- Email: [email protected]
The severity of acute alcohol pancreatitis (AAP) can be predicted by systemic levels of soluble Urokinase-type plasminogen activator receptor (suPAR)
S66
Abstracts / Pancreatology 15 (2015) S1eS141
1244. Empirical antibiotic treatment in infective necrotising pancreatitis: A retrospective analysis Donald R. Morice, David M. Williams, Richard Christie, Nicholas Mowbray, Tim H. Brown, Bilal Al-Sarireh Morriston Hospital, Swansea, Department of Pancreatic Surgery, United Kingdom Introduction: Infective complications of necrotising pancreatitis occur in 40-70% of patients with severe pancreatitis. This is often diagnosed on CT, and empirical antibiotics are initiated without culture results. Aims: To determine appropriate empirical antibiotic therapy for patients with infective necrotising pancreatitis Patients & methods: Retrospective analysis of patients in a tertiary pancreatic centre who underwent open or minimally invasive necrosectomy since 2009 was performed. Blood and necrosectomy cultures were analysed to identify pathogens, antibiotic sensitivity and resistance patterns as well as pre-operative white cell count (WCC) and C-reactive protein (CRP). Results: 38 patients received a necrosectomy. Four patients had no identifiable necrosectomy culture and four patients had negative necrosectomy cultures. Enterococcus Faecalis was the commonest pathogen, implicated in sixteen (42.1%) patients, followed by pseudomonas and E.coli in six (15.8%) and four (10.5%) patients respectively. Sixteen (42.1%) patients were infected with pathogens sensitive to Gentamycin followed by Ciprofloxacin and piperacillin/tazobactem in twelve (31.6%) patients. Resistance was found against amoxicillin, erythromycin, co-amoxiclav and cefuroxime in 31.60%, 23.70%, 21.05% and 18.42% respectively. Thirty-one patients had a CRP sample within one week of necrosectomy ranging from 5-478mg/L (median 149mg/L). 10.0% of patients with a CRP <110mg/L died compared with 30.0% of patients with a CRP between 110-190mg/L and 54.6% with CRP >190mg/L. Conclusion: Enterococcus faecalis was the commonest infective cause of necrotising pancreatitis and gentamycin would be the most effective empirical antibiotic therapy. Resistance was found against amoxicillin and erythromycin thus their use should be avoided until sensitivities are available. Increasing CRP is associated with increasing mortality. Further studies are required.
994. The risk of recurrent acute pancreatitis is associated with failure to treat the biliary aetiology Serena Stigliano, Matteo Piciucchi, Marianna Signoretti, Gianfranco Delle Fave, Gabriele Capurso
with the risk of biliary RAP (OR 4.4; 95% CI 1.1-17). In alcoholic AP, 33% of RAP had stopped drinking compared to 55.6% of not recurrent (p¼0.58). All alcoholic RAP had more than two attacks, compared to 12.5% of RAP due to other aetiologies (p¼0.013). Conclusion: RAP occurs in about 20% of cases, biliary aetiology being the most prevalent. Failure to treat biliary aetiology is associated with a 4fold recurrence risk increase. Alcoholic AP patients seem to have a lower risk of recurrence if quitting drinking, but more often experience multiple AP attacks.
1000. The severity of acute alcohol pancreatitis (AAP) can be predicted by systemic levels of soluble Urokinase-type plasminogen activator receptor (suPAR) Anssi Nikkola 1, Janne Aittoniemi 2, Reetta Huttunen 2, Juhani Sand 1, Johanna Laukkarinen 1 1
Dept. of Gastroenterology and Alimentary Tract Surgery, Tampere University Hospital, Tampere, Finland 2 Centre for Laboratory Medicine, Pirkanmaa Hospital Distric, Finland Introduction: SuPAR is a documented prognostic marker of sepsis, SIRS and various cancers. Aims: Our aim was to study the activation and prognostic value of plasma suPAR (P-suPAR) in patients with first AAP. Patients & methods: P-suPAR concentrations (ELISA from ViroGates A⁄ S, Birkerød, Denmark) were measured from 104 patients with first AAP during hospitalization and again 6-24 months after discharge. The severity of AAP was classified according to the revised Atlanta criteria. Results: Pancreatitis was mild in 66%, moderately severe in 28% and severe in 6% of the 104 patients with first AAP. For further analysis, the moderately severe and severe AAP were combined (non-mild AAP; 34%). P-suPAR levels were low as expected after the recovery from AAP (3.1 ng/ mL; 1.6-6.9), significantly elevated in mild AAP (4.2 ng/mL; 1.6-16.4, p<0.001) and significantly more increased in non-mild AAP (6.2 ng/mL; 1.9-39.0, p<0.001; median and range). There was a good predicting value of P-suPAR for AAP severity when the analysis was made within 1-4 days after admission (n¼68): area under ROC 0.81 (95% CI, 0.70-0.92, p<0.001). At a cut-off level of 5.0 ng/mL, sensitivity and specificity to predict a nonmild AAP were 79% and 78% respectively. At admission P-suPAR was found to be a better prognostic marker for the severity of AAP than CRP, hematocrit or creatinine. Conclusion: P-suPAR concentrations are elevated in AAP. P-suPAR over 5.0 ng/mL predicts the development of a moderately severe or severe AAP. These results suggest that P-suPAR may have a potential to serve as a novel prognostic marker for AAP severity at admission.
