Fungal infections in severe acute pancreatitis

Severe acute pancreatitis (SAP) is associated with significant morbidity and mortality. The majority of deaths related to SAP are the result of infectious complications. Although bacterial infections are most commonly encountered, fungal infections are increasingly being recognized. Candida is the most common fungal infection. The occurrence of fungal infection in patients with acute pancreatitis adversely affects the clinical course, leading to a higher incidence of systemic complications, and possibly mortality as well. Important risk factors for fungal infection in patients with acute pancreatitis include broad-spectrum antibiotics, prolonged hospitalization and surgical/endoscopic interventions, use of total parenteral nutrition, and mechanical ventilation. Patients with higher severity of pancreatitis are at a greater risk. The pathogenesis of fungal infection in patients with acute pancreatitis is multifactorial. Translocation of microorganisms across the gut epithelium, lymphocyte dysfunction, and the virulence of the invading microorganisms play important roles. Histological demonstration of fungi remains the gold standard of diagnosis, but a positive biopsy is rarely obtained. The role of biomarkers in the diagnosis is being investigated. As early diagnosis and treatment can lead to improved outcome, a high index of suspicion is required for prompt diagnosis. Limiting the use of broad-spectrum antibiotics, early introduction of enteral nutrition, and timely change of vascular catheters are important preventive strategies. The role of antifungal prophylaxis remains controversial. Surgical necrosectomy with antifungal therapy is the most widely used treatment approach. Clinical trials on antifungal prophylaxis are needed, and indications for surgical intervention need to be clearly defined.     

Long-term outcome of severe acute pancreatitis

Background/Purpose

This study was undertaken to evaluate the post-discharge outcome of severe acute pancreatitis (SAP) and to clarify the prognostic factors for poor outcome.

Methods

In 45 patients, recurrence of acute pancreatitis (AP), transition to chronic pancreatitis (CP), and development of diabetes mellitus (DM) were evaluated. Relationships of the outcome with the findings on admission and the presence/absence of alcohol intake were analyzed.

Results

The mean follow-up period was 56 ± 6 months. Recurrence of AP was noted in 19% of the patients. The recurrence rate was higher in patients with necrotizing pancreatitis than in those without this feature. C-reactive protein and white blood cell (WBC) count were higher in patients with recurrence of AP. Transition to CP was noted in 22% of patients. The transition rate was higher in those with alcoholic SAP than in those with biliary SAP. In patients with transition to CP, the WBC count, hematocrit, Ranson score, and Japanese severity score were higher, and base excess (BE) was lower, compared with these features in patients without this transition. Development of DM was noted in 39% of patients. Blood glucose and BE were higher in patients who developed DM than in those who did not.

Conclusions

The degree of inflammation and pancreatic necrosis found on admission for SAP may be related to the recurrence of AP. Alcoholic SAP in which the disease is very severe may contribute to the transition to CP. Patients with impaired glucose tolerance readily develop DM after SAP.

     

伴呼吸衰竭重症急性胰腺炎侵袭性真菌感染15例

目的:研究伴呼吸衰竭的重症急性胰腺炎(SAP)患者侵袭性真菌感染(IFI)的临床特征,为SAP治疗提供参考.方法:回顾性分析监护病房2003-06/2009-0955例伴呼吸衰竭SAP患者的临床资料,根据体液病原菌培养结果及临床表现,将其分为IFI组、细菌感染(BI)组及非感染(NI)组,比较3组APACHEⅡ评分、机...     

