Ostre zapalenie trzustki – Rokowania, prognozy i postęp choroby

Ostre zapalenie trzustki
Rokowania, prognozy i postęp choroby

Ostre zapalenie trzustki (OZT) charakteryzuje się nagłym początkiem i wysoką śmiertelnością, szczególnie w ciężkich postaciach, gdzie wskaźnik śmiertelności sięga 36-50%. Wczesna, precyzyjna ocena ryzyka w ciągu pierwszych 24 godzin od przyjęcia jest kluczowa dla identyfikacji pacjentów wymagających intensywnej terapii. Systemy oceny takie jak Ransona (wynik ≥3 wskazuje na ciężkie OZT, z ryzykiem śmiertelności od 15% do 100% w zależności od punktacji), APACHE II (wynik ≥8 punktów wiąże się z 11-18% śmiertelnością) oraz BISAP, Glasgow i SIRS są powszechnie stosowane, choć mają ograniczoną swoistość. Indeks Ciężkości CT z wynikiem ≥5 koreluje z 15-krotnie wyższą śmiertelnością, jednak nie przewyższa skutecznością tradycyjnych systemów oceny. Wartości progowe biomarkerów, takich jak rezystyna (13,7 ng/ml) i IL-6 (473,4 pg/ml), oraz objętość martwicy okołotrzustkowej (112,5 ml) mogą służyć jako wczesne markery ciężkiego przebiegu OZT.

Prognostyka w ostrym zapaleniu trzustki

Ostre zapalenie trzustki (OZT) to poważna choroba zapalna, charakteryzująca się nagłym początkiem i silnym bólem brzucha, związana z wysokim wskaźnikiem chorobowości i śmiertelności, szczególnie w przypadku wystąpienia ciężkich miejscowych i ogólnoustrojowych powikłań. Mimo że większość pacjentów z OZT wraca do zdrowia bez następstw, około 10-20% przypadków rozwija się w postać bardziej złożoną klinicznie, z wyższym ryzykiem chorobowości i śmiertelności.¹² Ogólny wskaźnik śmiertelności wynosi 3-10%, jednak pacjenci z ciężką postacią choroby są narażeni na zwiększone ryzyko zgonu, ze wskaźnikiem śmiertelności wynoszącym od 36% do 50%.³ Dane z amerykańskiego Krajowego Centrum Statystyki Zdrowia sugerują, że ogólna śmiertelność zmniejszyła się w ciągu ostatnich kilkudziesięciu lat, z szacunkami wahającymi się od 1% do 5%.⁴

Aby przewidywanie przebiegu było najcenniejsze dla klinicystów, powinno być dokładnie i niezawodnie stosowane jak najwcześniej, najlepiej w ciągu pierwszych 24 godzin od przyjęcia do szpitala.⁵ Pierwsze 24 godziny po pojawieniu się objawów są kluczowe dla identyfikacji pacjentów, którzy są zagrożeni rozwojem powikłań lub zgonem.⁶ Wczesna ocena i stratyfikacja ryzyka u pacjentów z OZT są ważne, aby odróżnić pacjentów z łagodną postacią od ciężkiej, ponieważ pacjenci z ciężką postacią często wymagają leczenia na oddziale intensywnej terapii.⁷

Znaczenie prognostyki w OZT

Zdolność do przewidywania ciężkości choroby może pomóc w identyfikacji pacjentów o zwiększonym ryzyku zachorowalności i śmiertelności, co pomaga we wczesnym triage’u na oddziałach intensywnej terapii i selekcji pacjentów do określonych interwencji.⁸ Te modele predykcyjne mają jednak niską swoistość (tj. wysokie wskaźniki fałszywie dodatnich), co w połączeniu z niską częstością występowania umiarkowanie ciężkiego (MSAP) i ciężkiego (SAP) typu, prowadzi do niskich dodatnich wartości predykcyjnych.⁹

Istnieje potrzeba identyfikacji markerów predykcyjnych lub narzędzi, które są dokładne w prognozowaniu zarówno MSAP, jak i SAP w ciągu pierwszych 24-72 godzin.¹⁰ Wczesna identyfikacja rozwoju ciężkiego OZT pozostaje dużym wyzwaniem.¹¹ Główną przeszkodą w badaniu patogenezy OZT jest jego szybki przebieg i względna niedostępność tkanki trzustkowej.¹²

Systemy oceny ciężkości OZT

Od czasu opublikowania oryginalnych kryteriów Ransona ponad 30 lat temu, niewiele tematów wzbudziło tak duże zainteresowanie jak przewidywanie wyniku w ostrym zapaleniu trzustki.¹³ Ocena ciężkości w tym stanie została po raz pierwszy rozpoczęta w 1974 roku przez Ransona i wsp.¹⁴ Od tego czasu zdefiniowano inne wieloczynnikowe systemy oceny, stosujące powszechne parametry kliniczne i biochemiczne, aby przewidzieć ciężkość choroby.¹⁵

Kryteria Ransona

Wynik Ransona jest używany do przewidywania ciężkości ostrego zapalenia trzustki. Jeśli wynik ≥3, prawdopodobne jest ciężkie zapalenie trzustki. Jeśli wynik <3, ciężkie zapalenie trzustki jest mało prawdopodobne.¹⁶

Interpretacja wyników Ransona:¹⁷

Wynik 0 do 2: 2% śmiertelności
Wynik 3 do 4: 15% śmiertelności
Wynik 5 do 6: 40% śmiertelności
Wynik 7 do 8: 100% śmiertelności

APACHE II

System oceny APACHE II (Acute Physiology and Chronic Health Evaluation) został szeroko zwalidowany do przewidywania zgonu w ostrym zapaleniu trzustki.¹⁸ Wynik APACHE II ≥8 punktów przewiduje 11% do 18% śmiertelności.¹⁹ Niektórzy eksperci zalecają stosowanie wyniku APACHE II, a także poziomu hematokrytu w surowicy wcześnie podczas hospitalizacji jako wskaźników prognostycznych.²⁰

BISAP

BISAP (Bedside Index for Severity in Acute Pancreatitis) to nowszy system oceny opracowany do stosowania w ciągu pierwszych 24 godzin od przyjęcia do szpitala.²¹ Ten pięcioczynnikowy system oceny wykazał podobną dokładność do APACHE II w prognozowaniu zgonu w początkowym badaniu retrospektywnym i w kilku późniejszych prospektywnych badaniach kohortowych.²² BISAP może być użyteczny do identyfikacji pacjentów, którzy najprawdopodobniej skorzystają z ukierunkowanego protokołu resuscytacji płynowej.²³

Skuteczność wyniku BISAP w przewidywaniu ciężkiego OZT została potwierdzona przez liczne badania. Chociaż jest łatwy do przeprowadzenia, jego użyteczność w warunkach klinicznych nie wydaje się atrakcyjna.²⁴

Skala Glasgow

Skala Glasgow jest ważna zarówno dla zapalenia trzustki wywołanego kamieniami żółciowymi, jak i alkoholem, podczas gdy wynik Ransona dotyczy tylko zapalenia trzustki wywołanego alkoholem.²⁵ Pacjenci z wynikiem zero mieli śmiertelność mniejszą niż jeden procent, natomiast pacjenci z wynikiem pięć mieli wskaźnik śmiertelności 22 procent.²⁶

Skala SIRS

Wynik SIRS (zespół ogólnoustrojowej reakcji zapalnej) jest prosty i szeroko stosowany w warunkach klinicznych. Kilka badań wykazało, że wynik SIRS może przewidzieć ciężkość OZT.²⁷ Badanie retrospektywne 759 pacjentów z OZT przeprowadzone przez Uniwersytet w Edynburgu wykazało, że 25,4% pacjentów z przetrwałym SIRS zmarło, w porównaniu z 8% z przejściowym SIRS i 0,7% bez SIRS.²⁸

CT Severity Index

Badania wykazały pewne zalety Indeksu Ciężkości CT w przewidywaniu ciężkości ostrego zapalenia trzustki w porównaniu z innymi systemami.²⁹ Wynik Indeksu Ciężkości CT równy 5 lub większy był związany ze wskaźnikiem śmiertelności 15 razy wyższym niż u osób z wynikiem mniejszym niż 5.³⁰ Inne badanie wykazało, że Indeks Ciężkości CT był silniejszym predyktorem ciężkiego ostrego zapalenia trzustki niż kryteria Ransona lub skala APACHE II.³¹

Pomimo wszystkich ulepszeń pierwszej skali, skanowanie CT nie przewidywało ciężkości OZT lepiej niż konwencjonalne systemy i nie jest zalecane przy przyjęciu wyłącznie do oceny ciężkości.³²

