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Development and external validation of models to predict acute respiratory distress syndrome related to severe acute pancreatitis

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World Journal of Gastroenterology 2022年第19期28卷 2123-2136页

作者： Yun-Long Li Ding-Ding Zhang Yang-Yang Xiong Rui-Feng Wang Xiao-Mao Gao Hui Gong Shi-Cheng Zheng Dong Wu Department of Gastroenterology Peking Union Medical College HospitalBeijing 100730China Medical Research Center Peking Union Medical College HospitalBeijing 100730China Clinical Epidemiology Unit International Clinical Epidemiology NetworkBeijing 100730China Department of Gastroenterology The First Affiliated HospitalZhejiang University School of MedicineHangzhou 310003Zhejiang ProvinceChina Department of Gastroenterology The Fourth Affiliated Hospital of Harbin Medical UniversityHarbin 150001Heilongjiang ProvinceChina Department of Gastroenterology The Sixth Hospital of BeijingBeijing 100191China Department of Gastroenterology West China Longquan Hospital Sichuan UniversityChengdu 610100Sichuan ProvinceChina

BACKGROUND acute respiratory distress syndrome(ARDS)is a major cause of death in patients with severe acute pancreatitis(SAP).Although a series of prediction models have been developed for early identification of such patients,the majority are complicated or lack validation.A simpler and more credible model is required for clinical practice.AIM To develop and validate a predictive model for SAP related ARDS.METHODS Patients diagnosed with AP from four hospitals located at different regions of China were retrospectively grouped into derivation and validation cohorts.Statistically significant variables were identified using the least absolute shrinkage and selection operator regression method.Predictive models with nomograms were further built using multiple logistic regression analysis with these picked predictors.The discriminatory power of new models was compared with some common models.The performance of calibration ability and clinical utility of the predictive models were evaluated.RESULTS Out of 597 patients with AP,139 were diagnosed with SAP(80 in derivation cohort and 59 in validation cohort)and 99 with ARDS(62 in derivation cohort and 37 in validation cohort).Four identical variables were identified as independent risk factors for both SAP and ARDS:heart rate[odds ratio(OR)=1.05;95%CI:1.04-1.07;P<0.001;OR=1.05,95%CI:1.03-1.07,P<0.001],respiratory rate(OR=1.08,95%CI:1.0-1.17,P=0.047;OR=1.10,95%CI:1.02-1.19,P=0.014),serum calcium concentration(OR=0.26,95%CI:0.09-0.73,P=0.011;OR=0.17,95%CI:0.06-0.48,P=0.001)and blood urea nitrogen(OR=1.15,95%CI:1.09-1.23,P<0.001;OR=1.12,95%CI:1.05-1.19,P<0.001).The area under receiver operating characteristic curve was 0.879(95%CI:0.830-0.928)and 0.898(95%CI:0.848-0.949)for SAP prediction in derivation and validation cohorts,respectively.This value was 0.892(95%CI:0.843-0.941)and 0.833(95%CI:0.754-0.912)for ARDS prediction,respectively.The discriminatory power of our models was improved compared with that of other widely used models and the calibration ability and clinical

关键词： acute pancreatitis acute respiratory distress syndrome Nomogram Calibration Early identification Predictive model

Management of infected acute necrotizing pancreatitis

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World Journal of Clinical Cases 2023年第2期11卷 482-486页

作者： Efstathios T Pavlidis Theodoros E Pavlidis Second Propedeutic Department of Surgery Hippocration HospitalSchool of MedicineAristotle University of ThessalonikiThessaloniki 54642Greece

Necrotizing or severe pancreatitis represents approximately 10%-20%of acute pancreatitis.30%-40%of patients with acute necrotizing pancreatitis(ANP)will develop debris infection through translocation of intestinal microbial flora.Infected ANP constitutes a serious clinical condition and is complicated by severe sepsis with high mortality rates of up to 40%despite progress in current intensive care.The timely detection of sepsis is crucial.The Quick Sequential Organ Failure Assessment score,procalcitonin levels>1.8 ng/mL and increased lactates>2 mmol/L(>18 mg/dL),indicate the need for urgent management.The escalated step-by-step management protocol starts with broad-spectrum antibiotics,percutaneous drainage or endoscopic management,and ends with surgical management if needed.The latter includes necrosectomy(either laparoscopic or traditional open surgery),peritoneal lavage and extensive drainage.This management protocol increases the chance of survival to approximately 60%in patients with otherwise fatal cases.Any treatment choice must be individualized,and the timing is critical.