Immunosuppression in patients with severe acute pancreatitis

Background In severe acute pancreatitis (SAP), immunologic impairment in the early phase may be linked to subsequent infectious complications. In this study, immunologic alterations in patients with SAP were analyzed, and immunologic parameters related to infectious complications were clarified. Methods A total of 101 patients with SAP were analyzed retrospectively. Various immunologic parameters on admission were analyzed and compared between the infection group and noninfection group during SAP. Furthermore, chronologic change in the lymphocyte count was investigated, and its utility for predicting infection was compared with conventional scoring systems. Results Serum immunoglobulin G (IgG), serum IgM, lymphokine-activated killer cell activity, and natural killer cell activity were low, and the incidence of abnormally low values was 50.0%, 65.0%, 45.5%, and 42.4%, respectively. Serum complement factor 3 was significantly negatively correlated with the APACHE II score. The lymphocyte count was decreased below the normal range, and was significantly negatively correlated with the APACHE II score. CD4-, CD8-, and CD20-positive lymphocyte counts were below the normal range, and CD4- and CD8-positive lymphocyte counts were significantly lower in the infection group. The lymphocyte count on day 14 after admission was significantly lower in the infection group and was more useful for predicting infection than conventional scoring systems. Conclusions Immunosuppression occurs from the early phase in SAP, and quantitative impairment of lymphocytes, mainly T lymphocytes, may be closely related to infectious complications during SAP. CD4- and CD8-positive lymphocyte counts on admission and the lymphocyte count on day 14 after admission may be useful for predicting infection.     

Treatment outcome of selective digestive decontamination and enteral nutrition in patients with severe acute pancreatitis

Background/Purpose

Sepsis due to infected pancreatic necrosis is the most serious complication in the late phase of severe acute pancreatitis (SAP). Bacterial translocation from the gut is thought to be the main cause of pancreatic infection. The possibility has recently been reported that selective digestive decontamination (SDD) and enteral nutrition (EN) may alleviate the complications and reduce the mortality rate in patients with SAP. We analyzed the treatment outcome of SDD and EN in patients with SAP.

Methods

We divided 90 patients with SAP into three groups: SDD(?)EN(?),group A; SDD(+)EN(?), group B; and SDD(+)EN(+), group C. Clinical outcome was analyzed retrospectively. The effect of SDD was compared in groups A and B, and the effect of EN was compared in groups B and C.

Results

The background of patients was not significantly different between the groups. SDD reduced the incidence of organ dysfunction (from 70% to 59%) and the mortality rate (from 40% to 28%), but the differences were not significant. EN reduced the incidence of infected pancreatic necrosis (from 31% to 24%) and the frequency of surgery for pancreas (from 28% to 18%), and further reduced the mortality rate (from 28% for SDD to 16%), but the differences were not significant. The peripheral lymphocyte count was significantly increased in patients with EN.

Conclusions

SDD and EN did not significantly affect the treatment outcome in SAP. However, the results in this study raise the possibility that SDD and EN may decrease the complications and reduce the mortality rate in SAP. The efficacy of SDD and EN for SAP should be evaluated in a randomized controlled trial.     

重症急性胰腺炎当前应关注的问题

<正>在重症急性胰腺炎治疗发展史上,不同时期会有不同问题被关注,这并不是疾病本质有什么变化,而是专科医师对其认识在逐步加深,正如一个覆盖着纱巾的少女,在纱巾被揭开的过程中她的容貌渐渐展现在人们的面前,其实,这并非是美丽少女有什么变化,只是纱巾被揭开的程度不同而已。在两百年以前的Senn及Moynihan时代,治疗急性胰腺炎     

Emergence of multidrug resistant infection in patients with severe acute pancreatitis

Background/objectivesInfection is the most important risk factor contributing to death in severe acute pancreatitis. Multidrug resistant (MDR) bacterial infections are an emerging problem in severe acute pancreatitis.MethodsFrom January 2009 to December 2011 the medical records of 46 patients with infected severe acute pancreatitis were reviewed retrospectively to identify risk factors for the development of MDR bacterial infection and assess the related outcomes.ResultsThe mean age of the 46 patients was 55 years; 38 were males. Thirty-six patients (78.3%) had necrotizing pancreatitis and all of enrolled 46 patients had suspected or proven pancreatic infection. MDR microorganisms was found in 29 (63%) of the 46 patients. A total of 51 episodes of MDR infection were collected from 11 cases of infected pancreatic pseudocysts, 36 cases of infected necrosis/infected walled-off necrosis and 4 cases of bacteremia. The most frequent MDR bacteria was methicillin-resistant Staphylococcus aureus (n = 15). Transferred patients had a higher incidence of MDR infections than primarily admitted patients (72% vs. 35%, P = .015). The mean intensive care unit stay was significantly longer in patients with MDR bacterial infections (20 vs. 2 days, P = .001). Mortality was not significantly different in the patients with MDR infections vs. those without it (14% vs. 6%, P = .411).ConclusionsClinicians should be aware of the high incidence of MDR bacterial infections in patients with severe acute pancreatitis, especially referred patients. Empiric therapy directed at these pathogens may be used in patients where severe sepsis persists, until definitive culture results are obtained.     

