Determinants of severity in acute pancreatitis, a nation-wide prospective multicenter study

Sternby, Hanna; Bolado, Federico; Canaval-Zuleta, Héctor J.; Marra-López, Carlos; Hernándo-Alonso, Ana I.; del-Val-Antoñana, Adolfo; García-Rayado, Guillermo; Irigoin, Robin Rivera; Grau-García, Francisco J.; Oms, Lluís; Millastre-Bocos, Judith; Pascual-Moreno, Isabel; Martı́nez-Ares, David; Rodríguez-Oballe, Juan A.; López-Serrano, Antonio; Ruiz-Rebollo, María Lourdes; Viejo-Almanzor, Alejandro; Zapater, Pedro; de–Madaria, Enrique

doi:10.1016/j.pan.2017.05.212

Cited by 29 publications

(66 citation statements)

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“…According to AP guidelines, patients with mild disease do not require a CECT unless another diagnosis needs to be excluded 27 . As a result, the group of patients with mild AP is likely to be smaller in radiology studies, as well as those with moderately severe diseases are more numerous compared with studies with consecutive inclusion of all AP patients 28 . We also acknowledge that the impact of oedema on our results, as well as those of all previous studies on body parameters in AP, remains largely unknown.…”

Section: Discussionmentioning

confidence: 91%

Mean muscle attenuation correlates with severe acute pancreatitis unlike visceral adipose tissue and subcutaneous adipose tissue

Sternby¹,

Mahle

Linder

et al. 2019

UEG Journal

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Background Acute pancreatitis (AP) is a frequent disorder with considerable morbidity and mortality. Obesity has previously been reported to influence disease severity. Objective The aim of this study was to investigate the association of adipose and muscle parameters with the severity grade of AP. Methods In total 454 patients were recruited. The first contrast-enhanced computed tomography of each patient was reviewed for adipose and muscle tissue parameters at L3 level. Associations with disease severity were analysed through logistic regression analysis. The predictive capacity of the parameters was investigated using receiver operating characteristic (ROC) curves. Results No distinct variation was found between the AP severity groups in either adipose tissue parameters (visceral adipose tissue and subcutaneous adipose tissue) or visceral muscle ratio. However, muscle mass and mean muscle attenuation differed significantly with p-values of 0.037 and 0.003 respectively. In multivariate analysis, low muscle attenuation was associated with severe AP with an odds ratio of 4.09 (95% confidence intervals: 1.61–10.36, p-value 0.003). No body parameter presented sufficient predictive capability in ROC-curve analysis. Conclusions Our results demonstrate that a low muscle attenuation level is associated with an increased risk of severe AP. Future prospective studies will help identify the underlying mechanisms and characterise the influence of body composition parameters on AP.

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Section: Discussionmentioning

confidence: 91%

Mean muscle attenuation correlates with severe acute pancreatitis unlike visceral adipose tissue and subcutaneous adipose tissue

Sternby¹,

Mahle

Linder

et al. 2019

UEG Journal

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“…All local complications increase morbidity in AP, but only an increase of mortality occurs if persistent OF is present 9 . The infection of pancreatic or peri‐pancreatic necrosis is particularly associated with worse outcomes.…”

Section: Natural Historymentioning

confidence: 99%

“…OF can be transient (up to 48 hours) or persistent (lasting for more than 48 hours) and single or multiple (if more than one system is affected). Any OF increases morbidity and mortality, but the risk of mortality is greatly increased in persistent OF and/or multiple OF (approximately 50% mortality in both types of OF according to prospective data) 9 …”

Section: Natural Historymentioning

confidence: 99%

“…Moderately severe AP is characterised by local complications and/or systemic complications (exacerbation of pre‐existing co‐morbidity) and/or transient OF, and is associated with increased morbidity but low mortality. Finally, the severe category is defined by persistent OF, and is linked to maximum morbidity and a high risk of mortality 9 . The early prediction of severity in AP is not fully addressed in this review, but briefly, advanced age, patients with obesity, co‐morbidity, increased serum blood urea nitrogen and/or haematocrit, patients with SIRS (particularly if lasting for more than two days) have a higher probability of adverse outcomes 9,12 .…”

