Zapalenie trzustki – Rokowania, prognozy i postęp choroby

Zapalenie trzustki
Rokowania, prognozy i postęp choroby

Ostre zapalenie trzustki (OZT) to stan o nagłym początku, charakteryzujący się silnym bólem brzucha i potencjalnie wysoką śmiertelnością, sięgającą 3-10%, a w ciężkich przypadkach nawet 36-50%. Kluczowe jest wczesne rozpoznanie pacjentów z wysokim ryzykiem powikłań, najlepiej w ciągu pierwszych 24 godzin od przyjęcia. Niezależnymi czynnikami ryzyka są wiek (szczególnie >75 lat), stężenie azotu mocznikowego (BUN) oraz mleczanów (ABL), a model nomogramowy ABL wykazuje wysoką wartość prognostyczną (wskaźnik C=0,896; 95% CI 0,825-0,967). Etiologia wpływa na przebieg choroby – zapalenie trzustki wywołane hipertriglicerydemią (HTG-AP) wiąże się z największą liczbą powikłań i wyższą śmiertelnością (OR=1,72 w porównaniu do alkoholowego zapalenia trzustki, AAP). Wczesna ocena ciężkości opiera się na skalach takich jak BISAP, APACHE II, Ransona czy Glasgow, z BISAP rekomendowaną do stosowania w pierwszych 24 godzinach ze względu na prostotę i skuteczność.

Prognostyka zapalenia trzustki

Czynniki prognostyczne
Wpływ etiologii na rokowanie

Systemy oceny ciężkości zapalenia trzustki

Skale rankingowe
Badania obrazowe w prognostyce
Biomarkery w prognostyce

Przewidywanie powikłań długoterminowych

Przewlekłe zapalenie trzustki

Wyzwania w prognostyce zapalenia trzustki

Przyszłe kierunki
Kolejne rozdziały

Prognostyka zapalenia trzustki

Zapalenie trzustki jest potencjalnie zagrażającym życiu stanem zapalnym trzustki, charakteryzującym się nagłym początkiem i silnym bólem brzucha. Mimo że większość pacjentów z ostrym zapaleniem trzustki wyzdrowieje bez następstw, od 10% do 20% pacjentów będzie miało bardziej skomplikowany przebieg kliniczny z większym ryzykiem zachorowalności i śmiertelności.¹ Pierwsze 24 godziny po wystąpieniu objawów są krytyczne dla identyfikacji pacjentów, którzy są zagrożeni rozwojem powikłań lub śmiercią.² Ogólna śmiertelność wynosi od 3% do 10%, ale pacjenci z ciężką postacią choroby są narażeni na zwiększone ryzyko zgonu, ze wskaźnikiem śmiertelności wynoszącym od 36% do 50%.³

Wczesna i dokładna identyfikacja pacjentów z wysokim ryzykiem rozwoju ciężkiego zapalenia trzustki może pomóc w poprawie indywidualnego rokowania, jednocześnie zmniejszając ryzyko powikłań.⁴ Aby mieć największą wartość dla klinicystów, prognozy wyniku powinny być stosowane dokładnie i wiarygodnie jak najwcześniej, najlepiej w ciągu pierwszych 24 godzin przyjęcia do szpitala.⁵

Czynniki prognostyczne

Wiele badań wykazało, że starszy wiek jest predyktorem gorszego rokowania, chociaż punkt odcięcia dla wieku różnił się od 55 do 75 lat w różnych raportach. W jednym z badań, pacjenci powyżej 75 roku życia mieli ponad 15-krotnie większą szansę na śmierć w ciągu dwóch tygodni i ponad 22-krotnie większą szansę na śmierć w ciągu 91 dni w porównaniu z pacjentami w wieku 35 lat lub młodszymi.⁶

Badania wykazały, że wiek, stężenie azotu mocznikowego (BUN) i mleczanów (ABL) są niezależnymi czynnikami ryzyka określonymi w analizie wieloczynnikowej. Model nomogramowy ABL, który wykorzystuje łatwo dostępne dane, wykazał wysoką wartość predykcyjną dla prognozowania śmiertelności wewnątrzszpitalnej w zapaleniu trzustki.⁷ Wskaźnik C modelu nomogramowego ABL wynosił 0,896 (95% CI 0,825 do 0,967), wykazując dużą zdolność dyskryminacyjną.⁸

Ostatnie dane sugerują, że seryjny pomiar stężenia azotu mocznikowego we krwi jest najbardziej przydatnym rutynowym badaniem laboratoryjnym do określenia ryzyka zgonu. Dokładność prognostyczna seryjnego pomiaru stężenia azotu mocznikowego we krwi została zweryfikowana przy użyciu danych z trzech niezależnych prospektywnych badań kohortowych.⁹

Wpływ etiologii na rokowanie

Ocena wpływu czynników etiologicznych na ciężkość i wynik zapalenia trzustki była przedmiotem wielu badań. Ryzyko umiarkowanie ciężkiego i ciężkiego stanu było najwyższe w przypadku zapalenia trzustki wywołanego hipertriglicerydemią (HTG-AP), a następnie alkoholowego zapalenia trzustki (AAP), żółciowego zapalenia trzustki (BAP) i zapalenia trzustki wywołanego lekami (PAP).¹⁰