Nosocomial mortality and early prediction of patients with severe acute pancreatitis

Background and Aims: The aim of this study is to analyze factors (especially serum total cholesterol) that can enable early prediction of in‐hospital mortality of patients with severe acute pancreatitis (SAP). Methods: Predictive factors (especially serum total cholesterol) for in‐hospital mortality were evaluated retrospectively from the clinical data obtained from 338 SAP patients in our hospital from January 1999 to January 2008, who underwent intensive care, blood routine, blood biochemical tests and even computed tomography at the time of admission. Results: This analysis revealed that within 24 h after admission, serum total cholesterol (TC) was a mortality‐reduced factor when it is between 4.37 mmol/L and 5.23 mmol/L (P < 0.05). Evaluated TC was accompanied by decreased C‐reactive protein (CRP). CRP > 170 mg/L and albumin (ALB) < 30 g/L increased the fatal outcome (P < 0.05). Low albumin was a stronger predictor than CRP. Conclusions: Within 24 h after admission, moderate elevation of TC level seemed to increase the resistance to inflammation and hence improved the survival rate in patients with SAP, and reduced the in‐hospital mortality. Inflammatory reaction (with or without infection), hypoalbuminemia and TC were prognostic factors for in‐hospital mortality; both high levels of CRP and low ALB levels were associated with in‐hospital mortality in patients with SAP.     

连续性血液净化对重症急性胰腺炎患者免疫内稳状态影响的临床对照研究

目的:观察连续性血液净化(CBP)治疗重症急性胰腺炎(SAP)患者的临床效果及其对免疫内稳状态的影响。方法:本文为前瞻性临床对照研究,12例男性SAP患者按随机原则分为Con组(常规治疗组,4例)和CBP治疗组(常规治疗 CBP治疗组,8例)。经72h治疗后对各组患者临床治疗效果进行比较(包括APACHE-Ⅱ评分及其它主要临床指标),同时在治疗0h、6h、12h、24h、48h和72h各时间点取血,动态观察SAP患者免疫内稳状态的变化,主要包括采用抗体芯片技术检测各组患者血浆细胞因子表达谱、Th1(促炎)/Th2(抗炎)细胞因子比例的变化,并观察治疗过程中单核细胞功能(HLA-DR表达)和单核细胞数目的变化。结果:(1)临床治疗效果比较:经72h治疗后,CBP组患者病情显著改善,血淀粉酶水平明显下降,肾功能恢复正常(P<0.05)。而Con组患者除血淀粉酶水平较治疗前有一定程度下降外,患者病情并无明显缓解,肾功能以及动脉血气等指标方面也无明显改善(P>0.05)。(2)免疫内稳状态指标的比较:除IL-4外,两组患者血浆中其它各种细胞因子水平均明显高于健康人群(P<0.05)。经72h治疗后,CBP组患者血IFN-γ,IL-1,IL-2和IL-5,IL-10,IL-13水平较治疗前明显降低(P<0.05);而血肿瘤坏死因子α(TNF-α)和IL-6水平虽较治疗前亦降低,但差异不具有统计学意义(P>0.05),IL-4水平则始终无明显变化。比值比提示经CBP治疗后SAP患者体内Th2类抗炎细胞因子IL-13、IL-10相对于Th1类促炎细胞因子IL-1、TNF-α水平下降显著。而且,经CBP治疗后,患者外周血单核细胞HLA-DR表达和单核细胞数目均较治疗前明显上升(P<0.05)。结论:CBP治疗除能快速有效改善SAP患者病情,纠正体内酸碱紊乱、清除体内代谢毒素外,还能清除体内过多生成的促炎和抗炎细胞因子,改善患者单核细胞抗原呈递能力,重建机体免疫系统内环境稳态,疗效明显优于传统疗法。经CBP治疗后SAP患者体内Th2类抗炎细胞因子IL-13、IL-10相对于Th1类促炎细胞因子IL-1、TNF-α水平下降显著,有利于改善患者体内的免疫抑制状态。     