关键词： Pancreas acute abdomen acute pancreatitis Necrotizing pancreatitis Sepsis Septic shock

Prediction of moderately severe and severe acute pancreatitis in pregnancy: Several issues

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World Journal of Gastroenterology 2022年第33期28卷 4926-4928页

作者： Qun-Ying Yang Jian-Wen Hu Department of Gastroenterology Dongyang People's HospitalDongyang 322100Zhejiang ProvinceChina

We reviewed a study addressing the development and validation of a prediction model for moderately severe and severe acute pancreatitis in pregnancy. We identified some statistical deficiencies in this article. In add... 详细信息

关键词： acute pancreatitis Prediction model Statistical analyses Cholesterol

Combined use of extracorporeal membrane oxygenation with interventional surgery for acute pancreatitis with pulmonary embolism: A case report

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World Journal of Clinical Cases 2022年第12期10卷 3899-3906页

作者： Ling-Ling Yan Xiu-Xiu Jin Xiao-Dan Yan Jin-Bang Peng Zhuo-Ya Li Bi-Li He Department of Gastroenterology Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical UniversityLinhai 317000Zhejiang ProvinceChina

BACKGROUND acute pancreatitis(AP) is an acute inflammatory process of the pancreas characterized by self-digestion of pancreatic tissue, which can trigger a systemic inflammatory response. Venous thrombosis, resulting from a hypercoagulable state, is a vascular complication of AP. AP complicated by pulmonary embolism(PE) is very rare, and the combined use of extracorporeal membrane oxygenation(ECMO) with a vascular interventional procedure for AP complicated by PE is even rarer.CASE SUMMARY A 32-year-old man with a history of obesity developed rapidly worsening AP secondary to hypertriglyceridemia. During treatment, the patient developed chest tightness, shortness of breath, and cardiac arrest. Computed tomography(CT) scans of his upper abdomen were consistent with pancreatitis. PE was identified by chest CT angiography involving the right main pulmonary artery and multiple lobar pulmonary arteries. The patient’s D-dime level was significantly elevated(> 20 mg/L). The patient received high-frequency oxygen inhalation, continuous renal replacement therapies, anti-infective therapy, inhibition of pancreatic secretion, emergent endotracheal intubation, and advanced cardiac life support with cardiopulmonary resuscitation. Following both ECMO and a vascular interventional procedure, the patient recovered and was discharged.CONCLUSION PE is a rare but potentially lethal complication of AP. The early diagnosis of PE is important because an accurate diagnosis and timely interventional procedures can reduce mortality. The combined use of ECMO with a vascular interventional procedure for AP complicated by PE can be considered a feasible treatment method. A collaborative effort between multiple teams is also vital.

关键词： acute pancreatitis Pulmonary embolism Extracorporeal membrane oxygenation Respiratory distress syndrome Case report

Post-acute pancreatitis diabetes:A complication waiting for more recognition and understanding

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World Journal of Gastroenterology 2023年第28期29卷 4405-4415页

作者： Diego García-Compeán Alan R Jiménez-Rodríguez Juan M Muñoz-Ayala José A González-González Héctor J Maldonado-Garza Jesús Z Villarreal-Pérez Department of Gastroenterology Autonomous University of Nuevo LeónMonterrey 64700Nuevo LeónMexico Department of Endocrinology Autonomous University of Nuevo LeónMonterrey 64700Nuevo LeónMexico

Post-acute pancreatitis diabetes(PAPD)is the second most common type of diabetes below type 2 diabetes mellitus.Due to the boom in research on this entity carried out during the last decade,its recognition has increased.However,much of the medical community still does not recognize it as a medium and long-term complication of acute pancreatitis(AP).Recent prospective cohort studies show that its incidence is about 23%globally and 34.5%in patients with severe AP.With the overall increase in the incidence of AP this complication will be certainly seen more frequently.Due to its high morbidity,mortality and difficult control,early detection and treatment are essential.However,its risk factors and pathophysiological mechanisms are not clearly defined.Its diagnosis should be made excluding pre-existing diabetes and applying the criteria of the American Diabetes Association after 90 d of resolution of one or more AP episodes.This review will show the evidence published so far on the incidence and prevalence,risk factors,possible pathophysiological mechanisms,clinical outcomes,clinical characteristics and preventive and corrective management of PAPD.Some important gaps needing to be clarified in forthcoming studies will also be discussed.

关键词： acute pancreatitis Diabetes mellitus Chronic pancreatitis Post-pancreatitis diabetes Pancreatogenic diabetes

Could extracellular vesicles derived from mesenchymal stem cells be a potential therapy for acute pancreatitis-induced cardiac injury?