Biomarkery w prognozowaniu OZT

Najnowsze dane sugerują, że seryjny pomiar poziomów azotu mocznikowego we krwi (BUN) jest najbardziej użytecznym rutynowym badaniem laboratoryjnym do określenia ryzyka zgonu.³³ Badano również kilka markerów stanu zapalnego jako potencjalne biomarkery pomocne w przewidywaniu wyniku ostrego zapalenia trzustki.³⁴

Modele z biomarkerami

Wiek, BUN (azot mocznikowy we krwi) i mleczan (ABL) były niezależnymi czynnikami ryzyka określonymi przez analizę wieloczynnikową.³⁵ Model nomogramu ABL, który wykorzystuje łatwo dostępne dane, wykazał wysoką wartość predykcyjną do przewidywania śmiertelności wewnątrzszpitalnej w OZT.³⁶ Wskaźnik C nomogramu ABL wyniósł 0,896 (95% CI 0,825 do 0,967), co wskazuje na świetną zdolność dyskryminacyjną.³⁷

Krzywa kalibracji modelu nomogramu ABL była bardzo bliska idealnej linii 45 stopni, co wskazuje na dobrą zgodność między przewidywaną a rzeczywistą śmiertelnością wewnątrzszpitalną.³⁸ Model nomogramu ABL spełnia wiele z tych cech: jest generowany z danych w ciągu 24 godzin po przyjęciu, używając wieku i niektórych łatwo dostępnych, wiarygodnych i niedrogich parametrów klinicznych i laboratoryjnych w modelu oraz jest wykonalny w przyjazny dla użytkownika sposób.³⁹

Adipokiny w przewidywaniu ciężkości OZT

Wartość prognostyczna adipokin w OZT jest ograniczona. Tylko poziomy rezystyny przy przyjęciu mogą służyć jako wczesny predyktor SAP.⁴⁰ Istotne różnice w stężeniach rezystyny, wisfatyny, leptyny i adiponektyny między pacjentami z łagodnym OZT (MAP) a SAP stwierdzono w niektórych starszych badaniach, ale wszystkie z nich różniły się znacznie pod względem metodologii, kryteriów diagnostycznych, klasyfikacji i oceny OZT.⁴¹

Badanie wykazało, że wartość adipokin w przewidywaniu przebiegu i wyniku OZT została oceniona zbyt dobrze. Tylko rezystyna może być używana do wczesnego przewidywania przebiegu OZT. Wartości graniczne rezystyny i IL-6 wynoszące 13,7 ng/ml i 473,4 pg/ml mogą być używane jako wczesne markery ciężkiego OZT, a także objętość martwicy okołotrzustkowej wynosząca 112,5 ml.⁴²

Nowsze podejścia do prognostyki OZT

Sztuczna inteligencja i Machine Learning

Ostatnie postępy w dziedzinie sztucznej inteligencji (AI) stwarzają nowe możliwości poprawy wyników poprzez analizę ogromnych ilości danych klinicznych i obrazowych. Algorytmy AI mogą analizować duże ilości danych klinicznych i obrazowych, identyfikować wzorce systemu oceny i przewidywać przebieg kliniczny choroby. Modele oparte na AI wykazały obiecujące wyniki w przewidywaniu ciężkości i śmiertelności OZT, ale konieczna jest dalsza walidacja i standaryzacja przed szerokim zastosowaniem klinicznym.⁴³

Badanie wykazało, że cechy kliniczne mogą dokładnie przewidzieć ryzyko PPDM-A (cukrzycy po ostrym zapaleniu trzustki) po wystąpieniu ostrego zapalenia trzustki, chociaż żadna z dziewięciu uwzględnionych cech klinicznych nie odzwierciedlała bezpośrednio funkcji komórek wysp. Badanie ujawniło, że wiek, BMI, stan metaboliczny i choroby współistniejące odgrywają różną rolę u poszczególnych osób i mogą prowadzić do przeciwnych wyników.⁴⁴

Modele ML, zwłaszcza RF (Random Forest), znacznie przewyższają tradycyjne wyniki kliniczne w przewidywaniu niekorzystnych wyników w OZT, co sugeruje, że integracja ML z praktyką kliniczną może poprawić oceny prognostyczne.⁴⁵ To badanie pokazuje, że algorytmy ML znacznie przewyższają tradycyjne systemy punktacji klinicznej w przewidywaniu wyników w OZT, szczególnie w szybkim tempie medycyny ratunkowej, gdzie kluczowe jest szybkie podejmowanie decyzji.⁴⁶

Modele nomograficzne

Model predykcyjny zawierający 6 wskaźników ryzyka może być używany do przewidywania ryzyka przetrwałej niewydolności narządów u pacjentów z ostrym zapaleniem trzustki. Częstość akcji serca, stężenie kreatyniny w surowicy, Ca (wapń), limfocyty i D-dimer są niezależnymi predyktorami POF (przetrwałej niewydolności narządów) i były niezależnie związane z przetrwałą niewydolnością narządów w ostrym zapaleniu trzustki. Korzystając z 6 klinicznych wskaźników ryzyka, opracowano nomogram i kalkulator internetowy.⁴⁷

Praktyczne zastosowanie prognostyki

Niezależnie od kryteriów oceny, oznaki niewydolności narządów w ciągu 24 godzin od przyjęcia znacznie zwiększają ryzyko zgonu.⁴⁸ Im wyższy wynik prognostyczny, tym gorszy wynik kliniczny, w tym śmiertelność.⁴⁹

Wczesne postępowanie bazujące na prognostyce

Odpowiednie zarządzanie pacjentami z OZT w ciągu pierwszych 2-3 dni może mieć kluczowe znaczenie i determinować przyszłe rokowanie.⁵⁰ Tylko wczesny predyktor mógłby pomóc w podjęciu decyzji o potrzebie przeniesienia pacjentów do ośrodka o dużej przepustowości na czas, o żywieniu dojelitowym i być może o profilaktycznym stosowaniu antybiotyków we wczesnej fazie OZT.⁵¹

Najnowsze postępy w określaniu rokowania w ostrym zapaleniu trzustki koncentrują się na metodach, które mogą pomóc w kierowaniu wysiłkami resuscytacyjnymi podczas kluczowej fazy choroby (tj. pierwszych 24 godzin po przyjęciu do szpitala).⁵² Obecnie trwają badania, które pomogą określić, czy takie obiektywne podejścia do początkowego zarządzania mogą prowadzić do poprawy wyników u pacjentów z ostrym zapaleniem trzustki.⁵³

Wskazania do OIOM i postępowanie w ciężkim OZT

Ogólnie pacjenci z niewydolnością narządów (dokładnie zdefiniowaną przy użyciu jednego z ustalonych kryteriów lub systemów punktacji) potrzebują pilnego przeniesienia na OIOM.⁵⁴ Trwała dysfunkcja narządów lub wystąpienie niewydolności narządów pomimo odpowiedniej resuscytacji płynowej jest wskazaniem do przyjęcia na OIOM.⁵⁵ Wczesna resuscytacja płynowa jest wskazana w celu optymalizacji celów perfuzji tkanek, bez oczekiwania na pogorszenie stanu hemodynamicznego.⁵⁶ Ciągłe monitorowanie funkcji życiowych w jednostce intensywnej opieki jest potrzebne, jeśli wystąpi dysfunkcja narządów.⁵⁷

Stosowanie i skuteczność profilaktycznej antybiotykoterapii w ostrym zapaleniu trzustki od dawna budzi kontrowersje. Antybiotyki są zawsze zalecane w leczeniu zakażonego ostrego zapalenia trzustki. Jednakże, diagnoza zakażonego zapalenia trzustki jest trudna z powodu obrazu klinicznego, którego nie można odróżnić od innych powikłań zakaźnych lub od stanu zapalnego spowodowanego ostrym zapaleniem trzustki.⁵⁸

Obecność gazu w przestrzeni zaotrzewnowej jest uważana za wskazującą na zakażone zapalenie trzustki w kontekście ciężkiego ostrego zapalenia trzustki, ale jest obecna tylko u ograniczonej liczby pacjentów. Czas zakażenia w martwicy trzustki jest zmienny i nieprzewidywalny oraz osiąga szczyt w drugim do czwartego tygodnia po wystąpieniu zapalenia trzustki.⁵⁹

Podsumowanie nowych kierunków badań

Objętość martwicy pozatrzustkowej dodatnio koreluje ze wskaźnikiem powikłań SAP, potencjalnie służąc jako wskaźnik do przewidywania niekorzystnych wyników w OZT. Wczesne przewidywanie SAP z wysoką śmiertelnością pozostaje wyzwaniem ze względu na ograniczoną dokładność obecnych narzędzi predykcyjnych i złożone cechy kliniczne SAP.⁶⁰

