Hepatic Steatosis May Predispose to More Severe Acute Pancreatitis

Bedside index for severity in acute pancreatitis: comparison with other scoring systems in predicting severity and organ failure

Background and Aims: Identification of patients at risk for severe disease early in the course of acute pancreatitis is essential to optimize management and to improve outcomes. We aimed to assess the Bedside Index for Severity in Acute Pancreatitis score as a predictor of disease severity in acute pancreatitis in a Turkish population. Materials and Methods: We analyzed retrospectively acute pancreatitis patients between January 1999 and December 2006. Bedside Index for Severity in Acute Pancreatitis, Ranson and Computed Tomography Severity Index scores were calculated. Clinical data, laboratory results, pancreatic necrosis, organ failure, and mortality were registered. Accuracy of the scoring system for predicting severity was measured by the area under the receiver operating characteristic curve. Results:Of the 111 patients, 63 (56.8%) were female. The median age was 59.1 years. Of all patients, 23 (20.7%) had severe acute pancreatitis and 57.7% had biliary pancreatitis. Of patients with severe acute pancreatitis, 15 (65.2%) developed organ failure, 7 (30.4%) developed pancreatic necrosis, and 2 (8.6%) died. Bedside Index for Severity in Acute Pancreatitis generated similar area under the receiver operating characteristic curve values to those of the Ranson score in predicting severe acute pancreatitis. The area under the receiver operating characteristic curve for the Bedside Index for Severity in Acute Pancreatitis score to detect pancreatic necrosis was 0.60 (0.38-0.80) and for the Ranson score was 0.70 (0.48-0.87), with no significant differences. To predict pancreatic necrosis, a Bedside Index for Severity in Acute Pancreatitis score >2 had a sensitivity, specificity, and positive and negative predictive values of 57%, 69%, 44%, and 79%, respectively. The Bedside Index for Severity in Acute Pancreatitis score was not as good as Ranson and Computed Tomography Severity Index scores for predicting organ failure. Conclusions:The Bedside Index for Severity in Acute Pancreatitis score was a useful method in a Turkish population for predicting the severity of acute pancreatitis, with the advantage of being simple and based on parameters obtained on the first day of hospitalization. The Bedside Index for Severity in Acute Pancreatitis score is valuable in predicting pancreatic necrosis in severe acute pancreatitis in Turkish patients

Introduction: Fatty Liver (FL) disease is commonly encountered in clinical practice and is frequently seen in patients with Acute Pancreatitis (AP) due to common risk factors such as obesity, alcohol abuse, and insulin resistance among others. Aim: To evaluate the effect of FL on the severity of AP radiologically using Computed Tomography (CT). Materials and Methods: This was a retrospective study, conducted from June 2021 to July 2021 in which plain CT images of patients with AP were reviewed to measure the mean attenuation values of the liver and spleen. A ratio of mean hepatic/splenic Hounsfield Units (HU) <1 was considered as FL. The severity of AP was assessed using the Modified CT Severity Index (CTSI) on Contrast Enhanced Computed Tomography (CECT) scan. Data collected was entered into Microsoft Excel datasheet and frequency (n) and percentages were calculated. Chi-square test was used to calculate the level of significance. Results: A total of 50 patients (44 males and 6 females; mean age 35.58±13.792 years) with AP were included in this study amongst whom FL was found in 23 patients (46%) and non FL in 27 patients (54%). The severity of pancreatitis was significantly greater in patients with FL than patients without FL. AP patients with FL had higher rates of local complications like acute Peripancreatic Fluid Collections (PPFC) (56.5% vs 22.2% p<0.001) and Acute Necrotic Collections (ANC) (26.1% vs 3.7% p<0.001) than those without FL. Conclusion: Fatty liver plays a significant role in the severity acute pancreatitis and can be used as an indicator for the same. Combined plain and contrast CT scans can be used to assess FL and diagnose and predict the severity of AP