Sant'andrea Hospital, Italy Introduction: There are limited data about recurrent acute pancreatitis (RAP), with rates ranging 17-31%. Risk of RAP seems higher in alcoholic and idiopathic AP, but most data were obtained in countries where alcohol is the most frequent aetiology. Aims: To evaluate rate of RAP and associated factors. Patients & methods: Single-centre prospective study of consecutive AP patients (previous biliary/pancreatic disorders excluded). All received follow-up visits. Results: 182 patients (biliary 47.8%, alcoholic 16.5%, idiopathic 10.9%) included. In a mean follow-up of 38 months 33 (18.1%) had RAP. Only 18% of recurrences occurred within 30 days from discharge, 61% within the first year. Aetiologies of RAP were biliary (48.5%), idiopathic (15.1%) and alcoholic (9.1%). Age, gender and severity were not associated with RAP risk. Of the 16 patients with biliary RAP only 3 (18.6%) had received cholecystectomy after the first AP, compared to 36 (51%) of the 71 who did not have recurrence (p¼0.03). Failure to perform cholecystectomy was associated
1006. Prospective evaluation of the aetiological profile of acute pancreatitis in young adult patients Adrian Culetto 1, Barbara Bournet 1, Jean-Marie Peron 2, Laurent Alric 3, Louis Buscail 1 1
Department of Gastroenterology, CHU Rangueil, Toulouse, France Department of Gastroenterology, CHU Purpan, Toulouse, France 3 Department of Internal Medicine, CHU Purpan, Toulouse, France 2
Introduction: The aetiologies of acute pancreatitis in young adult patients are poorly known. Aims: To prospectively evaluate the causes of acute pancreatitis in patients aged less than 35 years.
Abstracts / Pancreatology 15 (2015) S1eS141
1244. Empirical antibiotic treatment in infective necrotising pancreatitis: A retrospective analysis Donald R. Morice, David M. Williams, Richard Christie, Nicholas Mowbray, Tim H. Brown, Bilal Al-Sarireh Morriston Hospital, Swansea, Department of Pancreatic Surgery, United Kingdom Introduction: Infective complications of necrotising pancreatitis occur in 40-70% of patients with severe pancreatitis. This is often diagnosed on CT, and empirical antibiotics are initiated without culture results. Aims: To determine appropriate empirical antibiotic therapy for patients with infective necrotising pancreatitis Patients & methods: Retrospective analysis of patients in a tertiary pancreatic centre who underwent open or minimally invasive necrosectomy since 2009 was performed. Blood and necrosectomy cultures were analysed to identify pathogens, antibiotic sensitivity and resistance patterns as well as pre-operative white cell count (WCC) and C-reactive protein (CRP). Results: 38 patients received a necrosectomy. Four patients had no identifiable necrosectomy culture and four patients had negative necrosectomy cultures. Enterococcus Faecalis was the commonest pathogen, implicated in sixteen (42.1%) patients, followed by pseudomonas and E.coli in six (15.8%) and four (10.5%) patients respectively. Sixteen (42.1%) patients were infected with pathogens sensitive to Gentamycin followed by Ciprofloxacin and piperacillin/tazobactem in twelve (31.6%) patients. Resistance was found against amoxicillin, erythromycin, co-amoxiclav and cefuroxime in 31.60%, 23.70%, 21.05% and 18.42% respectively. Thirty-one patients had a CRP sample within one week of necrosectomy ranging from 5-478mg/L (median 149mg/L). 10.0% of patients with a CRP <110mg/L died compared with 30.0% of patients with a CRP between 110-190mg/L and 54.6% with CRP >190mg/L. Conclusion: Enterococcus faecalis was the commonest infective cause of necrotising pancreatitis and gentamycin would be the most effective empirical antibiotic therapy. Resistance was found against amoxicillin and erythromycin thus their use should be avoided until sensitivities are available. Increasing CRP is associated with increasing mortality. Further studies are required.
