Combination of APACHE-II score and an obesity score (APACHE-O) for the prediction of severe acute pancreatitis

Pancreatology ◽  
2004 ◽  
Vol 4 (1) ◽  
pp. 1-6 ◽  
Author(s):  
C.D. Johnson ◽  
S.K.C. Toh ◽  
M.J. Campbell
Keyword(s):  
Acute Pancreatitis ◽  
Severe Acute Pancreatitis ◽  
Apache Ii ◽  
Apache Ii Score ◽  
Score Apache

scholarly journals Soluble B7-H5 Is a Novel Diagnostic, Severity, and Prognosis Marker in Acute Pancreatitis

2021 ◽  
Vol 2021 ◽  
pp. 1-8
Author(s):  
Ruoxin Xu ◽  
Ju Gong ◽  
Wei Chen ◽  
Yakang Jin ◽  
Jian Huang
Keyword(s):  
Acute Pancreatitis ◽  
Abdominal Pain ◽  
Severe Acute Pancreatitis ◽  
Apache Ii ◽  
Apache Ii Score ◽  
Prognosis Marker ◽  
Score Apache ◽  
Marshall Score ◽  
Pain Patients ◽  
Ranson Score

As an important ligand in T lymphocyte costimulatory pathways, B7-H5 is involved deeply in the immune response in various diseases. However, its clinical usefulness as an early indicator in acute pancreatitis (AP) remains unclear. In this study, the levels of sB7-H5 and cytokines in plasma samples of 75 AP patients, 20 abdominal pain patients without AP, and 20 healthy volunteers were determined. Then, the correlation of sB7-H5 and clinical features, cytokines, the Ranson score, APACHE II score, Marshall score, and BISAP score was analysed, and the value of sB7-H5 for diagnostic, severity, and prognosis of AP was evaluated. We found that the levels of sB7-H5 were specifically upregulated in AP patients. Receiver operating characteristic (ROC) analysis revealed that sB7-H5 can identify AP patients from healthy or abdominal pain patients with 78.9% or 86.4% sensitivity and 93.3% or 90.0% specificity. Further analysis showed that the levels of sB7-H5 were significantly correlated with WBC ( p = 0.004 ), GLU ( p = 0.008 ), LDH ( p < 0.001 ), Ca2+ ( p = 0.006 ), AST ( p = 0.009 ), PLT ( p = 0.041 ), IL-6 ( p < 0.001 ), IL-10 ( p < 0.001 ), and TNF-α ( p < 0.001 ). And levels of sB7-H5 were gradually increased among patients with mildly acute pancreatitis (MAP), moderately severe acute pancreatitis (MSAP), and severe acute pancreatitis (SAP). It can distinguish the severity of AP with good sensitivity and specificity. Moreover, when dividing the patients into two groups according to the median level of sB7-H5, the local complication and length of stay of low levels of the sB7-H5 group were significantly less than those in high levels of the sB7-H5 group. And the levels of sB7-H5 in AP patients were significantly correlated with the Ranson score ( p < 0.001 ), APACHE II score ( p < 0.001 ), Marshall score ( p < 0.001 ), and BISAP score ( p < 0.001 ). The AUCs of assessing local complications of sB7-H5 at day 1 and day 3 were 0.704 ( p = 0.0024 ) and 0.727 ( p = 0.0373 ). These results showed the potential value of sB7-H5 as a diagnostic, severity, and prognosis marker of AP.