Objective: To determine the diagnostic accuracy of numerical CT severity index (CTSI) and Ranson score in pre­dicting severe Acute Pancreatitis (AP) keeping organ failure as the gold standard. Methodology: This descriptive cross-sectional study was carried out in the Department of Surgery, Medical Teaching Institute, Lady Reading Hospital Peshawar, from November 2020 to May 2021 on 238 patients with acute pancreatitis. All patients were subjected to the prediction of Severe Acute Pancreatitis (SAP)/organ failure on CTSI and Ranson criteria. Results: The mean age of the participants was 30.7+7.6 years. There were 54.2% male and 45.8% female as per gender distribution. The mean duration of AP at presentation was 3.8 +1.8 days. Prediction of SAP in terms of organ failure was predicted in 55.9% of patients on Ranson criteria and 59.2% of patients on CTSI. The sensi­tivity of Ranson criteria was 37.5% and specificity of 25.4% with a Positive Predictive Value (PPV) of 33.8% and a Negative Predictive Value (NPV) of 28.5%. The sensitivity of CTSI was 88.9% and specificity 71.1% with PPV of 75.9% & NPV of 86.6%. Conclusion: CTSI is a highly sensitive and specific tool for predicting the severity of acute pancreatitis when compared to the Ranson criteria in patients presenting with acute pancreatitis.

The natural course of acute pancreatitis is quite variable, where most patients with mild acute pancreatitis usually follow a self-limiting course, whereas the mortality is quite higher in severe acute pancreatitis. Hence, early prediction of severity is essential for proper triaging. The study aimed to assess the diagnostic accuracy of red blood cell distribution width (RDW)-to-platelet count ratio (RPR) as a prognostic marker in acute pancreatitis. It was a prospective, observational study conducted on consecutive patients with acute pancreatitis. All participants were subjected to routine laboratory investigations and radiological evaluation using transabdominal ultrasound at the time of admission and a contrast-enhanced CT scan after 96 hours. All the parameters, including RPR, and various severity scores, such as the Systemic Inflammatory Response Syndrome (SIRS) score, Ranson score, Bedside Index for Severity in Acute Pancreatitis (BISAP) score, and Modified Marshall score, were compared between patients with mild or moderate to severe acute pancreatitis by using standard statistical tests. A total of 200 patients diagnosed with acute pancreatitis were enrolled in this study, out of which the most common etiologies of acute pancreatitis were alcohol abuse (88 (44%)) and gallstones (57 (28.5%)). The overall mortality in our patients was seven (3.5%), which occurred only in severe acute pancreatitis. The mean RPR of patients with mild and moderately severe to severe acute pancreatitis were 0.07 ± 0.02 and 0.12 ± 0.09, respectively (p < 0.05), whereas the mean RPR of patients who survived and those who did not were 0.09 ± 0.06 and 0.12 ± 0.05, respectively (p < 0.05). RPR calculated at the time of admission is found to be an independent prognostic marker in acute pancreatitis with the potential to identify individuals at risk for developing severe acute pancreatitis as well as mortality.

Introduction: Fatty liver (FL) is often recognized in patients with acute pancreatitis (AP) and is frequently found in clinical practice because of substantial variables that put one at risk of complications. Aim: To evaluate the severity of acute pancreatitis in patients with and without fatty liver using CT severity index. Methodology: In this prospective study was carried out from June 2020 till December 2022. Liver and spleen mean attenuation values were examined using plain CT scans abdomen of patients with AP. Fatty liver was defined as a mean Hounsfield Unit (HU) liver/spleen) ratio &lt; 1. Contrast-enhanced computed tomography (CECT) scan and CT Severity Index (CTSI) to grade the severity of AP. Analyzed information in SPSS. Degree of significance was determined using the chi-square test. Results: This study comprised of 100 Patients with AP (88 (88.0%) males and 32 (32.0%) female, mean age 34.68 12.762 years), 46 (46.0%) had FL and 54 (54.0%), without FL. Patients with FL experienced much worse pancreatitis than patients without FL. Acute edematous pancreatitis (39.4% vs. 60.6%) and acute necrotic collections (58.8% vs. 41.2%) were observed in patients with FL and without FL respectively. Conclusion: The severity of acute pancreatitis is significantly influe