Trends in fungal colonization of pancreatic necrosis in patients undergoing necrosectomy for acute pancreatitis

Background. This study examines fungal colonization of post-inflammatory pancreatic necrosis in a cohort of patients undergoing open surgical necrosectomy in a single, tertiary referral unit over a 10-year period.Methods. The charts of all patients with acute pancreatitis who underwent surgical necrosectomy during the period January 1992 to December 2001 were examined. Following exclusions a population of 30 patients were identified. There were 18 men with a median (range) age of 42 (20–69) years. Sixteen (53%) underwent surgery because of positive fine needle aspirates and the remainder underwent surgery on clinical grounds. Twenty-nine (97%) received antibiotics prior to necrosectomy. Principal outcomes were the results of microbiological culture with reference to isolation of fungi, site of isolates, trends in colonization and outcome.Results. Candida were cultured from pancreatic necrosis in 5 (17%). These 5 individuals also had positive candidal cultures from sputum or bronchial aspirates. There were no deaths in patients with fungal colonization of necrosis. There was no change in the annual incidence of fungal colonization of necrosis over the study period.Conclusion. Although this is a small study, there are two consistent observations: mortality in fungal colonization of necrosis was low and there was no change in the annual incidence of fungal colonization of necrosis over the decade. Discrepancies between these findings and those of previous reports mandate larger prospective evaluation.     

舒血宁治疗高脂血症性重症急性胰腺炎的临床研究

目的观察舒血宁治疗高脂血症性重症急性胰腺炎(hyperlipidemic severe acute pancreatitis,HL-SAP)的作用。方法将50例HL-SAP患者随机分为A组(25例)和B组(25例),同时以健康志愿者25例作为正常对照组。A组采用常规治疗,B组采用常规治疗+舒血宁注射液治疗,以全自动血液黏度计测定全血高切黏度及全血低切黏度,以全自动生化分析仪测定血清甘油三酯(TG)水平,测定A、B两组胰腺Balthazar CT分级评分和APACHEⅡ评分。结果 B组治疗第15天全血高切黏度、全血低切黏度、血清甘油三酯、胰腺Balthazar CT分级评分及APACHEⅡ评分与入院时比较,降低程度均高于A组(P<0.01)。结论舒血宁对HL-SAP有较好的治疗作用。     

强化胰岛素治疗在老年重症急性胰腺炎患者中的临床作用

目的探讨强化胰岛素治疗控制血糖对于老年重症急性胰腺炎患者的临床意义。方法将40例〉70岁老年重症急性胰腺炎患者分成强化胰岛素治疗组（I组）和非强化治疗组（N组）,I组通过胰岛素静脉泵将空腹血糖（FBG）控制在4.4～6.1 mmol/L。N组当FBG〉11.1 mmol/L时使用胰岛素治疗并将FBG控制在10.0～11.1 mmol/L。观察2组血糖变化情况、APACHEⅡ评分变化情况、并发症发生情况、住院时间。结果（1）I组在治疗后1 d血糖降至正常水平,且较入院时明显下降,N组在治疗后3 d才较入院时明显下降;（2）I组在治疗后3 d APACHEⅡ评分较入院时明显下降,N组APACHEⅡ评分在治疗后7 d较入院时明显下降（P均〈0.05）;（3）I组住院时间明显短于N组（P〈0.01）;（4）I组与N组总体并发症发生情况无明显差异,但I组手术病人的并发症发生显著低于对照组（P〈0.05）。结论强化胰岛素治疗控制血糖对于改善老年重症急性胰腺炎患者的预后具有积极意义,并可减少手术患者并发症的发生。     

