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– Ranson criteria Apache II (1985) It is still one of the more used ways for PA severity stratification and risk of mortality 8 . It has 12 evaluation parameters, and extra score based on age and the presence of chronic disease (Figure 3) 14,25 . It has sensitivity of 76% and specificity of 61.5% to assess the PA severity PA 28 . Atlanta classification considers the diagnosis of severe PA when, by Apache classification, are assigned eight or more points 1 . It has the advantages of being able to be calculated within the first 24 h after patient's admission to hospital and can be performed daily in the evaluation of patient outcomes. The addition of BMI in Apache II score known as Apache-O -adds one point to BMI of >25-30 kg/m 2 and two points to BMI >30 kg/m 2 . Johnson reported that this system improves severe pancreatitis forecast 7 .
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Introduction:
Acute pancreatitis has as its main causes lithiasic biliary disease and alcohol abuse. Most of the time, the disease shows a self-limiting course, with a rapid recovery, only with supportive treatment. However, in a significant percentage of cases, it runs with important local and systemic complications associated with high mortality...
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Objectives:
Predicting severe acute pancreatitis (AP) remains a challenge. The present study compares admission blood urea nitrogen (BUN), hematocrit, and creatinine, as well as changes in their levels over 24 h, aiming to determine the most accurate laboratory test for predicting persistent organ failure and pancreatic necrosis.
Methods:
Clinic...
Citations
... Выявление острого некротического скопления при отсутствии некроза поджелудочной железы (ПЖ) выступает в качестве прогностического фактора неблагоприятного течения заболевания [1]. Существуют системы оценки состояния пациентов, достоверно увеличивающие точность прогноза течения ОП, такие как SAPS II [2]. Классификация распространенности поражения забрюшинной клетчатки K. Ishikawa в большей степени отражает выраженность парапанкреатита и его локализацию, чем индекс воспалительных изменений Balthazar [1]. ...
Aim . To analyze the most promising scientific and practical directions regarding the role of intestinal microbiota and its metabolites in the pathogenesis and clinical course of acute pancreatitis.
Materials and methods . The study involved a systematic literature review of the databases PubMed, EMBASE, and Cochrane for the last 20 years. A total of 5 meta-analyses, 234 clinical trials, 127 reviews, and 428 experimental studies were identified. Ultimately, 36 clinical trials, 2 reviews, and 18 experimental studies were selected for the inclusion. The systematic review was carried out in accordance with PRISMA recommendations.
Results . The structure of the intestinal microbiota significantly differs in healthy control groups and patients with acute pancreatitis. The microbiota of patients with acute pancreatitis closely correlates with systemic inflammation and intestinal barrier dysfunction. Cases of severe acute pancreatitis revealed an increase in Enterococcus, Proteobacteria, Escherichia, and Shigella, alongside a decrease in overall microbiome diversity and in Bifidobacterium , Prevotella , Faecalibacterium , Blautia , Lachnospiraceae , and Ruminococcaceae . Short-chain fatty acids, the concentration of which in the blood may indicate an increase in intestinal wall permeability, are directly involved in the pathogenesis of acute lung injury associated with acute pancreatitis.
Conclusion . Further study into the composition of the intestinal microbiota, its metabolites, and potential modulation strategies in various patient groups obtains high potential as a foundation for new diagnostic, therapeutic, and preventive approaches to acute pancreatitis.
... A decisão de evitar operação radical no caso de carcinomas de papila aplica-se aos adenocarcinomas bem diferenciados com margens negativas e carcinomas endócrinos com Ki67 menor que 2%, também com margens negativas; todos os outros casos requerem intervenção cirúrgica complementar. 14 Neste estudo ocorreram eventos adversos no grupo DM em 7/20 (35%), sendo sangramento o mais frequente, seguido pela pancreatite aguda. Destes, a pancreatite aguda merece especial atenção. ...
