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Mo1438 Study of Lung Function Tests to Predict Development of Acute Lung Injury in Patients With Acute Pancreatitis
AGA Abstracts
Table 1: Clinical features of patients in the DKA with pancreatitis group and the control group
Table 1 - Adjusted Odds Ratios, Means and p-values for the evaluated parameters for admissions during April, May and June compared with July, August and September.
Mo1436 Diabetic Ketoacidosis and Acute Pancreatitis: A Tale of Two Entities Prapimphan Aumpansub, Wiriyaporn Ridtitid, Sombat Treeprasertsuk, Pradermchai Kongkam, Rungsun Rerknimitr Background: The incidence, pathogenesis, and clinical course of acute pancreatitis (AP) coexisting with diabetic ketoacidosis (DKA) have never been well demonstrated. Since the clinical presentations of AP and DKA are overlapping, making the diagnosis of AP in the setting of DKA is difficult and potentially missed. We aimed to evaluate the clinical course and outcomes of patients who had AP in the setting of DKA. Methods: A total of 198 episodes of DKA were diagnosed in a tertiary-care academic medical center during 19982015. Medical records were retrospectively reviewed for the baseline characteristics, clinical and biochemical profiles, hospitalizations and complications. We dichotomized the study population into those with and without AP. AP was defined if a patient presented with severe pancreatic-type pain and elevated serum levels of amylase and lipase < 3 times normal. The control group included DKA episodes with no abdominal pain or associated with abdominal pain and elevations in serum amylase and lipase < 3 times normal. The case and control groups were compared. Results: During the 18-year study period, we included 198 episodes of DKA in 182 patients; 19 in the case group (DKA with AP) and 179 in the control group (DKA without AP). Baseline characteristics and underlying conditions were not different between the two groups except a history of alcohol use (p=0.02), previous episodes of pancreatitis (p<0.001) and a history of chronic pancreatitis (p=0.001) (Table 1). Although the statistic was not significant, patients diagnosed DKA with AP tended to have greater percentage of intensive care unit (ICU) admission, compared to those without AP (p=0.09). Regarding the complications, the portion of patients with septicemia (p=0.03) in the AP group was higher when compared with the control group, led to significant needs for renal replacement (RRT) (p=0.01), and oxygen support (p=0.01). Patients diagnosed DKA with AP developed greater numbers of upper gastrointestinal bleeding (UGIB) (p<0.001); however, all were confirmed as low risk ulcers at the index esophagogastroduodenoscopy (EGD). Based on biochemical profiles, the AP group was found to have more severity in metabolic acidosis, including lower pH (p=0.01) and serum bicarbonate (p=0.01) (Table2). Conclusions: Patient diagnosed AP coexisting with DKA is more likely to be associated with severe acidosis and complications, including septicemia and UGIB, led to significant needs for RRT, oxygen support and possible ICU admission. Therefore, more attention and awareness of the patients with AP in the setting of DKA would be helpful to arrange the proper management with prompt RRT, EGD, and ICU back up.
*Due to sepsis with multi-organ failure Table 2: Biochemical features of patients in the DKA with pancreatitis group and the control
Mo1438 Study of Lung Function Tests to Predict Development of Acute Lung Injury in Patients With Acute Pancreatitis Jayanta Samanta, Munish Ashat, Raghavendra Prasad, Narendra Dhaka, Yalaka R. Reddy, Ashutosh N. Aggarwal, Vikas Gupta, Thakur D. Yadav, Saroj K. Sinha, Rakesh Kochhar Introduction: The commonest organ failure in patients with acute pancreatitis (AP) is acute lung injury (ALI). Data on pulmonary function tests (PFT) in AP is limited. Aims & Methods: To study PFT in patients with AP and evaluate the role of PFTs in predicting ALI. In this prospective study between July 2013 and December 2014 consecutive patients of AP underwent complete demographic, clinical, biochemical and radiological evaluation. Severity classification was done using revised Atlanta classification and also systemic inflammatory response score (SIRS), Bedside Index of Severity of Acute Pancreatitis(BISAP), CT Severity Index(CTSI) and APACHE II scores were used. Serial arterial blood gas (ABG) analyses were done and ALI severity defined as per Berlin classification using PaO2/FiO2 ratio. Development of ALI was monitored in all the patients. PFTs were done by spirometry as soon as possible after admission. Forced expiratory volume in first second (FEV1), forced vital capacity (FVC) and FEV1/FVC ratio were used as basic parameters for interpretation and all measurements were expressed as a percentage of their predicted values (FVC%, FEV1%). Patients were divided into 2 groups: with and without ALI. The ALI cohort was further subdivided into
AGA Abstracts
