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Application of two new classification of acute PANCREATITIS (AP): Revised atlanta 2012 and determinant-based classification (DBC). A prospective two years single center.
Abstracts / Pancreatology 14 (2014) S1eS129
pancreas injury is critical to develop novel therapeutic strategies. Recent evidence suggests important roles for developmental and inflammatory transcription factors in several steps of the regeneration process. Aims: To analyze whether and how the inflammatory transcription factor NFATc1 is involved in the course of acute pancreatitis. Materials & methods: Caerulein and L-Arginin were used to induce acute pancreatitis in different pancreas specific transgenic mice models with differential expression of NFATc1. Mice were sacrificed at different time points after induction of acute pancreatitis to isolate pancreata for further analysis. Gene expression in mice tissue and acinar cell explants were determined by using RT-PCR, immunoblotting, immunofluorescence and immunohistochemical stainings. Local histone modifications on the NFATc1 promoter were investigated by ChIP analysis. Results: Caerulein mediated acute pancreatitis initiates acinar to ductal metaplasia, which goes along with activation of NFATc1 in metaplastic areas of the pancreas. Regeneration of the pancreas requires inactivation of NFATc1 by H3K27 trimethylation mediated by the Polycomb protein EZH2. While pharmacological or genetic inactivation of NFATc1 in mice accelerates pancreas regeneration, sustained activation of NFATc1 overcomes transcriptional silencing and fully prevents restoration of the organ. Conclusion: Our results provide evidence, that transcriptional silencing of NFATc1 by EZH2 is an inevitable prerequisite for sufficient regeneration from acute pancreatitis.
T-041. Application of two new classification of acute PANCREATITIS (AP): Revised atlanta 2012 and determinant-based classification (DBC). A prospective two years single center. Andreu Romaguera, Francisco Garcia-Borobia, Sheila Serra, Natalia Bejarano, Neus Garcia, Angel Corcuera, Pere Rebasa, Salvador Navarro Parc Tauli Hospital, Spain Background: Two new classification systems for severity have been recently proposed. Both have demonstrated association with clinical outcomes in USA. Presence of infected pancreatic necrosis (IPN) is a determinant in DBC and one of other four local complications in Atlanta 2012. Aims: Our aims were: to analyzed the association between these new classification and clinical outcomes and to determinated better classification for patients with IPN. Patients & methods: All patients admitted for AP between 2012 and 2013 were included. “Step- up approach” was applied. Clinical outcomes evaluated were: mortality, intensive care unit (ICU) admission, need for surgical interventions, need for drains, use of total parenteral nutrition (TPN), use of antibiotics, hospital stay, and re-admissions. IPN were too registered. We used chi^ a€▫square test and ^€▫Whitney’s U to compared variables according to need. Manna Results: 280 patients were included. Age 62 (sd 19), 142 females and 138 males. Overall, higher grades of severity were associated with worse all clinical outcomes evaluated for both classification systems in our environment. Patients with infected pancreatic necrosis are majority moderate in Atlanta 2012 and severe in DBC but clinical outcomes in terms of mortality, ICU admission, need for surgical interventions, need for drains, use of TPN, use of antibiotics, hospital stay, and re-admissions are better correlationed with severe. Conclusion: Both new classifications corresponding with clinical outcomes but patients with infected pancreatic necrosis are better classificated with DBC
S61
T-042. Disorders of haemostasis in patients with acute necrotising pancreatitis Marijana Levicanin, Djordje Bajec, Andrija Antic, Stefan Kmezic, Dejan Radenkovic First Surgical Clinic, Clinical Center of Serbia, Serbia Background: The disarrangement in the haemostatic balance resulting in a pro-coagulant state can appear as a complication of severe necrotising pancreatitis (SAP). This state is main cause for development of DIC, which results in fibrin deposition in the microvascular system that may be implicated in MOF. Aims: The aim of this study was to evaluate events in the haemostatic activation during SNP. Patients & methods: In a prospective clinical study, anticoagulant proteins (protein C, antithrombin III), coagulation variables (prothrombin time, fibrinogen, activate partial thromboplastin time), and fibrinolytic factors (tissue plasminogen activator, plasminogen activator inhibitor-1) were measured and correlated with outcome. These parameters were measured daily for first seven days and later every next weak (2,3,4). According to treatment outcome at the end of study, two groups of patients were compared: 26 survived and 15 non-survived patients. Results: A moderate activation of the coagulation system was found in both study groups. Distinct differences were found in protein C and AT III concentration between two groups. The other measured variables did not show differences between two groups. Multivariate analysis shows that levels of protein C activity were significant as prognostic factors for mortality. Conclusion: Coagulatory activation by itself is unlikely to directly cause deterioration of organ function, although it is involved in generalized endothelial activation with consecutive mediator release and increased leukocyte-endothelial cell interaction. This study show that low level of protein C activity are predictor for outcome of patients with SNP.