Introdução: A papilectomia endoscópica ainda é procedimento controverso para tratar os tumores da papila duodenal maior. Objetivo: Analisar a eficácia da papilectomia endoscópica nos tumores benignos e malignos da papila duodenal maior, em relação a recidiva tumoral no seguimento de 48 meses ( seguimento médio de 21,3 meses) e avaliar comparativamente as complicações decorrentes desse procedimento nas lesões benignas e malignas. Método: Cinquenta e quatro pacientes foram incluídos após estadiamento ecoendoscópico. Foram divididos em dois grupos, aqueles com doença maligna (DM) e benigna (DB). Analisou-se a ocorrência de eventos adversos, recidivas e os resultados do seguimento médio de 21,3 meses. Resultado: A biópsia endoscópica fez o diagnóstico de malignidade em 45% e benignidade em 55% dos casos. O total com doença maligna foi de 20 casos, sendo 15 adenocarcinomas, 3 carcinomas neuroendócrinos e 2 adenomas vilosos com displasia de alto grau. As doenças benignas foram 34, 15 adenomas tubulares, 12 adenomas vilosos e 7 hiperplasia duodenal. Efeitos adversos durante o tratamento no grupo benigno foram: hiperamilasemia (29,6%), pancreatite aguda (18,5%) e sangramento (13%); a ressecção foi completa em 91,7%. No grupo maligno houve sangramento em 15% e pancreatite aguda 10%. Nos dois grupos 65% possuía icterícia A ressecção foi completa em 92,9%. No seguimento de quatro anos 70% não possuíam qualquer sinal da doença. Foram encaminhados ao tratamento cirúrgico seis (30%) casos, três (5,55%) apresentando lesão residual e linfonodos comprometidos. Conclusão: A papilectomia endoscópica foi um procedimento eficaz e seguro no tratamento dos tumores de papila, benignos e malignos em relação a redicidiva tumoral no seguimento proposto de 48 meses ( seguimento médio de 21,3 meses). As complicações mais frequentes da papilectomia por tumores benignos foram: icterícia, hiperamilasemia, pancreatite aguda e sangramento, enquanto por tumores malignos foram: icterícia, sangramento e pancreatite.
... It is estimated that about 15-20% of the patients present a Severe Pancreatitis profile with organ failure (>8 hours). Another 20% present a Necrotizing Pancreatitis profile defined as focal areas of nonviable pancreatic parenchyma (>3 cm in size or > 30% of the pancreas) [18]. ...
Pancreatic insufficiency, both acute and chronic, is an important cause of maldigestion and malnutrition caused by impaired exocrine pancreatic function. Many causes are able to determine pancreatic insufficiency which, depending on the severity, can manifest itself with very diversified symptoms. The chapter will illustrate the diagnostic and monitoring methods of pancreatic pathology in the acute and chronic phases. Great attention will be given to oral nutrition, in its various forms, including enteral and peranterior artificial nutrition. Finally, we will discuss the most appropriate pharmacological therapy to optimise food absorption in the different phases of the disease. Each of the aspects considered takes into account the most recent literature and the clinical experience of the authors.
... [23] SAPS-II is an alternative version of the APACHE scale that is frequently used in the ICU setting. [24] Notably, SAPS-II is a predictor of mortality in patients with AP. [25] As such, all five of the predictors incorporated into our developed nomogram represent credible mortality-related risk factors worthy of consideration in clinical research. ...
Background:
Acute pancreatitis (AP) is a complex and heterogeneous disease. We aimed to design and validate a prognostic nomogram for improving the prediction of short-term survival in patients with AP.
Methods:
The clinical data of 632 patients with AP were obtained from the Medical Information Mart for Intensive Care (MIMIC)-IV database. The nomogram for the prediction of 30-day, 60-day and 90-day survival was developed by incorporating the risk factors identified by multivariate Cox analyses.
Results:
Multivariate Cox proportional hazard model analysis showed that age (hazard ratio [HR]=1.06, 95% confidence interval [95% CI] 1.03-1.08, P<0.001), white blood cell count (HR=1.03, 95% CI 1.00-1.06, P=0.046), systolic blood pressure (HR=0.99, 95% CI 0.97-1.00, P=0.015), serum lactate level (HR=1.10, 95% CI 1.01-1.20, P=0.023), and Simplified Acute Physiology Score II (HR=1.04, 95% CI 1.02-1.06, P<0.001) were independent predictors of 90-day mortality in patients with AP. A prognostic nomogram model for 30-day, 60-day, and 90-day survival based on these variables was built. Receiver operating characteristic (ROC) curve analysis demonstrated that the nomogram had good accuracy for predicting 30-day, 60-day, and 90-day survival (area under the ROC curve: 0.796, 0.812, and 0.854, respectively; bootstrap-corrected C-index value: 0.782, 0.799, and 0.846, respectively).
Conclusion:
The nomogram-based prognostic model was able to accurately predict 30-day, 60-day, and 90-day survival outcomes and thus may be of value for risk stratification and clinical decision-making for critically ill patients with AP.
... Most are mild and self-limited, 30% are moderately severe, and 10% are severe. Organ failure is the main determinant of severity and cause of early death; Overall mortality is 3-6% and increases to 30% in severe acute pancreatitis, with secondary infections, including infected acute necrotizing pancreatitis and sepsis, responsible for more deaths in recent years [3]. ...