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AGA Abstracts
persistent ALI (P ALI) and transient ALI (T-ALI). A subgroup of ALI group which developed ALI later during hospital stay was defined as "later onset" ALI (LO-ALI) to devise a predictive model for ALI with PFT parameters. Statistical analysis was done using SPSSv22.0 Results: Of the 107 patients (mean age of 38.4 yrs, 64.5% males, etiology: alcohol 36.4% gallstone disease 26.2% and others 51.4%), ALI developed in 51 (47.7%) patients of whom 40(78.4%) had ALI on admission while 11(21.6%) had LO-ALI. T-ALI was seen in 16(31.4%) while 35 (68.6%) had P-ALI. PFT could be performed in 87 patients (52 non-ALI, 35 ALI including 9 from LO-ALI subgroup). ALI group had significantly lower FVC%(p<0.0001) and FEV1%(p<0.0001) signifying higher lung dysfunction compared to those without ALI. Similarly, P-ALI had lower FVC% (58.9±14.8 vs. 69.6±17.2, p=0.06) and lower FEV1% (p=0.04) than T-ALI. A significant correlation existed between PaO2/FiO2 ratio and FVC% (r=0.513, P<0.0001) and FEV1% (r=0.488, p<0.0001). Both FEV1% and FVC% showed significant correlation with other severity parameters such as SIRS (p<0.0001), BISAP(p<0.00011), CTSI (p<0.0001) and APACHE II (p<0.002) and also with need for intervention (p=0.04), hospital stay (p<0.0001) and intensive care stay (p=0.001). LO-ALI (9) had significantly lower FVC%(p=0.02) and FEV1% (p=0.03) as compared to those without ALI, but a predictive cut off could not be achieved (AUC=0.257, p=0.021) due to small numbers. Conclusion: Patients who eventually develop ALI later have more severe lung dysfunction at baseline than those who do not and PFTs can act as a tool to predict it.
Mo1453 Pocket Ultrasound Device in Biliary Disease Mario Montanari, Jessica Peder, Marco Parravicini, Claudio Camillo Cortelezzi, Sergio Segato Background and aimThe accuracy of physical examination in suspected biliary diseases is usually poor and further tests are required for diagnosis; the use of pocket ultrasound device (PUD) can lead to an incremental benefit. We assessed whether the use of PUD should be recommended to improve the diagnostic accuracy of physical examination and drive the appropriteness of further investigations Material and methods A prospective study from february to september 2015 was performed: 31 patients with suspected biliary disease were evaluated in the emergency room by a physician expert in abdominal ultrasound; every patient was examined with the PUD v-Scan GE looking for dilation of the biliary tract or biliary stones. Then we monitored the following diagnostic tests and evaluated the correlation between PUD and gold standard methods (US, MRI., CT) Results In 77% of patients the PUD examination confirmed the suspected diagnosis; the correlation with standard US was 87%, 91% with CT, 90,5% with MRI; sensitivity was 88,2% and specificity was 100% Conclusions PUD can be used in combination with physical examination in the first assessment of patients with suspected biliary disease; in fact this tool is characterized by good sensitivity and specificity in identifying the presence of stones and/or dilation of the bile ducts. Its use could then optimize the demands of further investigations, by reducing waiting times and costs
Characteristics of Alcoholic Cirrhosis Patients who died during hospitalization and those who survived
Mo1519 In-Hospital Mortality in Alcoholic Cirrhosis - Analysis of the National Hospital Discharge Survey David Mossad, Ronald J. Markert, Padmini Krishnamurthy, Sangeeta Agrawal Introduction Alcoholic cirrhosis presents with notable risk for morbidity and mortality in both acute and chronic settings. Multiple scoring systems stratify risk as disease severity carries significant implications for short-term survival and organ allocation in candidates for transplantation. The purpose of this study was to evaluate the effects of patient demographics, comorbidity burden, and hospital characteristics on in-hospital mortality in patients with alcoholic cirrhosis. Methods We used ICD-9 diagnosis codes from the 2001-2010 National Hospital Discharge Survey to identify cases of alcoholic cirrhosis. Comparisons on demographics, number of comorbidities, hospital length of stay (LOS), and selected health system characteristics were made between those who died in-hospital and those discharged. SPSS was used for chi-square and t test analysis at alpha = 0.05. Results Among 12,246 cases of alcoholic cirrhosis, 960 died in-hospital and 11,286 were discharged. The mortality group was older (mean age of 56.6 vs 54.5 years, p<0.001) and had a longer LOS (9.9 vs 6.3 days, p<0.001). There was no difference in mortality between genders (7.9% of males vs 7.6% of females, p=0.55), but African Americans (9.7%) differed from Caucasians (7.6%) and other races (7.6%) (p=0.023). Patients with seven or more comorbidities had a higher mortality rate (8.8%) compared to those with six or fewer comorbidities (4.0%) [p<0.001]. Patients