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Acute pancreatitis associated with persistent and irreversible respiratory failure
Abstracts / Pancreatology 14 (2014) S1eS129
(VAT) may lead to acute fluid collection and, subsequently, some weeks after the occurrence of pancreatitis, a pseudocyst will form, including necrotic tissues. Aims: We investigated the relationship between VAT and severe acute pancreatitis. Materials & methods: We observed 37 acute pancreatitis patients (13 e mild, 24 e severe). Diagnostic criteria for acute pancreatitis were two of the following three features: abdominal pain characteristic of acute pancreatitis; serum amylase and/or lipase three times the upper limit of normal; characteristic findings of acute pancreatitis on ultrasonography or CT scan. Visceral adipose tissue was measured using computer software based on computed tomography images. Results: VAT was significantly related to severity of acute pancreatitis in the multiple logistic regression analysis. In a trend analysis, not only severity but also the presence of peripancreatic fluid collection, pseudocyst formation, and prognostic Ranson factor were significantly related to VAT volume. The presence of a pancreatic pseudocyst was strongly related to VAT volume. Conclusion: Peripancreatic VAT has a strong correlation with severe acute pancreatitis. VAT volume is strongly correlated with the formation of a pseudocyst and with systemic inflammatory response syndrome in patients with acute pancreatitis and high VAT volume may lead to severe acute pancreatitis.
T-048.
S63
Efficiency of scales of acute pancreatitis requires improvement. Currently reserves of estimation SAP using scales may be considered exhausted. Aims: Prediction of clinical course and outcome of SAP in applying of new approaches to the assessment of patients. Patients & methods: Retrospective and prospective comparative analysis of the clinical data in patients with SAP (n¼52). Results: We have compared the effectiveness of several severity scores of SAP, including APACHE II, and others, with the subjective judgment of the physician in the assessment of patients with SAP. Subjective physician decision was correct in 81% of cases. APACHE II score was the most accurate and demonstrated the correct result in 67%. We identify promising improvement is not one scale, and the identification of several "panels" for the objective status of the patient. These panels allow the physician personalize the assessment status of patient with SAP. The general picture SAP should be based on the assessment of severity of disease, activity and a common status of the patient. Conclusion: We need to create a system of individual assessment of patients with SAP. We consider that a composition of several "panels" revealing the severity of the patient's condition, the activity of the pathological process and the overall status of the patient is promising. The composition of "panels" requires further research, but it seems promising. The use of "panels" will provide a more an objective picture SAP.
Acute pancreatitis associated with persistent and irreversible respiratory failure Shamil Galeev, Yakubbay Abdullaev, Michael Rubtsov Saint Luke Clinical Hospital, Russia Background: Severe acute pancreatitis is often complicated by the development of multiorgan dysfunction syndrome. Among systemic complications, pulmonary complications are the most frequent and potentially the most serious. The direct correlations persists between early hypoxemia and mortality. Aims: To characterize patients with persistent and irreversible respiratory failure caused by severe pancreatitis. Identify initial severity of patients having severe lung injury, and assess their outcome. Materials & methods: 13 patients with persistent or irreversible respiratory failure were identified at the General Surgery Department of Saint Luke Clinical Hospital over a 9-year period. Respiratory failure was defined according to the Marshall scoring system. Clinical and radiological data (CT scan), characterizing local and systemic complications at the admission time, were analyzed. Results: Most of patients (8) had sterile necrosis e 61,5%, 3 e infected necrosis, 2 e fluid collections. Median APACHE II at the time of admission was 14 (IQR¼11-20). There were 11 deaths. 6 of patients (46,2%), had significant hypoxemia at the time of admission. Those who had infected necrosis developed persistent respiratory failure much later in the course of the disease. As a rule it was associated with sepsis and circulatory shock. 2 patients had critical hypoxemia at the time of admission. They died rapidly, during first week of the disease. Conclusion: Persistent lung injury as systemic complication of acute pancreatitis definitely aggravates clinical course of the disease.