IntroductionAcute pancreatitis (AP) is a pancreatic inflammatory disease that can range in severity from mild, self-limiting forms to severe cases with high mortality rates. AP has various etiologies, including lifestyle factors like alcohol consumption and obesity, and its rapid progression makes early and accurate prediction of severity critical for effective management and improved patient outcomes.The traditional AP severity assessment tools, such as Ranson's criteria and APACHE II, require extensive data and time, making them less feasible in emergency settings. In response, simpler biomarkers that can quickly predict AP severity upon patient presentation are needed to enable early risk stratification and targeted interventions.The study aims to address this research gap by evaluating the neutrophil-to-lymphocyte ratio (NLR) as a potential biomarker for predicting AP severity, as well as assessing its correlation with the CT Severity Index, a widely used measure of AP severity.MethodsThe study used a retrospective analytical design, conducted at the R L Jalappa Hospital & Research Centre in Karnataka, India. The researchers included 118 patients diagnosed with acute pancreatitis (AP) according to the Revised Atlanta Classification.The dataset collected from the participants' medical records included variables such as age, gender, history of alcohol and tobacco use, duration of abdominal pain, ICU stay, CT Severity Index scores, and the neutrophil-to-lymphocyte ratio (NLR).Statistical analysis was performed using SPSS software version 21.0 (IBM Corp., Armonk, NY, USA). A p-value of less than 0.05 was considered statistically significant.This comprehensive methodological approach aimed to provide precise insights into the role of NLR in predicting AP severity while accounting for variability in patient data.ResultsThe study included 118 patients, with 85 classified as having mild to moderate pancreatitis and 33 with severe pancreatitis. There were no significant differences between the two groups in terms of demographic factors such as gender, BMI, alcohol use, smoking, and comorbidities.The study also examined the relationship between the neutrophil-to-lymphocyte ratio (NLR) and the CT Severity Index, a measure of pancreatitis severity. The results showed a strong positive correlation between NLR and the CT Severity Index (r = 0.860, p < 0.001). This indicates that higher NLR values are associated with more severe pancreatitis, as measured by the CT Severity Index.These relationships suggest that NLR reflects the inflammatory response in acute pancreatitis, with higher levels of inflammatory markers associated with elevated NLR values.ConclusionThis study aimed to evaluate the neutrophil-to-lymphocyte ratio (NLR) as a biomarker for predicting the severity of acute pancreatitis (AP). We conducted a retrospective analysis of 118 AP patients, categorizing them into mild-to-moderate and severe groups. NLR was significantly higher in the severe AP group compared to the mild-to-moderate group, suggesting its potential as an early predictor of AP severity. The study also examined the correlation between NLR and the CT Severity Index, a widely used measure of AP severity, further supporting the utility of NLR as a rapid and accessible tool for risk stratification in AP management.