Wskaźnik śmiertelności był znacząco większy w HTG-AP w porównaniu z AAP lub BAP (OR=1,72 i 1,50, 95% CI 1,04-2,84 i 0,96-2,35, odpowiednio), martwica trzustki występowała częściej u pacjentów z AAP niż u pacjentów z BAP (OR=1,58, 95% CI 1,08-2,30).¹¹ Ogólnie, istnieje potencjalny związek między etiologią a rozwojem i przebiegiem zapalenia trzustki. HTG-AP jest związane z największą liczbą powikłań. Dlatego też niezbędne jest określenie przyczyny choroby w odpowiednim czasie, aby zastosować najbardziej odpowiednią terapię.¹²

Systemy oceny ciężkości zapalenia trzustki

Ocena ciężkości w zapaleniu trzustki rozpoczęła się w 1974 roku przez Ransona i wsp. Od tego czasu zdefiniowano inne wieloczynnikowe systemy oceny, stosujące powszechne parametry kliniczne i biochemiczne, aby przewidzieć ciężkość.¹³ Multidyscyplinarne podejścia, w tym opieka oparta na dowodach, są niezbędne do osiągnięcia optymalnych wyników klinicznych.¹⁴

Skale rankingowe

Skala Ransona – pierwsza specyficzna wieloczynnikowa skala oceny dla zapalenia trzustki, opublikowana w 1974 roku. Śmiertelność wzrasta wraz ze wzrostem wyniku.¹⁵
Skala Glasgow – dobra prognostyczna skala śmiertelności, niezależnie od etiologii.¹⁶
APACHE-II (Acute Physiology and Chronic Health Evaluation II) – stosowany jako standard referencyjny w kilku badaniach oceniających nowe prognostyczne systemy oceny lub identyfikujących indywidualne czynniki ryzyka ciężkich wyników.¹⁷
BISAP (Bedside Index of Severity in Acute Pancreatitis) – opracowana do użytku w ciągu pierwszych 24 godzin przyjęcia do szpitala i obejmuje pięć parametrów. Ten pięcioczynnikowy system oceny wykazał podobną dokładność do APACHE II w przewidywaniu śmierci w początkowym badaniu retrospektywnym i w kilku późniejszych prospektywnych badaniach kohortowych.¹⁸¹⁹
SIRS (Systemic Inflammatory Response Syndrome) – prosta i szeroko stosowana w warunkach klinicznych. Obecność zespołu w ciągu pierwszych 24 godzin przyjęcia do szpitala ma wysoką czułość w przewidywaniu niewydolności narządów (85%) i śmierci (100%), ale brakuje jej specyficzności dla ciężkiej choroby (41%).²⁰²¹
PASS (Pancreatic Activity Scoring System) – wydajność skali była porównywana z ustalonymi systemami stosowanymi do przewidywania ciężkiego zapalenia trzustki.²²

Badania porównawcze systemów oceny wykazały, że modele uczenia maszynowego, szczególnie Random Forest (RF), znacznie przewyższają tradycyjne kliniczne systemy oceny w przewidywaniu niekorzystnych wyników w zapaleniu trzustki, zwłaszcza w szybkim środowisku medycyny ratunkowej, gdzie szybkie podejmowanie decyzji jest kluczowe.²³

Badania obrazowe w prognostyce

Metody radiologiczne odgrywają kluczową rolę w diagnozowaniu zapalenia trzustki, ocenie jego ciężkości i przewidywaniu jego prognozy.²⁴ Zaawansowane techniki obrazowania, takie jak tomografia komputerowa (CT) o podwójnej energii i obrazowanie rezonansu magnetycznego (MRI) z ważeniem dyfuzyjnym, są użyteczne we wczesnej diagnozie zapalenia trzustki, a CT o podwójnej energii jest również przydatne w ocenie ciężkości i przewidywaniu prognozy.²⁵

Badania wykazały pewne zalety Indeksu Ciężkości CT (CT Severity Index, CTSI) w przewidywaniu ciężkości ostrego zapalenia trzustki w porównaniu z innymi systemami. Wynik CTSI wynoszący 5 lub większy korelował z przedłużoną hospitalizacją i wyższymi wskaźnikami śmiertelności i zachorowalności.²⁶ Badanie obserwacyjne wykazało, że wyniki CTSI, gdy uzyskano je w ciągu 48 godzin, lepiej korelowały z powikłaniami i śmiertelnością niż kryteria Ransona.²⁷

Opracowano i zwalidowano model predykcyjny łączący cechy radiomiczne CT i parametry kliniczne dla wczesnej oceny ciężkości zapalenia trzustki. Model kliniczno-radiomiczny oferuje nowe narzędzie do wczesnego przewidywania ciężkości zapalenia trzustki, zapewniając cenne wsparcie dla podejmowania decyzji klinicznych.²⁸ Połączony model przewyższał zarówno model radiomiczny, jak i kliniczny, z AUC 0,905 (95% CI, 0,837-0,973) w kohorcie treningowej i 0,908 (95% CI, 0,824-0,992) w kohorcie walidacyjnej.²⁹

Biomarkery w prognostyce

Termin biomarker został zdefiniowany przez Narodowe Instytuty Zdrowia jako „cecha, która jest obiektywnie mierzona i oceniana jako wskaźnik normalnych procesów biologicznych, procesów patogennych lub odpowiedzi farmakologicznych na interwencję terapeutyczną.”³⁰ W ostatnich latach wzrosło zainteresowanie identyfikacją wiarygodnych biomarkerów, które mogą przewidzieć ciężkość i wyniki ostrego zapalenia trzustki.³¹

