Preliminary data of a clinical survey on acute pancreatitis based on the Hungarian national registry

Preliminary data of a clinical survey on acute pancreatitis based on the Hungarian national registry

S68 Abstracts / Pancreatology 13 (2013) S2–S98 for ICU admission, nutritional support, invasive treatment and mortality, classifying subgroups of pa...

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S68

Abstracts / Pancreatology 13 (2013) S2–S98

for ICU admission, nutritional support, invasive treatment and mortality, classifying subgroups of patients with different natural history. Conclusion: Both classifications, based in current literature and the opinion of experts, describes accurately different subgroups of patients with AP.

PII-50 Abstract id: 337. Preliminary data of a clinical survey on acute pancreatitis based on the Hungarian national registry  s Taka cs 1, Anita Bala zs 1, Gyula Farkas, Jr. 2, Akos Lajos V. Kem eny 1, Tama szlo zsef Mal  Czako  1, Ella Szabo  1, Judit Pap 3, Jo eth 1, Andrea Geisz 1, La n Szepes 1, Andra s Roszto szlo nos czy 1, La  Rudas 5, Ja Gervain 4, Zolta 5  1 6    n Fogas , Jozsef Kiss , Barnabas Bod , Tamas Molnar 1, Krisztia lvo rd Ro n €lgyi 1, Richa ka 1, Istva Sepp 1, Judit Czelecz 7, Attila Pa r Forster 9, Ferenc Izb €rgy eki 4, Gyo Hritz 4, DezsT Kelemen 8, Tama n Rakonczay, Jr 1.  za r 2, Tibor Wittmann 1, P eter Hegyi 1, Zolta La 1

First Department of Medicine, University of Szeged, Hungary Department of Surgary, University of Szeged, Hungary 3 National Institute of Oncology, Budapest, Hungary 4 r Megyei Szent Gyo € rgy Hospital, Sze kesfehe rva r, Hungary Feje 5 Department of Anesthesiology and Intensive Care Unit, University of Szeged, Hungary 6 n Hospital, Szentes, Hungary Dr. Bugyi Istva 7 Bethasda Childrens Hospital, Budapest, Hungary 8 cs, Hungary Department of Surgary, University of Pe 9 Second Department of Medicine, University of Szeged, Hungary 2

Introduction: The Hungarian Pancreatic Registry was established in 2012. Aims: To investigate the etiological factors, clinical severity and outcome of acute pancreatitis (AP) in our recently established multicentric Hungarian Pancreatic Registry. Patients & methods: Retrospective analysis of 189 AP patients admitted to gastroenterology wards, ICUs and surgery wards between 2008 and 2013 focused on the etiology and clinical outcome. Results: Out of the 189 AP patients, 88 were females and 101 were males, the mean age at admission was 58.72.2 and 54.51.5 years, respectively. Regular alcohol consumption and smoking was present in 51% and 30% of males, whereas in only 4.6% and 5.8% in female patients, respectively. The most common cause of AP in females was biliary disease (52.3%), whereas in men, it was alcohol (32.7%). AP was idiopathic in 24.4% of female and 11.9% of male patients. Furthermore, dietary problem was identified in 23.3% and 49.5% of female and male patients, respectively. According to the revised Atlanta Classification, AP was mild in 88.3% and 73.3%, moderately severe in 5.8% and 10.9%, severe in 5.8% and 15.8% of female and male patients, respectively. 1 female (1.2%) and 7 males (6.9%) died among AP patients. Only severe AP resulted in death with a total mortality rate of 38.1%. Conclusion: Our study indicates that the revised Atlanta Classification is suitable for clinical practice, since it differentiates between the mortality rates of moderately severe and severe AP. Furthermore, registry provides a foundation for prospective clinical investigations of AP.