T-043. Early prediction of severity of acute pancreatitis using hematocrit level on admission Andrej Bajec a, Dejan Radenkovic b, Djordje Bajec b, Pavle Gregoric a, Marijana Levicanin b a Emergency Center Belgrade,Emergency Surgeru-III Department, Serbia b First Surgical Clinic, VIII Deprtment, Serbia
Background: The early and accurate prediction of the severity of acute pancreatitis (AP) and the assessment of prognosis of the disease are very important and can influence the course of disease and outcome. Aims: The aim of this study is to reevaluate the value of hematocrit level on admission as prediction of severity of AP. Patients & methods: This prospective study included 91 patients treated of acute pancreatitis in the Clinic for Emergency Surgery in time period between January 2012 and April 2013. The AP was diagnosed by typical clinical features. Patients were divided into two groups: patients with severe (SAP) and patients with mild AP (MAP). Severity of acute pancreatitis (SAP) was defined according to Atlanta classification system. Main characteristics curves (age, gender), etiology were determined, as well as value of hematocrit on admission. Receiver operation characteristics (ROC) analysis determined cut-off value, sensitivity and specificity of hematocrit level ad predictor.
pancreas injury is critical to develop novel therapeutic strategies. Recent evidence suggests important roles for developmental and inflammatory transcription factors in several steps of the regeneration process. Aims: To analyze whether and how the inflammatory transcription factor NFATc1 is involved in the course of acute pancreatitis. Materials & methods: Caerulein and L-Arginin were used to induce acute pancreatitis in different pancreas specific transgenic mice models with differential expression of NFATc1. Mice were sacrificed at different time points after induction of acute pancreatitis to isolate pancreata for further analysis. Gene expression in mice tissue and acinar cell explants were determined by using RT-PCR, immunoblotting, immunofluorescence and immunohistochemical stainings. Local histone modifications on the NFATc1 promoter were investigated by ChIP analysis. Results: Caerulein mediated acute pancreatitis initiates acinar to ductal metaplasia, which goes along with activation of NFATc1 in metaplastic areas of the pancreas. Regeneration of the pancreas requires inactivation of NFATc1 by H3K27 trimethylation mediated by the Polycomb protein EZH2. While pharmacological or genetic inactivation of NFATc1 in mice accelerates pancreas regeneration, sustained activation of NFATc1 overcomes transcriptional silencing and fully prevents restoration of the organ. Conclusion: Our results provide evidence, that transcriptional silencing of NFATc1 by EZH2 is an inevitable prerequisite for sufficient regeneration from acute pancreatitis.
