Discrepancy Between the Extent of Pancreatic Necrosis and Multiple Organ Failure Score in Severe Acute Pancreatitis

Mole, Damian J.; Mcclymont, Katie; Lau, Sarah; Mills, Rosamund; Stamp-Vincent, C; Garden, O. James; Parks, Rowan W.

doi:10.1007/s00268-009-0161-9

Cited by 18 publications

(10 citation statements)

References 41 publications

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“…A complex inflammatory network in which the extent of (peri)pancreatic necrosis influences the severity of OF and OF exacerbates the development of pancreatic necrosis might exist. 24,25 Given the apparent similarities in the etiology and phenotype of patients with varying grades of severity of AP, differences in inter-individual inflammatory responses might explain the variability in the severity of AP. It is conceivable that the highly variable inflammatory response might be related to an underlying genetic predisposition.…”

Section: How Common Is Of In Ap?mentioning

confidence: 99%

Organ Failure Due to Systemic Injury in Acute Pancreatitis

2019

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Acute pancreatitis may be associated with both local and systemic complications. Systemic injury manifests in the form of organ failure which is seen in approximately 20% of all cases of acute pancreatitis and defines 'severe acute pancreatitis'. Organ failure typically develops early in the course of acute pancreatitis, but may also develop later due to infected pancreatic necrosis induced sepsis. Organ failure is the most important determinant of outcome in acute pancreatitis. We review here the current understanding of the risk factors, pathophysiology, timing, impact on outcome and therapy of organ failure in acute pancreatitis. As we discuss the pathophysiology of severe systemic injury, the distinctions between markers and mediators of severity are highlighted based on evidence supporting their causality in organ failure. Emphasis is placed on clinically relevant end points of organ failure and the mechanisms underlying the pathophysiological perturbations, which offer insight into potential therapeutic targets to treat.

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Section: How Common Is Of In Ap?mentioning

confidence: 99%

Organ Failure Due to Systemic Injury in Acute Pancreatitis

2019

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“…MODS occurs in 1 in 4 individuals who develop AP and is accompanied by deregulation of cardiovascular, autonomic nervous and immune system homeostasis 6 , leading to death in one fifth of those with AP-MODS 7 . Despite this currently accepted unifying disease model, each person who develops AP has a severity pattern of systemic inflammation and MODS that is unique and is not directly proportional to the amount of pancreas damage on radiological imaging 8,9 , and this individualized response determines the disease outcome. This personalized response to AP is further nuanced by the diversity of etiologies and initiating events in AP, that include choledocholithiasis, excess ingestion of alcohol, trauma, pancreatic manipulation at endoscopy, viral infections, certain venoms and specific prescription medicines 6 .…”

Section: Mainmentioning

confidence: 99%

Molecular Patterns in Acute Pancreatitis Reflect Generalizable Endotypes of the Host Response to Systemic Injury in Humans

et al. 2020

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Objective: Acute Pancreatitis (AP) is sudden onset pancreas inflammation that causes systemic injury with a wide and markedly heterogeneous range of clinical consequences. Here, we hypothesized that this observed clinical diversity corresponds to diversity in molecular subtypes that can be identified in clinical and multiomics data. Summary Background Data: Observational cohort study. n ¼ 57 for the discovery cohort (clinical, transcriptomics, proteomics, and metabolomics data) and n ¼ 312 for the validation cohort (clinical and metabolomics data).Methods: We integrated coincident transcriptomics, proteomics, and metabolomics data at serial time points between admission to hospital and up to 48 hours after recruitment from a cohort of patients presenting with acute pancreatitis. We systematically evaluated 4 different metrics for patient similarity using unbiased mathematical, biological, and clinical measures of internal and external validity. We next compared the AP molecular endotypes with previous descriptions of endotypes in a critically ill population with acute respiratory distress syndrome (ARDS). Results: Our results identify 4 distinct and stable AP molecular endotypes. We validated our findings in a second independent cohort of patients with AP. We observed that 2 endotypes in AP recapitulate disease endotypes previously reported in ARDS. Conclusions: Our results show that molecular endotypes exist in AP and reflect biological patterns that are also present in ARDS, suggesting that generalizable patterns exist in diverse presentations of critical illness.

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“…Larger-scale randomised controlled trials looking at the effect of nasogastric tube feeding in patients with acute pancreatitis are desirable. In particular, a quality randomised controlled trial is needed to investigate whether nasogastric tube feeding can prevent the progression of severity in patients with acute pancreatitis [122, 123]. The potential benefits which enteral nutrition may offer are dual, that is, improvement in tolerance of oral refeeding and prevention of progression in severity of acute pancreatitis (Figure 1).…”

Section: Further Directionsmentioning

confidence: 99%

Nutrition, Inflammation, and Acute Pancreatitis

Petrov

2013

ISRN Inflammation

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Acute pancreatitis is acute inflammatory disease of the pancreas. Nutrition has a number of anti-inflammatory effects that could affect outcomes of patients with pancreatitis. Further, it is the most promising nonspecific treatment modality in acute pancreatitis to date. This paper summarizes the best available evidence regarding the use of nutrition with a view of optimising clinical management of patients with acute pancreatitis.

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Discrepancy Between the Extent of Pancreatic Necrosis and Multiple Organ Failure Score in Severe Acute Pancreatitis

Cited by 18 publications

References 41 publications

Organ Failure Due to Systemic Injury in Acute Pancreatitis

Organ Failure Due to Systemic Injury in Acute Pancreatitis

Molecular Patterns in Acute Pancreatitis Reflect Generalizable Endotypes of the Host Response to Systemic Injury in Humans

Nutrition, Inflammation, and Acute Pancreatitis

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