PII-51 Abstract id: 203. Early short-term continuous high-volume haemofiltration improves clinical outcomes of severe acute pancreatitis Wei Huang 1, Jia Guo 1, Xiao Yang 1, Tao Jin 1, Kiran Altaf 2, Muhammad Javed 2, Zi Lin 1, Zong Huang 1, Ping Xue 1, Marianne Johnstone 2, Robert Sutton 2, Qing Xia 1. 1 Sichuan Provincial Pancreatitis Centre, Department of Integrated Traditional Chinese and Western Medicine, West China Hospital, China

2 NIHR Liverpool Pancreas Biomedical Research Unit, Royal Liverpool University Hospital, United Kingdom

Introduction: Haemofitration was introduced to treat severe acute pancreatitis (SAP) with early short-term continuous high-volume haemofiltration (HVHF) reported to be the most effective modality, although this has not been tested in randomised clinical trials (RCTs). Aims: To conduct a single centre prospective trial of short-term continuous HVHF in patients with SAP. Patients & methods: Consenting SAP patients with APACHE II scores > 15 on admission to West China Hospital between January 2008 and December 2010 were allocated to receive either optimal standard therapy or 72 h of continuous HVHF on an alternate basis, beginning as soon as possible after admission. Biomarkers and clinical outcomes were compared between the two groups. Results: A total of 61 patients received either conventional therapy (n ¼ 29) or HVHF (n ¼ 32). HVHF treatment was associated with a significant reduction in the incidence of renal failure (P ¼ 0.013), infected pancreatic necrosis (P ¼ 0.048), length of hospitalisation (P ¼ 0.005), mortality (P ¼ 0.033), as well as duration of renal (P < 0.001), respiratory (P ¼ 0.002) and hepatic failure (P ¼ 0.001). APACHE II score, C-reactive protein and interleukin-6 were significantly reduced after the start of HVHF on days 1, 3 and 7 (all P < 0.05). Conclusion: This prospective study suggests that HVHF reduces the incidence and duration of organ failure, complications, and mortality in SAP patients with APACHE II score > 15, although high quality, large RCTs are required to confirm this effect.

PII-52 Abstract id: 162. Raised intestinal fatty acid binding protein correlates to severe acute pancreatitis Hannes Hartman 1, Tomi Sippola 2, Juozas Kupcinskas 3, Outi €m 2, Colin Johnson 4, Sara Regn er 1. Lindstro 1 € , Lund Department of Surgery, Skane University Hospital Malmo University, Sweden 2 Department of Surgery, Helsinki University Central Hospital, Helsinki, Finland 3 Department of Gastroenterology, Lithuanian University of Health Sciences, Kaunas, Lithuania 4 Cancer Sciences, University of Southampton School of Medicine, Southampton, United Kingdom

Introduction: Early fluid resuscitation in order to maintain sufficient circulation to vital tissues is essential in the management of Acute Pancreatitis (AP). Intestinal Fatty Acid Binding Protein (IFABp) is released due to intestinal ischemia. S-IFABp was analyzed to evaluate the efficacy of fluid resuscitation up to 3 days after admission in patients with AP. Aims: Our aim was to analyze the relationship between early fluid resuscitation, levels of s-IFABp and severity during the first 3 days of acute pancreatitis. Materials & methods: The study was designed as part of the Pancreas2000 educational program. Patients with AP were consecutively included at 4 centers. Hydration status was assessed 0-3, ranging from dehydration to fluid overload and the amount of fluids administered was registered. S-IFABp was analyzed at day 1 and 3. Results: 372 patients (237 men, 135 women) were included. 64% had no former history of AP at enrollment in the study. 16% were defined as severe (1993 Atlanta criteria) and 8% were treated at intensive care units. The number of patients undergoing drainage or surgery was 12 and 4% respectively. IFABp levels day 1 were significantly increased in patients with severe AP compared to patients with mild disease. This statistical difference did not remain after 3 days of fluid resuscitation. Conclusion: Preliminary data show that elevated levels of IFABp within 24h of admission is associated with severe AP, suggesting that intestinal ischemia may contribute to the pathogenesis of severe AP. The effects of fluid resuscitation and rehydration remain to be analyzed in detail.