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Mo1329 Urine Albumin: Creatinine Ratio Is Associated With Severity of Acute Pancreatitis: A Pilot Study
vancomycin and gentamicin serum concentrations in steady-state without detectable values. One patient developed urticaria after instillation of amphotericin B. In total, 201 cultures were performed during the study period of which 179 were positive and 22 sterile. In 145 cases (81%), the microbial findings were susceptible to one of the three drugs, vancomycin, gentamicin, or amphotericin B. Conclusion: Local instillation of vancomycin, gentamicin, and amphotericin B into an IPN is a safe procedure. Based on the susceptibility rates, local instillation of the antibiotics may be a promising alternative or supplement to systemic administration. Our results call for a randomized, prospective trial for the evaluation of the role of local instillation of antibiotics in the treatment of IPN.
BISAP-EGFR Could Improve Prediction of Severity and Mortality in Acute Pancreatitis. EGFR - Play the Trump Card Michal Lipinski, Grazyna Rydzewska Introduction: Early prediction of severity of acute pancreatitis (AP) by a simple system which includes clinical features would be very helpful as it may direct management and improve outcome. Certain components of different scores reflecting severe intravascular volume depletion can play an important role in accuracy of the method (but sensitivity and specificity of these scores are not at the desired level yet). Low eGFR (estimated glomerular filtration rate) is already known to be unfavorable prognostic parameter in AP, however it was never assessed as an element of multifactor score. Aim: The aim of this study is to determine whether replacing urea nitrogen (BUN) in bedside index of severity in acute pancreatitis (BISAP) score by eGFR (BISAP-eGFR score) improves prediction of severity and mortality in patients with AP. Methods: Cohort of 100 patients with AP were prospectively enrolled in the study. The BISAP and eGFR (abbreviated Modification of Diet in Renal Disease equation) were calculated using data from the first 24 h from admission. Severe AP was defined as the persistence of organ failure exceeding 48 hours. The predictive accuracy of the BISAP and BISAP-eGFR score was measured as the area under the receiver operating characteristic curve (AUC). Results: We evaluated a total of 100 consecutive patients with AP. Twenty of the 100 patients (20%) were considered severe AP. The best cutoff value of eGFR was 80 ml/min/1,73 m2. All 20 patients with severe pancreatitis had eGFR<80 ml/ min/1,73 m2 while only 8 of patients with severe pancreatitis had BUN>25 mg/dL (BISAP score cut-off for BUN). Overall, 16% of the 100 evaluated patients had a BISAP score ≥3 while BISAP-eGFR score ≥ 3 was reported for 23% patients. A BISAP score ≥ 3 had a sensitivity, specificity, positive and negative predictive value of 65%, 96.1%, 81.2% and 91.3% respectively, with an accuracy of 87% comparing to 95.2%, 96.2%, 86.9% and 98.7% respectively for BISAP-eGFR score with an accuracy of 96%. The AUC for severity predicted by BISAP was 0.762 and by BISAP-eGFR score was 0.942. There were statistically significant trends for increasing severity (P<0.001) and mortality (P<0.001) with increasing BISAPeGFR score. Ten out of ten (100%) patients with fatal AP had BISAP-eGFR ≥3, 6 of them (60%) reported BISAP≥3. Conclusion: BISAP-eGFR score is a simple method to identify patients at risk of increased mortality and allows predicting the severity of the AP. eGFR replacing BUN in BISAP score provides higher sensitivity, specificity and diagnostic accuracy comparing to "traditional" BISAP score. In addition, eGFR component may be helpful in planning fluid therapy, particularly in the acute phase of the AP. This finding may have important clinical implications, however further studies are required to validate the BISAPeGFR score in predicting severity and mortality in AP.