T-049. Severe acute pancreatitis (SAP): prognosis, severity or activity Alexandr Lemeschewskij Belarusian State Medical University, General Surgery, Belarus Background: Several severity scores have shown their importance for the early diagnosis of SAP, objectification in assessing disease severity, outcome prediction and improving treatment outcomes.
T-050. Examination of the prognostic value of leucocyte subsets and neutrophil-to-lymphocyte ratio in patients with acute pancreatitis M.J. Jones, C.P. Neal, W.S. Ngu, A.R. Dennison, G. Garcea UHL, United Kingdom Background: Several studies have recently reported the circulating neutrophil-to-lymphocyte ratio (NLR) to be associated with severity and length of stay in patients with acute pancreatitis. Associations with adverse outcome and mortality, however, remain untested, as does the multivariable significance of NLR and the prognostic significance of leucocyte subsets. Aims: We examined the association of leucocyte subsets and NLR with adverse outcome in a large cohort of patients with acute pancreatitis. Patients & methods: Data were obtained from a database of all patients presenting with acute pancreatitis between 2007 and 2011 (n¼629). Clinicopathological data (age, gender, ASA grade, Glasgow, Ranson, APACHE II and multi-organ dysfunction scores) and haematological variables (leucocyte count, neutrophil count, monocyte count, lymphocyte count, platelet count, NLR) were noted on days 1-3 of admission. Associations between variables and i) severity of pancreatitis, ii) adverse outcome, iii) pancreas-specific complications and iv) in-hospital mortality were determined by univariable and multivariable binary logistic regression analysis. Results: In-hospital rate mortality was 8.74% (n¼55). On univariable analysis, both NLR and lymphocyte count were significantly associated with all four outcomes. On multivariable analysis, however, only lymphocyte count maintained prognostic significance, with a low count (along with established clinicopathological scoring systems) independently associated with severity, adverse outcome, pancreas-specific complications and mortality. Conclusion: These data confirm that circulating haematological parameters are independently associated with adverse outcome in patients with AP, but suggest that it is the circulating lymphocyte count, rather than the NLR, that exerts the dominant prognostic effect. Further studies are needed to confirm these findings.
(VAT) may lead to acute fluid collection and, subsequently, some weeks after the occurrence of pancreatitis, a pseudocyst will form, including necrotic tissues. Aims: We investigated the relationship between VAT and severe acute pancreatitis. Materials & methods: We observed 37 acute pancreatitis patients (13 e mild, 24 e severe). Diagnostic criteria for acute pancreatitis were two of the following three features: abdominal pain characteristic of acute pancreatitis; serum amylase and/or lipase three times the upper limit of normal; characteristic findings of acute pancreatitis on ultrasonography or CT scan. Visceral adipose tissue was measured using computer software based on computed tomography images. Results: VAT was significantly related to severity of acute pancreatitis in the multiple logistic regression analysis. In a trend analysis, not only severity but also the presence of peripancreatic fluid collection, pseudocyst formation, and prognostic Ranson factor were significantly related to VAT volume. The presence of a pancreatic pseudocyst was strongly related to VAT volume. Conclusion: Peripancreatic VAT has a strong correlation with severe acute pancreatitis. VAT volume is strongly correlated with the formation of a pseudocyst and with systemic inflammatory response syndrome in patients with acute pancreatitis and high VAT volume may lead to severe acute pancreatitis.
T-048.
S63
Efficiency of scales of acute pancreatitis requires improvement. Currently reserves of estimation SAP using scales may be considered exhausted. Aims: Prediction of clinical course and outcome of SAP in applying of new approaches to the assessment of patients. Patients & methods: Retrospective and prospective comparative analysis of the clinical data in patients with SAP (n¼52). Results: We have compared the effectiveness of several severity scores of SAP, including APACHE II, and others, with the subjective judgment of the physician in the assessment of patients with SAP. Subjective physician decision was correct in 81% of cases. APACHE II score was the most accurate and demonstrated the correct result in 67%. We identify promising improvement is not one scale, and the identification of several "panels" for the objective status of the patient. These panels allow the physician personalize the assessment status of patient with SAP. The general picture SAP should be based on the assessment of severity of disease, activity and a common status of the patient. Conclusion: We need to create a system of individual assessment of patients with SAP. We consider that a composition of several "panels" revealing the severity of the patient's condition, the activity of the pathological process and the overall status of the patient is promising. The composition of "panels" requires further research, but it seems promising. The use of "panels" will provide a more an objective picture SAP.
