- Email: [email protected]
Comparison of clinical course and outcome of acute pancreatitis according to two main etiologies: alcohol vs. gallstone
S62
Abstracts / Pancreatology 14 (2014) S1eS129
Results: Group with SAP consisted of 33 (36%) patients and group with mild AP consisted of 58 (64%) patients. Average hematocrit level on admission was: 44% for SAP and 41% for mild AP patients. For hematocrit cut-off level on admission (44%), sensitivity and specificity for prediction of severity of AP were 63,5% and 85,7% respectively. Conclusion: The assessment of AP severity can be based on hematocrit level on admission that is higher than 44%. Among the variables available, the value of hematocrit on admission can be a useful and cost-effective marker which provides significant predictive power for clinical decisionmaking.
T-044. Comparison of clinical course and outcome of acute pancreatitis according to two main etiologies: alcohol vs. gallstone
with contrast-enhancement. There were different clinical, laboratory and instrumental data analyzed for detection severity and outcome markers. Results: Univariate analysis showed that 5 signs are useful for severe pancreatitis prediction: APACHE 8, CRP 120 mg/l, serum amylase < 250 U/l, procalcitonin 0,5 ng/ml, pleural effusion (on chest X-ray). Outcome prediction model also included 5 variables, conjoined into 3 groups: 1. early pancreatitis-specific organ failure (PO2/FiO2 < 250, creatinine > 150 mcmol/l, pressure-adjusted heart rate 10); 2. CT data (extended pancreatic necrosis); 3. infected necrosis. Outcome prediction accuracy of this model amounted to 88,3% (sensitivity-93,3%; specificity84,2%). Conclusion: Patients with severe pancreatitis mainly die due to systemic complications. It seems possible to identify outcome predictors during first few days after admission. Besides, our data suggest: severity predictors and precursors of outcome in acute pancreatitis are different.
Tae Nyeun Kim, Sung Bum Kim, Joon Hyun Cho, Kook Hyun Kim Yeungnam University Hospital, South Korea Background: Studies concerning clinical course and outcome of acute pancreatitis according to etiologies were rare, especially after year 2000. Aims: We compared clinical course and outcomes of acute pancreatitis caused by alcohol and gallstone. Patients & methods: Of the 128 patients diagnosed as acute pancreatitis from January 2011 to January 2013, Various clinical data and outcomes of 25 patients with acute pancreatitis caused by alcohol and 76 patients caused by gallstone were analyzed retrospectively. Results: Mean age of the patients in alcohol and biliary group was 52.3 and 67.3 years, respectively(p¼0.05). Male proportion was significantly higher in alcohol group than biliary group(88.0% vs. 52.6%, p¼0.030). Hemoglobin, hematocrit and 24 hour C-reactive protein level were significantly higher in alcohol group than biliary group. ALT was significantly higher in biliary group than alcohol group. Development of peripancreatic fluid collection was not significantly different between alcohol and biliary groups(32% vs. 18.4%, p¼0.170). Incidence of pseudocyst formation was significantly higher in alcohol group than biliary group(28% vs. 7%, p¼0.009). Among severity scoring system only CT severity index showed significant difference(p¼0.000) with a mean score of 3.0 in alcohol group and 1.7 in biliary group. In biliary group, endoscopic sphincterotomy and stone removal were done in 27 and 23 patients, respectively. Severe pancreatitis with organ failure persisting beyond 48 hours was seen in 6 patients(24%) in alcohol group and 1 patient(1.3%) in biliary group(p¼0.000). There were 2 cases of mortality in alcohol group only. Conclusion: Proportion of severe pancreatitis and pseudocyst formation are significantly higher in acute alcoholic pancreatitis than biliary pancreatitis.