加倍生长抑素联合早期肠内营养对重症急性胰腺炎炎症因子和肠通透性的影响

目的研究加倍生长抑素（SS）联合早期肠内营养对重症急性胰腺炎炎症因子和肠通透性的影响。方法将60例重症急性胰腺炎患者随机分成三组：SS组、加倍SS组（DSS组）和加倍SS联合早期肠内营养组（DSEN）。在第1、3、6、9天分别检测炎症介质（TNF-α、IL-1）和肠屏障通透性指标（D-乳酸及二胺氧化酶）。结果第3、6天DSS组和DSEN组的TNF-α、IL-1水平低于SS组;第9天DSEN组的TNF-α、IL-1水平低于SS组、DSS组,DSEN组D-乳酸及二胺氧化酶水平低于SS组、DSS组（P〈0.05或0.01）。而SS组D-乳酸及二胺氧化酶水平与DSS组比较无统计学差异（P〉0.05）。结论加倍SS早期能减少炎症因子生成,同时可能影响肠黏膜的通透性,而联合早期肠内营养能减少肠黏膜的通透性,达到保护肠黏膜屏障的作用。     

Peritoneal lavage with aprotinin in patients with severe acute pancreatitis

Summary Conclusion Although high-dose aprotinin given intraperitoneally to patients with severe acute pancreatitis seems to inhibit activated trypsin in the peritoneal cavity, the treatment has little effect on the balance between proteases and antiproteases. Plasma levels of leukocyte proteases were high in all the patients, indicating leukocyte activation to be an important feature of the pathophysiology of severe acute pancreatitis. A surprise finding was that the patients had higher peritoneal levels of pancreatic secretory trypsin inhibitor (PSTI) after the lavage procedure. Background Although most studies have shown protease inhibitor therapy to have little or no effect on acute pancreatitis, in an earlier study we found that very high doses of the protease inhibitor aprotinin given intraperitoneally to patients with severe acute pancreatitis seemed to reduce the need of surgical treatment for pancreatic necrosis. In the present study we have further analyzed plasma and peritoneal samples from the same patients to ascertain whether the aprotinin treatment affects the balance between proteases and endogenous antiproteases. Methods In a prospective double-blind randomized multicenter trial, 48 patients with severe acute pancreatitis were treated with intraperitoneal lavage. One group (aprotinin group,n=22) was also treated with high doses (20 million KIU given over 30 h) of aprotinin intraperitoneally. The remaining 26 patients made up the control group. The protease-antiprotease balance was studied by measuring immunoreactive anionic trypsin (irAT), cationic trypsin (irCT), complexes between cationic trypsin and alpha 1-protease inhibitor (irCT-α1PI), leukocyte elastase and neutrophil proteinase 4 (NP4), as well as the endogenous protease inhibitors, pancreatic secretory trypsin inhibitor (PSTI), alpha 2-macroglobulin (α 2M), alpha 1-protease inhibitor (α 1PI), antichymotrypsin (ACHY), and secretory leukocyte protease inhibitor (SLPI). Intraperitoneal levels were studied before and after the lavage procedure, and plasma levels were followed for 21 d. Results The control group had lower plasma levels of SLPI and analysis of peritoneal fluid showed the reduction of irCT-α 1PI to be more pronounced in the aprotinin group. None of the other variables measured differed significantly between the two groups. All patients had very high levels of leukocyte elastase and NP4 both in peritoneal exudate and in plasma. Peritoneal levels of PSTI were higher after the lavage procedure in contrast to the other measured variables that all showed lower peritoneal levels after the lavage.     

Prediction of early death in severe acute pancreatitis

Background In severe acute pancreatitis (SAP), it is clinically important at the time of admission to predict the likelihood of early death. This investigation aimed to clarify the factors predicting early death in SAP. Methods Early death was defined as death within 10 days after disease onset. Prediction factors for early death were evaluated from data obtained on admission from 93 patients with SAP, and the characteristics of patients who died early were analyzed. Results Between the early-death and early-survival groups, significant factors were base excess (BE), serum creatinine (Cr), blood sugar, serum glutamate oxaloacetic transaminase, and serum calcium. Multivariate analysis revealed that BE was an independent prediction factor for early death. The early-death rate in patients with BE < −5.5 mEq/l and Cr ≥ 3.0 mg/dl was 31% and 36%, respectively. The combination of BE and Cr raised the positive predictive value to 50%, and was equally able to predict early death as the Japanese Severity Score (JSS), which was the most useful of the three conventional scoring systems used. All early-death patients had pancreatic necrosis, and their JSS was ≥15 (stage 4). Characteristically, early-death patients had lactate dehydrogenase (LDH) > 1300 IU/l, or they had serious preexisting comorbidities. Conclusions As a single parameter, BE was most useful for predicting early death. The combination of BE and Cr could predict early death as well as the JSS. An extreme rise of LDH and serious preexisting comorbidity may also be risk factors for early death.     

