibility) and modifiable (smoking, alcohol, acute and chronic pancreatitis, diabetes mellitus, intestinal microbiota) risk factors are involved in PC pathogenesis. Chronic inflammation induced by various factors plays crucial roles in PC development from initiation to metastasis. In multiple malignant conditions such as PC, cytokines, chemokines, and growth factors activate the class I phosphoinositide 3-kinase (PI3K)/protein kinase B (AKT)/mammalian target of rapamycin (mTOR) (PI3K/AKT/mTOR) signaling pathway, which plays key roles in cell growth, survival, proliferation, metabolism, and motility. Currently, mTOR, AKT, and PI3K inhibitors are used in clinical studies. Moreover, PI3K/mTOR dual inhibitors are being tested in vitro and in vivo with promising results for PC patients. The main aim of this review is to present PC incidence, risk factors, tumor microenvironment development, and PI3K/AKT/mTOR dysregulation and inhibitors used in clinical, in vivo, and in vitro studies.

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Section: Pancreatic Cancer Risk Factorsmentioning

confidence: 99%

Targeting PI3K/AKT/mTOR Signaling Pathway in Pancreatic Cancer: From Molecular to Clinical Aspects

Stanciu¹,

Ioniţă-Radu²,

Ştefani³

et al. 2022

IJMS

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“…[23] SAPS-II is an alternative version of the APACHE scale that is frequently used in the ICU setting. [24] Notably, SAPS-II is a predictor of mortality in patients with AP. [25] As such, all five of the predictors incorporated into our developed nomogram represent credible mortality-related risk factors worthy of consideration in clinical research.…”

Section: Discussionmentioning

confidence: 99%

Development and validation of a nomogram for predicting survival in patients with acute pancreatitis

Zhu¹,

Jiang²,

Li³

et al. 2023

World Journal of Emergency Medicine

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BACKGROUND: Acute pancreatitis (AP) is a complex and heterogeneous disease. We aimed to design and validate a prognostic nomogram for improving the prediction of short-term survival in patients with AP. METHODS:The clinical data of 632 patients with AP were obtained from the Medical Information Mart for Intensive Care (MIMIC)-IV database. The nomogram for the prediction of 30-day, 60-day and 90-day survival was developed by incorporating the risk factors identifi ed by multivariate Cox analyses. RESULTS:Multivariate Cox proportional hazard model analysis showed that age (hazard ratio [HR]=1.06, 95% confi dence interval [95% CI] 1.03-1.08, P<0.001), white blood cell count (HR=1.03, 95% CI 1.00-1.06, P=0.046), systolic blood pressure (HR=0.99, 95% CI 0.97-1.00, P=0.015), serum lactate level (HR=1.10, 95% CI 1.01-1.20, P=0.023), and Simplified Acute Physiology Score II (HR=1.04, 95% CI 1.02-1.06, P<0.001) were independent predictors of 90-day mortality in patients with AP. A prognostic nomogram model for 30-day, 60-day, and 90-day survival based on these variables was built. Receiver operating characteristic (ROC) curve analysis demonstrated that the nomogram had good accuracy for predicting 30-day, 60-day, and 90-day survival (area under the ROC curve: 0.796, 0.812, and 0.854, respectively; bootstrap-corrected C-index value: 0.782, 0.799, and 0.846, respectively). CONCLUSION:The nomogram-based prognostic model was able to accurately predict 30day, 60-day, and 90-day survival outcomes and thus may be of value for risk stratifi cation and clinical decision-making for critically ill patients with AP.

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“…It was recommended that nasojejunal route could be selected for nutritional support for patients after surgical intervention. Another study (26) showed that SAP patients with early enteral feeding (usually in 24h after admission) would reducing the rate of infection or death, which is another intervention demonstrated to be clinical benefit in the management of patients with pancreatitis Over the years there are many classifications and scores to diagnose and assess the severity of the SAP such as the APACHE Score, and the Ranson score, (27). Temporarily there are no directly pharmacotherapy for treating with SAP, strategies are targeted at preventing end-organ damage or reducing complications (28).…”

Section: Discussionmentioning

confidence: 99%

A systematic review and meta-analysis of the effect of total parenteral nutrition and enteral nutrition on the prognosis of patients with acute pancreatitis

Liu

Gao²

2021

Ann Palliat Med

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Background: Nutritional support is very important in the treatment of severe acute pancreatitis, this study aimed to investigate the effect of total parenteral nutrition (TPN) and enteral nutrition (TEN) on the prognosis of patients with acute pancreatitis. Methods:The databases of PubMed, Embase, Cochrane Library, and Ovid were searched using the keywords acute pancreatitis, enteral nutrition, and parenteral nutrition to obtain the reports of randomized controlled trials (RCTs) published after 2000. After screening the articles according to the inclusion criteria, risk of bias of the included literatures was evaluated using the Cochrane Handbook for Systematic Reviews.The software RevMan 5.3.5 was used for analysis and the creation of a forest plot and funnel plot.Results: A total of 488 literatures were preliminarily searched in this study, from which 10 articles were included into the final quantitative analysis, involving a total of 699 participants. A total of 6 literatures (n=329 participants) reported the infection rate indicators. The obtained statistic value [odds ratio (OR) =0.25, 95% confidence interval (CI): 0.10 to 0.62] showed TEN had less infection rate that TPN (P=0.003). A total of 8 studies (654 participants) reported the incidence rate indicators of multiple organ failure rate indicator, the obtained statistic value (OR =0.50, 95% CI: 0.24 to 1.08) showed no statistical difference between TEN and TPN (P>0.05). A total of 7 studies (550 participants) reported the mortality indicators. The obtained statistic value (OR =0.59, 95% CI: 0.37 to 0.94) showed TEN had less mortality than TPN (P=0.03). A total of 3 studies reported the length of hospital stay indicators. The obtained statistic value [mean difference (MD) −4.18, 95% CI: −5.07 to −3.30] showed the length of hospital stay for TEN was shorter that TPN (P<0.001).Discussion: Compared with TPN, TEN can reduce the incidence of infection, reduce the development of multiple organ failure, reduce mortality, and shorten the length of hospital stay in patients with severe acute pancreatitis (SAP). However, attention should be paid to prevent the occurrence of complications during the implementation of nutritional intervention.

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Assessment of severity of acute pancreatitis over time

Cited by 12 publications

References 26 publications

Targeting PI3K/AKT/mTOR Signaling Pathway in Pancreatic Cancer: From Molecular to Clinical Aspects

Targeting PI3K/AKT/mTOR Signaling Pathway in Pancreatic Cancer: From Molecular to Clinical Aspects

Development and validation of a nomogram for predicting survival in patients with acute pancreatitis

A systematic review and meta-analysis of the effect of total parenteral nutrition and enteral nutrition on the prognosis of patients with acute pancreatitis

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