Badania wykazały, że prokalcytonina (PCT) jest najbardziej czułym badaniem laboratoryjnym do wykrywania zakażenia trzustki, a niskie poziomy wydają się być silnymi negatywnymi predyktorami zakażonej martwicy.³² Białko C-reaktywne (CRP) mierzone po 48 godzinach od pojawienia się objawów jest również dobrym biomarkerem ze względu na jego dostępność, prostotę i zdolność do przewidywania ciężkości zapalenia trzustki.³³

Wskaźnik Systemowej Odpowiedzi Immunologicznej (SIRI) i Systemowy Wskaźnik Zapalenia Immunologicznego (SII) wyłaniają się jako nowe biomarkery dla ogólnoustrojowego zapalenia.³⁴ Analiza ROC zastosowana do wczesnego przewidywania ciężkiego zapalenia trzustki wykazała istotne wyniki tylko dla rezystyny i IL-6 przy przyjęciu.³⁵ Wartości odcięcia dla rezystyny i IL-6 na poziomie 13,7 ng/ml i 473,4 pg/ml mogą być stosowane jako wczesne markery ciężkiego zapalenia trzustki, podobnie jak objętość martwicy okołotrzustkowej wynosząca 112,5 ml.³⁶

Przewidywanie powikłań długoterminowych

Wśród długoterminowych powikłań zapalenia trzustki, cukrzyca po ostrym zapaleniu trzustki (PPDM-A) jest głównym składnikiem egzokrynnej cukrzycy trzustkowej. Terminowa diagnoza PPDM-A poprawia wyniki pacjentów i łagodzenie obciążeń i kosztów.³⁷ Populacyjne badania kohortowe ujawniają, że ryzyko PPDM-A jest dwukrotnie wyższe niż u osób bez zapalenia trzustki, a występowanie PPDM-A jest obserwowane w całym spektrum ciężkości zapalenia trzustki.³⁸

Wyniki badań sugerują, że cechy kliniczne mogą dokładnie przewidzieć ryzyko PPDM-A po wystąpieniu ostrego zapalenia trzustki. Stwierdzono, że glukoza przy przyjęciu, otyłość (BMI≥28 kg/m2) i HDL-C≤1,03 mmol/l były trzema czynnikami, które miały największy wpływ na wynik.³⁹ Model predykcyjny mógłby stanowić podstawę do diagnozy i selektywnego badania przesiewowego w kierunku PPDM-A i pozwolić na spersonalizowane porady dla pacjentów dotyczące profilaktyki PPDM-A.⁴⁰

Przewlekłe zapalenie trzustki

Hipoteza martwica-włóknienie opisuje kontinuum między pojedynczymi atakami ostrego zapalenia trzustki (SAP), nawracającym ostrym zapaleniem trzustki (RAP) i przewlekłym zapaleniem trzustki (CP) z niewydolnością trzustki wewnątrzwydzielniczej i zewnątrzwydzielniczej.⁴¹

Mimo porównywalnego wyniku (krótkoterminowa śmiertelność, potrzeba interwencji i czas hospitalizacji) w obu grupach (SAP i RAP), tylko dwa parametry były predykcyjne w RAP. Martwica wewnątrztrzustkowa silnie korelowała z całkowitym czasem hospitalizacji, podczas gdy skurczowe ciśnienie krwi było słabym czynnikiem prognostycznym dla wymaganych interwencji i krótkoterminowej śmiertelności.⁴²

W SAP tylko zmodyfikowana skala Marshalla i mCTSI były predykcyjne dla krótkoterminowej śmiertelności, podczas gdy CTSI i zakres martwicy wewnątrztrzustkowej ujawniły wartość prognostyczną dla wymaganych interwencji.⁴³

Wyzwania w prognostyce zapalenia trzustki

Mimo intensywnych badań nad patofizjologią zapalenia trzustki, ogólna śmiertelność choroby nie uległa znaczącej poprawie. W tym sensie wczesna diagnoza i terminowa ocena ciężkości są niezbędne.⁴⁴ Jednakże idealny wieloczynnikowy system oceny i/lub biomarker biochemiczny do wczesnej oceny ciężkości zapalenia trzustki nie został jeszcze zdefiniowany.⁴⁵

Wczesne przewidywanie ciężkiego zapalenia trzustki z wysoką śmiertelnością pozostaje wyzwaniem ze względu na ograniczoną dokładność obecnych narzędzi predykcyjnych i złożone cechy kliniczne ciężkiego zapalenia trzustki.⁴⁶ Istnieje potrzeba zidentyfikowania markerów predykcyjnych lub narzędzi, które są dokładne w prognozowaniu zarówno umiarkowanie ciężkiego, jak i ciężkiego zapalenia trzustki w ciągu pierwszych 24 do 72 godzin.⁴⁷

Na podstawie analizy dostępnych danych i dowodów, sugeruje się stosowanie skali BISAP jako wieloczynnikowego systemu oceny i CRP po 48 godzinach od pojawienia się jako biomarker biochemiczny ze względu na ich dostępność, prostotę i zdolność do przewidywania ciężkości zapalenia trzustki.⁴⁸ Jednak nie ma jeszcze optymalnego wczesnego markera do stratyfikacji ciężkości zapalenia trzustki.⁴⁹