Rozwój narzędzi stratyfikacji ryzyka, które spełniają potrzeby kliniczne i kierują klinicystów w zakresie alokacji zasobów, konsultacji pacjentów i audytu klinicznego, oraz podejścia multidyscyplinarne, w tym opieka oparta na dowodach, są niezbędne do osiągnięcia optymalnych wyników klinicznych. Dlatego wczesna ocena etiologii i ciężkości OZT jest niezbędna dla szybkiego leczenia i ścisłego monitorowania ciężkich pacjentów.⁶¹

Kluczowe jest zaprojektowanie i przeprowadzenie dużych badań populacyjnych i wieloośrodkowych w celu identyfikacji parametrów, które pozwolą na zdefiniowanie wieloczynnikowych wyników lub biomarkerów do przewidywania ciężkości OZT i monitorowania progresji choroby, które można rutynowo stosować.⁶²

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Materiały źródłowe

#1 Prognosis in acute pancreatitis
https://pmc.ncbi.nlm.nih.gov/articles/PMC3071387/
Since the original Ranson criteria were published more than 30 years ago, few topics have engendered as much sustained interest as the prediction of outcome in acute pancreatitis. […] Although most patients with acute pancreatitis will recover without sequelae, between 10% and 20% will have a more complicated clinical course with a higher risk of morbidity and mortality. […] Most studies that evaluate prediction methods in acute pancreatitis have focused on death as the outcome of interest because it is a well-defined, clinically significant outcome. […] However, recent data from the US National Center for Health Statistics suggest that overall mortality has declined over the past several decades, with estimates ranging from 1%5%. […] To be of the greatest value to clinicians, predictions of outcome should be accurately and reliably applied as early as possible, preferably during the first 24 hours of admission to hospital.
#2 Multifactorial Scores and Biomarkers of Prognosis of Acute Pancreatitis: Applications to Research and Practice
https://www.mdpi.com/1422-0067/21/1/338
Acute pancreatitis (AP) is a severe inflammation of the pancreas presented with sudden onset and severe abdominal pain with a high morbidity and mortality rate, if accompanied by severe local and systemic complications. […] Extensive studies conducted over the last decades have demonstrated that the first 24 h after symptom onset are critical for the identification of which patients are at risk of developing complications or death. […] The overall mortality rate is 3% to 10%, but patients with the severe form of the disease are at an increased risk of death, with a mortality rate of 36% to 50%. […] In this sense and in order to avoid unnecessary overtreatment, thereby reducing the financial implications, proper identification of the mild disease is also important and necessary. […] Despite recent progress in understanding the pathophysiology of AP, more research is needed to enable a faster and more accurate prediction of severe AP.
#3 Multifactorial Scores and Biomarkers of Prognosis of Acute Pancreatitis: Applications to Research and Practice
https://www.mdpi.com/1422-0067/21/1/338
Acute pancreatitis (AP) is a severe inflammation of the pancreas presented with sudden onset and severe abdominal pain with a high morbidity and mortality rate, if accompanied by severe local and systemic complications. […] Extensive studies conducted over the last decades have demonstrated that the first 24 h after symptom onset are critical for the identification of which patients are at risk of developing complications or death. […] The overall mortality rate is 3% to 10%, but patients with the severe form of the disease are at an increased risk of death, with a mortality rate of 36% to 50%. […] In this sense and in order to avoid unnecessary overtreatment, thereby reducing the financial implications, proper identification of the mild disease is also important and necessary. […] Despite recent progress in understanding the pathophysiology of AP, more research is needed to enable a faster and more accurate prediction of severe AP.
#4 Prognosis in acute pancreatitis
https://pmc.ncbi.nlm.nih.gov/articles/PMC3071387/
Since the original Ranson criteria were published more than 30 years ago, few topics have engendered as much sustained interest as the prediction of outcome in acute pancreatitis. […] Although most patients with acute pancreatitis will recover without sequelae, between 10% and 20% will have a more complicated clinical course with a higher risk of morbidity and mortality. […] Most studies that evaluate prediction methods in acute pancreatitis have focused on death as the outcome of interest because it is a well-defined, clinically significant outcome. […] However, recent data from the US National Center for Health Statistics suggest that overall mortality has declined over the past several decades, with estimates ranging from 1%5%. […] To be of the greatest value to clinicians, predictions of outcome should be accurately and reliably applied as early as possible, preferably during the first 24 hours of admission to hospital.
#5 Prognosis in acute pancreatitis
https://pmc.ncbi.nlm.nih.gov/articles/PMC3071387/
Since the original Ranson criteria were published more than 30 years ago, few topics have engendered as much sustained interest as the prediction of outcome in acute pancreatitis. […] Although most patients with acute pancreatitis will recover without sequelae, between 10% and 20% will have a more complicated clinical course with a higher risk of morbidity and mortality. […] Most studies that evaluate prediction methods in acute pancreatitis have focused on death as the outcome of interest because it is a well-defined, clinically significant outcome. […] However, recent data from the US National Center for Health Statistics suggest that overall mortality has declined over the past several decades, with estimates ranging from 1%5%. […] To be of the greatest value to clinicians, predictions of outcome should be accurately and reliably applied as early as possible, preferably during the first 24 hours of admission to hospital.
#6 Multifactorial Scores and Biomarkers of Prognosis of Acute Pancreatitis: Applications to Research and Practice
https://www.mdpi.com/1422-0067/21/1/338
Acute pancreatitis (AP) is a severe inflammation of the pancreas presented with sudden onset and severe abdominal pain with a high morbidity and mortality rate, if accompanied by severe local and systemic complications. […] Extensive studies conducted over the last decades have demonstrated that the first 24 h after symptom onset are critical for the identification of which patients are at risk of developing complications or death. […] The overall mortality rate is 3% to 10%, but patients with the severe form of the disease are at an increased risk of death, with a mortality rate of 36% to 50%. […] In this sense and in order to avoid unnecessary overtreatment, thereby reducing the financial implications, proper identification of the mild disease is also important and necessary. […] Despite recent progress in understanding the pathophysiology of AP, more research is needed to enable a faster and more accurate prediction of severe AP.
#7 Acute Pancreatitis: Diagnosis, Prognosis, and Treatment | AAFP
https://www.aafp.org/pubs/afp/issues/2007/0515/p1513.html
Mild acute pancreatitis has a low mortality rate, but patients with severe acute pancreatitis are more likely to develop complications and have a much higher death rate. […] Mild acute pancreatitis has a very low mortality rate (less than 1 percent), whereas the death rate for severe acute pancreatitis can be 10 to 30 percent depending on the presence of sterile versus infected necrosis. […] Early evaluation and risk stratification for patients with acute pancreatitis are important to differentiate patients with mild versus severe disease because patients with severe disease often need intensive care treatment. Several scoring systems can predict the severity of pancreatitis, and recent work has attempted to compare their relative predictive values. […] Ranson’s criteria, the Imrie scoring system, the Acute Physiology and Chronic Health Evaluation (APACHE II) scale, and the Computed Tomography (CT) Severity Index have been developed and validated to predict adverse outcomes, including mortality, in patients with pancreatitis.
#8 Predicting the severity of acute pancreatitis – UpToDate
https://www.uptodate.com/contents/predicting-the-severity-of-acute-pancreatitis
Approximately 15 to 25 percent of all patients with acute pancreatitis (AP) develop moderately severe or severe AP. […] The ability to predict its severity can help identify patients at increased risk for morbidity and mortality, thereby assisting in appropriate early triage to intensive care units and the selection of patients for specific interventions. […] However, these predictive models have low specificity (ie, high false-positive rates), which, when coupled with the low prevalence of moderately severe (MSAP) and severe (SAP) types, results in low positive predictive values. […] There is a need to identify predictive markers or tools that are accurate in prognosticating both MSAP and SAP during the initial 24 to 72 hours. […] Older age â Several studies have concluded that older age is a predictor of a worse prognosis, although the age cutoff has varied from 55 to 75 years in different reports.
#9 Predicting the severity of acute pancreatitis – UpToDate
https://www.uptodate.com/contents/predicting-the-severity-of-acute-pancreatitis
Approximately 15 to 25 percent of all patients with acute pancreatitis (AP) develop moderately severe or severe AP. […] The ability to predict its severity can help identify patients at increased risk for morbidity and mortality, thereby assisting in appropriate early triage to intensive care units and the selection of patients for specific interventions. […] However, these predictive models have low specificity (ie, high false-positive rates), which, when coupled with the low prevalence of moderately severe (MSAP) and severe (SAP) types, results in low positive predictive values. […] There is a need to identify predictive markers or tools that are accurate in prognosticating both MSAP and SAP during the initial 24 to 72 hours. […] Older age â Several studies have concluded that older age is a predictor of a worse prognosis, although the age cutoff has varied from 55 to 75 years in different reports.