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World Journal of Stem Cells 2023年第7期15卷 654-664页

作者： Long-Fei Pan Ze-Qun Niu Song Ren Hong-Hong Pei Yan-Xia Gao Hui Feng Jiang-Li Sun Zheng-Liang Zhang Emergency Department The Second Affiliated Hospital of Xi'an Jiaotong UniversityXi’an 710004Shaanxi ProvinceChina Department of Geriatric Digestive Surgery The Second Affiliated Hospital of Xi'an Jiaotong UniversityXi’an 710004Shaanxi ProvinceChina

acute pancreatitis(AP)often leads to a high incidence of cardiac injury,posing significant challenges in the treatment of severe AP and contributing to increased mortality rates.Mesenchymal stem cells(MSCs)release bioactive molecules that participate in various inflammatory diseases.Similarly,extracellular vesicles(EVs)secreted by MSCs have garnered extensive attention due to their comparable anti-inflammatory effects to MSCs and their potential to avoid risks associated with cell transplantation.Recently,the therapeutic potential of MSCs-EVs in various inflammatory diseases,including sepsis and AP,has gained increasing recognition.Although preclinical research on the utilization of MSCs-EVs in AP-induced cardiac injury is limited,several studies have demonstrated the positive effects of MSCs-EVs in regulating inflammation and immunity in sepsis-induced cardiac injury and cardiovascular diseases.Furthermore,clinical studies have been conducted on the therapeutic application of MSCs-EVs for some other diseases,wherein the contents of these EVs could be deliberately modified through prior modulation of MSCs.Consequently,we hypothesize that MSCs-EVs hold promise as a potential therapy for AP-induced cardiac injury.This paper aims to discuss this topic.However,additional research is essential to comprehensively elucidate the underlying mechanisms of MSCs-EVs in treating AP-induced cardiac injury,as well as to ascertain their safety and efficacy.

关键词： acute pancreatitis Cardiac injury Mesenchymal stem cells Extracellular vesicles Inflammation Therapeutic strategies

Value of neutrophil-lymphocyte ratio in evaluating response to percutaneous catheter drainage in patients with acute pancreatitis

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World Journal of Clinical Cases 2022年第1期10卷 91-103页

作者： Pankaj Gupta Gaurav Chayan Das Akash Bansal Jayanta Samanta Harshal S Mandavdhare Vishal Sharma Shano Naseem Vikas Gupta Thakur Deen Yadav Usha Dutta Neelam Varma Manavjit Singh Sandhu Rakesh Kochhar Department of Radiodiagnosis Postgraduate Institute of Medical Education and ResearchChandigarh 160012India Department of Gastroenterology Postgraduate Institute of Medical Education and ResearchChandigarh 160012India Department of Hematology Postgraduate Institute of Medical Education and ResearchChandigarh 160012India Department of Surgical Gastroenterology Postgraduate Institute of Medical Education and ResearchChandigarh 160012India

BACKGROUND Early prediction of response to percutaneous catheter drainage(PCD)of necrotic collections in acute pancreatitis(AP)using simple and objective tests is critical as it may determine patient prognosis.The role of white blood cell(WBC)count and neutrophil-lymphocyte ratio(NLR)has not been assessed as a tool of early prediction of PCD success and is the focus of this study.AIM To assess the value of WBC and NLR in predicting response to PCD in AP.METHODS This retrospective study comprised consecutive patients with AP who underwent PCD between June 2018 and December 2019.Severity and fluid collections were classified according to the revised Atlanta classification and organ failure was defined according to the modified Marshall Score.WBC and NLR were monitored 24 h prior PCD(WBC-0/NLR-0)and 24 h(WBC-1/NLR-1),48 h(WBC-2/NLR-2)and 72 h(WBC-3/NLR-3)after PCD.NLR was calculated by dividing the number of neutrophils by the number of lymphocytes.The association of success of PCD(defined as survival without the need for surgery)with WBC and NLR was assessed.The trend of WBC and NLR was also assessed post PCD.RESULTS One hundred fifty-five patients[median age 40±13.6(SD),64.5%males,53.5%severe AP]were included in the final analysis.PCD was done for acute necrotic collection in 99(63.8%)patients and walled-off necrosis in 56(36.1%)patients.Median pain to PCD interval was 24±69.89 d.PCD was successful in 109 patients(group 1)and 46 patients(group 2)who failed to respond.There was no significant difference in the baseline characteristics between the two groups except the severity of AP and frequency of organ failure.Both WBC and NLR showed an overall decreasing trend.There was a significant difference between WBC-0 and WBC-1(P=0.0001).WBC-1 and NLR-1 were significantly different between the two groups(P=0.048 and 0.003,respectively).The area under the curve of WBC-1 and NLR-1 for predicting the success of PCD was 0.602 and 0.682,respectively.At a cut-off value of 9.87 for NLR-1,the sensitivity and specificity for pred

关键词： acute pancreatitis Percutaneous catheter drainage White blood cell Neutrophil-lymphocyte ratio Necrotic collection

Identification of optimal reference genes in golden Syrian hamster with ethanol-and palmitoleic acid-induced acute pancreatitis using quantitative real-time polymerase chain reaction