急性胰腺炎272例死亡原因分析及治疗探讨

目的分析影响重症急性胰腺炎（SAP）病死率的因素和治疗策略。方法回顾性分析46例SAP死亡病例的临床资料。结果与病死率相关的高危因素为低氧血症、多器官功能衰竭、感染、SIRS和腹腔室隔综合征；FAP患者的病死率明显要高于SAP患者。结论临床上要重视SAP的早期治疗，特别是FAP这一特殊类型。对高危因素的预防和治疗是降低病死率的关键。     

连续性高容量血液滤过对重症急性胰腺炎患者C-反应蛋白的影响

目的 :C 反应蛋白 (C reactiveprotein ,CRP)是一种急性时相蛋白 ,是早期评价急性胰腺炎严重程度及其预后的有效血清学参数 ,本文研究了连续性高容量血液滤过对重症急性胰腺炎 (SAP)患者CRP的影响和临床意义。　 方法 :　SAP患者 2 3例 ,男性 15例 ,女性 8例 ,平均年龄 2 7～ 73(47 7± 13 6 )岁 ,其诱因分别为胆源性胰腺炎 15例 ,酒精性胰腺炎 2例 ,高脂血症性胰腺炎 2例 ,兼有多种因素者 1例 ,原因不明者 3例。入院时APACHEⅡ评分为 6～ 2 0 (11 6± 4 36 )分。合并急性呼吸窘迫综合征 /急性肺损伤 (ARDS/API) 2 2例 ,呼吸机治疗 13例 ,少尿型急性肾衰 (ARF) 5例 ,低血压休克 5例 ,胰性脑病 6例。患者入院明确诊断之后 ,即在床边行连续性高容量静脉 静脉血液滤过 (CHVHF) ,连续治疗 72h不间断。所用滤器为AN6 9膜 ,面积 1 2m2 ,每隔 2 4h更换一次。治疗中血流量为 2 5 0ml/min ,置换液量定为 4 0 0 0ml/h ,前稀释方式输入 ,超滤量根据治疗量和患者容量负荷情况设定。　 结果 :2 3例患者中 ,存活 2 0例 (存活率 87 0 % ) ;死亡 3例 (死亡率 13 0 % )。实际CHVHF治疗时间为 6 7～ 76h ,平均(71 95± 1 33)h ,实际超滤率为 (396 6 4± 2 4 0 2 )ml/h。行CHVHF治疗后发热、心动过速等症状明显好转、血     

Sequential blood purification therapy for critical patients with hyperlipidemic severe acute pancreatitis

AIM: To evaluate the efficacy of sequential blood purification therapy in the treatment of critical patients with hyperlipidemic severe acute pancreatitis.METHODS: Thirty-one intensive care unit(ICU) patients with hyperlipidemic severe acute pancreatitis treated at the Second Affiliated Hospital of Harbin Medical University were divided into either a study group(n = 15; July 1, 2012 to June 30, 2014) or a control group(n = 16; July 1, 2010 to June 30, 2012) based on the implementation of sequential blood purification therapy. The control group received continuous venous-venous hemofiltration(CVVH) on the basis of conventional treatments, and the therapeutic dose of CVVH was 30 m L/kg per hour. The study group received sequential plasma exchange and CVVH on the basis of conventional treatments. The anticoagulation regimen of CVVH is the regional citrate anticoagulation. Mortality rate on day 28, rates of systemic and local complications, duration of ICU, and time to target serum lipid level, as well as physiologic and laboratory indices were compared between the two groups.RESULTS: The mortality rate on day 28 was significantly lower in the study group than in the control group(13.33% vs 37.50%; P 0.05). The duration of ICU stay was significantly shorter in the study group than in the control group(7.4 ± 1.35 d vs 9.19 ± 2.99 d, P 0.05). The time to target serum lipid level was significantly shorter in the study group than in the control group(3.47 ± 0.52 d vs 7.90 ± 1.14 d, P 0.01). There were no significant differences in the rates of systemic complications and local complications between the two groups(60% vs 50% and 80% vs 81%, respectively). In the comparisons of physiologic and laboratory indices, serum albumin and C-reactive protein were significantly better in the study group than in the control group after treatment(37.8 ± 4.6 g/L vs 38.9 ± 5.7 g/L, and 20.5 ± 6.4 mg/L vs 28.5 ± 7.1 mg/L, respectively, both P 0.05). With the exception of plateletcrit, no other indices showed significant differences between the two groups.CONCLUSION: Sequential blood purification therapy is effective in the treatment of ICU patients with hyperlipidemic severe acute pancreatitis and can improve patient prognosis.     

