Pub Date : 2024-04-01Epub Date: 2024-02-12DOI: 10.1097/MPA.0000000000002307
Xiaolong Mu, Mingjun Zhao, Junbo Zhao
Abstract: A few pediatric cases of abdominal paragonimiasis have been described. Here we describe a case of pulmonary and abdominal paragonimiasis with involvement of the pancreas in a 9-year-old boy. The aim of this study was to analyze the clinical and radiological features of pancreatic paragonimiasis in children and raise the awareness of this disease.
{"title":"Pancreatic Paragonimiasis in Children: A Case Report.","authors":"Xiaolong Mu, Mingjun Zhao, Junbo Zhao","doi":"10.1097/MPA.0000000000002307","DOIUrl":"10.1097/MPA.0000000000002307","url":null,"abstract":"<p><strong>Abstract: </strong>A few pediatric cases of abdominal paragonimiasis have been described. Here we describe a case of pulmonary and abdominal paragonimiasis with involvement of the pancreas in a 9-year-old boy. The aim of this study was to analyze the clinical and radiological features of pancreatic paragonimiasis in children and raise the awareness of this disease.</p>","PeriodicalId":19733,"journal":{"name":"Pancreas","volume":null,"pages":null},"PeriodicalIF":2.9,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139723525","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background: Pseudoaneurysm usually occurs after vascular injuries or erosions such as in trauma or inflammation like pancreatitis and is associated with high morbidity and mortality.
Aim: The aim of study is to assess efficacy and safety of EUS-guided thrombin injection in pseudoaneurysm.
Materials and methods: Prospective data collection was done at SMS Hospital, Jaipur, from January 2015 to March 2023. All patients with pseudoaneurysm were consecutively enrolled.
Results: Twenty patients (M/F, 18:2) with median age of 41 years (25-58 years), were studied. Underlying etiology of pseudoaneurysm was chronic pancreatitis in 75% of the patients, blunt trauma abdomen in 15% of the patients, recurrent acute pancreatitis in 5%, and idiopathic in 5% of the patients. At the time of admission, mean hemoglobin was 6.7 g/dL (3.4-8.2), with median blood transfusion requirement was 2 units (0-6 units). Hemoglobin values after 4-6 weeks showed a significant improvement ( t = 9.21, P < 0.05).Mean dose of human thrombin required for complete obliteration of pseudoaneurysm was 520 ± 188.6 IU per patient (300-800 IU). Amount of thrombin (IU) dose needed to achieve complete obliteration correlated well significantly with the dimension of pseudoaneurysm, P value less than 0.05 ( R = 0.80). Median follow-up duration in this study was 44 months (3-84 months), which was the longest follow-up period by far.
Conclusions: Endoscopic ultrasound-guided thrombin injection in visceral artery pseudoaneurysm is a safe and effective alternative for patients not amenable for digital subtraction angiography-guided angioembolization.
{"title":"Efficacy and Rationale of Endoscopic Ultrasound-Guided Thrombin Injection in Visceral Artery Pseudoaneurysm Not Amenable to Angioembolization.","authors":"Ashok Jhajharia, Shashank Singh, Monika Chaudhary, Mayank Ameta, Prachis Ashdhir, Sandeep Nijhawan","doi":"10.1097/MPA.0000000000002303","DOIUrl":"10.1097/MPA.0000000000002303","url":null,"abstract":"<p><strong>Background: </strong>Pseudoaneurysm usually occurs after vascular injuries or erosions such as in trauma or inflammation like pancreatitis and is associated with high morbidity and mortality.</p><p><strong>Aim: </strong>The aim of study is to assess efficacy and safety of EUS-guided thrombin injection in pseudoaneurysm.</p><p><strong>Materials and methods: </strong>Prospective data collection was done at SMS Hospital, Jaipur, from January 2015 to March 2023. All patients with pseudoaneurysm were consecutively enrolled.</p><p><strong>Results: </strong>Twenty patients (M/F, 18:2) with median age of 41 years (25-58 years), were studied. Underlying etiology of pseudoaneurysm was chronic pancreatitis in 75% of the patients, blunt trauma abdomen in 15% of the patients, recurrent acute pancreatitis in 5%, and idiopathic in 5% of the patients. At the time of admission, mean hemoglobin was 6.7 g/dL (3.4-8.2), with median blood transfusion requirement was 2 units (0-6 units). Hemoglobin values after 4-6 weeks showed a significant improvement ( t = 9.21, P < 0.05).Mean dose of human thrombin required for complete obliteration of pseudoaneurysm was 520 ± 188.6 IU per patient (300-800 IU). Amount of thrombin (IU) dose needed to achieve complete obliteration correlated well significantly with the dimension of pseudoaneurysm, P value less than 0.05 ( R = 0.80). Median follow-up duration in this study was 44 months (3-84 months), which was the longest follow-up period by far.</p><p><strong>Conclusions: </strong>Endoscopic ultrasound-guided thrombin injection in visceral artery pseudoaneurysm is a safe and effective alternative for patients not amenable for digital subtraction angiography-guided angioembolization.