Prognostic indicators in acute pancreatitis: CT vs APACHE II

AimTo investigate the predictive value of C-reactive protein (CRP) to serum albumin (ALB) ratio in the severity and prognosis of acute pancreatitis (AP), and compare the predictive value of the CRP/ALB ratio with the Ranson score, modified computed tomography severity index (MCTSI) score, and Bedside Index of Severity in Acute Pancreatitis (BISAP) score.MethodsThis cohort study retrospectively analyzed clinical data of AP patients from August 2018 to August 2020 in our hospital. Logistic regression analysis was utilized to determine the effects of CRP/ALB ratio, Ranson, MCTSI, and BISAP score on severe AP (SAP), pancreatic necrosis, organ failure, and death. The predictive values of CRP/ALB ratio, Ranson, MCTSI, and BISAP score were examined with the area under the curve (AUC) of the receiver operator characteristic (ROC) curve analysis. DeLong test was used to compare the AUCs between CRP/ALB ratio, Ranson, MCTSI, and BISAP score.ResultsTotally, 284 patients were included in this study, of which 35 AP patients (12.32%) developed SAP, 29 (10.21%) organ failure, 30 (10.56%) pancreatic necrosis and 11 (3.87%) died. The result revealed that CRP/ALB ratio on day 2 was associated with SAP [odds ratio (OR): 1.74, 95% confidence interval (CI): 1.32 to 2.29], death (OR: 1.73, 95%CI: 1.24 to 2.41), pancreatic necrosis (OR: 1.28, 95%CI: 1.08 to 1.50), and organ failure (OR: 1.43, 95%CI: 1.18 to 1.73) in AP patients. Similarly, CRP/ALB on day 3 was related to a higher risk of SAP (OR: 1.50, 95%CI: 1.24 to 1.81), death (OR: 1.8, 95%CI: 1.34 to 2.65), pancreatic necrosis (OR: 1.22, 95%CI: 1.04 to 1.42), and organ failure (OR: 1.21, 95%CI: 1.04 to 1.41). The predictive value of CRP/ALB ratio for pancreatic necrosis was lower than that of MCTSI, for organ failure was lower than that of Ranson and BISAP, and for death was higher than that of MCTSI.ConclusionThe CRP/ALB ratio may be a novel but promising, easily measurable, reproducible, non-invasive prognostic score that can be used to predict SAP, death, pancreatic necrosis, and organ failure in AP patients, which can be a supplement of Ranson, MCTSI, and BISAP scores.

BackgroundThe aim of the present study was to investigate risk factors for developing more severe pancreatitis, including moderately severe (MSAP) and severe acute pancreatitis (SAP), in patients admitted with mild acute pancreatitis (MAP).Material/MethodsPatients admitted with MAP to our hospital from March 2013 to May 2016 were included and prospectively evaluated. Possible risk factors for developing MSAP or SAP were age, blood glucose level on admission, etiology, sex, Ranson score, amylase level, Acute Physiology and Chronic Health Evaluation II (APACHE-II) scores, C-reactive protein (CRP) level, serum calcium level, visceral fat area (VFA), body mass index (BMI), whether this was the first episode of AP, and method of administration of octreotide. The effects of variables for developing MSAP or SAP were evaluated using univariate and multivariate logistic regression models. Mortality, hospital duration, and rate of ICU transfer of patients were compared between patients who developed MSAP or SAP and patients who did not.ResultsA total of 602 patients admitted with MAP were recruited into this study (256 men and 346 women). Seventy-four patients (12.3%) developed MSAP or SAP. According to univariate logistic regression analyses, the results indicated that there were 5 significant differences between patients who developed MSAP or SAP and those who did not: VFA (>100 cm2) (p=0.003), BMI (≥25 kg/m2) (p=0.001), Ranson score(p=0.004), APACHE-II (≥5) (p=0.001), and blood glucose level on admission (>11.1 mmol/L) (p=0.040). Further multivariate logistic regression analyses revealed that BMI (≥25 kg/m2) (p=0.005), APACHE-II (≥5) (p=0.001), and blood glucose level on admission (>11.1 mmol/L) (p=0.004) were independent risk factors for developing MSAP or SAP in patients admitted with MAP. Moreover, patients who developed MSAP or SAP had a mortality rate of 5.4%.ConclusionsSignificant risk factors for developing MSAP or SAP in patients admitted with MAP included BMI (≥25 kg/m2), APACHE-II (≥5), and blood glucose level on admission (>11.1 mmol/L). These factors should be used in the prediction of more severe pancreatitis in patients admitted with MAP.