Acute pancreatitis is one of the high-mortality gastrointestinal disorders that requires hospitalization, in this pathology there are various degrees of severity, and it is important to define and stratify them to identify dangerous patients who require aggressive treatment on admission, to identify patients worthy of referral for specialized care and to assign these patients to stratification into subgroups with persistent organ failure and local or systemic complications, the use of scales and criteria is implemented to determine the degree of severity of this and the possible management, among them we find the Ranson criteria, which contribute to the determination of severity, conduct to follow and possible complications, which is usually very useful for the patient's prognosis, but although it is true, the Ranson criteria are simple, easy to remember and very available in any laboratory to carry out ar tests, but they are also limited since they present greater specificity after the first 48 hours of the patient's admission and, in addition, they can be inconclusive because they vary according to the presence or not of a biliary pathology, thus increasing the parameters to be evaluated.
... The early determining of severity, forecasting of complications and predicting the outcomes of the AP is very important for achieving better results. The aim of study was to determine the predictive value of inflammatory markers for the early diagnostic of severity of acute pancreatitis and for prediction of further course of pathological processes in pancreas [12][13][14][15]. ...
Background/Aim: Prognosis of complications is important in patients with acute pancreatitis (AP). The aim was to determine
the severity of AP based on changes of inflammatory markers (IM).
Material and Methods: WBC, immature granulocytes (IG), neutrophil-lymphocytes ratio (NLR) and the C-reactive protein
(CRP) were compared in 243 patients with moderately severe pancreatitis (MSP) and in 59 patients with acute severe
pancreatitis (ASP).
Results: WBC count was significantly more in ASP compare to MSP group (15.4±2.3×109/l. vs. 12.7±1.2×109/l.). IG
percentage was high in ASP group; however, lymphocytes count was lower in ASP. NLR during early 48 hours decreased in
MSP; but significantly increased in ASP group. The “cut off” for NLR was determined as 10.5. 3-weeks survival in patients with
NLI<10.5 was 95.9%. In patients with NLI>10.5 the survival was 79.2% and mortality raised up to 21.8%. IG in MSP group was
0.39±0.21% and 1.7±0.51% in ASP.CRP on admission was not differ between groups, but increased in ASP in 2nd day and was
significantly higher compare to MSP.
Conclusion: NLR can predict the survival on admission, but CRP only 2nd day achieve the predictive value. Rational evaluating
of IM during early 2 days can predict the further clinical course of AP.
Keywords: Acute Pancreatitis; Inflammatory Markers; Prognosis; Neutrophil-Lymphocytes Ratio
... Este critério foi desenvolvido por John HC Ranson em 1974 e tem importante valor histórico por ser o primeiro escore de pancreatite aguda amplamente utilizado. Após algumas mudanças, atualmente é composto por 11 parâmetros clínicos e laboratoriais que possuem clara relação com a morbimortalidade dos pacientes com PA, como mostrados na Tabela 25.3 (FERREIRA et al., 2015). ...
... Idade > 55 anos Idade > 70 anos GB > 16.000/mm³ GB > 18.000/mm³ LDH > 350 U/L LDH > 250 U/L AST > 250 U/ L AST > 250 U/ L Glicemia > 200 mg/dL Glicemia > 220 mg/dL Às 48h: Às 48h: Queda do hematócrito > 10% Queda do hematócrito > 10% Aumento do BUN > 5 mg/dL Aumento do BUN > 2 mg/dL Cálcio < 8 mg/dL Cálcio < 8 mg/dL PO2 < 60 mmHg PO2 < 60 mmHg Déficit de Bases > 4 mEq/L Déficit de Bases > 5 mEq/L Perda de fluídos > 6 L Perda de fluídos > 4 L Legenda: GB = global de leucócitos; LDH = desidrogenase láctica; AST = aspartato aminotransferase; BUN = ureia sérica; PO2 = pressão parcial do oxigênio no sangue arterial. Fonte: Adaptado de Ferreira et al., 2015 Cada item do critério de Ranson contabiliza 1 ponto. A presença de três ou mais critérios nas 48 horas da admissão classifica a PA como grave. ...
... A presença de três ou mais critérios nas 48 horas da admissão classifica a PA como grave. Assim, a mortalidade dos pacientes com PA se eleva proporcionalmente a maiores pontuações, de modo que pacientes que apresentem pontuação entre 0 e 2 pontos apresentam mortalidade de 2%, enquanto pontuações de 7 a 8 pontos podem indicar uma mortalidade de até 100% (FERREIRA et al., 2015). ...
... Este critério foi desenvolvido por John HC Ranson em 1974 e tem importante valor histórico por ser o primeiro escore de pancreatite aguda amplamente utilizado. Após algumas mudanças, atualmente é composto por 11 parâmetros clínicos e laboratoriais que possuem clara relação com a morbimortalidade dos pacientes com PA, como mostrados na Tabela 25.3 (FERREIRA et al., 2015). ...
