scholarly journals Factors Associated with Fluid Sequestration in Patients with Acute Pancreatitis: A Prospective Study in Tertiary Centre Hospital in Nepal

2021 ◽  
Vol 2021 ◽  
pp. 1-6
Author(s):  
Raju Bhandari ◽  
Krishna Sapkota ◽  
Seema Subedi ◽  
Som Kumar Shrestha ◽  
Edward Sutanto ◽  
...  
Keyword(s):  
Acute Pancreatitis ◽  
Hospital Mortality ◽  
Organ Failure ◽  
Pancreatic Necrosis ◽  
Linear Regression Analysis ◽  
University Teaching ◽  
Persistent Organ Failure ◽  
Younger Age ◽  
Significant Difference ◽  
The Difference

Background. Acute pancreatitis (AP) is associated with extensive fluid sequestration. The aim of this study was to determine association of fluid sequestration at 48 hours after hospital admission (FS48) in AP patients with demographics, clinical parameters, and outcomes of AP. Methods. A prospective observational study was carried out on all adult patients with AP admitted to Tribhuvan University Teaching Hospital, Nepal, from January to September 2017. FS48 was calculated as the difference between fluid input and output in the first 48 hours of admission. The Kruskal-Wallis test with post hoc Dunn’s test examined the difference in FS48 between mild AP, moderately severe AP, and severe AP. Linear regression analysis was used to evaluate association between FS48 with patients’ characteristics and outcomes of AP. Outcomes of AP assessed included pancreatic necrosis, persistent organ failure, length of stay, and in-hospital mortality. Results. Eighty patients (median age 44 years; 57% male) with a median FS48 of 1610 mL were evaluated. The median FS48 for mild AP, moderately severe AP, and severe AP were 1,180 mL, 2,380 mL, and 3,500 mL, respectively. There was a significant difference in pairwise comparisons between mild AP and moderately severe AP, along with mild AP and severe AP. Younger age, other etiology, and higher creatinine were independently associated with increased FS48. Increased FS48 was significantly associated with pancreatic necrosis, persistent organ failure, and in-hospital mortality. Conclusions. In our study population, younger age and higher creatinine were predictors of increased FS48. Increased FS48 was associated with poorer outcomes of AP.

scholarly journals Aggressive Versus Conservative Fluid Treatment for Acute Pancreatitis in Adult Patients: A Meta-Analysis of 3,127 Cases

2021 ◽  
Author(s):  
Jiyang Liao ◽  
Yang Zhan ◽  
Huachu Wu ◽  
Zhijun Yao ◽  
Xian Peng ◽  
...  
Keyword(s):  
Renal Failure ◽  
Acute Pancreatitis ◽  
Respiratory Failure ◽  
Hospital Mortality ◽  
Organ Failure ◽  
Pancreatic Necrosis ◽  
Meta Analysis ◽  
Adult Patients ◽  
Cochrane Library ◽  
Persistent Organ Failure

Abstract Background: The advantages of aggressive fluid treatment (AFT) compared to conservative fluid treatment (CFT) within 24 h for acute pancreatitis (AP) remain controversial in adult patients. A meta-analysis was undertaken to investigate whether aggressive strategies are more beneficial.Methods: We searched (on February 1, 2021) PubMed, Embase, and the Cochrane Library for eligible trials that assessed the two therapies and performed a meta-analysis. The primary endpoint was in-hospital mortality. Secondary outcomes were adverse events (e.g., renal failure and pancreatic necrosis) within 24 h of treatment.Results: Five randomized controlled trials (RCTs) and 8 observational studies involving 3,127 patients were identified. There was a significant difference in in-hospital mortality for AFT compared to CFT (OR, 1.66; P = 0.0001). The incidences of renal failure (OR, 2.38; P < 0.00001) and pancreatic necrosis (OR, 2.34; P < 0.0001) were similar and significantly different between the two groups. Patients aged > 50 years had a potentially higher utilization of mechanical ventilation and incidence of respiratory failure (OR, 4.88; P < 0.00001). Persistent organ failure, systemic inflammatory response syndrome (SIRS) and length of hospital stay did not differ significantly between the two groups. Sensitivity analysis identified two significant changes: one in persistent SIRS (OR, 2.37; P = 0.02) in patients aged > 50 years and one in the overall incidence of persistent organ failure (OR, 1.81; P = 0.02).Conclusions: Compared to CFT, AFT increases in-hospital mortality and the incidence of renal failure, pancreatic necrosis and respiratory failure with relatively strong evidence.

scholarly journals A prospective study of BISAP score in assessing severity of acute pancreatitis

2018 ◽  
Vol 5 (5) ◽  
pp. 1785
Author(s):  
Mahidhar Reddy Venkatapuram ◽  
Sreeram Sateesh ◽  
Deepthi Batchu
Keyword(s):  
Acute Pancreatitis ◽  
Prospective Study ◽  
Organ Failure ◽  
Scoring System ◽  
Pancreatic Necrosis ◽  
Statistical Analyses ◽  
Exact Probability ◽  
Patients At Risk ◽  
The Difference ◽  
A Prospective Study

Background: Aim of study is to prospectively evaluate the ability of the Bedside Index for Severity in Acute Pancreatitis (BISAP) score to predict mortality as well as intermediate markers of severity.Methods: 50 patients admitted from December 2015 to November 2017 with acute pancreatitis were included in the study. BISAP score is calculated in all such patients based on data obtained within 24hrs of hospitalization. Patients were assessed for organ failure according to Marshall scoring system and followed throughout hospitalization for assessment of complications. Statistical analyses were made using Fischer’s exact probability test. The difference was assumed statistically significant when p<0.05.Results: There was a statistically highly significant trend for increasing mortality (p < 0.05) and intermediate markers of severity (p<0.05) that is transient organ failure, persistent organ failure and pancreatic necrosis with BISAP score ≥3.Conclusions: The BISAP score represents a simple way to identify patients at risk of increased mortality and the development of intermediate markers of severity within 24 hours of presentation.

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