Plasma ADAMTS13 activity parallels the APACHE II score, reflecting an early prognostic indicator for patients with severe acute pancreatitis

2008 ◽  
Vol 43 (11) ◽  
pp. 1387-1396 ◽  
Author(s):  
Chie Morioka ◽  
Masahito Uemura ◽  
Tomomi Matsuyama ◽  
Masanori Matsumoto ◽  
Seiji Kato ◽  
...  
Keyword(s):  
Acute Pancreatitis ◽  
Severe Acute Pancreatitis ◽  
Prognostic Indicator ◽  
Apache Ii ◽  
Apache Ii Score ◽  
Adamts13 Activity

scholarly journals Prognostic Indicator in Severe Acute Pancreatitis

2018 ◽  
Vol 3 (05) ◽  
Author(s):  
Dr. Ajay Khanolkar ◽  
Dr. Manish Khare
Keyword(s):  
Acute Pancreatitis ◽  
Severe Acute Pancreatitis ◽  
Surgical Intervention ◽  
Financial Burden ◽  
Fluid Collection ◽  
Prognostic Indicator ◽  
Apache Ii ◽  
Management Decision ◽  
Apache Ii Score ◽  
Local Complication

Aim of study: - To assess the utility of each as prognostic indicator in Severe Acute Pancreatitis. Material and Methods: This prospective study entitled “To assess the utility of each as prognostic indicator in Severe Acute Pancreatitis” was carried out on patients hospitalized for acute pancreatitis in the surgery department at Chandulal Chandrakar Memorial Medical College and CM Hospital, Bhilai from March 2015 to October 2017.50 patients with the diagnosis of first attack of acute pancreatitis of both sexes and all age groups were selected for the study. Conclusion:- On the basis of observation and result of the study, it can be safely stated that APACHE II Scoring is quick, safe, reproducible, ongoing and cost effective. It can be done by resident or intelligent nursing staff. Give an idea regarding improving or worsening of patients. APACHE II Scoring system when complimented by high quality CECT abdomen can further refine the results and give an idea of likelihood of patients developing local complication. Thus it can also be used along with CECT abdomen for Risk Stratification of subset of patients who are likely to develop local complication who might need surgical intervention. CECT on 3rd day adds nothing to management. It has a tendency to over predict the regional complication, which are in anyway apart of natural course of history of disease (acute fluid collection). Management decision could not be based on CECT abdomen on 3rd day alone, since it is not needed to make a diagnosis of acute pancreatitis it should be abundant, thus reducing the financial burden of patients and institute. CECT abdomen done after 2nd week in the course of illness along with APACHE II Score and clinical finding are better guide for management and surgical intervention.

scholarly journals Clinical Profile and Outcome of Patients with Severe Acute Pancreatitis

2020 ◽  
Vol 9 (3) ◽  
pp. 8-11
Author(s):  
Rishabh Sehgal ◽  
Inder Pal Singh ◽  
Jyotisterna Mittal
Keyword(s):  
Acute Pancreatitis ◽  
Alcohol Consumption ◽  
Severe Acute Pancreatitis ◽  
Sofa Score ◽  
Clinical Profile ◽  
Etiological Factor ◽  
Clinical Severity ◽  
Apache Ii ◽  
Apache Ii Score ◽  
Marshall Score

Background: Acute pancreatitis (AP) is an acute inflammatory condition of the pancreas leading to pancreatic autodigestion. The present study was conducted to study the clinical profile and outcome of patients with severe acute pancreatitis. Subjects & Methods: The study was conducted on 40 patients of acute pancreatitis. Clinical profile including history, examination findings, etiology of pancreatitis, clinical severity (according to Modified Marshall Score, BISAP score, APACHE II, HAPS score, SOFA score) was recorded. Results: Severe Acute Pancreatitis (SAP) among patients. Majority of the patients i.e. 22 (55%) had alcohol consumption as etiological factor causing SAP followed by biliary 10 (25%) & idiopathic 5 (12.5%). Hypertriglyceridemia and drug-induced (herbal medication) pancreatitis was present in 1 (2.5%) patient each. Out of all 1 (2.5%), patients had a history of both alcohol consumption and the presence of gallstone as an etiological factor. 22 patients (55%) out of 40 patients only conservative management was used while 18(45%) patients underwent USG guided percutaneous drainage was done. Out of these 18 patients, 3(7.5%) patients required Laparoscopic Necrosectomy & 2(5%) patients required open necrosectomy in addition to ultrasound-guided PCD. Patients who improved had a mean BISAP SCORE of 2.15   0.54, Modified Marshall score of 3.65    1.44, APACHE II score of 9.77  4.45, SOFA score 5.54  2.49, RANSON’s score 3.85   1.80 and HAP score of 0.65   0.63. Conclusion: Most common   etiology of severe acute pancreatitis is alcohol followed by biliary etiology. Out of severity scores (BISAP, APACHE-II, SOFA, HAPS), only BISAP score ≥3 is predictive of poor outcome in patients with severe acute pancreatitis.