#10 Predicting the severity of acute pancreatitis – UpToDate
https://www.uptodate.com/contents/predicting-the-severity-of-acute-pancreatitis
Approximately 15 to 25 percent of all patients with acute pancreatitis (AP) develop moderately severe or severe AP. […] The ability to predict its severity can help identify patients at increased risk for morbidity and mortality, thereby assisting in appropriate early triage to intensive care units and the selection of patients for specific interventions. […] However, these predictive models have low specificity (ie, high false-positive rates), which, when coupled with the low prevalence of moderately severe (MSAP) and severe (SAP) types, results in low positive predictive values. […] There is a need to identify predictive markers or tools that are accurate in prognosticating both MSAP and SAP during the initial 24 to 72 hours. […] Older age â Several studies have concluded that older age is a predictor of a worse prognosis, although the age cutoff has varied from 55 to 75 years in different reports.
#11 Multifactorial Scores and Biomarkers of Prognosis of Acute Pancreatitis: Applications to Research and Practice
https://www.mdpi.com/1422-0067/21/1/338
In this review, an overview of the multifactorial scoring systems and biochemical markers for predicting severe AP will be discussed, with a special focus on their advantages and limitations. […] The term biomarker has been defined by the National Institutes of Health as âa characteristic that is objectively measured and evaluated as an indicator of normal biological processes, pathogenic processes, or pharmacological responses to a therapeutic intervention.â […] Early assessment of severity in AP becomes crucial, especially on the day of admission, as this period is considered a window of opportunity for defining interventions to prevent pancreatic necrosis and organ failure. […] Therefore, early identification of the development of severe AP remains a great challenge. […] The major obstacles in the study of pathogenesis of AP is its rapid course and relative inaccessibility of pancreatic tissue.
#12 Multifactorial Scores and Biomarkers of Prognosis of Acute Pancreatitis: Applications to Research and Practice
https://www.mdpi.com/1422-0067/21/1/338
In this review, an overview of the multifactorial scoring systems and biochemical markers for predicting severe AP will be discussed, with a special focus on their advantages and limitations. […] The term biomarker has been defined by the National Institutes of Health as âa characteristic that is objectively measured and evaluated as an indicator of normal biological processes, pathogenic processes, or pharmacological responses to a therapeutic intervention.â […] Early assessment of severity in AP becomes crucial, especially on the day of admission, as this period is considered a window of opportunity for defining interventions to prevent pancreatic necrosis and organ failure. […] Therefore, early identification of the development of severe AP remains a great challenge. […] The major obstacles in the study of pathogenesis of AP is its rapid course and relative inaccessibility of pancreatic tissue.
#13 Prognosis in acute pancreatitis
https://pmc.ncbi.nlm.nih.gov/articles/PMC3071387/
Since the original Ranson criteria were published more than 30 years ago, few topics have engendered as much sustained interest as the prediction of outcome in acute pancreatitis. […] Although most patients with acute pancreatitis will recover without sequelae, between 10% and 20% will have a more complicated clinical course with a higher risk of morbidity and mortality. […] Most studies that evaluate prediction methods in acute pancreatitis have focused on death as the outcome of interest because it is a well-defined, clinically significant outcome. […] However, recent data from the US National Center for Health Statistics suggest that overall mortality has declined over the past several decades, with estimates ranging from 1%5%. […] To be of the greatest value to clinicians, predictions of outcome should be accurately and reliably applied as early as possible, preferably during the first 24 hours of admission to hospital.
#14 Multifactorial Scores and Biomarkers of Prognosis of Acute Pancreatitis: Applications to Research and Practice
https://www.mdpi.com/1422-0067/21/1/338
Severity assessment in this condition was first started in 1974 by Ranson et al. […] Since then other multifactorial scoring systems applying common clinical and biochemical parameters, have been defined to predict the severity. […] The BISAP score was aimed for use during the first 24 h of admission to hospital and includes five parameters. […] The performance of the BISAP score in predicting severe AP has been corroborated by numerous studies. […] Although easy to perform, its utility in a clinical setting does not appear appealing. […] The SIRS score is simple and widely used in the clinical setting. […] Several studies have shown that the SIRS score can predict the severity of AP. […] Despite all the improvements to the first score, CT scanning did not predict the severity of AP better than conventional systems and it is not recommended on admission purely for severity assessment.
#15 Multifactorial Scores and Biomarkers of Prognosis of Acute Pancreatitis: Applications to Research and Practice
https://www.mdpi.com/1422-0067/21/1/338
Severity assessment in this condition was first started in 1974 by Ranson et al. […] Since then other multifactorial scoring systems applying common clinical and biochemical parameters, have been defined to predict the severity. […] The BISAP score was aimed for use during the first 24 h of admission to hospital and includes five parameters. […] The performance of the BISAP score in predicting severe AP has been corroborated by numerous studies. […] Although easy to perform, its utility in a clinical setting does not appear appealing. […] The SIRS score is simple and widely used in the clinical setting. […] Several studies have shown that the SIRS score can predict the severity of AP. […] Despite all the improvements to the first score, CT scanning did not predict the severity of AP better than conventional systems and it is not recommended on admission purely for severity assessment.
#16 Acute pancreatitis – Wikipedia
https://en.wikipedia.org/wiki/Acute_pancreatitis
Acute pancreatitis patients recover in majority of cases. Some may develop abscess, pseudocyst or duodenal obstruction. About 20% of the acute pancreatitis are severe with a mortality of about 20%. […] Several clinical scoring tools have been developed to determine prognostic information and may guide certain areas of clinical management, such as need for ICU admission. […] Two such scoring systems are the Ranson criteria and APACHE II (Acute Physiology and Chronic Health Evaluation) indices. […] Some experts recommend using the APACHE II score as well as a serum hematocrit level early during the admission as prognostic indicators. […] The Ranson score is used to predict the severity of acute pancreatitis. […] If the score 3, severe pancreatitis likely. If the score 3, severe pancreatitis is unlikely.
#17 Acute pancreatitis – Wikipedia
https://en.wikipedia.org/wiki/Acute_pancreatitis
Score 0 to 2 : 2% mortality Score 3 to 4 : 15% mortality Score 5 to 6 : 40% mortality Score 7 to 8 : 100% mortality. […] „Acute Physiology And Chronic Health Evaluation” (APACHE II) score 8 points predicts 11% to 18% mortality. […] The Glasgow score is valid for both gallstone and alcohol induced pancreatitis, whereas the Ranson score is only for alcohol induced pancreatitis. […] Patients with a score of zero had a mortality of less than one percent, whereas patients with a score of five had a mortality rate of 22 percent.
#18 Prognosis in acute pancreatitis
https://pmc.ncbi.nlm.nih.gov/articles/PMC3071387/
A prediction tool should also have a high level of sensitivity; underestimating the severity of pancreatitis can have life-threatening consequences. […] This scoring system has been widely validated for predicting death in acute pancreatitis. […] A more recent scoring system developed for use during the first 24 hours of admission to hospital is the Bedside Index of Severity in Acute Pancreatitis (BISAP). […] This five-factor scoring system was shown to have similar accuracy to the APACHE II for predicting death in the initial retrospective study and in several subsequent prospective cohort studies. […] Recent data suggest that serial measurement of blood urea nitrogen levels is the most useful routine laboratory test for determining risk of death. […] Several markers of systemic inflammation have also been studied as potential biomarkers to help predict the outcome of acute pancreatitis.
#19 Acute pancreatitis – Wikipedia
https://en.wikipedia.org/wiki/Acute_pancreatitis
Score 0 to 2 : 2% mortality Score 3 to 4 : 15% mortality Score 5 to 6 : 40% mortality Score 7 to 8 : 100% mortality. […] „Acute Physiology And Chronic Health Evaluation” (APACHE II) score 8 points predicts 11% to 18% mortality. […] The Glasgow score is valid for both gallstone and alcohol induced pancreatitis, whereas the Ranson score is only for alcohol induced pancreatitis. […] Patients with a score of zero had a mortality of less than one percent, whereas patients with a score of five had a mortality rate of 22 percent.
#20 Acute pancreatitis – Wikipedia
https://en.wikipedia.org/wiki/Acute_pancreatitis
Acute pancreatitis patients recover in majority of cases. Some may develop abscess, pseudocyst or duodenal obstruction. About 20% of the acute pancreatitis are severe with a mortality of about 20%. […] Several clinical scoring tools have been developed to determine prognostic information and may guide certain areas of clinical management, such as need for ICU admission. […] Two such scoring systems are the Ranson criteria and APACHE II (Acute Physiology and Chronic Health Evaluation) indices. […] Some experts recommend using the APACHE II score as well as a serum hematocrit level early during the admission as prognostic indicators. […] The Ranson score is used to predict the severity of acute pancreatitis. […] If the score 3, severe pancreatitis likely. If the score 3, severe pancreatitis is unlikely.