Amaç: Akut pankreatitli hastalarda ciddiyetin ve prognozunu tahmin edilmesinde Ranson skoru (RS) ve Balthazar Bilgisayarlı Tomografi Şiddet İndeksini (CTSI) yaygın olarak kullanılmaktadır. Ancak, bu skorlama sistemlerinin biliyer olmayan akut pankreatitin prognouzu tahmin etmedeki tanısal üstünlükleri belirsizliğini korumaktadır. Bu nedenle, bu çalışmada nonbiliyer AP'nin prognozunu tahmin etmede RS ve CTSI'yi karşılaştırmayı amaçladık. Gereç ve Yöntemler: Bu retrospektif çalışmaya, Ocak 2021 ile Mayıs 2023 arasında İç Hastalıkları kliniğinde takip edilen 67 nonbiliyer AP hastası dahil edildi. RS ve CTSI, hastaların laboratuvar ve radyolojik bulgularına dayanarak hesaplanmıştır. Son noktalar, uzun süreli hastanede yatış (≥8 gün), komplikasyonlar ve mortaliteden oluşmaktadır. Bulgular: Hastaların ortalama yaşı 50.1±8.3 yıl olup, çoğunluğu erkek (%59.7) idi. Hastaların %11.9'unda komplikasyon gelişti, %26.9'unda uzun süreli hastanede yatış meydana geldi ve %6'sında ölüm gözlendi. Uzun süreli hastanede yatış ve komplikasyon riskini tahmin etmede CTSI, RS'ye göre üstün tanısal performans sergiledi (uzun süreli hastanede kalma için eğri altındaki alan (AUC) = 0.590 vs. 0.856, p

Objectives To determine the serum levels of high mobility group box-1 protein ( HMGB1 )in patients with acute pancreatitis (AP) and to investigate the contributions of HMGB1 in the pathogenesis of AP. Methods The serum HMGB1 concentrations were determined by enzyme-linked immunosorbent assay in 33 patients with severe acute pancreatitis (SAP), 38 patients with mild acute pancreatitis (MAP) and 28 healthy controls at the time of admission within 72 h after the onset. THe relationships between the serum HMGB1 levels and sex, age, etiology, disease onset, Ranson score, Balthazar CT score, C-reactive protein,lactate dehydrogenase and serum creatinine, total bilirubin levels, local and systematic complications were analized. Results The serum HMGB1 levels in healthy control group, MAP group and SAP group were ( 1.82 ±0.64)μg/L, (6. 13 ±5.80) μg/L and (11.48 ±6.94)μg/L, respectively. The mean value of serum HMGB1 level in MAP group was significantly higher than that in healthy group ( P < 0. 05 ), while it was significantly lower than that in SAP group ( P <0.05 ). Within 24 h after disease onset, the serum levels of HMGB1 began to increase, and reached the peak at 48 h, then decreased and remained higher than normal value at 72 h.There were no remarkable relationships between the serum HMGB1 levels and sex, age, etiology, but it was positively correlated with Ranson score, Balthazar CT score, C-reactive protein, lactate dehydrogenase and serum crkatinine. The serum levels of HMGB 1 in patients with local and / or systematic complications were higher than those in patients without complications, but the difference was not statistically significant.Conclusions HMGB1 is a late inflammation mediator and serum HMGB1 levels were correlated with the severity of AP. HMGB1 may participate in the development of acute renal insufficiency during SAP. Key words: Pancreatitis,acute necrotizing; High mobility group proteins; Enzyme-Linked immunosorbet assay; Inflammation mediators

Background: Acute pancreatitis is inflammation of the pancreas. Severe cases can lead to multi-organ dysfunction. So accurate prediction of severity is of great importance to improve survival. For the prediction of severity, there are several criteria. In this study, we have compared clinical criteria and imaging criteria to detect the severity of acute pancreatitis. In clinical criteria, we have taken Ranson criteria and BISAP(Bedside Index for Severity of Acute Pancreatitis) score. In imaging, we have taken MCTSI(Modified Computed Tomography Severity Index). Method: 50 patients (45 males &amp; 05 females) in the age group of 15-65 years with a diagnosis of acute pancreatitis, admitted to a tertiary government hospital from July 2017 to June 2019 were included. BISAP score, Ranson criteria, and MCTSI were calculated for all the cases. Then Ranson and BISAP criteria were compared with MCTSI, deciding optimum cut-offs for these scorings, by obtaining the area under the curve analysis. Results: As per Atlanta classification, 31 cases were mild, 8 cases categorized as severe and 11 were grouped as moderately severe acute pancreatitis. Out of 50 cases, Pancreatic necrosis was found in 13 cases. Similarly, 15 patients landed in organ failure. The AUC for MCTSI was found to be consistently higher for predicting severe acute pancreatitis (0.958), pancreatic necrosis (0.942), organ failure (0.941) than Ranson criteria and BISAP criteria. The AUC for Ranson and BISAP criteria in predicting severe acute pancreatitis was 0.904 and 0.874, predicting pancreatic necrosis was 0.876 and 0.896 &amp; in predicting organ failure was 0.881 and 0.880 respectively. Conclusion: MCTSI is more effective in detecting severe acute pancreatitis, organ failure, and pancreatic necrosis. So, the CECT scan is a better and simpler tool to detect the severity objectively for acute pancreatitis.