Decreased Activity of Plasma ADAMTS13 Parallels Enhanced Endotoxemia in Patients with Severe Acute Pancreatitis: Relationship to Multiorgan Failure

Blood ◽  
2008 ◽  
Vol 112 (11) ◽  
pp. 4541-4541
Author(s):  
Chie Morioka ◽  
Masahito Uemura ◽  
Tomomi Matsuyama ◽  
Masanori Matsumoto ◽  
Masao Fujimoto ◽  
...  
Keyword(s):  
Acute Pancreatitis ◽  
Severe Acute Pancreatitis ◽  
Sofa Score ◽  
Multiorgan Failure ◽  
Prognostic Indicator ◽  
Apache Ii ◽  
Apache Ii Score ◽  
Healthy Controls ◽  
Endotoxin Concentration ◽  
Plasma Endotoxin

Abstract Background: Severe acute pancreatitis (SAP) frequently progresses to pancreatitis-associated multiorgan failure (MOF) with high mortality. Decreased plasma ADAMTS13 activity (ADAMTS13:AC) results in the accumulation of unusually large von Willebrand factor multimers (UL-VWFM) and the formation of platelet thrombi, ultimately leading to MOF. We demonstrated that the imbalance between decreased ADAMTS13:AC and increased UL-VWFM could contribute to SAP pathogenesis through enhanced thrombogenesis, and serve as an early prognostic indicator for SAP patients (Scand J Gastroenterol, 2008, 26:1). Endotoxin has been considered to be the principle activator of the systemic inflammatory response syndrome, which predisposes patients for MOF and/or pancreatic necrosis, ultimately leading to SAP. We investigated the relationship of endotoxin to ADAMTS13:AC and its related parameters, and tried to explore their potential role on the development of MOF in patients with SAP. Methods: We sequentially determined plasma endotoxin concentration, ADAMTS13:AC and its related parameters in 13 SAP patients (APACHE-II score mean 6.6 ± 2.7), who were admitted into intensive care unit of our hospital between 2004 and 2006. Eleven patients were survivors and two were non-survivors whose APACHE II scores were 10 and 12 died of MOF, respectively. The degree of MOF was evaluated according to the SOFA score. Endotoxin concentration was determined by a chromogenic substrate assay (Toxicolor LS –M Set, Seikagaku Kogyo Co.) with kinetic analysis after pretreatment with detergent, Triton X-100, and heating at 70 °C for 10 min. Plasma ADAMTS13:AC was determined by a sensitive chromogenic ELISA (ADAMTS13-act-ELISA: Kainos Inc.). Plasma UL-VWFM was analyzed by a vertical SDS-1.0% agarose gel electrophoresis. Plasma VWF antigen (VWF:AG), interleukin 6 (IL-6), interleukin 8 (IL-8), and tumor necrosis factor -α (TNF-α) were measured by ELISA. Results: In normal healthy controls (n=20), plasma endotoxin concentration was 7.9±1.7 pg/ml (mean ± SD). The concentration in the SAP patients significantly increased at day 1 (means 65 pg/ml, p&lt;0.001) and at day 2 (88 pg/ml, p&lt;0.001) as compared to healthy controls. The values, thereafter, gradually decreased in 8 survivors (55 pg/ml at day 5, 53 pg/ml at day 7, 27 pg/ml at day 14), while in remaining 3 survivors needing necrosectomy, the concentration further increased (98 pg/ml at day 5, 178 pg/ml at day 7), and decreased to 20 pg/ml at day 14 at the recovery phase. In two non-survivors, the endotoxin levels increased from 37 pg/ml at day 1 to 462 pg/ml at day 2 in one needing necrosectomy, and showed 51 pg/ml at day 1 in another at the age of 91. Within 1 or 2 days after admission, the ADAMTS13:AC was lower in SAP patients (mean 29%, p&lt;0.001) than in healthy controls (99%), and gradually recovered in the 11 survivors but further decreased in the 2 non-survivors. On admission, VWF:Ag was higher (402%, p&lt;0.001) in SAP patients than controls (100%). VWF:Ag gradually decreased in the survivors, except in the 3 survivors needing a necrosectomy, but remained high in the non-survivors. UL-VWFM positive patients showed lower ADAMTS13:AC (25% vs. 42%, p&lt;0.05) and higher VWF:Ag ( 481% vs. 332%, p&lt;0.05), resulting in higher ratio of VWF:Ag to ADAMTS13:AC (25.2 vs. 9.1, p&lt;0.02), as compared to UL-VWFM negative ones. Patients with higher endotoxin concentration more than 50 pg/ml showed lower ADAMTS13:AC than those without (22% vs. 43%, p&lt;0.05). Plasma endotoxin concentration positively correlated with the ratio of VWF:Ag to ADAMTS13:AC (r=0.732, p&lt;0.005). The SOFA score correlated positively with plasma endotoxin concentration (r=0.604, p&lt;0.03), IL-8 (r=0.843, p&lt;0.001), and the ratio of VWF:Ag to ADAMTS13:AC (r=0.700, p&lt;0.01), and inversely with the ADAMTS13:AC (r= − 0.601, p&lt;0.03). Conclusion. The imbalance between decreased ADAMTS13:AC and increased UL-VWFM is closely related to enhanced endotoxemia, which may contribute to the development of SAP and subsequent MOF through enhanced thrombogenesis.