Przyszłe kierunki

Sztuczna inteligencja (AI) zapewnia nowe możliwości poprawy wydajności istniejących metod 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 zapalenia trzustki, ale przed powszechnym zastosowaniem klinicznym wymagana jest dalsza walidacja i standaryzacja.⁵⁰

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.⁵¹ Dlatego wczesna ocena etiologii i ciężkości zapalenia trzustki jest niezbędna do szybkiego leczenia i ścisłego monitorowania ciężkich pacjentów.⁵²

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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 Prognostic models for predicting the severity and mortality in people with acute pancreatitis
https://pmc.ncbi.nlm.nih.gov/articles/PMC6494466/
Severe acute pancreatitis carries the worst prognosis in terms of mortality (Munigala 2016), along with persistent organ failure (Banks 2013). […] According to the revised Atlanta classification, severe pancreatitis is associated with the presence of persistent organ failure (organ failure for longer than 48 hours) (Banks 2013), but according to the original Atlanta classification, severe pancreatitis is associated with the presence of either organ failure or local complications such as necrosis, pseudocyst, or abscess (Bradley 1993). […] Timely and accurate identification of patients who are at high risk of developing severe acute pancreatitis may help to improve their individual prognosis while reducing their risk of complications. […] Although several scoring systems have been developed to predict severe acute pancreatitis, evidence on their predictive performance is variable and inconsistent (Bollen 2012; Gao 2015; Papachristou 2010). […] A formal synthesis of studies providing evidence on the predictive ability of the various available scoring systems will show which systems are more reliable in routine care, thereby facilitating evidence-based decision making for treatment of patients with acute pancreatitis.
#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 Predicting the severity of acute pancreatitis – UpToDate
https://www.uptodate.com/contents/predicting-the-severity-of-acute-pancreatitis
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. […] In an illustrative study, patients older than 75 years had more than a 15-fold greater chance of dying within two weeks and a more than 22-fold greater chance of dying within 91 days compared with patients aged 35 years or younger.
#7 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 outcome of the prediction model was in-hospital mortality. […] 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.
#8 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 outcome of the prediction model was in-hospital mortality. […] 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.
#9 Prognosis in acute pancreatitis
https://pmc.ncbi.nlm.nih.gov/articles/PMC3071387/
Specificity is increased with the duration of the syndrome, such that persistent systemic inflammatory response syndrome (i.e., longer than 48 hours) has been linked with adverse outcomes that include organ dysfunction and death. […] Recent data suggest that serial measurement of blood urea nitrogen levels is the most useful routine laboratory test for determining risk of death. […] The prognostic accuracy of serial measurement of blood urea nitrogen levels has since been validated using data from three independent prospective cohort studies. […] In addition, serial measurement of routine laboratory tests such as blood urea nitrogen may help track a patients progress during early resuscitation.
#10 Assessment of the course of acute pancreatitis in the light of aetiology: a systematic review and meta-analysis | Scientific Reports
https://www.nature.com/articles/s41598-020-74943-8
The aim of this meta-analysis was to evaluate the effects of these aetiological factors on the severity and outcome of AP. […] The risk for non-mild (moderately severe and severe) condition was the highest in HTG-induced AP (HTG-AP) followed by alcoholic AP (AAP), biliary AP (BAP) and PAP. […] Mortality rate was significantly greater in HTG-AP vs. AAP or BAP (OR=1.72 and 1.50, 95% CI 1.042.84 and 0.962.35, respectively), pancreatic necrosis occurred more frequently in AAP than BAP patients (OR=1.58, 95% CI 1.082.30). […] Overall, there is a potential association between aetiology and the development and course of AP. HTG-AP is associated with the highest number of complications. […] Greater emphasis should be placed on determining aetiology on admission. […] To date, numerous clinical studies have investigated the effect of aetiology on AP progression.
#11 Assessment of the course of acute pancreatitis in the light of aetiology: a systematic review and meta-analysis | Scientific Reports
https://www.nature.com/articles/s41598-020-74943-8
The aim of this meta-analysis was to evaluate the effects of these aetiological factors on the severity and outcome of AP. […] The risk for non-mild (moderately severe and severe) condition was the highest in HTG-induced AP (HTG-AP) followed by alcoholic AP (AAP), biliary AP (BAP) and PAP. […] Mortality rate was significantly greater in HTG-AP vs. AAP or BAP (OR=1.72 and 1.50, 95% CI 1.042.84 and 0.962.35, respectively), pancreatic necrosis occurred more frequently in AAP than BAP patients (OR=1.58, 95% CI 1.082.30). […] Overall, there is a potential association between aetiology and the development and course of AP. HTG-AP is associated with the highest number of complications. […] Greater emphasis should be placed on determining aetiology on admission. […] To date, numerous clinical studies have investigated the effect of aetiology on AP progression.
#12 Assessment of the course of acute pancreatitis in the light of aetiology: a systematic review and meta-analysis | Scientific Reports
https://www.nature.com/articles/s41598-020-74943-8
Our study revealed that the prevalence of severe and moderately severe (non-mild) disease forms was highest in case of HTG-AP which was followed by AAP, BAP and PAP. […] In our study, no difference could be observed between any aetiological groups in POF. […] Our study has shown that HTG-AP led to significantly higher mortality rate than AAP. […] HTG carried the greatest risk for non-mild (moderately severe and severe) AP, which was followed by AAP; the least severe disease forms were observed in BAP and PAP. […] It is essential to determine the cause of the disease in time to apply the most appropriate therapy.
