Pancreatology最新文献

Background: Fluid resuscitation is critical in patients with acute pancreatitis (AP) but there is no consensus regarding the amount of fluid to be infused. This is primarily due to difficulty in assessing the fluid deficit accurately. Our objective was to measure the amount of fluid sequestration and intravascular plasma volume deficit by measuring fluid in various body compartments in patients with AP.

Methods: Patients with predicted severe AP presenting within 72 h of onset of pain were included prospectively. These patients underwent analysis of the body fluid composition (distribution of fluid in different compartments) by the Body Composition Monitor, a whole-body multifrequency bioimpedance analysis device. Total body water (TBW), intracellular fluid (ICF), and extracellular fluid (ECF) were measured. Intravascular plasma volume was measured objectively by ⁵¹Chromium radio-isotope labelled RBCs dilution method. Fluid sequestration in the interstitial compartment was calculated based on the fluid distribution.

Results: Twenty patients with predicted severe AP were included in the study [median age 37 years, 75 % male]. The median measured ECF was 13.8 (9.9-18.8) L [58.6 % increase], ICF was 16.3 (10.4-23.3) L [20.1 % decrease], and interstitial fluid volume was 12.7 (8.9-16.3) L [101 % increase] at 48 h after hospitalization. The median plasma volume was 1.4 (0.5-2.3) L at 48 h as compared to 2.4 (1.6-3.1) L at baseline i.e. 48.6 % decrease with a plasma volume deficit of 1.1 (0.4-2.0) L. Fluid sequestration was 2.5 (1.2-3.7) L as per bioimpedance method.

Conclusion: The objective measurement of fluid distribution in body compartments revealed a modest plasma volume deficit in AP, supporting the rationale behind moderate fluid therapy to replenish the plasma volume deficit, rather than the total fluid sequestered in the interstitium.

Background: Factor VII activating protease (FSAP) can be activated by damaged or necrotic cells and plays a role in coagulation and inflammation.

Methods: Patients who were consecutively admitted and diagnosed with acute pancreatitis (AP) were screened. Multivariate logistic regression analysis was performed to analyze the relationship between plasma FSAP levels and disease severity. Spearman analysis was employed to explore the relationship between plasma FSAP levels and inflammation and coagulation indicators. The outcomes of interest included new-onset venous thrombosis, abdominal infection, pancreatic necrosis, and organ failure during hospitalization. Patients were followed up for 1-3 months to observe the evolution of AP.

Results: A total of 61 patients were included. The plasma FSAP levels in the severe acute pancreatitis (SAP) group were significantly higher than those in non-SAP group [15.95 (11.23, 22.81) μg/mL versus 7.36 (5.40, 11.46) μg/mL, p < 0.001] and were significantly associated with inflammation (C-reactive protein and procalcitonin) and coagulation (D-dimer and antithrombin III). High plasma FSAP levels were independently associated with the risk of pancreatic necrosis [OR (95 % CI): 1.23 (1.01-1.50), p = 0.046], and organ failure [OR (95 % CI): 1.37 (1.04-1.81), p = 0.025] during hospitalization, but not with new-onset venous thrombosis and abdominal infection. Higher plasma FSAP levels were also associated with longer recovery time for oral feeding and worse prognosis.

Conclusion: Plasma FSAP level can serve as a biomarker of disease severity and prognosis in AP.