with chronic kidney disease (CKD) suffered a significantly higher mortality rate (12.3%) compared to those without CKD (7.7%) (p=0.002). There was no difference in mortality between the Midwest (7.6%), Northeast (8.4%), South (7.3%), and West (8.5%). Neither hospital size (p=0.25) nor hospital ownership (p=0.26) impacted mortality rate. Principal source of payment did not affect mortality rate (p=0.81). Patients transferred from skilled nursing/intermediate care facilities (13.9%) and other healthcare facilities (10.1%) had the highest mortality rates (p<0.001). Elective admissions (5.4%) showed a lower mortality rate compared to emergent (8.0%) and urgent (8.4%) admissions (p=0.021). Conclusions Risk stratification in alcoholic cirrhosis is paramount due to the implications for short-term survival and need for organ transplantation. We found that age, race, LOS, comorbidity burden, type of admission, and source of admission impact in-hospital mortality. Comorbid CKD was related to increased mortality in these patients, which is consistent with validated scoring systems that utilize serum creatinine (e.g., Model for End-stage Liver Disease). Demographic and Clinical Characteristics of Hospitalized Alcoholic Cirrhosis Patients in the US from 2001-2010
Mo1520 Analysis of Gut Microbiota Among Various Diet-Induced NASH Models in Mice Mitsuaki Ishioka, Kouichi Miura, Shinichiro Minami, Hirohide Ohnishi (Background) Gut microbiota is closely associated with the development of many liver diseases including nonalcoholic steatohepatitis (NASH). Currently, several types of diets have been used in experimental NASH models. However, the comparison of gut microbiota among these diets has not been investigated. Herein, we analyzed a composition of gut microbiota and sought to determine the key microbiota in the development of NASH.
S-713
AGA Abstracts
Table 1: Clinical features of patients in the DKA with pancreatitis group and the control group
Table 1 - Adjusted Odds Ratios, Means and p-values for the evaluated parameters for admissions during April, May and June compared with July, August and September.
Mo1436 Diabetic Ketoacidosis and Acute Pancreatitis: A Tale of Two Entities Prapimphan Aumpansub, Wiriyaporn Ridtitid, Sombat Treeprasertsuk, Pradermchai Kongkam, Rungsun Rerknimitr Background: The incidence, pathogenesis, and clinical course of acute pancreatitis (AP) coexisting with diabetic ketoacidosis (DKA) have never been well demonstrated. Since the clinical presentations of AP and DKA are overlapping, making the diagnosis of AP in the setting of DKA is difficult and potentially missed. We aimed to evaluate the clinical course and outcomes of patients who had AP in the setting of DKA. Methods: A total of 198 episodes of DKA were diagnosed in a tertiary-care academic medical center during 19982015. Medical records were retrospectively reviewed for the baseline characteristics, clinical and biochemical profiles, hospitalizations and complications. We dichotomized the study population into those with and without AP. AP was defined if a patient presented with severe pancreatic-type pain and elevated serum levels of amylase and lipase < 3 times normal. The control group included DKA episodes with no abdominal pain or associated with abdominal pain and elevations in serum amylase and lipase < 3 times normal. The case and control groups were compared. Results: During the 18-year study period, we included 198 episodes of DKA in 182 patients; 19 in the case group (DKA with AP) and 179 in the control group (DKA without AP). Baseline characteristics and underlying conditions were not different between the two groups except a history of alcohol use (p=0.02), previous episodes of pancreatitis (p<0.001) and a history of chronic pancreatitis (p=0.001) (Table 1). Although the statistic was not significant, patients diagnosed DKA with AP tended to have greater percentage of intensive care unit (ICU) admission, compared to those without AP (p=0.09). Regarding the complications, the portion of patients with septicemia (p=0.03) in the AP group was higher when compared with the control group, led to significant needs for renal replacement (RRT) (p=0.01), and oxygen support (p=0.01). Patients diagnosed DKA with AP developed greater numbers of upper gastrointestinal bleeding (UGIB) (p<0.001); however, all were confirmed as low risk ulcers at the index esophagogastroduodenoscopy (EGD). Based on biochemical profiles, the AP group was found to have more severity in metabolic acidosis, including lower pH (p=0.01) and serum bicarbonate (p=0.01) (Table2). Conclusions: Patient diagnosed AP coexisting with DKA is more likely to be associated with severe acidosis and complications, including septicemia and UGIB, led to significant needs for RRT, oxygen support and possible ICU admission. Therefore, more attention and awareness of the patients with AP in the setting of DKA would be helpful to arrange the proper management with prompt RRT, EGD, and ICU back up.