</p>","PeriodicalId":19733,"journal":{"name":"Pancreas","volume":null,"pages":null},"PeriodicalIF":2.9,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139723574","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Solitary Peritoneal Metastasis of Pancreatic Tail Cancer to a Surgical Mesh for Inguinal Hernia Repair: A Case Report and Literature Review.","authors":"Kenta Aso, Kyoji Ito, Nobuyuki Takemura, Fuyuki Inagaki, Fuminori Mihara, Norihiro Kokudo","doi":"10.1097/MPA.0000000000002302","DOIUrl":"10.1097/MPA.0000000000002302","url":null,"abstract":"","PeriodicalId":19733,"journal":{"name":"Pancreas","volume":null,"pages":null},"PeriodicalIF":2.9,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139723526","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Objectives: Signal intensity ratio of pancreas to spleen (SI ratio p/s ) on fat-suppressed T1-weighted images of magnetic resonance imaging has been associated with pancreatic exocrine function. We here investigated the predictive value of the SI ratio p/s for the development of nonalcoholic fatty liver disease (NAFLD) after pancreaticoduodenectomy (PD).
Materials and methods: This study comprised 208 patients who underwent PD. NAFLD was defined as a liver-to-spleen attenuation ratio of <0.9 calculated by a computed tomography 1 year after surgery. SI ratio p/s was calculated by dividing the average pancreas SI by the spleen SI. We retrospectively investigated the association of clinical variables including the SI ratio p/s and NAFLD by univariate and multivariate analyses.
Results: NAFLD after 1 year was developed in 27 patients (13%). In multivariate analysis, the SI ratio p/s < 1 ( P < 0.001) was an independent predictor of incidence of NAFLD. The SI ratio p/s < 1 was associated with low amylase level of the pancreatic juice ( P < 0.001) and progressed pancreatic fibrosis ( P = 0.017). According to the receiver operating characteristics curve, the SI ratio p/s had better prognostic ability of NAFLD than the remnant pancreas volume.
Conclusions: The SI ratio p/s is useful to predict NAFLD development after PD. Moreover, the SI ratio p/s can be a surrogate marker, which represents exocrine function of the pancreas.
{"title":"The Signal Intensity Ratio of Pancreas to Spleen in Magnetic Resonance Imaging Can Predict Nonalcoholic Fatty Liver Disease After Pancreaticoduodenectomy.","authors":"Masashi Tsunematsu, Koichiro Haruki, Yoshihiro Shirai, Shinji Onda, Kenei Furukawa, Norimitsu Okui, Kyohei Abe, Taro Sakamoto, Takeshi Gocho, Toru Ikegami","doi":"10.1097/MPA.0000000000002306","DOIUrl":"10.1097/MPA.0000000000002306","url":null,"abstract":"<p><strong>Objectives: </strong>Signal intensity ratio of pancreas to spleen (SI ratio p/s ) on fat-suppressed T1-weighted images of magnetic resonance imaging has been associated with pancreatic exocrine function. We here investigated the predictive value of the SI ratio p/s for the development of nonalcoholic fatty liver disease (NAFLD) after pancreaticoduodenectomy (PD).</p><p><strong>Materials and methods: </strong>This study comprised 208 patients who underwent PD. NAFLD was defined as a liver-to-spleen attenuation ratio of <0.9 calculated by a computed tomography 1 year after surgery. SI ratio p/s was calculated by dividing the average pancreas SI by the spleen SI. We retrospectively investigated the association of clinical variables including the SI ratio p/s and NAFLD by univariate and multivariate analyses.</p><p><strong>Results: </strong>NAFLD after 1 year was developed in 27 patients (13%). In multivariate analysis, the SI ratio p/s < 1 ( P < 0.001) was an independent predictor of incidence of NAFLD. The SI ratio p/s < 1 was associated with low amylase level of the pancreatic juice ( P < 0.001) and progressed pancreatic fibrosis ( P = 0.017). According to the receiver operating characteristics curve, the SI ratio p/s had better prognostic ability of NAFLD than the remnant pancreas volume.</p><p><strong>Conclusions: </strong>The SI ratio p/s is useful to predict NAFLD development after PD. Moreover, the SI ratio p/s can be a surrogate marker, which represents exocrine function of the pancreas.</p>","PeriodicalId":19733,"journal":{"name":"Pancreas","volume":null,"pages":null},"PeriodicalIF":2.9,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139735807","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-04-01Epub Date: 2024-02-26DOI: 10.1097/MPA.0000000000002308
Paya Sarraf, Rohit Agrawal, Haya Alrashdan, Mitali Agarwal, Brian Boulay, Ece R Mutlu, Lisa Tussing-Humphreys, Darwin Conwell, Sage Kim, Brian T Layden, Cemal Yazici
Objectives: The primary objective was to determine differences in Social Vulnerability Index (SVI) scores among minorities (African-Americans and Hispanics) with acute pancreatitis (AP) compared with non-Hispanic whites (NHWs) with AP. The secondary objectives were to determine differences in diet, sulfidogenic bacteria gene copy numbers (gcn) and hydrogen sulfide (H2S) levels between the 2 groups.