Section: Natural Historymentioning

confidence: 99%

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Towards evidence‐based and personalised care of acute pancreatitis

2020

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Acute pancreatitis is a heterogeneous illness. Most patients experience a mild course of disease, but one third will develop local complications and/or organ failure associated with increased morbidity and risk of mortality. Diagnosis of acute pancreatitis is based on typical epigastric pain, elevation of serum lipase or amylase levels, and/or characteristic findings on imaging. Personalised management is needed in patients with acute pancreatitis. Currently, analgesia, Ringer’s lactate solution-based goal-directed fluid resuscitation and early oral refeeding providing enteral nutrition if not tolerated are the cornerstones for early management. Prophylactic antibiotics or endoscopic retrograde cholangiopancreatography in the absence of cholangitis are considered to be futile. Future clinical trials should address optimal fluid resuscitation, the early administration of anti-inflammatory drugs and the exact role of nutritional support in severe acute pancreatitis. Here, we present a patient case and review the diagnosis, treatment and prognosis of acute pancreatitis.

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“…Acute pancreatitis (AP) is a common inflammatory disease caused by multiple factors, which can result in an approximately 35% mortality when progressing into severe acute pancreatitis (SAP) [1,2]. SAP is characterized by systemic inflammatory responses (SIRS) and multiple organ dysfunction syndromes (MODS).…”

Section: Introductionmentioning

confidence: 99%

Mesenteric Lymph Duct Ligation Alleviates Acute Lung Injury Caused by Severe Acute Pancreatitis Through Inhibition of High Mobility Group Box 1-Induced Inflammation in Rats

et al. 2021

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Background Acute lung injury (ALI) is the most common complication and one of the leading causes of mortality of severe acute pancreatitis (SAP). Nevertheless, no effective therapeutic schemes are presently available. Aims To investigate the effect and potential mechanism of mesenteric lymph duct ligation (MLDL) on experimental SAP-induced ALI. Methods Immediately following MLDL, rats were subjected to SAP by retrograde injection of 5% sodium taurocholate into the biliopancreatic duct. At 24 h after modeling, tissues were collected for morphological examination. The levels of TNF-α, IL-6, intercellular adhesion molecule-1 (ICAM1), diamine oxidase (DAO), and D -lactic acid ( D -LA) in serum, and the myeloperoxidase (MPO) activity in lung tissues were determined. Moreover, the expressions of high mobility group box 1 (HMGB1), receptor of advanced glycation endproducts (RAGE), and NF-κB p65 at the mRNA and protein levels in lung tissues, and the expressions of HMGB1, RAGE, and TNF-α at the mRNA level in intestinal lymphoid tissues were evaluated. Results MLDL significantly attenuated the histological injury of the pancreas and lung and reduced the production of TNF-α, IL-6, and ICAM1. Besides, MLDL repressed the activity of MPO in the lung. However, the levels of serum DAO and D -LA were decreased without obvious morphological improvement in intestinal injury. Moreover, MLDL apparently reduced the up-regulation of HMGB1, RAGE, and NF-κB p65 in lung tissues, as well as the expressions of HMGB1, RAGE, and TNF-α in intestinal lymphoid tissues. Conclusions Mesenteric lymph was a source of harmful factors leading to SAP-ALI. MLDL could alleviate SAP-ALI probably by inhibiting HMGB1-induced production of inflammation factors. Supplementary Information The online version contains supplementary material available at 10.1007/s10620-020-06801-6.

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Determinants of severity in acute pancreatitis, a nation-wide prospective multicenter study

Cited by 29 publications

References 0 publications

Mean muscle attenuation correlates with severe acute pancreatitis unlike visceral adipose tissue and subcutaneous adipose tissue

Mean muscle attenuation correlates with severe acute pancreatitis unlike visceral adipose tissue and subcutaneous adipose tissue

Towards evidence‐based and personalised care of acute pancreatitis

Mesenteric Lymph Duct Ligation Alleviates Acute Lung Injury Caused by Severe Acute Pancreatitis Through Inhibition of High Mobility Group Box 1-Induced Inflammation in Rats

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