Mo1329 Urine Albumin: Creatinine Ratio Is Associated With Severity of Acute Pancreatitis: A Pilot Study Sara Bertilsson, Per Sward, Evangelos Kalaitzakis Acute pancreatitis is characterized by a systemic inflammatory response leading to endothelial damage and capillary leak. Albuminuria is thought to represent the glomerular component of systemic capillary leak, which is an important step in the pathophysiology of multiple organ failure. Albuminuria occurring during increased systemic inflammation has been proposed as an early predictor of outcome in several conditions, such as sepsis and trauma. Data on the occurrence of increased albuminuria in patients presenting with acute pancreatitis and its potential relation with inflammatory response and disease severity are very limited. Methods All patients admitted in the acute surgical ward of our institution due to acute pancreatitis during a period of 1 year were prospectively enrolled. Urinary samples were obtained upon admission to measure urine albumin and creatinine. The albumin:creatinine ratio (ACR) was calculated. Clinical data, such as demographics, pancreatitis etiology and the occurrence of systemic inflammatory response syndrome (SIRS; defined as ≥2 criteria), were also registered. Pancreatitis severity was classified according to the revised Atlanta criteria. Results A total of 85 patients with acute pancreatitis (median age 58 yr, interquartile range 25 yr; 42% female; 48% with biliary, 25% with alcoholic, and 21% with idiopathic pancreatitis) accepted to participate. In all, 49% of patients had SIRS, 22% had APACHE II score >8 upon admission, 15% experienced organ failure, 36% had C-reactive protein >150 mg/l at 48 h following admission, and 8% had severe, 26% moderate and 66% mild pancreatitis. ACR was significantly higher in patients with increased severity indices and in males, but it was not related to pancreatitis etiology (table), age (Spearman's rho=0.02, p= 0.86), or serum creatinine (Spearman's rho=0.11, p=0.36). Although ACR was related to the occurrence of infections (n=18/85) (table), its association with pancreatitis severity remained unchanged when analyses were performed in the group of patients without infections (data not shown). Conclusions In this pilot study, albuminuria was related to inflammatory response parameters as well as to severity of acute pancreatitis. Further research is warranted in order to investigate the potential role of albuminuria in early prediction of the outcome of acute pancreatitis. Urine albumin:creatinine ratio in patients with acute pancreatitis (n=85)
Mo1327 Early Oral Feeding and Selection of Initial Diet in Mild Acute Pancreatitis Umit Karabulut, Mahmut Bakir Koyuncu, Orhan Sezgin, Enver Ucbilek, Mehmet Kasim Aydin, Engin Altintas OBJECTIVE: When and how to initiate oral feeding in mild acute pancreatitis patients is still an important issue. The aim of this study is, to evaluate the efficacy of early oral feeding in these patients. METHOD: This is a unicenter, prospective, randomized controlled trial. Mild acute pancreatitis patients (according to Atlanta) who admitted to our hospital included. The patients were seperated into two different main groups: early oral feeding and routine oral feeding. These main two groups has divided into three subgroups according to initial dietary regimen ( liquid, soft and solid diet). After the comparison according to mean pain index (total abdominal pain score divide to pain frequency in a day), pain score after onset of oral feeding, hospitalisation period and need of antibiotics between two main groups, subgroups were compared according to same parameters. RESULTS: There were 49 patients in the early oral refeeding group and 49 patients in the routine oral refeeding group. In the group of early oral feeding group, mean hospitalisation time, mean pain index and need of antibiotics is seen significantly lower (p values in order <0.001, 0.003, 0.009). Post feeding pain index was lower in the routine oral feeding group (p<0.001). Subgroups were compared according to same parameters, there were no significant difference. CONCLUSION: In the mild acute pancreatitis patients, early oral feeding found effective on hospitalisation time and pain index independently from initial dietary regimen. KEY WORDS: acute pancreatitis, oral refeeding, pain index
IQR, interquartile range
Mo1328 Local Instillation of Antibiotics Through Naso-Cystic Catheter Is Safe and Provides Broad Coverage of Microbials Found in Infected Pancreatic Necrosis Palle N. Schmidt, Stine Roug, Mikkel Werge, Jenny D. Knudsen, Bo Søndergaard, Erik Feldager, Srdan Novovic
Mo1330 Recurrent Acute Pancreatitis Significantly Impairs the Quality of Life. Validation of RAPQOLI Nalini M. Guda, Martin L. Freeman, Marc F. Catalano, Joseph Romagnuolo, Patrick R. Pfau, Kulwinder S. Dua, Gregory A. Cote, Daniel Mullady, Paul R. Tarnasky, David C. Whitcomb, C. Mel Wilcox, Colin D. Johnson