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Animal Models and Experimental Medicine 2023年第6期6卷 609-618页

作者： Jinxin Miao Le Kang Tianfeng Lan Jianyao Wang Siqing Wu Yifan Jia Xia Xue Haoran Guo Pengju Wang Yan Li Academy of Chinese Medicine Science Henan University of Chinese MedicineZhengzhouChina Sino-British Research Centre for Molecular Oncology National Center for International Research in Cell and Gene TherapySchool of Basic Medical SciencesAcademy of Medical SciencesZhengzhou UniversityZhengzhouChina Henan Key Laboratory of Helicobacter pylori and Microbiota and Gastrointestinal Cancer Marshall Medical Research CenterThe Fifth Affiliated Hospital of Zhengzhou UniversityZhengzhouChina

Background:acute pancreatitis(AP)is a severe disorder that leads to high morbidity and mortality.Appropriate reference genes are important for gene analysis in AP.This study sought to study the expression stability of several reference genes in the golden Syrian hamster,a model of AP.Methods:AP was induced in golden Syrian hamster by intraperitoneal injection of ethanol(1.35 g/kg)and palmitoleic acid(2 mg/kg).The expression of candidate genes,including Actb,Gapdh,Eef2,Ywhaz,Rps18,Hprt1,Tubb,Rpl13a,Nono,and B2m,in hamster pancreas at different time points(1,3,6,9,and 24 h)posttreatment was analyzed using quantitative polymerase chain reaction.The expression stability of these genes was calculated using Best Keeper,Comprehensive Delta CT,Norm Finder,and ge Norm algorithms and Ref Finder software.Results:Our results show that the expression of these reference genes fluctuated during AP,of which Ywhaz and Gapdh were the most stable genes,whereas Tubb,Eef2,and Actb were the least stable genes.Furthermore,these genes were used to normalize the expression of TNF-αmessenger ribonucleic acid in inflamed pancreas.Conclusions:In conclusion,Ywhaz and Gapdh were suitable reference genes for gene expression analysis in AP induced in Syrian hamster.

关键词： acute pancreatitis reference genes Syrian hamster TNF-α

Machine learning-based decision tool for selecting patients with idiopathic acute pancreatitis for endosonography to exclude a biliary aetiology

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世界胃肠病学杂志:英文版 2023年第35期29卷 5138-5153页

作者： Simon Sirtl Michal Żorniak Eric Hohmann Georg Beyer Miriam Dibos Annika Wandel Veit Phillip Christoph Ammer-Herrmenau Albrecht Neesse Christian Schulz Jörg Schirra Julia Mayerle Ujjwal Mukund Mahajan Department of Medicine II LMU University HospitalMunich 81377Germany Department of Endoscopy Maria Sklodowska-Curie National Research Institute of OncologyGliwice 44-113Poland Department of Internal Medicine II School of MedicineUniversity Hospital Rechts der IsarTechnical University of MunichMunich 81675Germany Department of Gastroenterology Gastrointestinal Oncology and EndocrinologyUniversity Medical CenterGöttingen 37075Germany

BACKGROUND Biliary microlithiasis/sludge is detected in approximately 30%of patients with idiopathic acute pancreatitis(IAP).As recurrent biliary pancreatitis can be prevented,the underlying aetiology of IAP should be established.AIM To develop a machine learning(ML)based decision tool for the use of endosonography(EUS)in pancreatitis patients to detect sludge and microlithiasis.METHODS We retrospectively used routinely recorded clinical and laboratory parameters of 218 consecutive patients with confirmed AP admitted to our tertiary care hospital between 2015 and 2020.Patients who did not receive EUS as part of the diagnostic work-up and whose pancreatitis episode could be adequately explained by other causes than biliary sludge and microlithiasis were excluded.We trained supervised ML classifiers using H_(2)O.ai automatically selecting the best suitable predictor model to predict microlithiasis/sludge.The predictor model was further validated in two independent retrospective cohorts from two tertiary care centers(117 patients).RESULTS Twenty-eight categorized patients’variables recorded at admission were identified to compute the predictor model with an accuracy of 0.84[95%confidence interval(CI):0.791-0.9185],positive predictive value of 0.84,and negative predictive value of 0.80 in the identification cohort(218 patients).In the validation cohort,the robustness of the prediction model was confirmed with an accuracy of 0.76(95%CI:0.673-0.8347),positive predictive value of 0.76,and negative predictive value of 0.78(117 patients).CONCLUSION We present a robust and validated ML-based predictor model consisting of routinely recorded parameters at admission that can predict biliary sludge and microlithiasis as the cause of AP.

关键词： acute pancreatitis Idiopathic acute pancreatitis Biliary pancreatitis Microlithiasis Sludge Endosonography