*Due to sepsis with multi-organ failure Table 2: Biochemical features of patients in the DKA with pancreatitis group and the control
Mo1438 Study of Lung Function Tests to Predict Development of Acute Lung Injury in Patients With Acute Pancreatitis Jayanta Samanta, Munish Ashat, Raghavendra Prasad, Narendra Dhaka, Yalaka R. Reddy, Ashutosh N. Aggarwal, Vikas Gupta, Thakur D. Yadav, Saroj K. Sinha, Rakesh Kochhar Introduction: The commonest organ failure in patients with acute pancreatitis (AP) is acute lung injury (ALI). Data on pulmonary function tests (PFT) in AP is limited. Aims & Methods: To study PFT in patients with AP and evaluate the role of PFTs in predicting ALI. In this prospective study between July 2013 and December 2014 consecutive patients of AP underwent complete demographic, clinical, biochemical and radiological evaluation. Severity classification was done using revised Atlanta classification and also systemic inflammatory response score (SIRS), Bedside Index of Severity of Acute Pancreatitis(BISAP), CT Severity Index(CTSI) and APACHE II scores were used. Serial arterial blood gas (ABG) analyses were done and ALI severity defined as per Berlin classification using PaO2/FiO2 ratio. Development of ALI was monitored in all the patients. PFTs were done by spirometry as soon as possible after admission. Forced expiratory volume in first second (FEV1), forced vital capacity (FVC) and FEV1/FVC ratio were used as basic parameters for interpretation and all measurements were expressed as a percentage of their predicted values (FVC%, FEV1%). Patients were divided into 2 groups: with and without ALI. The ALI cohort was further subdivided into
AGA Abstracts
S-712
AGA Abstracts
persistent ALI (P ALI) and transient ALI (T-ALI). A subgroup of ALI group which developed ALI later during hospital stay was defined as "later onset" ALI (LO-ALI) to devise a predictive model for ALI with PFT parameters. Statistical analysis was done using SPSSv22.0 Results: Of the 107 patients (mean age of 38.4 yrs, 64.5% males, etiology: alcohol 36.4% gallstone disease 26.2% and others 51.4%), ALI developed in 51 (47.7%) patients of whom 40(78.4%) had ALI on admission while 11(21.6%) had LO-ALI. T-ALI was seen in 16(31.4%) while 35 (68.6%) had P-ALI. PFT could be performed in 87 patients (52 non-ALI, 35 ALI including 9 from LO-ALI subgroup). ALI group had significantly lower FVC%(p<0.0001) and FEV1%(p<0.0001) signifying higher lung dysfunction compared to those without ALI. Similarly, P-ALI had lower FVC% (58.9±14.8 vs. 69.6±17.2, p=0.06) and lower FEV1% (p=0.04) than T-ALI. A significant correlation existed between PaO2/FiO2 ratio and FVC% (r=0.513, P<0.0001) and FEV1% (r=0.488, p<0.0001). Both FEV1% and FVC% showed significant correlation with other severity parameters such as SIRS (p<0.0001), BISAP(p<0.00011), CTSI (p<0.0001) and APACHE II (p<0.002) and also with need for intervention (p=0.04), hospital stay (p<0.0001) and intensive care stay (p=0.001). LO-ALI (9) had significantly lower FVC%(p=0.02) and FEV1% (p=0.03) as compared to those without ALI, but a predictive cut off could not be achieved (AUC=0.257, p=0.021) due to small numbers. Conclusion: Patients who eventually develop ALI later have more severe lung dysfunction at baseline than those who do not and PFTs can act as a tool to predict it.