Materials and methods: Patients with AP were enrolled during hospitalization (n = 54). Patient residential addresses were geocoded, and the Centers for Disease Control and Prevention's SVI scores were appended. Dietary intake and serum H2S levels were determined. Microbial DNAs were isolated from stool, and gcn of sulfidogenic bacteria were determined.
Results: Minorities had higher SVI scores compared with NHWs ( P = 0.006). They also had lower consumption of beneficial nutrients such as omega-3 fatty acids [stearidonic ( P = 0.019), and eicosapentaenoic acid ( P = 0.042)], vitamin D ( P = 0.025), and protein from seafood ( P = 0.031). Lastly, minorities had higher pan-dissimilatory sulfite reductase A ( pan-dsrA ) gcn ( P = 0.033) but no significant differences in H2S levels ( P = 0.226).
Conclusion: Minorities with AP have higher SVI compared with NHWs with AP. Higher SVI scores, lower consumption of beneficial nutrients, and increased gcn of pan-dsrA in minorities with AP suggest that neighborhood vulnerability could be contributing to AP inequities.
目标:首要目标是确定患有急性胰腺炎(AP)的少数族裔(非裔美国人和西班牙裔美国人)与患有急性胰腺炎的非西班牙裔白人(NHWs)在社会脆弱性指数(SVI)得分上的差异。次要目标是确定两组患者在饮食、硫化细菌基因拷贝数(gcn)和硫化氢(H2S)水平方面的差异:住院期间登记的 AP 患者(n = 54)。对患者居住地址进行了地理编码,并附加了美国疾病控制和预防中心的 SVI 评分。测定饮食摄入量和血清 H2S 水平。从粪便中分离出微生物 DNA,并测定硫化细菌的 gcn:结果:少数民族的 SVI 分数高于非华裔(P = 0.006)。他们的有益营养素摄入量也较低,如欧米加-3 脂肪酸[硬脂酸(P = 0.019)和二十碳五烯酸(P = 0.042)]、维生素 D(P = 0.025)和海产品蛋白质(P = 0.031)。最后,少数民族的泛分解亚硫酸盐还原酶 A(pan-dsrA)gcn 较高(P = 0.033),但 H2S 水平无显著差异(P = 0.226):结论:与患有 AP 的 NHWs 相比,患有 AP 的少数民族具有更高的 SVI。患有 AP 的少数族裔的 SVI 分数更高、有益营养素的摄入量更低以及 pan-dsrA 的 gcn 增加表明,邻里关系的脆弱性可能是导致 AP 不平等的原因之一。
{"title":"Racial and Ethnic Minorities With Acute Pancreatitis Live in Neighborhoods With Higher Social Vulnerability Scores.","authors":"Paya Sarraf, Rohit Agrawal, Haya Alrashdan, Mitali Agarwal, Brian Boulay, Ece R Mutlu, Lisa Tussing-Humphreys, Darwin Conwell, Sage Kim, Brian T Layden, Cemal Yazici","doi":"10.1097/MPA.0000000000002308","DOIUrl":"10.1097/MPA.0000000000002308","url":null,"abstract":"<p><strong>Objectives: </strong>The primary objective was to determine differences in Social Vulnerability Index (SVI) scores among minorities (African-Americans and Hispanics) with acute pancreatitis (AP) compared with non-Hispanic whites (NHWs) with AP. The secondary objectives were to determine differences in diet, sulfidogenic bacteria gene copy numbers (gcn) and hydrogen sulfide (H2S) levels between the 2 groups.</p><p><strong>Materials and methods: </strong>Patients with AP were enrolled during hospitalization (n = 54). Patient residential addresses were geocoded, and the Centers for Disease Control and Prevention's SVI scores were appended. Dietary intake and serum H2S levels were determined. Microbial DNAs were isolated from stool, and gcn of sulfidogenic bacteria were determined.</p><p><strong>Results: </strong>Minorities had higher SVI scores compared with NHWs ( P = 0.006). They also had lower consumption of beneficial nutrients such as omega-3 fatty acids [stearidonic ( P = 0.019), and eicosapentaenoic acid ( P = 0.042)], vitamin D ( P = 0.025), and protein from seafood ( P = 0.031). Lastly, minorities had higher pan-dissimilatory sulfite reductase A ( pan-dsrA ) gcn ( P = 0.033) but no significant differences in H2S levels ( P = 0.226).</p><p><strong>Conclusion: </strong>Minorities with AP have higher SVI compared with NHWs with AP. Higher SVI scores, lower consumption of beneficial nutrients, and increased gcn of pan-dsrA in minorities with AP suggest that neighborhood vulnerability could be contributing to AP inequities.</p>","PeriodicalId":19733,"journal":{"name":"Pancreas","volume":null,"pages":null},"PeriodicalIF":2.9,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10959690/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139990792","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-04-01Epub Date: 2024-02-12DOI: 10.1097/MPA.0000000000002305