... Idade > 55 anos Idade > 70 anos GB > 16.000/mm³ GB > 18.000/mm³ LDH > 350 U/L LDH > 250 U/L AST > 250 U/ L AST > 250 U/ L Glicemia > 200 mg/dL Glicemia > 220 mg/dL Às 48h: Às 48h: Queda do hematócrito > 10% Queda do hematócrito > 10% Aumento do BUN > 5 mg/dL Aumento do BUN > 2 mg/dL Cálcio < 8 mg/dL Cálcio < 8 mg/dL PO2 < 60 mmHg PO2 < 60 mmHg Déficit de Bases > 4 mEq/L Déficit de Bases > 5 mEq/L Perda de fluídos > 6 L Perda de fluídos > 4 L Legenda: GB = global de leucócitos; LDH = desidrogenase láctica; AST = aspartato aminotransferase; BUN = ureia sérica; PO2 = pressão parcial do oxigênio no sangue arterial. Fonte: Adaptado de Ferreira et al., 2015 Cada item do critério de Ranson contabiliza 1 ponto. A presença de três ou mais critérios nas 48 horas da admissão classifica a PA como grave. ...
... A presença de três ou mais critérios nas 48 horas da admissão classifica a PA como grave. Assim, a mortalidade dos pacientes com PA se eleva proporcionalmente a maiores pontuações, de modo que pacientes que apresentem pontuação entre 0 e 2 pontos apresentam mortalidade de 2%, enquanto pontuações de 7 a 8 pontos podem indicar uma mortalidade de até 100% (FERREIRA et al., 2015). ...
O capítulo aborda sobre a epidemiologia, fisiopatologia, classificação, diagnóstico/exame, tratamento e as perspectivas futuras em relação ao tratamento atual utilizado.
... Thus, the use of multifactor scoring methods such as Ranson, APACHE II, Glasgow, SAPS II, among others, to determine the severity of patients with acute pancreatitis is no longer recommended (12,13) . The delay in establishing patients' severity level is one of the main disadvantages associated with the use of scoring methods such as the Ranson criteria (the most used system in past clinical practices), which requires 48 hours to determine the severity of acute pancreatitis (14) . ...
... Some prognostic risk factors focused on predicting the most severe forms of acute pancreatitis have also been investigated. So far, only overweight (body mass index >25 kg/m 2 ) and hyperglycemia (blood glucose level higher than 11.1 mmol/L or 200 mg/dL) have been identified and established as eligible factors (13,17) . ...
Background:
New recommendations for the management of patients with acute pancreatitis were set after the Atlanta Classification was revised in 2012.
Objective:
The aim of the present systematic review is to assess whether these recommendations have already been accepted and implemented in daily medical practices.
Methods:
A systematic literature review was carried out in studies conducted with humans and published in English and Portuguese language from 10/25/2012 to 11/30/2018. The search was conducted in databases such as PubMed/Medline, Cochrane and SciELO, based on the following descriptors/Boolean operator: "Acute pancreatitis" AND "Atlanta". Only Randomized Clinical Trials comprising some recommendations released after the revised Atlanta Classification in 2012 were included in the study.
Results:
Eighty-nine studies were selected and considered valid after inclusion, exclusion and qualitative evaluation criteria application. These studies were stratified as to whether, or not, they applied the recommendations suggested after the Atlanta Classification revision. Based on the results, 68.5% of the studies applied the recommendations, with emphasis on the application of severity classification (mild, moderately severe, severe); 16.4% of them were North-American and 14.7% were Chinese. The remaining 31.5% just focused on comparing or validating the severity classification.
Conclusion:
Few studies have disclosed any form of acceptance or practice of these recommendations, despite the US and Chinese efforts. The lack of incorporation of these recommendations didn't enable harnessing the benefits of their application in the clinical practice (particularly the improvement of the communication among health professionals and directly association with the worst prognoses); thus, it is necessary mobilizing the international medical community in order to change this scenario.
... Acute Pancreatitis (AP) is a disease that is triggered by abnormal activation of proteolytic enzymes within the gland and the release of a number of inflammatory mediators (acute inflammation) [1][2] . It may manifest either as acute or chronic form [1] . ...
... • Modified Computed Tomography Severity Index (MCTSI) had been introduced in 2004, which unlike the Computed Tomography Severity Index (CTSI) includes the presence of extra-pancreatic complications, necrosis, and grading the peripancreatic fluid collection in terms of presence or absence instead of the number of fluid collections [11] . AP can be diagnosed either by clinical, laboratory, or image findings [2] . For an appropriate diagnosis of AP, at least two of the following criteria to be fulfilled [12] . ...
... For an appropriate diagnosis of AP, at least two of the following criteria to be fulfilled [12] . In majority of cases, the disease is self-limiting and presents with response to supportive treatment alone [2] . The assessment of the severity of AP has a significant role in management. ...