Mo1453 Pocket Ultrasound Device in Biliary Disease Mario Montanari, Jessica Peder, Marco Parravicini, Claudio Camillo Cortelezzi, Sergio Segato Background and aimThe accuracy of physical examination in suspected biliary diseases is usually poor and further tests are required for diagnosis; the use of pocket ultrasound device (PUD) can lead to an incremental benefit. We assessed whether the use of PUD should be recommended to improve the diagnostic accuracy of physical examination and drive the appropriteness of further investigations Material and methods A prospective study from february to september 2015 was performed: 31 patients with suspected biliary disease were evaluated in the emergency room by a physician expert in abdominal ultrasound; every patient was examined with the PUD v-Scan GE looking for dilation of the biliary tract or biliary stones. Then we monitored the following diagnostic tests and evaluated the correlation between PUD and gold standard methods (US, MRI., CT) Results In 77% of patients the PUD examination confirmed the suspected diagnosis; the correlation with standard US was 87%, 91% with CT, 90,5% with MRI; sensitivity was 88,2% and specificity was 100% Conclusions PUD can be used in combination with physical examination in the first assessment of patients with suspected biliary disease; in fact this tool is characterized by good sensitivity and specificity in identifying the presence of stones and/or dilation of the bile ducts. Its use could then optimize the demands of further investigations, by reducing waiting times and costs
Characteristics of Alcoholic Cirrhosis Patients who died during hospitalization and those who survived
Mo1519 In-Hospital Mortality in Alcoholic Cirrhosis - Analysis of the National Hospital Discharge Survey David Mossad, Ronald J. Markert, Padmini Krishnamurthy, Sangeeta Agrawal Introduction Alcoholic cirrhosis presents with notable risk for morbidity and mortality in both acute and chronic settings. Multiple scoring systems stratify risk as disease severity carries significant implications for short-term survival and organ allocation in candidates for transplantation. The purpose of this study was to evaluate the effects of patient demographics, comorbidity burden, and hospital characteristics on in-hospital mortality in patients with alcoholic cirrhosis. Methods We used ICD-9 diagnosis codes from the 2001-2010 National Hospital Discharge Survey to identify cases of alcoholic cirrhosis. Comparisons on demographics, number of comorbidities, hospital length of stay (LOS), and selected health system characteristics were made between those who died in-hospital and those discharged. SPSS was used for chi-square and t test analysis at alpha = 0.05. Results Among 12,246 cases of alcoholic cirrhosis, 960 died in-hospital and 11,286 were discharged. The mortality group was older (mean age of 56.6 vs 54.5 years, p<0.001) and had a longer LOS (9.9 vs 6.3 days, p<0.001). There was no difference in mortality between genders (7.9% of males vs 7.6% of females, p=0.55), but African Americans (9.7%) differed from Caucasians (7.6%) and other races (7.6%) (p=0.023). Patients with seven or more comorbidities had a higher mortality rate (8.8%) compared to those with six or fewer comorbidities (4.0%) [p<0.001]. Patients with chronic kidney disease (CKD) suffered a significantly higher mortality rate (12.3%) compared to those without CKD (7.7%) (p=0.002). There was no difference in mortality between the Midwest (7.6%), Northeast (8.4%), South (7.3%), and West (8.5%). Neither hospital size (p=0.25) nor hospital ownership (p=0.26) impacted mortality rate. Principal source of payment did not affect mortality rate (p=0.81). Patients transferred from skilled nursing/intermediate care facilities (13.9%) and other healthcare facilities (10.1%) had the highest mortality rates (p<0.001). Elective admissions (5.4%) showed a lower mortality rate compared to emergent (8.0%) and urgent (8.4%) admissions (p=0.021). Conclusions Risk stratification in alcoholic cirrhosis is paramount due to the implications for short-term survival and need for organ transplantation. We found that age, race, LOS, comorbidity burden, type of admission, and source of admission impact in-hospital mortality. Comorbid CKD was related to increased mortality in these patients, which is consistent with validated scoring systems that utilize serum creatinine (e.g., Model for End-stage Liver Disease). Demographic and Clinical Characteristics of Hospitalized Alcoholic Cirrhosis Patients in the US from 2001-2010
Mo1520 Analysis of Gut Microbiota Among Various Diet-Induced NASH Models in Mice Mitsuaki Ishioka, Kouichi Miura, Shinichiro Minami, Hirohide Ohnishi (Background) Gut microbiota is closely associated with the development of many liver diseases including nonalcoholic steatohepatitis (NASH). Currently, several types of diets have been used in experimental NASH models. However, the comparison of gut microbiota among these diets has not been investigated. Herein, we analyzed a composition of gut microbiota and sought to determine the key microbiota in the development of NASH.
S-713
AGA Abstracts