T-045. Factors predicting outcome in severe acute pancreatitis
T-046. First surgical clinic, clinical centre of Serbia, eight departement Andrija Antic, Dejan Radenkovic, Marijana Levicanin, Stefan Kmezic, Djordje Bajec First Surgical Clinic, Clinical centre of Serbia, Eight departement, Serbia Background: The right management of severe narcotizing pancreatitis (SNP) can prevent occurrence and development of feared complications such as infected pancreatic necrosis and organ failure (OF). Aims: The aim of this study was to demonstrate the relation between pancreatic necrosis leading to OF and multiple organ failure (MOF). Patients & methods: This is prospective study that includes 71 patients with SNP. All patients were diagnosed with NP, which was confirmed by contrast-enhanced CT and/or by intraoperative findings (41 patients). The bacterial status of necrotic areas was assessed by intraoperative smears (41 patients) and/or bacterial cultures obtained from sonographically guided fine-needle aspiration. The Atlanta classification system was used to define the occurrence of (OF). Results: In 29 patients (41%) pancreatic infection occurred while in 42 patients (59%) the necrosis remained sterile. OF occurred in 79% of patients with infected and in 55% of patients with sterile necrosis and differences were statistically significant (p¼ 0,033). MOF was observed in 38% of the patients with infected necrosis, compared with 17% of the patients in the sterile group and differences were statistically significant (p¼0,043). Conclusion: The higher incidence of OF and MOF is expected within the group of patients with infected pancreatic necrosis. The severity of illness is increased by OF, which has strong impact to outcome of patients with SNP.
Shamil Galeev, Michael Rubtsov, Yakubbay Abdullaev Saint Luke Clinical Hospital, Russia Background: There are few relevant methods for predicting of fatal outcome and prolonged ICU stay in acute pancreatitis. According to literature data, most scoring systems (Ranson, APACHE etc.) serve as predictors of severity and outcome simultaneously. Aims: To detect and compare precursors associated with severe pancreatitis and unfavorable disease outcome. Materials & methods: A retrospective study of 89 patients with acute pancreatitis in 9 year period (2000-2009) was done. 71 patients suffered from severe disease, 17 had mild pancreatitis confirmed by CT
T-047. Visceral adipose tissue and acute pancreatitis Serge Chooklin, Mariay Shavarova Regional Clinical Hospital, Lviv, Ukraine Background: Obesity is one of the most important risk factors for developing severe acute pancreatitis. Some reports indicated that obesity has relationships with the local complication rate, organ dysfunction, and mortality in acute pancreatitis. A large amount of necrotic visceral adipose tissue
Abstracts / Pancreatology 14 (2014) S1eS129
Results: Group with SAP consisted of 33 (36%) patients and group with mild AP consisted of 58 (64%) patients. Average hematocrit level on admission was: 44% for SAP and 41% for mild AP patients. For hematocrit cut-off level on admission (44%), sensitivity and specificity for prediction of severity of AP were 63,5% and 85,7% respectively. Conclusion: The assessment of AP severity can be based on hematocrit level on admission that is higher than 44%. Among the variables available, the value of hematocrit on admission can be a useful and cost-effective marker which provides significant predictive power for clinical decisionmaking.
T-044. Comparison of clinical course and outcome of acute pancreatitis according to two main etiologies: alcohol vs. gallstone
with contrast-enhancement. There were different clinical, laboratory and instrumental data analyzed for detection severity and outcome markers. Results: Univariate analysis showed that 5 signs are useful for severe pancreatitis prediction: APACHE 8, CRP 120 mg/l, serum amylase < 250 U/l, procalcitonin 0,5 ng/ml, pleural effusion (on chest X-ray). Outcome prediction model also included 5 variables, conjoined into 3 groups: 1. early pancreatitis-specific organ failure (PO2/FiO2 < 250, creatinine > 150 mcmol/l, pressure-adjusted heart rate 10); 2. CT data (extended pancreatic necrosis); 3. infected necrosis. Outcome prediction accuracy of this model amounted to 88,3% (sensitivity-93,3%; specificity84,2%). Conclusion: Patients with severe pancreatitis mainly die due to systemic complications. It seems possible to identify outcome predictors during first few days after admission. Besides, our data suggest: severity predictors and precursors of outcome in acute pancreatitis are different.