#21 Prognosis in acute pancreatitis
https://pmc.ncbi.nlm.nih.gov/articles/PMC3071387/
A prediction tool should also have a high level of sensitivity; underestimating the severity of pancreatitis can have life-threatening consequences. […] This scoring system has been widely validated for predicting death in acute pancreatitis. […] A more recent scoring system developed for use during the first 24 hours of admission to hospital is the Bedside Index of Severity in Acute Pancreatitis (BISAP). […] This five-factor scoring system was shown to have similar accuracy to the APACHE II for predicting death in the initial retrospective study and in several subsequent prospective cohort studies. […] Recent data suggest that serial measurement of blood urea nitrogen levels is the most useful routine laboratory test for determining risk of death. […] Several markers of systemic inflammation have also been studied as potential biomarkers to help predict the outcome of acute pancreatitis.
#22 Prognosis in acute pancreatitis
https://pmc.ncbi.nlm.nih.gov/articles/PMC3071387/
A prediction tool should also have a high level of sensitivity; underestimating the severity of pancreatitis can have life-threatening consequences. […] This scoring system has been widely validated for predicting death in acute pancreatitis. […] A more recent scoring system developed for use during the first 24 hours of admission to hospital is the Bedside Index of Severity in Acute Pancreatitis (BISAP). […] This five-factor scoring system was shown to have similar accuracy to the APACHE II for predicting death in the initial retrospective study and in several subsequent prospective cohort studies. […] Recent data suggest that serial measurement of blood urea nitrogen levels is the most useful routine laboratory test for determining risk of death. […] Several markers of systemic inflammation have also been studied as potential biomarkers to help predict the outcome of acute pancreatitis.
#23 Prognosis in acute pancreatitis
https://pmc.ncbi.nlm.nih.gov/articles/PMC3071387/
Although current practice guidelines universally recommend aggressive fluid resuscitation, limited data is available to support these recommendations. […] Recent advances in determining prognosis for acute pancreatitis have centred on methods that can help guide resuscitation efforts during the crucial phase of illness (i.e., the first 24 hours after admission to hospital). […] Scoring systems such as the BISAP can be useful to identify patients most likely to benefit from a targeted fluid resuscitation protocol. […] Studies are currently underway that will help determine whether such objective approaches to initial management can lead to improved outcomes for patients with acute pancreatitis.
#24 Multifactorial Scores and Biomarkers of Prognosis of Acute Pancreatitis: Applications to Research and Practice
https://www.mdpi.com/1422-0067/21/1/338
Severity assessment in this condition was first started in 1974 by Ranson et al. […] Since then other multifactorial scoring systems applying common clinical and biochemical parameters, have been defined to predict the severity. […] The BISAP score was aimed for use during the first 24 h of admission to hospital and includes five parameters. […] The performance of the BISAP score in predicting severe AP has been corroborated by numerous studies. […] Although easy to perform, its utility in a clinical setting does not appear appealing. […] The SIRS score is simple and widely used in the clinical setting. […] Several studies have shown that the SIRS score can predict the severity of AP. […] Despite all the improvements to the first score, CT scanning did not predict the severity of AP better than conventional systems and it is not recommended on admission purely for severity assessment.
#25 Acute pancreatitis – Wikipedia
https://en.wikipedia.org/wiki/Acute_pancreatitis
Score 0 to 2 : 2% mortality Score 3 to 4 : 15% mortality Score 5 to 6 : 40% mortality Score 7 to 8 : 100% mortality. […] „Acute Physiology And Chronic Health Evaluation” (APACHE II) score 8 points predicts 11% to 18% mortality. […] The Glasgow score is valid for both gallstone and alcohol induced pancreatitis, whereas the Ranson score is only for alcohol induced pancreatitis. […] Patients with a score of zero had a mortality of less than one percent, whereas patients with a score of five had a mortality rate of 22 percent.
#26 Acute pancreatitis – Wikipedia
https://en.wikipedia.org/wiki/Acute_pancreatitis
Score 0 to 2 : 2% mortality Score 3 to 4 : 15% mortality Score 5 to 6 : 40% mortality Score 7 to 8 : 100% mortality. […] „Acute Physiology And Chronic Health Evaluation” (APACHE II) score 8 points predicts 11% to 18% mortality. […] The Glasgow score is valid for both gallstone and alcohol induced pancreatitis, whereas the Ranson score is only for alcohol induced pancreatitis. […] Patients with a score of zero had a mortality of less than one percent, whereas patients with a score of five had a mortality rate of 22 percent.
#27 Multifactorial Scores and Biomarkers of Prognosis of Acute Pancreatitis: Applications to Research and Practice
https://www.mdpi.com/1422-0067/21/1/338
Severity assessment in this condition was first started in 1974 by Ranson et al. […] Since then other multifactorial scoring systems applying common clinical and biochemical parameters, have been defined to predict the severity. […] The BISAP score was aimed for use during the first 24 h of admission to hospital and includes five parameters. […] The performance of the BISAP score in predicting severe AP has been corroborated by numerous studies. […] Although easy to perform, its utility in a clinical setting does not appear appealing. […] The SIRS score is simple and widely used in the clinical setting. […] Several studies have shown that the SIRS score can predict the severity of AP. […] Despite all the improvements to the first score, CT scanning did not predict the severity of AP better than conventional systems and it is not recommended on admission purely for severity assessment.
#28 2019 WSES guidelines for the management of severe acute pancreatitis | World Journal of Emergency Surgery | Full Text
https://wjes.biomedcentral.com/articles/10.1186/s13017-019-0247-0
Thus, it is important to diagnose (or better predict) an episode of severe acute pancreatitis (SAP), and to identify the patients with high risk of developing complications. […] If organ failure persists for more than 48 h, the patient is at high risk of death (one out of three) and a severe category can be established. […] A retrospective study of 759 patients with AP performed by the University of Edinburgh found that 25.4% of the patients with persistent systemic inflammatory response syndrome (SIRS) died, compared with 8% with transient SIRS and 0.7% without SIRS. […] These and other studies showed that organ failure is central to the definition of SAP. […] The critical category in DBC identified the most severe disease. […] The RAC and the DBC performed better than the Atlanta 1992, and they were comparable in predicting long-term clinical prognosis, major complications, and clinical interventions.
#29 Acute Pancreatitis: Diagnosis, Prognosis, and Treatment | AAFP
https://www.aafp.org/pubs/afp/issues/2007/0515/p1513.html
Research has shown some advantages of the CT Severity Index in predicting the severity of acute pancreatitis compared with the other systems. […] A CT Severity Index score of 5 or greater was associated with a mortality rate 15 times higher than in those with a score of less than 5. […] Another study demonstrated that the CT Severity Index was a stronger predictor of severe acute pancreatitis than Ranson’s criteria or the APACHE II scale. […] The higher the prognostic score, the poorer the clinical outcome, including mortality. Irrespective of scoring criteria, signs of organ failure within 24 hours of admission significantly increase the risk of death.
#30 Acute Pancreatitis: Diagnosis, Prognosis, and Treatment | AAFP
https://www.aafp.org/pubs/afp/issues/2007/0515/p1513.html
Research has shown some advantages of the CT Severity Index in predicting the severity of acute pancreatitis compared with the other systems. […] A CT Severity Index score of 5 or greater was associated with a mortality rate 15 times higher than in those with a score of less than 5. […] Another study demonstrated that the CT Severity Index was a stronger predictor of severe acute pancreatitis than Ranson’s criteria or the APACHE II scale. […] The higher the prognostic score, the poorer the clinical outcome, including mortality. Irrespective of scoring criteria, signs of organ failure within 24 hours of admission significantly increase the risk of death.
#31 Acute Pancreatitis: Diagnosis, Prognosis, and Treatment | AAFP
https://www.aafp.org/pubs/afp/issues/2007/0515/p1513.html
Research has shown some advantages of the CT Severity Index in predicting the severity of acute pancreatitis compared with the other systems. […] A CT Severity Index score of 5 or greater was associated with a mortality rate 15 times higher than in those with a score of less than 5. […] Another study demonstrated that the CT Severity Index was a stronger predictor of severe acute pancreatitis than Ranson’s criteria or the APACHE II scale. […] The higher the prognostic score, the poorer the clinical outcome, including mortality. Irrespective of scoring criteria, signs of organ failure within 24 hours of admission significantly increase the risk of death.
#32 Multifactorial Scores and Biomarkers of Prognosis of Acute Pancreatitis: Applications to Research and Practice
https://www.mdpi.com/1422-0067/21/1/338
Severity assessment in this condition was first started in 1974 by Ranson et al. […] Since then other multifactorial scoring systems applying common clinical and biochemical parameters, have been defined to predict the severity. […] The BISAP score was aimed for use during the first 24 h of admission to hospital and includes five parameters. […] The performance of the BISAP score in predicting severe AP has been corroborated by numerous studies. […] Although easy to perform, its utility in a clinical setting does not appear appealing. […] The SIRS score is simple and widely used in the clinical setting. […] Several studies have shown that the SIRS score can predict the severity of AP. […] Despite all the improvements to the first score, CT scanning did not predict the severity of AP better than conventional systems and it is not recommended on admission purely for severity assessment.