Chunyan Chen, Yu Zhang, Zhengdong Ding, Suyan Zhu
Objectives: Identifying patients with severe hypertriglyceridemia (HTG) who are prone to developing hypertriglyceridemic pancreatitis (HTGP) is essential for facilitating preventative interventions. This research aims to explore which part of the HTG patients is easy to develop into HTGP.
Materials and methods: An observational cohort study was conducted in patients with serum triglycerides (TGs) ≥ 5.65 mmol/L. Propensity score matching (PSM) and logistic regression were used to adjust for potential confounding factors. Receiver operating characteristic (ROC) curves were applied to evaluate the predictive potential for HTGP.
Results: A total of 283 patients were included finally with a PSM cohort consisting of 55 HTGP matched with 77 non-HTGP. In multivariate logistic regression analysis, fatty liver (FL) (odds ratio, 2.535; P = 0.019) showed statistically significant association with HTGP, whereas statin use was correlated with a lower rate of HTGP (odds ratio, 0.203; P = 0.009). Finally, the ROC analysis showed that the TGs threshold thought to be causal of HTGP in patients with FL was significantly lower (9.31 vs 14.67 mmol/L) than that in patients without FL.
Conclusions: Although with lower TGs levels, patients with FL are much more prone to generate HTGP, and our findings suggest a potential role of statin as protective agents against HTGP.
{"title":"Fatty Liver, Statin Therapy, and the Risk of Hypertriglyceridemic Acute Pancreatitis: A Retrospective Study.","authors":"Chunyan Chen, Yu Zhang, Zhengdong Ding, Suyan Zhu","doi":"10.1097/MPA.0000000000002305","DOIUrl":"10.1097/MPA.0000000000002305","url":null,"abstract":"<p><strong>Objectives: </strong>Identifying patients with severe hypertriglyceridemia (HTG) who are prone to developing hypertriglyceridemic pancreatitis (HTGP) is essential for facilitating preventative interventions. This research aims to explore which part of the HTG patients is easy to develop into HTGP.</p><p><strong>Materials and methods: </strong>An observational cohort study was conducted in patients with serum triglycerides (TGs) ≥ 5.65 mmol/L. Propensity score matching (PSM) and logistic regression were used to adjust for potential confounding factors. Receiver operating characteristic (ROC) curves were applied to evaluate the predictive potential for HTGP.</p><p><strong>Results: </strong>A total of 283 patients were included finally with a PSM cohort consisting of 55 HTGP matched with 77 non-HTGP. In multivariate logistic regression analysis, fatty liver (FL) (odds ratio, 2.535; P = 0.019) showed statistically significant association with HTGP, whereas statin use was correlated with a lower rate of HTGP (odds ratio, 0.203; P = 0.009). Finally, the ROC analysis showed that the TGs threshold thought to be causal of HTGP in patients with FL was significantly lower (9.31 vs 14.67 mmol/L) than that in patients without FL.</p><p><strong>Conclusions: </strong>Although with lower TGs levels, patients with FL are much more prone to generate HTGP, and our findings suggest a potential role of statin as protective agents against HTGP.</p>","PeriodicalId":19733,"journal":{"name":"Pancreas","volume":null,"pages":null},"PeriodicalIF":2.9,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139723523","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Objectives: We set out to predict whether nonsurgical treatment is likely to succeed in removing pancreatic stones in a given patient and also to determine an optimal maximal number of extracorporeal shock wave lithotripsy (ESWL) sessions for treatment of pancreatolithiasis in that patient.