Background: Infected pancreatic necrosis (IPN) is often associated with both hepatic and renal insufficiency, none the less these patients often require systemic administration of antibiotics with primary hepatic and/or renal clearance. Furthermore, the ability of intravenously administered antibiotics to penetrate into an IPN has been questioned. Thus, safe and sufficient antibiotic treatment in patients with IPN can be challenging. In 2005, we introduced endoscopic, transmural drainage and necrosectomy for the treatment of walledoff necrosis in our tertiary referral centre. Since 2007, we have added antibiotics (either gentamicin, vancomycin, or amphotericin B) to the irrigation fluid according to the microbiological findings. Aim: Our primary aim was to evaluate the safety profile of locally installed antibiotics, i.e. whether local instillation resulted in detectable serum concentrations and whether any allergic reaction occurred during the treatment period. The secondary aim was to evaluate whether microbial findings were susceptible to the three types of antibiotics added to the irrigation fluids. Methods: Irrigation of the IPN through a naso-cystic catheter was done 3-6 times a day. The irrigation volume depended on the size of the IPN, generally 100-250 mL sterile saline per procedure. Antibiotics were added to the irrigation fluid according to previous microbiological findings Results: Between January 2007 and October 2013, 58 patients were treated with local instillation of antibiotics. We measured both
Introduction: Recurrent Acute Pancreatitis (RAP) is a significant clinical problem. Symptoms vary from episodes of pain to debilitating chronic pain and other illness, likely to impair quality of life. The EORTC QLQ-C30 and QLQ-PAN26 have been validated in chronic pancreatitis (CP) but there are no disease specific quality of life instruments for RAP. Aim: To assess the quality of life in patients with RAP and modify existing questionnaires to create a disease specific quality of life instrument (RAP-QOL) Methods: The collaborative RAP study group was formed to study the natural history of RAP, and the effects and effectiveness of endoscopic interventions. Initially 10 physicians specializing in the management of RAP reviewed the 56 questions of the QLQ-C30 and QLQ-PAN26 to identify any redundant or missing issues (free text comment). 49 subjects with RAP completed the questionnaires and a semi-structured interview (relevance, importance, missing issues, redundancy, readability, time to complete, help required). Questionnaire responses were compared with data from 101 normal subjects (median (range) 40 (20-84)yr), 66 CP patients and with 34 RAP patients undergoing minor papillotomy in the Frequency of Recurrent Acute
S-621
AGA Abstracts
AGA Abstracts
Mo1326
BISAP-EGFR Could Improve Prediction of Severity and Mortality in Acute Pancreatitis. EGFR - Play the Trump Card Michal Lipinski, Grazyna Rydzewska Introduction: Early prediction of severity of acute pancreatitis (AP) by a simple system which includes clinical features would be very helpful as it may direct management and improve outcome. Certain components of different scores reflecting severe intravascular volume depletion can play an important role in accuracy of the method (but sensitivity and specificity of these scores are not at the desired level yet). Low eGFR (estimated glomerular filtration rate) is already known to be unfavorable prognostic parameter in AP, however it was never assessed as an element of multifactor score. Aim: The aim of this study is to determine whether replacing urea nitrogen (BUN) in bedside index of severity in acute pancreatitis (BISAP) score by eGFR (BISAP-eGFR score) improves prediction of severity and mortality in patients with AP. Methods: Cohort of 100 patients with AP were prospectively enrolled in the study. The BISAP and eGFR (abbreviated Modification of Diet in Renal Disease equation) were calculated using data from the first 24 h from admission. Severe AP was defined as the persistence of organ failure exceeding 48 hours. The predictive accuracy of the BISAP and BISAP-eGFR score was measured as the area under the receiver operating characteristic curve (AUC). Results: We evaluated a total of 100 consecutive patients with AP. Twenty of the 100 patients (20%) were considered severe AP. The best cutoff value of eGFR was 80 ml/min/1,73 m2. All 20 patients with severe pancreatitis had eGFR<80 ml/ min/1,73 m2 while only 8 of patients with severe pancreatitis had BUN>25 mg/dL (BISAP score cut-off for BUN). Overall, 16% of the 100 evaluated patients had a BISAP score ≥3 while BISAP-eGFR score ≥ 3 was reported for 23% patients. A BISAP score ≥ 3 had a sensitivity, specificity, positive and negative predictive value of 65%, 96.1%, 81.2% and 91.3% respectively, with an accuracy of 87% comparing to 95.2%, 96.2%, 86.9% and 98.7% respectively for BISAP-eGFR score with an accuracy of 96%. The AUC for severity predicted by BISAP was 0.762 and by BISAP-eGFR score was 0.942. There were statistically significant trends for increasing severity (P<0.001) and mortality (P<0.001) with increasing BISAPeGFR score. Ten out of ten (100%) patients with fatal AP had BISAP-eGFR ≥3, 6 of them (60%) reported BISAP≥3. Conclusion: BISAP-eGFR score is a simple method to identify patients at risk of increased mortality and allows predicting the severity of the AP. eGFR replacing BUN in BISAP score provides higher sensitivity, specificity and diagnostic accuracy comparing to "traditional" BISAP score. In addition, eGFR component may be helpful in planning fluid therapy, particularly in the acute phase of the AP. This finding may have important clinical implications, however further studies are required to validate the BISAPeGFR score in predicting severity and mortality in AP.