#33 Prognosis in acute pancreatitis
https://pmc.ncbi.nlm.nih.gov/articles/PMC3071387/
A prediction tool should also have a high level of sensitivity; underestimating the severity of pancreatitis can have life-threatening consequences. […] This scoring system has been widely validated for predicting death in acute pancreatitis. […] A more recent scoring system developed for use during the first 24 hours of admission to hospital is the Bedside Index of Severity in Acute Pancreatitis (BISAP). […] This five-factor scoring system was shown to have similar accuracy to the APACHE II for predicting death in the initial retrospective study and in several subsequent prospective cohort studies. […] Recent data suggest that serial measurement of blood urea nitrogen levels is the most useful routine laboratory test for determining risk of death. […] Several markers of systemic inflammation have also been studied as potential biomarkers to help predict the outcome of acute pancreatitis.
#34 Prognosis in acute pancreatitis
https://pmc.ncbi.nlm.nih.gov/articles/PMC3071387/
A prediction tool should also have a high level of sensitivity; underestimating the severity of pancreatitis can have life-threatening consequences. […] This scoring system has been widely validated for predicting death in acute pancreatitis. […] A more recent scoring system developed for use during the first 24 hours of admission to hospital is the Bedside Index of Severity in Acute Pancreatitis (BISAP). […] This five-factor scoring system was shown to have similar accuracy to the APACHE II for predicting death in the initial retrospective study and in several subsequent prospective cohort studies. […] Recent data suggest that serial measurement of blood urea nitrogen levels is the most useful routine laboratory test for determining risk of death. […] Several markers of systemic inflammation have also been studied as potential biomarkers to help predict the outcome of acute pancreatitis.
#35 Early prediction of in-hospital mortality in acute pancreatitis: a retrospective observational cohort study based on a large multicentre critical care database | BMJ Open
https://bmjopen.bmj.com/content/10/12/e041893
Objective To develop and validate a prediction model for predicting in-hospital mortality in patients with acute pancreatitis (AP). […] The overall in-hospital mortality rate is 4.447%. Age, BUN (blood urea nitrogen) and lactate (ABL) were the independent risk factors determined by multivariate analysis. […] Nomogram model ABL, which used readily available data, exhibited high predictive value for predicting in-hospital mortality in AP. […] The nomogram model ABL presents an excellent prognostic ability for predicting in-hospital mortality in patients with acute pancreatitis (AP). […] The C-index of our nomogram model ABL was 0.896 (95% CI 0.825 to 0.967), showing a great discrimination ability. […] The bootstrapping technique was employed to internally validate model performance.
#36 Early prediction of in-hospital mortality in acute pancreatitis: a retrospective observational cohort study based on a large multicentre critical care database | BMJ Open
https://bmjopen.bmj.com/content/10/12/e041893
Objective To develop and validate a prediction model for predicting in-hospital mortality in patients with acute pancreatitis (AP). […] The overall in-hospital mortality rate is 4.447%. Age, BUN (blood urea nitrogen) and lactate (ABL) were the independent risk factors determined by multivariate analysis. […] Nomogram model ABL, which used readily available data, exhibited high predictive value for predicting in-hospital mortality in AP. […] The nomogram model ABL presents an excellent prognostic ability for predicting in-hospital mortality in patients with acute pancreatitis (AP). […] The C-index of our nomogram model ABL was 0.896 (95% CI 0.825 to 0.967), showing a great discrimination ability. […] The bootstrapping technique was employed to internally validate model performance.
#37 Early prediction of in-hospital mortality in acute pancreatitis: a retrospective observational cohort study based on a large multicentre critical care database | BMJ Open
https://bmjopen.bmj.com/content/10/12/e041893
Objective To develop and validate a prediction model for predicting in-hospital mortality in patients with acute pancreatitis (AP). […] The overall in-hospital mortality rate is 4.447%. Age, BUN (blood urea nitrogen) and lactate (ABL) were the independent risk factors determined by multivariate analysis. […] Nomogram model ABL, which used readily available data, exhibited high predictive value for predicting in-hospital mortality in AP. […] The nomogram model ABL presents an excellent prognostic ability for predicting in-hospital mortality in patients with acute pancreatitis (AP). […] The C-index of our nomogram model ABL was 0.896 (95% CI 0.825 to 0.967), showing a great discrimination ability. […] The bootstrapping technique was employed to internally validate model performance.
#38 Early prediction of in-hospital mortality in acute pancreatitis: a retrospective observational cohort study based on a large multicentre critical care database | BMJ Open
https://bmjopen.bmj.com/content/10/12/e041893
The calibration curve of nomogram model ABL was very close to the 45-degree ideal line, showing good agreement between the predicted and actual in-hospital mortality. […] The integrated discrimination improvement index (IDI) is a method to quantify the incremental predictive value of new methods to existing predictive models. […] The nomogram model ABL achieves many of these characteristics: it is generated from data within 24 hours after admission, using age and some easily obtainable, reliable and inexpensive clinical and laboratory parameters in a model, and is feasible in a user-friendly manner. […] We propose a refined nomogram model ABL with age, easily obtainable clinical and biochemical parameters, the BUN and lactate. This nomogram model ABL shows excellent performance and allows clinical practitioners to perform early and quick risk-stratification and guide early management strategies for patients with AP.
#39 Early prediction of in-hospital mortality in acute pancreatitis: a retrospective observational cohort study based on a large multicentre critical care database | BMJ Open
https://bmjopen.bmj.com/content/10/12/e041893
The calibration curve of nomogram model ABL was very close to the 45-degree ideal line, showing good agreement between the predicted and actual in-hospital mortality. […] The integrated discrimination improvement index (IDI) is a method to quantify the incremental predictive value of new methods to existing predictive models. […] The nomogram model ABL achieves many of these characteristics: it is generated from data within 24 hours after admission, using age and some easily obtainable, reliable and inexpensive clinical and laboratory parameters in a model, and is feasible in a user-friendly manner. […] We propose a refined nomogram model ABL with age, easily obtainable clinical and biochemical parameters, the BUN and lactate. This nomogram model ABL shows excellent performance and allows clinical practitioners to perform early and quick risk-stratification and guide early management strategies for patients with AP.
#40 The clinical value of adipokines in predicting the severity and outcome of acute pancreatitis | BMC Gastroenterology | Full Text
https://bmcgastroenterol.biomedcentral.com/articles/10.1186/s12876-016-0514-4
Recent data shows that patients with severe acute pancreatic might benefit from early intensive therapy, enteral nutrition and timely transfer to specialized centers. […] This study aims to evaluate the prognostic usefulness of adipokines in prediction of the severity and outcome of acute pancreatitis (AP). […] The prognostic value of adipokines in AP is limited. Only admission resistin levels could serve as an early predictor for SAP. […] The adequate management of the AP patients within first 2 3 days could be of vital importance and determine the future prognosis. […] Currently prognosis of the AP is largely based on clinical scores, such as APACHE II, BISAP and many others. […] The predictive value of adipokines, such as leptin, adiponectin, resistin and visfatin, is less explored.
#41 The clinical value of adipokines in predicting the severity and outcome of acute pancreatitis | BMC Gastroenterology | Full Text
https://bmcgastroenterol.biomedcentral.com/articles/10.1186/s12876-016-0514-4
The significant differences of resistin, visfatin, leptin and adiponectin concentrations between mild AP (MAP) and SAP patients were found in some older studies, but all of them were very different in their methodology, diagnostic criteria, classification and evaluation of AP. […] Only the early predictor could help to make the decision about the patients needs to be transferred to the high volume center timely, enteral nutrition and maybe prophylactic administration of antibiotics use in early phase of AP. […] Our study has shown that the value of adipokines in predicting the course and outcome of AP was rated too good. Only resistin can be used for early AP course prediction. […] Resistin and IL-6 cut-off values 13.7 ng/ml and 473.4 pg/ml could be used as an early markers of severe AP as well as the peripancreatic necrosis volume of 112.5 ml. […] There is no optimal early marker for AP severity stratification yet.
#42 The clinical value of adipokines in predicting the severity and outcome of acute pancreatitis | BMC Gastroenterology | Full Text
https://bmcgastroenterol.biomedcentral.com/articles/10.1186/s12876-016-0514-4