Materials and methods: We ascertained the number of ESWL sessions for each of 164 patients undergoing that treatment for pancreatolithiasis between 1992 and 2020. Median follow-up duration was 31 months (range, 0-239), median age was 58 years (22-83), and the male to female ratio was 5.1:1.0. Patients were divided into 2 groups based upon an optimal maximal number of ESWL sessions determined by receiver operating characteristic analysis.
Results: Total stone clearance was achieved in 130 of 164 patients (79%). The median number of ESWL sessions was 3 (1-61). Receiver operating characteristic analysis determined 7 to be the optimal maximal number of sessions. Complete clearance was more frequent (87%) among the 131 patients requiring 7 or fewer ESWL sessions than among the 33 undergoing more (48%, P < 0.001). Seventeen patients (52%) undergoing 8 or more sessions still had residual stones.
Conclusions: If any pancreatic stones persist after 7 ESWL sessions, we recommend transition to medical or surgical treatments.
{"title":"A Predictive Strategy for Nonsurgical Management of Pancreatic Stones.","authors":"Satoshi Yamamoto, Kazuo Inui, Yoshiaki Katano, Hironao Miyoshi, Takashi Kobayashi, Yoshihiko Tachi","doi":"10.1097/MPA.0000000000002310","DOIUrl":"10.1097/MPA.0000000000002310","url":null,"abstract":"<p><strong>Objectives: </strong>We set out to predict whether nonsurgical treatment is likely to succeed in removing pancreatic stones in a given patient and also to determine an optimal maximal number of extracorporeal shock wave lithotripsy (ESWL) sessions for treatment of pancreatolithiasis in that patient.</p><p><strong>Materials and methods: </strong>We ascertained the number of ESWL sessions for each of 164 patients undergoing that treatment for pancreatolithiasis between 1992 and 2020. Median follow-up duration was 31 months (range, 0-239), median age was 58 years (22-83), and the male to female ratio was 5.1:1.0. Patients were divided into 2 groups based upon an optimal maximal number of ESWL sessions determined by receiver operating characteristic analysis.</p><p><strong>Results: </strong>Total stone clearance was achieved in 130 of 164 patients (79%). The median number of ESWL sessions was 3 (1-61). Receiver operating characteristic analysis determined 7 to be the optimal maximal number of sessions. Complete clearance was more frequent (87%) among the 131 patients requiring 7 or fewer ESWL sessions than among the 33 undergoing more (48%, P < 0.001). Seventeen patients (52%) undergoing 8 or more sessions still had residual stones.</p><p><strong>Conclusions: </strong>If any pancreatic stones persist after 7 ESWL sessions, we recommend transition to medical or surgical treatments.</p>","PeriodicalId":19733,"journal":{"name":"Pancreas","volume":null,"pages":null},"PeriodicalIF":2.9,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139723573","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
To establish an early prediction model for acute pancreatitis (AP) complicated with acute kidney injury (AKI) and evaluate its diagnostic value. AP patients were recruited from the Emergency Department at Peking University People's Hospital in 2021 and stratified into AKI and control (no AKI) groups. Their clinical data were analyzed. The risk for AKI development was determined using logistic analyses to establish a risk prediction model, whose diagnostic value was analyzed using a receiver operating characteristic curve. There was no significant difference in the basic renal function between the AKI (n = 79) and control (n = 179) groups. The increased triglyceride glucose index (odds ratio [OR], 2.613; 95% confidence interval [CI], 1.324–5.158; P = 0.006), age (OR, 1.076; 95% CI, 1.016–1.140; P = 0.013), and procalcitonin (OR, 1.377; 95% CI, 1.096–1.730, P = 0.006) were associated with AKI development. A model was established for prediction of AKI (sensitivity 79.75%, specificity 96.65%). The area under the receiver operating characteristic curve was 0.856 which was superior to the Ranson, Bedside Index for Severity in AP, and Acute Physiology and Chronic Health Evaluation II scores (0.856 vs 0.691 vs 0.745 vs 0.705). The prediction model based on age, triglyceride glucose, and procalcitonin is valuable for the prediction of AP-related AKI.
