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Severe acute pancreatitis: Pathogenetic aspects and prognostic factors

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World Journal of Gastroenterology 2008年第5期14卷 675-684页

作者： Ibrahim A Al Mofleh Department of Medicine College of Medicine & King Khalid University Hospital King Saud University Riyadh 11461 Saudi Arabia

Approximately 20% of patients with acute pancreatitis develop a severe disease associated with complications and high risk of mortality. The purpose of this study is to review pathogenesis and prognostic factors of severe acute pancreatitis （SAP）. An extensive medline search was undertaken with focusing on pathogenesis, complications and prognostic evaluation of SAP. Cytokines and other inflammatory markers play a major role in the pathogenesis and course of SAP and can be used as prognostic markers in its early phase. Other markers such as simple prognostic scores have been found to be as e^ective as multifactorial scoring systems （MFSS） at 48 h with the advantage of simplicity, efficacy, low cost, accuracy and early prediction of SAP. Recently, several laboratory markers including hematocrit, blood urea nitrogen （BUN）, creatinine, matrix metalloproteinase-9 （MMP-9） and serum amyloid A （SAA） have been used as early predictors of severity within the first 24 h. The last few years have witnessed a tremendous progress in understanding the pathogenesis and predicting the outcome of SAP. In this review we classified the prognostic markers into predictors of severity, pancreatic necrosis （PN）, infected PN （IPN） and mortality.

关键词： Acute pancreatitis Pathogenesis Prediction Severity necrosis infected necrosis Mortality

SARS-CoV-2 and the pancreas: What do we know about acute pancreatitis in COVID-19 positive patients?

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World Journal of Gastroenterology 2022年第36期28卷 5240-5249页

作者： Giuseppe Brisinda Maria Michela Chiarello Giuseppe Tropeano Gaia Altieri Caterina Puccioni Pietro Fransvea Valentina Bianchi Department of Medical and Surgical Sciences Fondazione Policlinico Universitario A Gemelli IRCCSRome 00168Italy Department of Medicine and Surgery UniversitàCattolica del Sacro CuoreRome 00168Italy Department of Surgery Azienda Sanitaria Provinciale di CosenzaCosenza 87100Italy Emergency Surgery and Trauma Center Fondazione Policlinico Universitario A Gemelli IRCCSRome 00168Italy

Severe acute respiratory syndrome coronavirus 2(SARS-CoV-2)can cause pancreatic damage,both directly to the pancreas via angiotensin-converting enzyme 2 receptors(the transmembrane proteins required for SARS-CoV-2 entry,which are highly expressed by pancreatic cells)and indirectly through locoregional vasculitis and *** that,there is no clear evidence that SARS-CoV-2 is an etiological agent of acute *** pancreatitis in coronavirus disease 2019(COVID-19)positive patients often recognizes biliary or alcoholic *** prevalence of acute pancreatitis in COVID-19 positive patients is not exactly ***,COVID-19 positive patients with acute pancreatitis have a higher mortality and an increased risk of intensive care unit admission and necrosis compared to COVID-19 negative *** respiratory distress syndrome is the most frequent cause of death in COVID-19 positive patients and concomitant acute *** this article,we reported recent evidence on the correlation between COVID-19 infection and acute pancreatitis.

关键词： Acute pancreatitis SARS-CoV-2 Severe acute pancreatitis Multiparametric scores infected necrosis Step-up approach

Severe acute pancreatitis: Clinical course and management

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World Journal of Gastroenterology 2007年第38期13卷 5043-5051页

作者： Hans G Beger Bettina M Rau Department of General Surgery Department of Viszeralsurgery University of Ulm (1982-2001) Donau-Klinikum Neu-Ulm Germany Department of General Viszeral Vascular and Pediatric Surgery Universit?tsklinikum des Saarlandes Homburg/ Saar Germany

Severe acute pancreatitis (SAP) develops in about 25% of patients with acute pancreatitis (AP). Severity of AP is linked to the presence of systemic organ dysfunctions and/or necrotizing pancreatitis pathomorphologically. Risk factors determining independently the outcome of SAP are early multi-organ failure, infection of necrosis and extended necrosis (> 50%). Up to one third of patients with necrotizing pancreatitis develop in the late course infection of necroses. Morbidity of SAP is biphasic, in the first week strongly related to early and persistence of organ or multi-organ dysfunction. Clinical sepsis caused by infected necrosis leading to multi-organ failure syndrome (MOFS) occurs in the later course after the first week. To predict sepsis, MOFS or deaths in the first 48-72 h, the highest predictive accuracy has been objectified for procalcitonin and IL-8; the Sepsis- Related Organ Failure Assessment (SOFA)-score predicts the outcome in the first 48 h, and provides a daily assessment of treatment response with a high positive predictive value. Contrast-enhanced CT provides the highest diagnostic accuracy for necrotizing pancreatitis when performed after the first week of disease. Patients who suffer early organ dysfunctions or at risk of developing a severe disease require early intensive care treatment. Early vigorous intravenous fluid replacement is of foremost importance. The goal is to decrease the hematocrit or restore normal cardiocirculatory functions. Antibiotic prophylaxis has not been shown as an effective preventive treatment. Early enteral feeding is based on a high level of evidence, resulting in a reduction of local and systemic infection. Patients suffering infected necrosis causing clinical sepsis, pancreatic abscess or surgical acute abdomen are candidates for early intervention. Hospital mortality of SAP after interventional or surgical debridement has decreased in high volume centers to below 20%.