scholarly journals Procalcitonin and BISAP score versus c-reactive protein and APACHE II score in early assessment of severity and outcome of acute pancreatitis

2012 ◽  
Vol 69 (5) ◽  
pp. 425-431 ◽  
Author(s):  
Mihailo Bezmarevic ◽  
Zoran Kostic ◽  
Miodrag Jovanovic ◽  
Sasa Mickovic ◽  
Darko Mirkovic ◽  
...  
Keyword(s):  
Acute Pancreatitis ◽  
Severe Form ◽  
Apache Ii ◽  
Apache Ii Score ◽  
Serum Concentrations ◽  
Key Factors ◽  
Early Assessment ◽  
Adequate Treatment ◽  
Reactive Protein ◽  
Score Apache

Background/Aim. Early assessment of severity and continuous monitoring of patients are the key factors for adequate treatment of acute pancreatitis (AP). The aim of this study was to determine the value of procalcitonin (PCT) and Bedside Index for Severity in Acute Pancreatitis (BISAP) scoring system as prognostic markers in early stages of AP with comparison to other established indicators such as Creactive protein (CRP) and Acute Physiology and Chronic Health Evaluation (APACHE) II score. Methods. This prospective study included 51 patients (29 with severe AP). In the first 24 h of admission in all patients the APACHE II score and BISAP score, CRP and PCT serum concentrations were determined. The values of PCT serum concentrations and BISAP score were compared with values of CRP serum concentrations and APACHE II score, in relation to the severity and outcome of the disease. Results. Values of PCT, CRP, BISAP score and APACHE II score, measured at 24 h of admission, were significantly elevated in patients with severe form of the disease. In predicting severity of AP at 24 h of admission, sensitivity and specificity of the BISAP score were 74% and 59%, respectively, APACHE II score 89% and 69%, respectively, CRP 75% and 86%, respectively, and PCT 86% and 63%, respectively. It was found that PCT is highly significant predictor of the disease outcome (p < 0,001). Conclusion. In early assessment of AP severity, PCT has better predictive value than CRP, and similar to the APACHE II score. APACHE II score is a stronger predictor of the disease severity than BISAP score. PCT is a good predictor of AP outcome.