建立急性胰腺炎并发急性肾损伤(AKI)的早期预测模型,并评估其诊断价值。 研究人员于 2021 年从北京大学人民医院急诊科招募急性胰腺炎患者,并将其分为急性肾损伤组和对照组(无急性肾损伤)。分析了他们的临床数据。利用逻辑分析法确定了发生 AKI 的风险,建立了风险预测模型,并利用接收者操作特征曲线分析了该模型的诊断价值。 AKI 组(79 人)和对照组(179 人)的基本肾功能无明显差异。甘油三酯葡萄糖指数增加(几率比[OR],2.613;95% 置信区间[CI],1.324-5.158;P = 0.006)、年龄(OR,1.076;95% CI,1.016-1.140;P = 0.013)和降钙素原(OR,1.377;95% CI,1.096-1.730;P = 0.006)与 AKI 的发生相关。建立了 AKI 预测模型(灵敏度 79.75%,特异性 96.65%)。接收者操作特征曲线下面积为 0.856,优于 Ranson、AP 床边严重程度指数和急性生理学和慢性健康评估 II 评分(0.856 vs 0.691 vs 0.745 vs 0.705)。 基于年龄、甘油三酯血糖和降钙素原的预测模型对预测 AP 相关性 AKI 很有价值。
{"title":"Establishment and Diagnostic Value of an Early Prediction Model for Acute Pancreatitis Complicated With Acute Kidney Injury","authors":"Cheng Chi, Xiaojing Song, Yong Ma, Chunyu Wang, Jihong Zhu","doi":"10.1097/mpa.0000000000002325","DOIUrl":"https://doi.org/10.1097/mpa.0000000000002325","url":null,"abstract":"\u0000 \u0000 To establish an early prediction model for acute pancreatitis (AP) complicated with acute kidney injury (AKI) and evaluate its diagnostic value.\u0000 \u0000 \u0000 \u0000 AP patients were recruited from the Emergency Department at Peking University People's Hospital in 2021 and stratified into AKI and control (no AKI) groups. Their clinical data were analyzed. The risk for AKI development was determined using logistic analyses to establish a risk prediction model, whose diagnostic value was analyzed using a receiver operating characteristic curve.\u0000 \u0000 \u0000 \u0000 There was no significant difference in the basic renal function between the AKI (n = 79) and control (n = 179) groups. The increased triglyceride glucose index (odds ratio [OR], 2.613; 95% confidence interval [CI], 1.324–5.158; P = 0.006), age (OR, 1.076; 95% CI, 1.016–1.140; P = 0.013), and procalcitonin (OR, 1.377; 95% CI, 1.096–1.730, P = 0.006) were associated with AKI development. A model was established for prediction of AKI (sensitivity 79.75%, specificity 96.65%). The area under the receiver operating characteristic curve was 0.856 which was superior to the Ranson, Bedside Index for Severity in AP, and Acute Physiology and Chronic Health Evaluation II scores (0.856 vs 0.691 vs 0.745 vs 0.705).\u0000 \u0000 \u0000 \u0000 The prediction model based on age, triglyceride glucose, and procalcitonin is valuable for the prediction of AP-related AKI.\u0000","PeriodicalId":19733,"journal":{"name":"Pancreas","volume":null,"pages":null},"PeriodicalIF":2.9,"publicationDate":"2024-03-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140393148","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background: Post-endoscopic retrograde cholangio-pancreatography pancreatitis (PEP) is seen in 3% to 16% of children undergoing therapeutic endoscopic retrograde cholangio-pancreatography (ERCP). We evaluated the risk factors of PEP and utility of 4-hour post-ERCP amylase and lipase for early prediction of PEP in children with chronic pancreatitis (CP).
Materials and methods: Thirty children with CP (boys 20, 14.3 [interquartile range, 9.3-16] years) who underwent 62 ERCP procedures were studied. Clinical and procedural details with outcome were noted. Serum amylase and lipase were measured before, 4 hours, and 24 hours after ERCP. Multivariate analysis was done to identify risk factors for PEP. Cutoff scores of 4-hour amylase and lipase were identified.