T-041. Application of two new classification of acute PANCREATITIS (AP): Revised atlanta 2012 and determinant-based classification (DBC). A prospective two years single center. Andreu Romaguera, Francisco Garcia-Borobia, Sheila Serra, Natalia Bejarano, Neus Garcia, Angel Corcuera, Pere Rebasa, Salvador Navarro Parc Tauli Hospital, Spain Background: Two new classification systems for severity have been recently proposed. Both have demonstrated association with clinical outcomes in USA. Presence of infected pancreatic necrosis (IPN) is a determinant in DBC and one of other four local complications in Atlanta 2012. Aims: Our aims were: to analyzed the association between these new classification and clinical outcomes and to determinated better classification for patients with IPN. Patients & methods: All patients admitted for AP between 2012 and 2013 were included. “Step- up approach” was applied. Clinical outcomes evaluated were: mortality, intensive care unit (ICU) admission, need for surgical interventions, need for drains, use of total parenteral nutrition (TPN), use of antibiotics, hospital stay, and re-admissions. IPN were too registered. We used chi^ a€▫square test and ^€▫Whitney’s U to compared variables according to need. Manna Results: 280 patients were included. Age 62 (sd 19), 142 females and 138 males. Overall, higher grades of severity were associated with worse all clinical outcomes evaluated for both classification systems in our environment. Patients with infected pancreatic necrosis are majority moderate in Atlanta 2012 and severe in DBC but clinical outcomes in terms of mortality, ICU admission, need for surgical interventions, need for drains, use of TPN, use of antibiotics, hospital stay, and re-admissions are better correlationed with severe. Conclusion: Both new classifications corresponding with clinical outcomes but patients with infected pancreatic necrosis are better classificated with DBC
S61
T-042. Disorders of haemostasis in patients with acute necrotising pancreatitis Marijana Levicanin, Djordje Bajec, Andrija Antic, Stefan Kmezic, Dejan Radenkovic First Surgical Clinic, Clinical Center of Serbia, Serbia Background: The disarrangement in the haemostatic balance resulting in a pro-coagulant state can appear as a complication of severe necrotising pancreatitis (SAP). This state is main cause for development of DIC, which results in fibrin deposition in the microvascular system that may be implicated in MOF. Aims: The aim of this study was to evaluate events in the haemostatic activation during SNP. Patients & methods: In a prospective clinical study, anticoagulant proteins (protein C, antithrombin III), coagulation variables (prothrombin time, fibrinogen, activate partial thromboplastin time), and fibrinolytic factors (tissue plasminogen activator, plasminogen activator inhibitor-1) were measured and correlated with outcome. These parameters were measured daily for first seven days and later every next weak (2,3,4). According to treatment outcome at the end of study, two groups of patients were compared: 26 survived and 15 non-survived patients. Results: A moderate activation of the coagulation system was found in both study groups. Distinct differences were found in protein C and AT III concentration between two groups. The other measured variables did not show differences between two groups. Multivariate analysis shows that levels of protein C activity were significant as prognostic factors for mortality. Conclusion: Coagulatory activation by itself is unlikely to directly cause deterioration of organ function, although it is involved in generalized endothelial activation with consecutive mediator release and increased leukocyte-endothelial cell interaction. This study show that low level of protein C activity are predictor for outcome of patients with SNP.
T-043. Early prediction of severity of acute pancreatitis using hematocrit level on admission Andrej Bajec a, Dejan Radenkovic b, Djordje Bajec b, Pavle Gregoric a, Marijana Levicanin b a Emergency Center Belgrade,Emergency Surgeru-III Department, Serbia b First Surgical Clinic, VIII Deprtment, Serbia
Background: The early and accurate prediction of the severity of acute pancreatitis (AP) and the assessment of prognosis of the disease are very important and can influence the course of disease and outcome. Aims: The aim of this study is to reevaluate the value of hematocrit level on admission as prediction of severity of AP. Patients & methods: This prospective study included 91 patients treated of acute pancreatitis in the Clinic for Emergency Surgery in time period between January 2012 and April 2013. The AP was diagnosed by typical clinical features. Patients were divided into two groups: patients with severe (SAP) and patients with mild AP (MAP). Severity of acute pancreatitis (SAP) was defined according to Atlanta classification system. Main characteristics curves (age, gender), etiology were determined, as well as value of hematocrit on admission. Receiver operation characteristics (ROC) analysis determined cut-off value, sensitivity and specificity of hematocrit level ad predictor.