#13 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 Ranson score was published in 1974 as the first specific multifactorial scoring system for AP. […] Mortality increases with an increasing score. […] The Glasgow score is a good prognostic tool for mortality, regardless of the etiology. […] The APACHE-II has been used as a reference standard in several studies to evaluate new prognostic scoring systems or to identify individual risk factors for severe outcomes. […] The BISAP score was aimed for use during the first 24 h of admission to hospital and includes five parameters. […] The SIRS score is simple and widely used in the clinical setting.
#14 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.
#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 Ranson score was published in 1974 as the first specific multifactorial scoring system for AP. […] Mortality increases with an increasing score. […] The Glasgow score is a good prognostic tool for mortality, regardless of the etiology. […] The APACHE-II has been used as a reference standard in several studies to evaluate new prognostic scoring systems or to identify individual risk factors for severe outcomes. […] The BISAP score was aimed for use during the first 24 h of admission to hospital and includes five parameters. […] The SIRS score is simple and widely used in the clinical setting.
#16 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 Ranson score was published in 1974 as the first specific multifactorial scoring system for AP. […] Mortality increases with an increasing score. […] The Glasgow score is a good prognostic tool for mortality, regardless of the etiology. […] The APACHE-II has been used as a reference standard in several studies to evaluate new prognostic scoring systems or to identify individual risk factors for severe outcomes. […] The BISAP score was aimed for use during the first 24 h of admission to hospital and includes five parameters. […] The SIRS score is simple and widely used in the clinical setting.
#17 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 Ranson score was published in 1974 as the first specific multifactorial scoring system for AP. […] Mortality increases with an increasing score. […] The Glasgow score is a good prognostic tool for mortality, regardless of the etiology. […] The APACHE-II has been used as a reference standard in several studies to evaluate new prognostic scoring systems or to identify individual risk factors for severe outcomes. […] The BISAP score was aimed for use during the first 24 h of admission to hospital and includes five parameters. […] The SIRS score is simple and widely used in the clinical setting.
#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. […] The BISAP is a simplified scoring system that can be easily applied in the earliest phases of acute pancreatitis to help identify which patients have an increased risk of death. […] Although the presence of the syndrome during the first 24 hours of admission to hospital has high sensitivities for predicting organ failure (85%) and death (100%), it lacks specificity for severe disease (41%).
#19 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 Ranson score was published in 1974 as the first specific multifactorial scoring system for AP. […] Mortality increases with an increasing score. […] The Glasgow score is a good prognostic tool for mortality, regardless of the etiology. […] The APACHE-II has been used as a reference standard in several studies to evaluate new prognostic scoring systems or to identify individual risk factors for severe outcomes. […] The BISAP score was aimed for use during the first 24 h of admission to hospital and includes five parameters. […] The SIRS score is simple and widely used in the clinical setting.
#20 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. […] The BISAP is a simplified scoring system that can be easily applied in the earliest phases of acute pancreatitis to help identify which patients have an increased risk of death. […] Although the presence of the syndrome during the first 24 hours of admission to hospital has high sensitivities for predicting organ failure (85%) and death (100%), it lacks specificity for severe disease (41%).
#21 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 Ranson score was published in 1974 as the first specific multifactorial scoring system for AP. […] Mortality increases with an increasing score. […] The Glasgow score is a good prognostic tool for mortality, regardless of the etiology. […] The APACHE-II has been used as a reference standard in several studies to evaluate new prognostic scoring systems or to identify individual risk factors for severe outcomes. […] The BISAP score was aimed for use during the first 24 h of admission to hospital and includes five parameters. […] The SIRS score is simple and widely used in the clinical setting.
#22 Multifactorial Scores and Biomarkers of Prognosis of Acute Pancreatitis: Applications to Research and Practice
https://www.mdpi.com/1422-0067/21/1/338
The PASS score performance was compared to established systems used to predict severe AP. […] Studies showed that PCT is the most sensitive laboratory test for the detection of pancreatic infection, and low levels appear to be strong negative predictors of infected necrosis. […] Despite intense research on the pathophysiology of AP, overall disease mortality has not significantly improved. […] In this sense, early diagnosis and timely assessment of the severity are essential. […] However, an ideal multifactorial scoring system and/or biochemical marker for early assessment of the severity of AP has yet to be defined. […] Based on the analysis of available data and evidence, the authors suggest the use of the BISAP score as a multifactorial scoring system and the CRP at 48 h of presentation as the biochemical marker due to their availability, simplicity, and capability to predict AP severity.
#23 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
OBJECTIVES: Traditional scoring systems have been widely used to predict acute pancreatitis (AP) severity but have limitations in predictive accuracy. This study investigates the use of machine learning (ML) algorithms to improve predictive accuracy in AP. […] CONCLUSION: 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.
#24 Complementary comments on diagnosis, severity and prognosis prediction of acute pancreatitis
https://www.wjgnet.com/1007-9327/full/v30/i1/108.htm