Results: PEP occurred in 14.5% (9/62) of ERCP procedures (mild, 8; moderate, 1) with no mortality. On univariate analysis, endoscopic sphincterotomy ( P = 0.04), difficult cannulation ( P = 0.004), and prior PEP ( P = 0.036) were risk factors, while prior ERCP ( P = 0.04) was protective. Difficult cannulation (odds ratio, 5.83; 95% confidence interval, 1.329-25.592) was the independent risk factor on multivariate analysis overall and for first ERCP session alone. Amylase >3.3 times upper limit of normal (ULN) and lipase of >5 times ULN at 4 hours had best sensitivity and specificity for diagnosis of PEP. All cases with PEP were symptomatic by 6 hours and none had amylase/lipase <3 ULN at 4 hours. Amylase/lipase of <3 ULN at 4 hours could exclude PEP with good sensitivity (100%) and specificity (76% and 81%, respectively).
Conclusions: PEP occurred in 14.5% of procedures in children with CP, with difficult cannulation being the independent risk factor. Asymptomatic patients with 4-hour amylase/lipase <3 times ULN can be safely discharged.
背景:接受治疗性内镜逆行胰胆管造影术(ERCP)的儿童中,3%至16%会出现内镜逆行胰胆管造影术后胰腺炎(PEP)。我们评估了慢性胰腺炎(CP)患儿发生 PEP 的风险因素以及 ERCP 术后 4 小时淀粉酶和脂肪酶对早期预测 PEP 的作用:研究对象为接受过 62 次 ERCP 手术的 30 名 CP 患儿(男孩 20 名,14.3 岁[四分位数间距为 9.3-16 岁])。记录了临床和手术细节及结果。在ERCP术前、术后4小时和24小时测量了血清淀粉酶和脂肪酶。进行了多变量分析以确定 PEP 的风险因素。确定了4小时淀粉酶和脂肪酶的临界值:14.5%的ERCP手术(9/62)发生了PEP(轻度8例;中度1例),无死亡病例。单变量分析显示,内镜下括约肌切开术(P = 0.04)、困难插管(P = 0.004)和之前的 PEP(P = 0.036)是风险因素,而之前的 ERCP(P = 0.04)是保护因素。插管困难(几率比,5.83;95% 置信区间,1.329-25.592)是多变量分析中的独立风险因素,也是首次ERCP治疗的独立风险因素。淀粉酶大于正常值上限(ULN)的 3.3 倍和脂肪酶大于正常值上限(ULN)的 5 倍在 4 小时内对 PEP 的诊断具有最佳的敏感性和特异性。所有 PEP 病例在 6 小时内均无症状,且均无淀粉酶/脂肪酶结论:14.5%的CP患儿在手术中发生了PEP,插管困难是独立的风险因素。4小时淀粉酶/脂肪酶正常的无症状患者
{"title":"Risk Factors for Post-Endoscopic Retrograde Cholangio-Pancreatography Pancreatitis in Children With Chronic Pancreatitis and Its Prediction Using 4-Hour Postprocedure Serum Amylase and Lipase Levels.","authors":"Arghya Samanta, Srinivas Srinidhi Vadlapudi, Anshu Srivastava, Samir Mohindra, Moinak Sen Sarma, Ujjal Poddar, Vivek Anand Saraswat, Prabhakar Mishra","doi":"10.1097/MPA.0000000000002296","DOIUrl":"10.1097/MPA.0000000000002296","url":null,"abstract":"<p><strong>Background: </strong>Post-endoscopic retrograde cholangio-pancreatography pancreatitis (PEP) is seen in 3% to 16% of children undergoing therapeutic endoscopic retrograde cholangio-pancreatography (ERCP). We evaluated the risk factors of PEP and utility of 4-hour post-ERCP amylase and lipase for early prediction of PEP in children with chronic pancreatitis (CP).</p><p><strong>Materials and methods: </strong>Thirty children with CP (boys 20, 14.3 [interquartile range, 9.3-16] years) who underwent 62 ERCP procedures were studied. Clinical and procedural details with outcome were noted. Serum amylase and lipase were measured before, 4 hours, and 24 hours after ERCP. Multivariate analysis was done to identify risk factors for PEP. Cutoff scores of 4-hour amylase and lipase were identified.</p><p><strong>Results: </strong>PEP occurred in 14.5% (9/62) of ERCP procedures (mild, 8; moderate, 1) with no mortality. On univariate analysis, endoscopic sphincterotomy ( P = 0.04), difficult cannulation ( P = 0.004), and prior PEP ( P = 0.036) were risk factors, while prior ERCP ( P = 0.04) was protective. Difficult cannulation (odds ratio, 5.83; 95% confidence interval, 1.329-25.592) was the independent risk factor on multivariate analysis overall and for first ERCP session alone. Amylase >3.3 times upper limit of normal (ULN) and lipase of >5 times ULN at 4 hours had best sensitivity and specificity for diagnosis of PEP. All cases with PEP were symptomatic by 6 hours and none had amylase/lipase <3 ULN at 4 hours. Amylase/lipase of <3 ULN at 4 hours could exclude PEP with good sensitivity (100%) and specificity (76% and 81%, respectively).</p><p><strong>Conclusions: </strong>PEP occurred in 14.5% of procedures in children with CP, with difficult cannulation being the independent risk factor. Asymptomatic patients with 4-hour amylase/lipase <3 times ULN can be safely discharged.</p>","PeriodicalId":19733,"journal":{"name":"Pancreas","volume":null,"pages":null},"PeriodicalIF":2.9,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139477368","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-03-01Epub Date: 2024-01-25DOI: 10.1097/MPA.0000000000002292
Guru Trikudanathan, Mohamed Abdallah, Satish Munigala, Kornpong Vantanasiri, David Jonason, Nauroze Faizi, Robben Schat, Anil Chauhan, Martin L Freeman, Melena D Bellin
Objectives: We aimed to estimate the incidence of new-onset diabetes (NOD) and identify risk factors for NOD in patients with necrotizing pancreatitis (NP).