994. The risk of recurrent acute pancreatitis is associated with failure to treat the biliary aetiology Serena Stigliano, Matteo Piciucchi, Marianna Signoretti, Gianfranco Delle Fave, Gabriele Capurso
with the risk of biliary RAP (OR 4.4; 95% CI 1.1-17). In alcoholic AP, 33% of RAP had stopped drinking compared to 55.6% of not recurrent (p¼0.58). All alcoholic RAP had more than two attacks, compared to 12.5% of RAP due to other aetiologies (p¼0.013). Conclusion: RAP occurs in about 20% of cases, biliary aetiology being the most prevalent. Failure to treat biliary aetiology is associated with a 4fold recurrence risk increase. Alcoholic AP patients seem to have a lower risk of recurrence if quitting drinking, but more often experience multiple AP attacks.
1000. The severity of acute alcohol pancreatitis (AAP) can be predicted by systemic levels of soluble Urokinase-type plasminogen activator receptor (suPAR) Anssi Nikkola 1, Janne Aittoniemi 2, Reetta Huttunen 2, Juhani Sand 1, Johanna Laukkarinen 1 1
Dept. of Gastroenterology and Alimentary Tract Surgery, Tampere University Hospital, Tampere, Finland 2 Centre for Laboratory Medicine, Pirkanmaa Hospital Distric, Finland Introduction: SuPAR is a documented prognostic marker of sepsis, SIRS and various cancers. Aims: Our aim was to study the activation and prognostic value of plasma suPAR (P-suPAR) in patients with first AAP. Patients & methods: P-suPAR concentrations (ELISA from ViroGates A⁄ S, Birkerød, Denmark) were measured from 104 patients with first AAP during hospitalization and again 6-24 months after discharge. The severity of AAP was classified according to the revised Atlanta criteria. Results: Pancreatitis was mild in 66%, moderately severe in 28% and severe in 6% of the 104 patients with first AAP. For further analysis, the moderately severe and severe AAP were combined (non-mild AAP; 34%). P-suPAR levels were low as expected after the recovery from AAP (3.1 ng/ mL; 1.6-6.9), significantly elevated in mild AAP (4.2 ng/mL; 1.6-16.4, p<0.001) and significantly more increased in non-mild AAP (6.2 ng/mL; 1.9-39.0, p<0.001; median and range). There was a good predicting value of P-suPAR for AAP severity when the analysis was made within 1-4 days after admission (n¼68): area under ROC 0.81 (95% CI, 0.70-0.92, p<0.001). At a cut-off level of 5.0 ng/mL, sensitivity and specificity to predict a nonmild AAP were 79% and 78% respectively. At admission P-suPAR was found to be a better prognostic marker for the severity of AAP than CRP, hematocrit or creatinine. Conclusion: P-suPAR concentrations are elevated in AAP. P-suPAR over 5.0 ng/mL predicts the development of a moderately severe or severe AAP. These results suggest that P-suPAR may have a potential to serve as a novel prognostic marker for AAP severity at admission.
Sant'andrea Hospital, Italy Introduction: There are limited data about recurrent acute pancreatitis (RAP), with rates ranging 17-31%. Risk of RAP seems higher in alcoholic and idiopathic AP, but most data were obtained in countries where alcohol is the most frequent aetiology. Aims: To evaluate rate of RAP and associated factors. Patients & methods: Single-centre prospective study of consecutive AP patients (previous biliary/pancreatic disorders excluded). All received follow-up visits. Results: 182 patients (biliary 47.8%, alcoholic 16.5%, idiopathic 10.9%) included. In a mean follow-up of 38 months 33 (18.1%) had RAP. Only 18% of recurrences occurred within 30 days from discharge, 61% within the first year. Aetiologies of RAP were biliary (48.5%), idiopathic (15.1%) and alcoholic (9.1%). Age, gender and severity were not associated with RAP risk. Of the 16 patients with biliary RAP only 3 (18.6%) had received cholecystectomy after the first AP, compared to 36 (51%) of the 71 who did not have recurrence (p¼0.03). Failure to perform cholecystectomy was associated
1006. Prospective evaluation of the aetiological profile of acute pancreatitis in young adult patients Adrian Culetto 1, Barbara Bournet 1, Jean-Marie Peron 2, Laurent Alric 3, Louis Buscail 1 1
Department of Gastroenterology, CHU Rangueil, Toulouse, France Department of Gastroenterology, CHU Purpan, Toulouse, France 3 Department of Internal Medicine, CHU Purpan, Toulouse, France 2
Introduction: The aetiologies of acute pancreatitis in young adult patients are poorly known. Aims: To prospectively evaluate the causes of acute pancreatitis in patients aged less than 35 years.