The significant differences of resistin, visfatin, leptin and adiponectin concentrations between mild AP (MAP) and SAP patients were found in some older studies, but all of them were very different in their methodology, diagnostic criteria, classification and evaluation of AP. […] Only the early predictor could help to make the decision about the patients needs to be transferred to the high volume center timely, enteral nutrition and maybe prophylactic administration of antibiotics use in early phase of AP. […] Our study has shown that the value of adipokines in predicting the course and outcome of AP was rated too good. Only resistin can be used for early AP course prediction. […] Resistin and IL-6 cut-off values 13.7 ng/ml and 473.4 pg/ml could be used as an early markers of severe AP as well as the peripancreatic necrosis volume of 112.5 ml. […] There is no optimal early marker for AP severity stratification yet.
#43 Acute pancreatitis: A review of diagnosis, severity prediction and prognosis assessment from imaging technology, scoring system and artificial intelligence
https://www.wjgnet.com/1007-9327/full/v29/i37/5268.htm
Acute pancreatitis (AP) is a potentially life-threatening inflammatory disease of the pancreas, with clinical management determined by the severity of the disease. Diagnosis, severity prediction, and prognosis assessment of AP typically involve the use of imaging technologies, such as computed tomography, magnetic resonance imaging, and ultrasound, and scoring systems, including Ranson, Acute Physiology and Chronic Health Evaluation II, and Bedside Index for Severity in AP scores. […] Despite the central role of imaging technologies and scoring systems in AP management, these methods have limitations in terms of accuracy, reproducibility, practicality and economics. Recent advancements of artificial intelligence (AI) provide new opportunities to enhance their performance by analyzing vast amounts of clinical and imaging data. AI algorithms can analyze large amounts of clinical and imaging data, identify scoring system patterns, and predict the clinical course of disease. AI-based models have shown promising results in predicting the severity and mortality of AP, but further validation and standardization are required before widespread clinical application.
#44 Machine learning for post-acute pancreatitis diabetes mellitus prediction and personalized treatment recommendations | Scientific Reports
https://www.nature.com/articles/s41598-023-31947-4
PPDM-A is the most common sequela of pancreatitis and is characterized by poorer glycaemic control, a higher risk of developing cancer, and a higher risk of mortality. […] Our results suggest that clinical features can accurately predict the risk of PPDM-A after the onset of acute pancreatitis, although none of the nine clinical features we included directly reflected islet cell function. […] Our study reveals that age, BMI, metabolic status, and comorbidities play different roles in individuals and may lead to opposite outcomes. […] We assessed the characteristics that had the most profound impact on the model’s predictions by Shapley value. […] Our predictive model could form the basis for diagnosis and selective screening for PPDM-A and allow for personalized advice to patients on PPDM-A prevention. […] Future prospective studies, as well as multicentre, multicohort prospective studies, are needed to assess the clinical value of the model.
#45 Improved outcome prediction in acute pancreatitis with generated data and advanced machine learning algorithms | 2025, Volume 25, Issue 1 | Turkish Journal of Emergency Medicine
https://turkjemergmed.com/full-text/902
ML models, especially RF, significantly outperform traditional clinical scores in predicting adverse outcomes in AP, suggesting that integrating ML into clinical practice could improve prognostic assessments. […] This study demonstrates that ML algorithms significantly outperform traditional clinical scoring systems in predicting outcomes in AP, particularly in the fast paced environment of emergency medicine, where rapid decision making is critical. […] These predictors can easily determine the intensive care requirements and mortality risks of AP in the emergency department in the early period. […] The ML models, particularly RF, significantly outperformed traditional clinical scores in predicting adverse outcomes in AP. While BISAP and modified Glasgow showed some utility, their overall effectiveness was lower, particularly compared to the ML approaches. These findings suggest that integrating advanced ML models into clinical practice could enhance the accuracy and reliability of predicting adverse outcomes in AP. At last, lactate, glucose, BUN, and age predictors that evaluate the prognosis of AP much more successfully than traditional scoring methods can be used in emergency departments.
#46 Improved outcome prediction in acute pancreatitis with generated data and advanced machine learning algorithms | 2025, Volume 25, Issue 1 | Turkish Journal of Emergency Medicine
https://turkjemergmed.com/full-text/902
ML models, especially RF, significantly outperform traditional clinical scores in predicting adverse outcomes in AP, suggesting that integrating ML into clinical practice could improve prognostic assessments. […] This study demonstrates that ML algorithms significantly outperform traditional clinical scoring systems in predicting outcomes in AP, particularly in the fast paced environment of emergency medicine, where rapid decision making is critical. […] These predictors can easily determine the intensive care requirements and mortality risks of AP in the emergency department in the early period. […] The ML models, particularly RF, significantly outperformed traditional clinical scores in predicting adverse outcomes in AP. While BISAP and modified Glasgow showed some utility, their overall effectiveness was lower, particularly compared to the ML approaches. These findings suggest that integrating advanced ML models into clinical practice could enhance the accuracy and reliability of predicting adverse outcomes in AP. At last, lactate, glucose, BUN, and age predictors that evaluate the prognosis of AP much more successfully than traditional scoring methods can be used in emergency departments.
#47 Predicting persistent organ failure in acute pancreatitis | JIR
https://www.dovepress.com/nomogram-and-web-calculator-based-on-lasso-logistic-regression-for-pre-peer-reviewed-fulltext-article-JIR
Predictive model including 6 risk indicators can be used to predict the risk of persistent organ failure in patients with acute pancreatitis. […] Heart Rate, Serum Creatinine, Ca (Calcium), Lymphocytes and D-dimer are independent predictors of POF were independently associated with persistent organ failure in acute pancreatitis. Using 6 clinical risk indicators, we developed nomogram and web calculator.
#48 Acute Pancreatitis: Diagnosis, Prognosis, and Treatment | AAFP
https://www.aafp.org/pubs/afp/issues/2007/0515/p1513.html
Research has shown some advantages of the CT Severity Index in predicting the severity of acute pancreatitis compared with the other systems. […] A CT Severity Index score of 5 or greater was associated with a mortality rate 15 times higher than in those with a score of less than 5. […] Another study demonstrated that the CT Severity Index was a stronger predictor of severe acute pancreatitis than Ranson’s criteria or the APACHE II scale. […] The higher the prognostic score, the poorer the clinical outcome, including mortality. Irrespective of scoring criteria, signs of organ failure within 24 hours of admission significantly increase the risk of death.
#49 Acute Pancreatitis: Diagnosis, Prognosis, and Treatment | AAFP
https://www.aafp.org/pubs/afp/issues/2007/0515/p1513.html
Research has shown some advantages of the CT Severity Index in predicting the severity of acute pancreatitis compared with the other systems. […] A CT Severity Index score of 5 or greater was associated with a mortality rate 15 times higher than in those with a score of less than 5. […] Another study demonstrated that the CT Severity Index was a stronger predictor of severe acute pancreatitis than Ranson’s criteria or the APACHE II scale. […] The higher the prognostic score, the poorer the clinical outcome, including mortality. Irrespective of scoring criteria, signs of organ failure within 24 hours of admission significantly increase the risk of death.
#50 The clinical value of adipokines in predicting the severity and outcome of acute pancreatitis | BMC Gastroenterology | Full Text
https://bmcgastroenterol.biomedcentral.com/articles/10.1186/s12876-016-0514-4
Recent data shows that patients with severe acute pancreatic might benefit from early intensive therapy, enteral nutrition and timely transfer to specialized centers. […] This study aims to evaluate the prognostic usefulness of adipokines in prediction of the severity and outcome of acute pancreatitis (AP). […] The prognostic value of adipokines in AP is limited. Only admission resistin levels could serve as an early predictor for SAP. […] The adequate management of the AP patients within first 2 3 days could be of vital importance and determine the future prognosis. […] Currently prognosis of the AP is largely based on clinical scores, such as APACHE II, BISAP and many others. […] The predictive value of adipokines, such as leptin, adiponectin, resistin and visfatin, is less explored.
#51 The clinical value of adipokines in predicting the severity and outcome of acute pancreatitis | BMC Gastroenterology | Full Text
https://bmcgastroenterol.biomedcentral.com/articles/10.1186/s12876-016-0514-4
The significant differences of resistin, visfatin, leptin and adiponectin concentrations between mild AP (MAP) and SAP patients were found in some older studies, but all of them were very different in their methodology, diagnostic criteria, classification and evaluation of AP. […] Only the early predictor could help to make the decision about the patients needs to be transferred to the high volume center timely, enteral nutrition and maybe prophylactic administration of antibiotics use in early phase of AP. […] Our study has shown that the value of adipokines in predicting the course and outcome of AP was rated too good. Only resistin can be used for early AP course prediction. […] Resistin and IL-6 cut-off values 13.7 ng/ml and 473.4 pg/ml could be used as an early markers of severe AP as well as the peripancreatic necrosis volume of 112.5 ml. […] There is no optimal early marker for AP severity stratification yet.