Mo1329 Urine Albumin: Creatinine Ratio Is Associated With Severity of Acute Pancreatitis: A Pilot Study Sara Bertilsson, Per Sward, Evangelos Kalaitzakis Acute pancreatitis is characterized by a systemic inflammatory response leading to endothelial damage and capillary leak. Albuminuria is thought to represent the glomerular component of systemic capillary leak, which is an important step in the pathophysiology of multiple organ failure. Albuminuria occurring during increased systemic inflammation has been proposed as an early predictor of outcome in several conditions, such as sepsis and trauma. Data on the occurrence of increased albuminuria in patients presenting with acute pancreatitis and its potential relation with inflammatory response and disease severity are very limited. Methods All patients admitted in the acute surgical ward of our institution due to acute pancreatitis during a period of 1 year were prospectively enrolled. Urinary samples were obtained upon admission to measure urine albumin and creatinine. The albumin:creatinine ratio (ACR) was calculated. Clinical data, such as demographics, pancreatitis etiology and the occurrence of systemic inflammatory response syndrome (SIRS; defined as ≥2 criteria), were also registered. Pancreatitis severity was classified according to the revised Atlanta criteria. Results A total of 85 patients with acute pancreatitis (median age 58 yr, interquartile range 25 yr; 42% female; 48% with biliary, 25% with alcoholic, and 21% with idiopathic pancreatitis) accepted to participate. In all, 49% of patients had SIRS, 22% had APACHE II score >8 upon admission, 15% experienced organ failure, 36% had C-reactive protein >150 mg/l at 48 h following admission, and 8% had severe, 26% moderate and 66% mild pancreatitis. ACR was significantly higher in patients with increased severity indices and in males, but it was not related to pancreatitis etiology (table), age (Spearman's rho=0.02, p= 0.86), or serum creatinine (Spearman's rho=0.11, p=0.36). Although ACR was related to the occurrence of infections (n=18/85) (table), its association with pancreatitis severity remained unchanged when analyses were performed in the group of patients without infections (data not shown). Conclusions In this pilot study, albuminuria was related to inflammatory response parameters as well as to severity of acute pancreatitis. Further research is warranted in order to investigate the potential role of albuminuria in early prediction of the outcome of acute pancreatitis. Urine albumin:creatinine ratio in patients with acute pancreatitis (n=85)
Mo1327 Early Oral Feeding and Selection of Initial Diet in Mild Acute Pancreatitis Umit Karabulut, Mahmut Bakir Koyuncu, Orhan Sezgin, Enver Ucbilek, Mehmet Kasim Aydin, Engin Altintas OBJECTIVE: When and how to initiate oral feeding in mild acute pancreatitis patients is still an important issue. The aim of this study is, to evaluate the efficacy of early oral feeding in these patients. METHOD: This is a unicenter, prospective, randomized controlled trial. Mild acute pancreatitis patients (according to Atlanta) who admitted to our hospital included. The patients were seperated into two different main groups: early oral feeding and routine oral feeding. These main two groups has divided into three subgroups according to initial dietary regimen ( liquid, soft and solid diet). After the comparison according to mean pain index (total abdominal pain score divide to pain frequency in a day), pain score after onset of oral feeding, hospitalisation period and need of antibiotics between two main groups, subgroups were compared according to same parameters. RESULTS: There were 49 patients in the early oral refeeding group and 49 patients in the routine oral refeeding group. In the group of early oral feeding group, mean hospitalisation time, mean pain index and need of antibiotics is seen significantly lower (p values in order <0.001, 0.003, 0.009). Post feeding pain index was lower in the routine oral feeding group (p<0.001). Subgroups were compared according to same parameters, there were no significant difference. CONCLUSION: In the mild acute pancreatitis patients, early oral feeding found effective on hospitalisation time and pain index independently from initial dietary regimen. KEY WORDS: acute pancreatitis, oral refeeding, pain index