关键词： Severe acute pancreatitis Multiorgan failure syndrome infected necrosis Fluid replacement Enteral feeding Surgical and interventional debridement

Surgical management of necrotizing pancreatitis:An overview

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World Journal of Gastroenterology 2014年第43期20卷 16106-16112页

作者： George Kokosis Alexander Perez Theodore N Pappas Department of Surgery Duke University Medical CenterDurhamNC 27705United States

Necrotizing pancreatitis is an uncommon yet serious complication of acute pancreatitis with mortality rates reported up to 15%that reach 30%in case of *** open surgical debridement was the only tool in our disposal to manage this serious clinical *** approach is however associated with poor *** has now shifted away from open surgical debridement to a more conservative management and minimally invasive *** approach to patients with necrotizing pancreatitis and/or infectious pancreatitis is summarized in the 3Ds:Delay,Drain and *** can be managed in the intensive care unit and any intervention should be *** drainage can be utilized first and early in the course of the disease,followed by endoscopic drainage or video assisted retroperitoneoscopic drainage if necrosectomy is deemed *** surgery is now less frequently performed and should be reserved for cases refractory to any other *** management of necrotizing pancreatitis therefore requires a multidisciplinary dynamic model of approach rather than being a surgical disease.

关键词： Necrotizing pancreatitis Severe acute pancreatitis Debridement Necrosectomy infected necrosis Endoscopic necrosectomy Video-assisted retroperitoneal debridement Percutaneous catheter drainage

Advances in prognostic factors in acute pancreatitis:a mini-review

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Hepatobiliary & Pancreatic Diseases International 2010年第5期9卷 482-486页

作者： Theodoros E Pavlidis Efstathios T Pavlidis Athanasios K Sakantamis Surgical Propedeutical Department Medical SchoolAristotle University of ThessalonikiHippocration Hospital

BACKGROUND:Early assessment of the severity of acute pancreatitis is essential to the proper management of the *** is dependent on the criteria of the Atlanta classification *** SOURCES:PubMed search of recent relevant articles was performed to identify information about the severity and prognosis of acute ***:The scoring systems included the Ranson’s or Glasgow’s criteria ≥3,the APACHE II classification system ≥8,and the Balthazar’s criteria ≥4 according to the computed tomography enhanced scanning *** single factors on admission included age >65 years,obesity,hemoconcentration(>44%),abnormal chest X-ray,creatinine >2 mg/dl,C-reactive protein>150 mg/dl,procalcitonin >1.8 ng/ml,albumin 50 pg/ml with calcium <6.6 mg/***:The prediction of the severity of acute pancreatitis is largely based on well defined multiple factor scoring systems as well as several single risk factors.

关键词： acute pancreatitis severity prediction risk factor prognostic sign scoring system infected necrosis

The Open Packing of the Lesser Sac Technique in infected Severe Acute Pancreatitis

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Surgical Science 2010年第1期1卷 7-14页

作者： DCochiorSConstantinoiu DPeta Mariana Cochior Rodica Birla LPripisi Clinical Hospital CF 2 Bucharest Department of SurgeryResearch DepartmentFaculty of Medicine of theUniversity Titu MaiorescuBucharestRumania Clinical Hospital “Santa Maria”BucharestDepartment of General and Esophageal Surgery University ofMedicine and Pharmacy Carol DavilaBucharestRumania Emergency Clinic Hospital Intensive Care UnitUniversity of Medicine and PharmacyCarol DavilaBucharestRumania

Aim: The goal of this study is to evaluate the open packing of the lesser sac (OPLS) in treatment of infected severe acute pancreatitis Methodology: The study was based on 98 cases in which this technique was applied during the period between 19942007, in two departments of surgery (Clinical Hospital CF 2 and Clinical Hospital ?Sf. Maria” Bucharest). The technique was applied based on the therapeutically protocol previously established beginning with 2000. The OPLS technique was analyzed relatively to: timing of surgery, the localization of the infected necrosis or abscesses, growing germs on the cultures, antibiotics received, executed primarily or at reintervention, the number of debridement, hospitalization, morbidity and mortality. The information was statistically processed using SPSS test version 17 for Windows. Results: The OPLS technique improved the control of the local sepsis, in the retrospective/prospective study in 83.7%. Mortality was 16.3% (16/98), with a global mortality of 26.3% (75/285) and a postoperative mortality of 29.5% (66/224). Conclusions: Considering the fact that the intensive care techniques are approximately the same in the last 15 years, we thought that this improvement in the survival rate may be due to the application of OPLS in cases with indication and optimal timing for surgery.

关键词： Open Packing of the Lesser Sac (OPLS) Severe Acute Pancreatitis (SAP) infected necrosis Pancreatic Abscess and Necrosectomy