#52 Prognosis in acute pancreatitis
https://pmc.ncbi.nlm.nih.gov/articles/PMC3071387/
Although current practice guidelines universally recommend aggressive fluid resuscitation, limited data is available to support these recommendations. […] Recent advances in determining prognosis for acute pancreatitis have centred on methods that can help guide resuscitation efforts during the crucial phase of illness (i.e., the first 24 hours after admission to hospital). […] Scoring systems such as the BISAP can be useful to identify patients most likely to benefit from a targeted fluid resuscitation protocol. […] Studies are currently underway that will help determine whether such objective approaches to initial management can lead to improved outcomes for patients with acute pancreatitis.
#53 Prognosis in acute pancreatitis
https://pmc.ncbi.nlm.nih.gov/articles/PMC3071387/
Although current practice guidelines universally recommend aggressive fluid resuscitation, limited data is available to support these recommendations. […] Recent advances in determining prognosis for acute pancreatitis have centred on methods that can help guide resuscitation efforts during the crucial phase of illness (i.e., the first 24 hours after admission to hospital). […] Scoring systems such as the BISAP can be useful to identify patients most likely to benefit from a targeted fluid resuscitation protocol. […] Studies are currently underway that will help determine whether such objective approaches to initial management can lead to improved outcomes for patients with acute pancreatitis.
#54 2019 WSES guidelines for the management of severe acute pancreatitis | World Journal of Emergency Surgery | Full Text
https://wjes.biomedcentral.com/articles/10.1186/s13017-019-0247-0
In general, patients with organ failure (accurately defined utilizing one of the established criteria or scoring systems) need an urgent transfer to an ICU. […] Persistent organ dysfunction or organ failure occurrence despite adequate fluid resuscitation is an indication for ICU admission. […] Early fluid resuscitation is indicated to optimize tissue perfusion targets, without waiting for hemodynamic worsening. […] Continuous vital signs monitoring in high dependency care unit is needed if organ dysfunction occurs. […] The use and efficacy of prophylactic antibiotic therapy in acute pancreatitis has long been a point of controversy. […] Antibiotics are always recommended to treat infected acute pancreatitis. However, diagnosis of infected pancreatitis is challenging due to the clinical picture that cannot be distinguished from other infectious complications or from the inflammatory status caused by acute pancreatitis.
#55 2019 WSES guidelines for the management of severe acute pancreatitis | World Journal of Emergency Surgery | Full Text
https://wjes.biomedcentral.com/articles/10.1186/s13017-019-0247-0
In general, patients with organ failure (accurately defined utilizing one of the established criteria or scoring systems) need an urgent transfer to an ICU. […] Persistent organ dysfunction or organ failure occurrence despite adequate fluid resuscitation is an indication for ICU admission. […] Early fluid resuscitation is indicated to optimize tissue perfusion targets, without waiting for hemodynamic worsening. […] Continuous vital signs monitoring in high dependency care unit is needed if organ dysfunction occurs. […] The use and efficacy of prophylactic antibiotic therapy in acute pancreatitis has long been a point of controversy. […] Antibiotics are always recommended to treat infected acute pancreatitis. However, diagnosis of infected pancreatitis is challenging due to the clinical picture that cannot be distinguished from other infectious complications or from the inflammatory status caused by acute pancreatitis.
#56 2019 WSES guidelines for the management of severe acute pancreatitis | World Journal of Emergency Surgery | Full Text
https://wjes.biomedcentral.com/articles/10.1186/s13017-019-0247-0
In general, patients with organ failure (accurately defined utilizing one of the established criteria or scoring systems) need an urgent transfer to an ICU. […] Persistent organ dysfunction or organ failure occurrence despite adequate fluid resuscitation is an indication for ICU admission. […] Early fluid resuscitation is indicated to optimize tissue perfusion targets, without waiting for hemodynamic worsening. […] Continuous vital signs monitoring in high dependency care unit is needed if organ dysfunction occurs. […] The use and efficacy of prophylactic antibiotic therapy in acute pancreatitis has long been a point of controversy. […] Antibiotics are always recommended to treat infected acute pancreatitis. However, diagnosis of infected pancreatitis is challenging due to the clinical picture that cannot be distinguished from other infectious complications or from the inflammatory status caused by acute pancreatitis.
#57 2019 WSES guidelines for the management of severe acute pancreatitis | World Journal of Emergency Surgery | Full Text
https://wjes.biomedcentral.com/articles/10.1186/s13017-019-0247-0
In general, patients with organ failure (accurately defined utilizing one of the established criteria or scoring systems) need an urgent transfer to an ICU. […] Persistent organ dysfunction or organ failure occurrence despite adequate fluid resuscitation is an indication for ICU admission. […] Early fluid resuscitation is indicated to optimize tissue perfusion targets, without waiting for hemodynamic worsening. […] Continuous vital signs monitoring in high dependency care unit is needed if organ dysfunction occurs. […] The use and efficacy of prophylactic antibiotic therapy in acute pancreatitis has long been a point of controversy. […] Antibiotics are always recommended to treat infected acute pancreatitis. However, diagnosis of infected pancreatitis is challenging due to the clinical picture that cannot be distinguished from other infectious complications or from the inflammatory status caused by acute pancreatitis.
#58 2019 WSES guidelines for the management of severe acute pancreatitis | World Journal of Emergency Surgery | Full Text
https://wjes.biomedcentral.com/articles/10.1186/s13017-019-0247-0
In general, patients with organ failure (accurately defined utilizing one of the established criteria or scoring systems) need an urgent transfer to an ICU. […] Persistent organ dysfunction or organ failure occurrence despite adequate fluid resuscitation is an indication for ICU admission. […] Early fluid resuscitation is indicated to optimize tissue perfusion targets, without waiting for hemodynamic worsening. […] Continuous vital signs monitoring in high dependency care unit is needed if organ dysfunction occurs. […] The use and efficacy of prophylactic antibiotic therapy in acute pancreatitis has long been a point of controversy. […] Antibiotics are always recommended to treat infected acute pancreatitis. However, diagnosis of infected pancreatitis is challenging due to the clinical picture that cannot be distinguished from other infectious complications or from the inflammatory status caused by acute pancreatitis.
#59 2019 WSES guidelines for the management of severe acute pancreatitis | World Journal of Emergency Surgery | Full Text
https://wjes.biomedcentral.com/articles/10.1186/s13017-019-0247-0
The presence of gas in the retroperitoneal area is considered indicative of infected pancreatitis in the context of severe acute pancreatitis, but it is only present in a limited number of patients. […] The timing of infection in pancreatic necrosis is variable and unpredictable and peaks in the second to fourth week after the onset of pancreatitis.
#60 Acute pancreatitis: A review of diagnosis, severity prediction and prognosis assessment from imaging technology, scoring system and artificial intelligence
https://www.wjgnet.com/1007-9327/full/v29/i37/5268.htm
The volume of extrapancreatic necrosis positively correlates with the complication rate of SAP, potentially serving as an indicator for predicting adverse outcomes in AP. Early prediction of SAP with high mortality remains a challenge due to the limited accuracy of current predictive tools and the complex clinical features of SAP. […] The development of risk stratification tools that meet clinical needs and guide clinicians in terms of resource allocation, patient consultation and clinical audit, and the multidisciplinary approaches including evidence-based care are essential to achieve optimal clinical outcomes. […] Therefore, early assessment of the etiology and severity of AP is essential for prompt treatment and close monitoring of severe patients.
#61 Acute pancreatitis: A review of diagnosis, severity prediction and prognosis assessment from imaging technology, scoring system and artificial intelligence
https://www.wjgnet.com/1007-9327/full/v29/i37/5268.htm
The volume of extrapancreatic necrosis positively correlates with the complication rate of SAP, potentially serving as an indicator for predicting adverse outcomes in AP. Early prediction of SAP with high mortality remains a challenge due to the limited accuracy of current predictive tools and the complex clinical features of SAP. […] The development of risk stratification tools that meet clinical needs and guide clinicians in terms of resource allocation, patient consultation and clinical audit, and the multidisciplinary approaches including evidence-based care are essential to achieve optimal clinical outcomes. […] Therefore, early assessment of the etiology and severity of AP is essential for prompt treatment and close monitoring of severe patients.
#62 Multifactorial Scores and Biomarkers of Prognosis of Acute Pancreatitis: Applications to Research and Practice
https://www.mdpi.com/1422-0067/21/1/338
The clinical presentation of AP is very variable. […] The actual management of AP is based on parenteral intravenous fluid therapy, pain control, and adequate nutrition. […] It is critical to design and conduct large population-based multicenter studies to identify parameters that allow for the definition of multifactorial scores or biomarkers to predict AP severity and monitor disease progression that can be used routinely.