Pediatric acute pancreatitis (AP) is a rare but important clinical entity associated with significant morbidity. Predicting the severity and outcome of AP in pediatric patients can be challenging because there are few validated severity scoring systems. Moreover, the etiology of pediatric AP in the Japanese population is different from that of Western populations. The performance of severity scores in pediatric AP with a high prevalence of severe cases is still unknown. The aim of this study was to assess the performance of existing severity scoring systems when used for Japanese children at a tertiary care center. We reviewed the electronic medical records of all children (≤18 years) treated for AP at between 2002 and 2012 at National Center for Child Health and Development, Tokyo. The modified Glasgow acute pancreatitis severity score (modified Glasgow), Ranson criteria (Ranson), Balthazar computed tomography severity index (CTSI), and pediatric acute pancreatitis severity (PAPS) score were assessed for their ability to distinguish severe pancreatitis from the milder forms. Thirty-three Japanese children with AP were identified. Among them, 37 episodes were analyzed for the performance of the scoring systems and 33 for the etiology. The most common etiology of AP was structural abnormality (n = 8). Sensitivity for the modified Glasgow, Ranson, PAPS, and CTSI was 42.9%, 52.4%, 81.0%, and 50.0%, respectively, while specificity was 81.3%, 81.3%, 37.5%, and 76.9%, respectively. We found PAPS to be the most reliable when used for discriminating the severe form of AP from the milder forms at a Japanese tertiary pediatric care center.

Background Acute pancreatitis (AP) isan acute inflammatory condition of the pancreas, peri-pancreatic tissues, and several organs, leading to multiple organ dysfunction syndrome and a higher risk of mortality. For many years, scoring systems that include biochemical, radiological, and clinical criteria for determining severity have been used. Though numerous studies have used various scoring methods to evaluate the severity of AP, this study has been conducted to compare four scoring systems: bedside index of severity in AP (BISAP), acute physiology and chronic health evaluation (APACHE II), Ranson's, and modified CT severity index (CTSI)based on clinical, biochemical, and radiological parameters. Materials and methods It was a prospective-comparative study. The study was conducted from December 2016 to August 2018 in the Department of General Surgery at Byramjee Jeejeebhoy Government Medical College (B.J.G.M.C.)and Sassoon Hospital, Pune, Maharashtra, India. A total of 75 participants were enrolled in the study. Results The study population ranged from 18 to 68 years, with a mean age of 40.8±11.5 years. AP was most prevalent in the age group of 31-40 years (33.3% cases). Out of 75 patients in this study, 14 patients (18.7%) had severe AP (SAP), 18 patients (24%) had moderate SAP, and 43 patients (57.3%) had mild AP. Ten patients expired, with a mortality rate of 13.3%. It has been observed that the BISAP score had the best specificity (100%) and the CTSI score had the highest sensitivity (96.9%) among our study's four scores for predicting pancreatic necrosis. When predicting persistent organ failure, BISAP had the highest specificity, and Ranson and CTSI scored the highest sensitivity. The modified CTSI poorly predicted AP, patients' mortality, and SAP. Conclusion The BISAP score provides a straightforward and accurate way to analyze the seriousness of AP. Ranson's score is also a reliable indicator of ongoing organ failure among AP cases. The most reliable technique for predicting pancreatitis mortality is the APACHE II score.