scholarly journals Dynamic Changes in Plasma Mitochondrial DNA Concentration in Patients with Severe Acute Pancreatitis

2020 ◽  
Author(s):  
Zepeng Duan ◽  
Yujing Wang ◽  
Hua Ling ◽  
Qiong Li ◽  
Xingui Dai
Keyword(s):  
Acute Pancreatitis ◽  
Mitochondrial Dna ◽  
Severe Acute Pancreatitis ◽  
Sofa Score ◽  
Early Stage ◽  
Dynamic Change ◽  
Apache Ii ◽  
Apache Ii Score ◽  
Reactive Protein ◽  
Failure Assessment

Abstract Background: The elevated plasma mitochondrial DNA (mtDNA) is associated with prognosis in patients with severe acute pancreatitis (SAP). However, it is not clear that the dynamic process of plasma mtDNA during the early stage of SAP and the correction between mtDNA and clinical features.Methods: Twenty-six eligible patients with SAP in the general intensive care unit of our institution were enrolled in this study. The mtDNA concentration were assessed at admission and on days 3, 5, and 7.Results: The mtDNA concentration of the patients with SAP was elevated at each time point compared with that in the healthy controls. The mtDNA levels increased rapidly, peaking on day 3 after admission, and began to decrease on day 5. The trend remained statistically consistent among the acute physiology and chronic health evaluation (APACHE II) score, the sequential organ failure assessment (SOFA) score, C-reactive protein (CRP) levels and mtDNA levels. Contrastingly, the changes were not statistically consistent among the procalcitonin (PCT), calciumion (Ca2+) and mtDNA concentrations. The mtDNA level correlated significantly with the APACHE II score, SOFA score, and Ranson score, but not with the CRP, PCT, and Ca2+ concentrations. Conclusions: The dynamic change of plasma mtDNA correlated significantly with SAP development. The elevated mtDNA levels could be used as a biomarker for the early stage of SAP.Trial registration: NCT: 04079777. Registered 4 September 2019 - Retrospectively registered, https://register.clinicaltrials.gov/prs/app/action/SelectProtocol?sid=S00096E5&selectaction=Edit&uid=U0002O5I&ts=2&cx=-e6bci8

scholarly journals Management of Severe Acute Pancreatitis

2019 ◽  
Vol 7 (19) ◽  
pp. 3319-3323 ◽  
Author(s):  
Gontar Alamsyah Siregar ◽  
Ginanda Putra Siregar
Keyword(s):  
Acute Pancreatitis ◽  
Organ Failure ◽  
Severe Acute Pancreatitis ◽  
Imaging Finding ◽  
Scoring Systems ◽  
Gastrointestinal Diseases ◽  
Apache Ii Score ◽  
Common Causes ◽  
Score Apache ◽  
Pancreas Necrosis

Acute pancreatitis is one of the most common causes of hospitalisation from gastrointestinal diseases. The causes of pancreatitis vary between countries. Acute pancreatitis is classified based on Revised Atlanta classification 2013 as mild, moderately severe and severe acute pancreatitis. Acute pancreatic severity can be stratified by scoring systems such as Ranson’s score, BISAP score, APACHE-II score, SOFA score. In severe acute pancreatitis, to diagnose, abdominal pain raised amylase or lipase, supported imaging finding and organ failure. Organ failure can be diagnosed by using Modified Marshall Scoring System. Management is started conservatively, which are fluid resuscitation, enteral nutrition, analgesics, and antibiotics. Surgical management is indicated when infected pancreas necrosis is detected. In this review, we will discuss the current management based on recent research.

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