Acute pancreatitis associated with persistent and irreversible respiratory failure Shamil Galeev, Yakubbay Abdullaev, Michael Rubtsov Saint Luke Clinical Hospital, Russia Background: Severe acute pancreatitis is often complicated by the development of multiorgan dysfunction syndrome. Among systemic complications, pulmonary complications are the most frequent and potentially the most serious. The direct correlations persists between early hypoxemia and mortality. Aims: To characterize patients with persistent and irreversible respiratory failure caused by severe pancreatitis. Identify initial severity of patients having severe lung injury, and assess their outcome. Materials & methods: 13 patients with persistent or irreversible respiratory failure were identified at the General Surgery Department of Saint Luke Clinical Hospital over a 9-year period. Respiratory failure was defined according to the Marshall scoring system. Clinical and radiological data (CT scan), characterizing local and systemic complications at the admission time, were analyzed. Results: Most of patients (8) had sterile necrosis e 61,5%, 3 e infected necrosis, 2 e fluid collections. Median APACHE II at the time of admission was 14 (IQR¼11-20). There were 11 deaths. 6 of patients (46,2%), had significant hypoxemia at the time of admission. Those who had infected necrosis developed persistent respiratory failure much later in the course of the disease. As a rule it was associated with sepsis and circulatory shock. 2 patients had critical hypoxemia at the time of admission. They died rapidly, during first week of the disease. Conclusion: Persistent lung injury as systemic complication of acute pancreatitis definitely aggravates clinical course of the disease.
T-049. Severe acute pancreatitis (SAP): prognosis, severity or activity Alexandr Lemeschewskij Belarusian State Medical University, General Surgery, Belarus Background: Several severity scores have shown their importance for the early diagnosis of SAP, objectification in assessing disease severity, outcome prediction and improving treatment outcomes.
T-050. Examination of the prognostic value of leucocyte subsets and neutrophil-to-lymphocyte ratio in patients with acute pancreatitis M.J. Jones, C.P. Neal, W.S. Ngu, A.R. Dennison, G. Garcea UHL, United Kingdom Background: Several studies have recently reported the circulating neutrophil-to-lymphocyte ratio (NLR) to be associated with severity and length of stay in patients with acute pancreatitis. Associations with adverse outcome and mortality, however, remain untested, as does the multivariable significance of NLR and the prognostic significance of leucocyte subsets. Aims: We examined the association of leucocyte subsets and NLR with adverse outcome in a large cohort of patients with acute pancreatitis. Patients & methods: Data were obtained from a database of all patients presenting with acute pancreatitis between 2007 and 2011 (n¼629). Clinicopathological data (age, gender, ASA grade, Glasgow, Ranson, APACHE II and multi-organ dysfunction scores) and haematological variables (leucocyte count, neutrophil count, monocyte count, lymphocyte count, platelet count, NLR) were noted on days 1-3 of admission. Associations between variables and i) severity of pancreatitis, ii) adverse outcome, iii) pancreas-specific complications and iv) in-hospital mortality were determined by univariable and multivariable binary logistic regression analysis. Results: In-hospital rate mortality was 8.74% (n¼55). On univariable analysis, both NLR and lymphocyte count were significantly associated with all four outcomes. On multivariable analysis, however, only lymphocyte count maintained prognostic significance, with a low count (along with established clinicopathological scoring systems) independently associated with severity, adverse outcome, pancreas-specific complications and mortality. Conclusion: These data confirm that circulating haematological parameters are independently associated with adverse outcome in patients with AP, but suggest that it is the circulating lymphocyte count, rather than the NLR, that exerts the dominant prognostic effect. Further studies are needed to confirm these findings.