The radiological differential diagnosis of acute pancreatitis includes diffuse pancreatic lymphoma, diffuse autoimmune pancreatitis and groove located mass lesions that may mimic groove pancreatitis. […] Dual energy computed tomography and diffusion weighted magnetic resonance imaging are useful in the early diagnosis of acute pancreatitis, and dual energy computed tomography is also useful in severity assessment and prognosis prediction. […] Radiological methods play a key role in diagnosing acute pancreatitis, assessing its severity and predicting its prognosis. […] As mentioned in the article by Hu et al, imaging methods, especially CT and MRI, play an important role in determining the severity and predicting the prognosis of acute pancreatitis. […] In addition to being crucial in the diagnosis of acute pancreatitis, MRI can also be used to assess the severity and predict the prognosis of acute pancreatitis by identifying and characterizing extrapancreatic necrosis and inflammation.
#25 Complementary comments on diagnosis, severity and prognosis prediction of acute pancreatitis
https://www.wjgnet.com/1007-9327/full/v30/i1/108.htm
The radiological differential diagnosis of acute pancreatitis includes diffuse pancreatic lymphoma, diffuse autoimmune pancreatitis and groove located mass lesions that may mimic groove pancreatitis. […] Dual energy computed tomography and diffusion weighted magnetic resonance imaging are useful in the early diagnosis of acute pancreatitis, and dual energy computed tomography is also useful in severity assessment and prognosis prediction. […] Radiological methods play a key role in diagnosing acute pancreatitis, assessing its severity and predicting its prognosis. […] As mentioned in the article by Hu et al, imaging methods, especially CT and MRI, play an important role in determining the severity and predicting the prognosis of acute pancreatitis. […] In addition to being crucial in the diagnosis of acute pancreatitis, MRI can also be used to assess the severity and predict the prognosis of acute pancreatitis by identifying and characterizing extrapancreatic necrosis and inflammation.
#26 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 correlated with prolonged hospitalization and higher rates of mortality and morbidity. […] 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; however, the CT Severity Index was conducted 72 hours after admission, whereas the APACHE II scale and Ranson’s criteria scores were calculated at 24 and 48 hours, respectively. […] An observational study showed that CT Severity Index scores, when obtained within 48 hours, correlated better with complications and mortality than Ranson’s criteria. […] 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; and thus, physiologic response to treatment needs to be monitored closely.
#27 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 correlated with prolonged hospitalization and higher rates of mortality and morbidity. […] 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; however, the CT Severity Index was conducted 72 hours after admission, whereas the APACHE II scale and Ranson’s criteria scores were calculated at 24 and 48 hours, respectively. […] An observational study showed that CT Severity Index scores, when obtained within 48 hours, correlated better with complications and mortality than Ranson’s criteria. […] 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; and thus, physiologic response to treatment needs to be monitored closely.
#28 Prediction of acute pancreatitis severity based on early CT radiomics | BMC Medical Imaging | Full Text
https://bmcmedimaging.biomedcentral.com/articles/10.1186/s12880-024-01509-9
This study aims to develop and validate an integrated predictive model combining CT radiomics and clinical parameters for early assessment of acute pancreatitis severity. […] The clinical-radiomics model offers a novel tool for the early prediction of acute pancreatitis severity, providing valuable support for clinical decision-making. […] The combined model outperformed both the radiomics and clinical models, with an AUC of 0.905 (95% CI, 0.8370.973) in the training cohort and 0.908 (95% CI, 0.8240.992) in the validation cohort. […] These results underscore the significant potential of integrating radiomics features with clinical parameters for early prediction of AP severity in clinical practice. […] An individualized model was developed incorporating CT radiomics features and independent clinical predictors, aiding clinicians in the prompt and accurate assessment of AP severity.
#29 Prediction of acute pancreatitis severity based on early CT radiomics | BMC Medical Imaging | Full Text
https://bmcmedimaging.biomedcentral.com/articles/10.1186/s12880-024-01509-9
This study aims to develop and validate an integrated predictive model combining CT radiomics and clinical parameters for early assessment of acute pancreatitis severity. […] The clinical-radiomics model offers a novel tool for the early prediction of acute pancreatitis severity, providing valuable support for clinical decision-making. […] The combined model outperformed both the radiomics and clinical models, with an AUC of 0.905 (95% CI, 0.8370.973) in the training cohort and 0.908 (95% CI, 0.8240.992) in the validation cohort. […] These results underscore the significant potential of integrating radiomics features with clinical parameters for early prediction of AP severity in clinical practice. […] An individualized model was developed incorporating CT radiomics features and independent clinical predictors, aiding clinicians in the prompt and accurate assessment of AP severity.
#30 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.
#31 Prediction of Acute Pancreatitis Outcome
https://ctv.veeva.com/study/prediction-of-acute-pancreatitis-outcome
Aim of study prediction of acute pancreatitis outcome by using cheap and available laboratory resources. […] The mortality rate of acute pancreatitis varies, ranging from 3% in cases of mild edematous pancreatitis to as high as 20% in patients with pancreatic necrosis. […] The progression of AP can lead to systemic complications, making early prediction of clinical outcomes essential for effective management. […] In recent years, there has been growing interest in identifying reliable biomarkers that can predict the severity and outcomes of acute pancreatitis. […] SIRI and the Systemic Immune Inflammation Index (SII) are emerging as novel biomarkers for systemic inflammation.
#32 Multifactorial Scores and Biomarkers of Prognosis of Acute Pancreatitis: Applications to Research and Practice
https://www.mdpi.com/1422-0067/21/1/338