Low-grade inflammation for predicting severe acute pancreatitis in patients with hypertriglyceridemic acute pancreatitis

Objectives

We aimed to evaluate the association between low-grade inflammation (LGI) and the severity of hypertriglyceridemic acute pancreatitis (HTG-AP).

Methods

We retrospectively reviewed 311 patients with HTG-AP who were admitted to the Department of Gastroenterology, Fujian Provincial Hospital between April 2012 and March 2021. Inpatient medical and radiological records were reviewed to collect the clinical manifestations, disease severity, and comorbidities. C-reactive protein (CRP) level, white blood cell (WBC) count, platelet (PLT) count, and neutrophil-to-lymphocyte ratio (NLR) were considered LGI components and were combined to calculate a standardized LGI score. The association between the LGI score and the severity of HTG-AP was analyzed using univariate and multivariate logistic regression analyses.

Results

Of the 311 patients with HTG-AP, 47 (15.1%) had mild acute pancreatitis (MAP), 184 (59.2%) had moderately severe acute pancreatitis (MSAP), and 80 (25.7%) had severe acute pancreatitis (SAP), respectively. Patients with MSAP and SAP had a higher LGI score than those with MAP (1.50 vs −6.00, P < 0.001). Univariate logistic regression analysis revealed that patients with LGI scores in the fourth quartile were more likely to have MSAP and SAP (odds ratio [OR] 21.925, 95% confidence interval [CI] 5.014–95.867, P < 0.001). The multivariate logistic regression analysis confirmed that low calcium (OR 0.105, 95% CI 0.011–0.969, P = 0.047) and high LGI score (OR 1.253, 95% CI 1.066–1.473, P = 0.006) were associated with MSAP and SAP. When predicting the severity of acute pancreatitis, the LGI score had the highest area under the receiver operating characteristic (ROC) curve (0.7737) compared to its individual components.

Conclusion

An elevated LGI score was associated with a higher risk of SAP in patients with HTG-AP.     

Prevalence of ischemic enterocolitis in patients with acute pancreatitis

Background A considerable number of acute pancreatitis cases have been reported to be complicated by nonocclusive mesenteric ischemia. However, no reports have ever referred to the incidence of ischemic enterocolitis in patients with acute pancreatitis, using a series of autopsy cases. Here, we report our review of autopsy cases of patients with acute pancreatitis to examine the incidence of associated ischemic enterocolitis.Methods The intestinal and pancreatic slides of 48 autopsy cases of patients with acute pancreatitis were reviewed and the incidence of ischemic enterocolitis was determined. Clinical case records were also reviewed.Results Thirteen (27%) of 48 autopsy cases of patients with acute pancreatitis were complicated by ischemic enterocolitis. The frequency of shock was significantly higher in patients with ischemic enterocolitis than in those without ischemic enterocolitis. The intestinal lesion was diffuse in many cases and gangrene was not an unusual finding.Conclusions The incidence of ischemic enterocolitis in patients with acute pancreatitis was much higher than that in the previous reports. Clinicians who treat patients with acute pancreatitis should consider ischemic enterocolitis as one of the frequent and severe complications of this condition.