IQR, interquartile range
Mo1328 Local Instillation of Antibiotics Through Naso-Cystic Catheter Is Safe and Provides Broad Coverage of Microbials Found in Infected Pancreatic Necrosis Palle N. Schmidt, Stine Roug, Mikkel Werge, Jenny D. Knudsen, Bo Søndergaard, Erik Feldager, Srdan Novovic
Mo1330 Recurrent Acute Pancreatitis Significantly Impairs the Quality of Life. Validation of RAPQOLI Nalini M. Guda, Martin L. Freeman, Marc F. Catalano, Joseph Romagnuolo, Patrick R. Pfau, Kulwinder S. Dua, Gregory A. Cote, Daniel Mullady, Paul R. Tarnasky, David C. Whitcomb, C. Mel Wilcox, Colin D. Johnson
Background: Infected pancreatic necrosis (IPN) is often associated with both hepatic and renal insufficiency, none the less these patients often require systemic administration of antibiotics with primary hepatic and/or renal clearance. Furthermore, the ability of intravenously administered antibiotics to penetrate into an IPN has been questioned. Thus, safe and sufficient antibiotic treatment in patients with IPN can be challenging. In 2005, we introduced endoscopic, transmural drainage and necrosectomy for the treatment of walledoff necrosis in our tertiary referral centre. Since 2007, we have added antibiotics (either gentamicin, vancomycin, or amphotericin B) to the irrigation fluid according to the microbiological findings. Aim: Our primary aim was to evaluate the safety profile of locally installed antibiotics, i.e. whether local instillation resulted in detectable serum concentrations and whether any allergic reaction occurred during the treatment period. The secondary aim was to evaluate whether microbial findings were susceptible to the three types of antibiotics added to the irrigation fluids. Methods: Irrigation of the IPN through a naso-cystic catheter was done 3-6 times a day. The irrigation volume depended on the size of the IPN, generally 100-250 mL sterile saline per procedure. Antibiotics were added to the irrigation fluid according to previous microbiological findings Results: Between January 2007 and October 2013, 58 patients were treated with local instillation of antibiotics. We measured both
Introduction: Recurrent Acute Pancreatitis (RAP) is a significant clinical problem. Symptoms vary from episodes of pain to debilitating chronic pain and other illness, likely to impair quality of life. The EORTC QLQ-C30 and QLQ-PAN26 have been validated in chronic pancreatitis (CP) but there are no disease specific quality of life instruments for RAP. Aim: To assess the quality of life in patients with RAP and modify existing questionnaires to create a disease specific quality of life instrument (RAP-QOL) Methods: The collaborative RAP study group was formed to study the natural history of RAP, and the effects and effectiveness of endoscopic interventions. Initially 10 physicians specializing in the management of RAP reviewed the 56 questions of the QLQ-C30 and QLQ-PAN26 to identify any redundant or missing issues (free text comment). 49 subjects with RAP completed the questionnaires and a semi-structured interview (relevance, importance, missing issues, redundancy, readability, time to complete, help required). Questionnaire responses were compared with data from 101 normal subjects (median (range) 40 (20-84)yr), 66 CP patients and with 34 RAP patients undergoing minor papillotomy in the Frequency of Recurrent Acute
S-621
AGA Abstracts
AGA Abstracts
Mo1326