The PASS score performance was compared to established systems used to predict severe AP. […] Studies showed that PCT is the most sensitive laboratory test for the detection of pancreatic infection, and low levels appear to be strong negative predictors of infected necrosis. […] Despite intense research on the pathophysiology of AP, overall disease mortality has not significantly improved. […] In this sense, early diagnosis and timely assessment of the severity are essential. […] However, an ideal multifactorial scoring system and/or biochemical marker for early assessment of the severity of AP has yet to be defined. […] Based on the analysis of available data and evidence, the authors suggest the use of the BISAP score as a multifactorial scoring system and the CRP at 48 h of presentation as the biochemical marker due to their availability, simplicity, and capability to predict AP severity.
#33 Multifactorial Scores and Biomarkers of Prognosis of Acute Pancreatitis: Applications to Research and Practice
https://www.mdpi.com/1422-0067/21/1/338
The PASS score performance was compared to established systems used to predict severe AP. […] Studies showed that PCT is the most sensitive laboratory test for the detection of pancreatic infection, and low levels appear to be strong negative predictors of infected necrosis. […] Despite intense research on the pathophysiology of AP, overall disease mortality has not significantly improved. […] In this sense, early diagnosis and timely assessment of the severity are essential. […] However, an ideal multifactorial scoring system and/or biochemical marker for early assessment of the severity of AP has yet to be defined. […] Based on the analysis of available data and evidence, the authors suggest the use of the BISAP score as a multifactorial scoring system and the CRP at 48 h of presentation as the biochemical marker due to their availability, simplicity, and capability to predict AP severity.
#34 Prediction of Acute Pancreatitis Outcome
https://ctv.veeva.com/study/prediction-of-acute-pancreatitis-outcome
Aim of study prediction of acute pancreatitis outcome by using cheap and available laboratory resources. […] The mortality rate of acute pancreatitis varies, ranging from 3% in cases of mild edematous pancreatitis to as high as 20% in patients with pancreatic necrosis. […] The progression of AP can lead to systemic complications, making early prediction of clinical outcomes essential for effective management. […] In recent years, there has been growing interest in identifying reliable biomarkers that can predict the severity and outcomes of acute pancreatitis. […] SIRI and the Systemic Immune Inflammation Index (SII) are emerging as novel biomarkers for systemic inflammation.
#35 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. […] The ROC analysis applied for early SAP prediction showed significant results only for admission resistin and IL-6. […] The ROC analysis applied to predict the development of necrosis on admission showed no significant results for adipokines. […] The peripancreatic necrosis is associated with the development of SAP. […] 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.
#36 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. […] The ROC analysis applied for early SAP prediction showed significant results only for admission resistin and IL-6. […] The ROC analysis applied to predict the development of necrosis on admission showed no significant results for adipokines. […] The peripancreatic necrosis is associated with the development of SAP. […] 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.
#37 Machine learning for post-acute pancreatitis diabetes mellitus prediction and personalized treatment recommendations | Scientific Reports
https://www.nature.com/articles/s41598-023-31947-4
Post-acute pancreatitis diabetes mellitus (PPDM-A) is the main component of pancreatic exocrine diabetes mellitus. Timely diagnosis of PPDM-A improves patient outcomes and the mitigation of burdens and costs. […] National Population-Based cohort studies reveal that the risk of PPDM-A is twofold higher than those without AP, and the occurrence of PPDM-A is observed across the spectrum of severity in AP. […] However, PPDM-A has not drawn sufficient attention and has often been misdiagnosed as T2DM. […] Therefore, screening high-risk patients is essential for developing PPDM-A prevention guidelines, delaying islet function damage, avoiding adverse outcomes, and improving the prognosis of PPDM-A. […] 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.
#38 Machine learning for post-acute pancreatitis diabetes mellitus prediction and personalized treatment recommendations | Scientific Reports
https://www.nature.com/articles/s41598-023-31947-4
Post-acute pancreatitis diabetes mellitus (PPDM-A) is the main component of pancreatic exocrine diabetes mellitus. Timely diagnosis of PPDM-A improves patient outcomes and the mitigation of burdens and costs. […] National Population-Based cohort studies reveal that the risk of PPDM-A is twofold higher than those without AP, and the occurrence of PPDM-A is observed across the spectrum of severity in AP. […] However, PPDM-A has not drawn sufficient attention and has often been misdiagnosed as T2DM. […] Therefore, screening high-risk patients is essential for developing PPDM-A prevention guidelines, delaying islet function damage, avoiding adverse outcomes, and improving the prognosis of PPDM-A. […] 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.
#39 Machine learning for post-acute pancreatitis diabetes mellitus prediction and personalized treatment recommendations | Scientific Reports
https://www.nature.com/articles/s41598-023-31947-4
We found that admission glucose, obesity (BMI28 kg/m2), and HDL-C1.03 mmol /l were the three factors that had the most significant impact on the outcome, and this result is consistent with the results of feature extraction. […] 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.
#40 Machine learning for post-acute pancreatitis diabetes mellitus prediction and personalized treatment recommendations | Scientific Reports
https://www.nature.com/articles/s41598-023-31947-4
We found that admission glucose, obesity (BMI28 kg/m2), and HDL-C1.03 mmol /l were the three factors that had the most significant impact on the outcome, and this result is consistent with the results of feature extraction. […] 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.
#41 Clinico-radiological comparison and short-term prognosis of single acute pancreatitis and recurrent acute pancreatitis including pancreatic volumetry | PLOS One
https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0206062
The necrosis-fibrosis hypothesis describes a continuum between single attacks of acute pancreatitis (SAP), recurrent acute pancreatitis (RAP) and chronic pancreatitis (CP) with endocrine and exocrine pancreatic insufficiency. […] For prevention purposes we evaluated clinico-radiological parameters and pancreatic volumetry to compare SAP and RAP and provide prognostic relevance on short-term mortality, need for intervention and the hospitalization duration. […] All outcome parameters including the mortality rates (SAP vs. RAP: 15% vs. 7%) were comparable in both groups (p0.05). […] In patients with SAP, the modified Marshall score was the strongest predictor of short-term mortality, followed by the mCTSI on multivariate logistic regression (Marshall score: -coefficient: 1.79, p0.001; mCTSI: -coefficient: 0.40, p0.001).