Tae Nyeun Kim, Sung Bum Kim, Joon Hyun Cho, Kook Hyun Kim Yeungnam University Hospital, South Korea Background: Studies concerning clinical course and outcome of acute pancreatitis according to etiologies were rare, especially after year 2000. Aims: We compared clinical course and outcomes of acute pancreatitis caused by alcohol and gallstone. Patients & methods: Of the 128 patients diagnosed as acute pancreatitis from January 2011 to January 2013, Various clinical data and outcomes of 25 patients with acute pancreatitis caused by alcohol and 76 patients caused by gallstone were analyzed retrospectively. Results: Mean age of the patients in alcohol and biliary group was 52.3 and 67.3 years, respectively(p¼0.05). Male proportion was significantly higher in alcohol group than biliary group(88.0% vs. 52.6%, p¼0.030). Hemoglobin, hematocrit and 24 hour C-reactive protein level were significantly higher in alcohol group than biliary group. ALT was significantly higher in biliary group than alcohol group. Development of peripancreatic fluid collection was not significantly different between alcohol and biliary groups(32% vs. 18.4%, p¼0.170). Incidence of pseudocyst formation was significantly higher in alcohol group than biliary group(28% vs. 7%, p¼0.009). Among severity scoring system only CT severity index showed significant difference(p¼0.000) with a mean score of 3.0 in alcohol group and 1.7 in biliary group. In biliary group, endoscopic sphincterotomy and stone removal were done in 27 and 23 patients, respectively. Severe pancreatitis with organ failure persisting beyond 48 hours was seen in 6 patients(24%) in alcohol group and 1 patient(1.3%) in biliary group(p¼0.000). There were 2 cases of mortality in alcohol group only. Conclusion: Proportion of severe pancreatitis and pseudocyst formation are significantly higher in acute alcoholic pancreatitis than biliary pancreatitis.
T-045. Factors predicting outcome in severe acute pancreatitis
T-046. First surgical clinic, clinical centre of Serbia, eight departement Andrija Antic, Dejan Radenkovic, Marijana Levicanin, Stefan Kmezic, Djordje Bajec First Surgical Clinic, Clinical centre of Serbia, Eight departement, Serbia Background: The right management of severe narcotizing pancreatitis (SNP) can prevent occurrence and development of feared complications such as infected pancreatic necrosis and organ failure (OF). Aims: The aim of this study was to demonstrate the relation between pancreatic necrosis leading to OF and multiple organ failure (MOF). Patients & methods: This is prospective study that includes 71 patients with SNP. All patients were diagnosed with NP, which was confirmed by contrast-enhanced CT and/or by intraoperative findings (41 patients). The bacterial status of necrotic areas was assessed by intraoperative smears (41 patients) and/or bacterial cultures obtained from sonographically guided fine-needle aspiration. The Atlanta classification system was used to define the occurrence of (OF). Results: In 29 patients (41%) pancreatic infection occurred while in 42 patients (59%) the necrosis remained sterile. OF occurred in 79% of patients with infected and in 55% of patients with sterile necrosis and differences were statistically significant (p¼ 0,033). MOF was observed in 38% of the patients with infected necrosis, compared with 17% of the patients in the sterile group and differences were statistically significant (p¼0,043). Conclusion: The higher incidence of OF and MOF is expected within the group of patients with infected pancreatic necrosis. The severity of illness is increased by OF, which has strong impact to outcome of patients with SNP.
Shamil Galeev, Michael Rubtsov, Yakubbay Abdullaev Saint Luke Clinical Hospital, Russia Background: There are few relevant methods for predicting of fatal outcome and prolonged ICU stay in acute pancreatitis. According to literature data, most scoring systems (Ranson, APACHE etc.) serve as predictors of severity and outcome simultaneously. Aims: To detect and compare precursors associated with severe pancreatitis and unfavorable disease outcome. Materials & methods: A retrospective study of 89 patients with acute pancreatitis in 9 year period (2000-2009) was done. 71 patients suffered from severe disease, 17 had mild pancreatitis confirmed by CT
T-047. Visceral adipose tissue and acute pancreatitis Serge Chooklin, Mariay Shavarova Regional Clinical Hospital, Lviv, Ukraine Background: Obesity is one of the most important risk factors for developing severe acute pancreatitis. Some reports indicated that obesity has relationships with the local complication rate, organ dysfunction, and mortality in acute pancreatitis. A large amount of necrotic visceral adipose tissue