Methods: Necrotizing pancreatitis patients were reviewed for NOD, diagnosed >90 days after acute pancreatitis. Baseline demographics, comorbidities, clinical outcomes, computed tomography (CT) characteristics of necrotic collections, and CT-derived abdominal fat measurements were analyzed to identify predictors for NOD.
Results: Among 390 eligible NP patients (66% men; median age, 51 years; interquartile range [IQR], 36-64) with a median follow-up of 400 days (IQR, 105-1074 days), NOD developed in 101 patients (26%) after a median of 216 days (IQR, 92-749 days) from NP. Of the NOD patients, 84% required insulin and 69% developed exocrine pancreatic insufficiency (EPI). Age (odds ratio [OR], 0.98), male sex (OR, 2.7), obesity (OR, 2.1), presence of EPI (OR, 2.7), and diffuse pancreatic necrosis (OR, 2.4) were independent predictors. In a separate multivariable model assessing abdominal fat on CT, visceral fat area (highest quartile) was an independent predictor for NOD (OR, 3.01).
Conclusions: New-onset diabetes was observed in 1 of 4 patients with NP, most within the first year and requiring insulin. Male sex, obesity, diffuse pancreatic necrosis, development of EPI, and high visceral adiposity identified those at highest risk.
{"title":"Visceral Fat Predicts New-Onset Diabetes After Necrotizing Pancreatitis.","authors":"Guru Trikudanathan, Mohamed Abdallah, Satish Munigala, Kornpong Vantanasiri, David Jonason, Nauroze Faizi, Robben Schat, Anil Chauhan, Martin L Freeman, Melena D Bellin","doi":"10.1097/MPA.0000000000002292","DOIUrl":"10.1097/MPA.0000000000002292","url":null,"abstract":"<p><strong>Objectives: </strong>We aimed to estimate the incidence of new-onset diabetes (NOD) and identify risk factors for NOD in patients with necrotizing pancreatitis (NP).</p><p><strong>Methods: </strong>Necrotizing pancreatitis patients were reviewed for NOD, diagnosed >90 days after acute pancreatitis. Baseline demographics, comorbidities, clinical outcomes, computed tomography (CT) characteristics of necrotic collections, and CT-derived abdominal fat measurements were analyzed to identify predictors for NOD.</p><p><strong>Results: </strong>Among 390 eligible NP patients (66% men; median age, 51 years; interquartile range [IQR], 36-64) with a median follow-up of 400 days (IQR, 105-1074 days), NOD developed in 101 patients (26%) after a median of 216 days (IQR, 92-749 days) from NP. Of the NOD patients, 84% required insulin and 69% developed exocrine pancreatic insufficiency (EPI). Age (odds ratio [OR], 0.98), male sex (OR, 2.7), obesity (OR, 2.1), presence of EPI (OR, 2.7), and diffuse pancreatic necrosis (OR, 2.4) were independent predictors. In a separate multivariable model assessing abdominal fat on CT, visceral fat area (highest quartile) was an independent predictor for NOD (OR, 3.01).</p><p><strong>Conclusions: </strong>New-onset diabetes was observed in 1 of 4 patients with NP, most within the first year and requiring insulin. Male sex, obesity, diffuse pancreatic necrosis, development of EPI, and high visceral adiposity identified those at highest risk.</p>","PeriodicalId":19733,"journal":{"name":"Pancreas","volume":null,"pages":null},"PeriodicalIF":2.9,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139546873","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}