#42 Clinico-radiological comparison and short-term prognosis of single acute pancreatitis and recurrent acute pancreatitis including pancreatic volumetry | PLOS One
https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0206062
Total pancreatic volume differed significantly between interstitial RAP and SAP and intrapancreatic necrosis volume revealed prognostic value for the total hospitalization duration in necrotizing RAP. […] Despite comparable outcome (short-term mortality, need for intervention, and hospitalization duration) in both groups, only two parameters were predictive in RAP. Intrapancreatic necrosis strongly correlated with total hospitalization duration, whereas systolic blood pressure was a weak prognostic factor for required interventions and the short-term mortality. […] In SAP, only the modified Marshall score and mCTSI were predictive for short-term mortality, while CTSI and the extent of intrapancreatic necrosis revealed prognostic value for the required interventions.
#43 Clinico-radiological comparison and short-term prognosis of single acute pancreatitis and recurrent acute pancreatitis including pancreatic volumetry | PLOS One
https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0206062
Total pancreatic volume differed significantly between interstitial RAP and SAP and intrapancreatic necrosis volume revealed prognostic value for the total hospitalization duration in necrotizing RAP. […] Despite comparable outcome (short-term mortality, need for intervention, and hospitalization duration) in both groups, only two parameters were predictive in RAP. Intrapancreatic necrosis strongly correlated with total hospitalization duration, whereas systolic blood pressure was a weak prognostic factor for required interventions and the short-term mortality. […] In SAP, only the modified Marshall score and mCTSI were predictive for short-term mortality, while CTSI and the extent of intrapancreatic necrosis revealed prognostic value for the required interventions.
#44 Multifactorial Scores and Biomarkers of Prognosis of Acute Pancreatitis: Applications to Research and Practice
https://www.mdpi.com/1422-0067/21/1/338
The PASS score performance was compared to established systems used to predict severe AP. […] Studies showed that PCT is the most sensitive laboratory test for the detection of pancreatic infection, and low levels appear to be strong negative predictors of infected necrosis. […] Despite intense research on the pathophysiology of AP, overall disease mortality has not significantly improved. […] In this sense, early diagnosis and timely assessment of the severity are essential. […] However, an ideal multifactorial scoring system and/or biochemical marker for early assessment of the severity of AP has yet to be defined. […] Based on the analysis of available data and evidence, the authors suggest the use of the BISAP score as a multifactorial scoring system and the CRP at 48 h of presentation as the biochemical marker due to their availability, simplicity, and capability to predict AP severity.
#45 Multifactorial Scores and Biomarkers of Prognosis of Acute Pancreatitis: Applications to Research and Practice
https://www.mdpi.com/1422-0067/21/1/338
The PASS score performance was compared to established systems used to predict severe AP. […] Studies showed that PCT is the most sensitive laboratory test for the detection of pancreatic infection, and low levels appear to be strong negative predictors of infected necrosis. […] Despite intense research on the pathophysiology of AP, overall disease mortality has not significantly improved. […] In this sense, early diagnosis and timely assessment of the severity are essential. […] However, an ideal multifactorial scoring system and/or biochemical marker for early assessment of the severity of AP has yet to be defined. […] Based on the analysis of available data and evidence, the authors suggest the use of the BISAP score as a multifactorial scoring system and the CRP at 48 h of presentation as the biochemical marker due to their availability, simplicity, and capability to predict AP severity.
#46 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.
#47 Predicting the severity of acute pancreatitis – UpToDate
https://www.uptodate.com/contents/predicting-the-severity-of-acute-pancreatitis
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. […] In an illustrative study, patients older than 75 years had more than a 15-fold greater chance of dying within two weeks and a more than 22-fold greater chance of dying within 91 days compared with patients aged 35 years or younger.
#48 Multifactorial Scores and Biomarkers of Prognosis of Acute Pancreatitis: Applications to Research and Practice
https://www.mdpi.com/1422-0067/21/1/338
The PASS score performance was compared to established systems used to predict severe AP. […] Studies showed that PCT is the most sensitive laboratory test for the detection of pancreatic infection, and low levels appear to be strong negative predictors of infected necrosis. […] Despite intense research on the pathophysiology of AP, overall disease mortality has not significantly improved. […] In this sense, early diagnosis and timely assessment of the severity are essential. […] However, an ideal multifactorial scoring system and/or biochemical marker for early assessment of the severity of AP has yet to be defined. […] Based on the analysis of available data and evidence, the authors suggest the use of the BISAP score as a multifactorial scoring system and the CRP at 48 h of presentation as the biochemical marker due to their availability, simplicity, and capability to predict AP severity.
#49 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. […] The ROC analysis applied for early SAP prediction showed significant results only for admission resistin and IL-6. […] The ROC analysis applied to predict the development of necrosis on admission showed no significant results for adipokines. […] The peripancreatic necrosis is associated with the development of SAP. […] 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.
#50 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.
#51 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.
#52 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.