S1373 Analysis of Prevalence, Mortality Rate and Predicting Factors for Severe Acute Pancreatitis According to the Revised Atlanta Classification

bacterial infection; while 5 (25%) had additional fungal infection. On univariate analysis, BUN >25 mg/dL and SIRS >2 at admission were found to significantly predict primary intraabdominal infection with OR (95% CI) of 2.68 (0.96 -6.96) and 3.59 (1.42-9.51)[2-tailed p = 0.048 and 0.007 respectively]. On multivariate analysis, only SIRS >2 was found to be significantly predictive with an adjusted OR (95% CI) of 3.13 (1.21-8.49)[p=0.018]. The other study parameters, namely hematocrit, BMI and serum creatinine, did not predict the development of primary intra-abdominal infection. Conclusions: SIRS is a simple and inexpensive severity assessment tool available at admission, that can predict the development of primary intra-abdominal infection in AP early in the disease course. S1372 Do Outcome Predictors of Acute Pancreatitis Change With Disease Severity A Nationwide Analysis of Hospitalizations? Nilay Kumar, Ashwin N. Ananthakrishnan, Abhishek Deshmukh, Emily L. McGinley, Daniel Eastwood, Gagan Kumar Introduction The number of hospitalizations for acute pancreatitis (AP) has increased during the recent years. The direct cost related to hospitalizations for AP was estimated at $2 billion in 2003. The hospital course of AP can be variable from a mild to severe course requiring advanced diagnostic and therapeutic procedures and critical care management. Due to this spectrum of illness, we aimed to stratify AP by disease severity to evaluate if predictive factors differentially affected outcomes based on underlying severity of illness. Methods This was an observational cross-sectional study utilizing the NIS database, the largest national all-payer database for inpatient hospitalizations in the United States. Using the International Classification of Diseases, 9th Revision (ICD-9-CM) code 577.0, all patients with the primary discharge diagnosis of AP were identified. Using appropriate ICD-9-CM codes, we identified from among this cohort patients who had hypovolemia including shock, prolonged mechanical ventilation, endotracheal intubation, acute renal failure, dialysis, coagulopathy and encephalopathy (as markers of severe organ dysfunction). Any patient with a primary diagnosis of AP and one of the secondary diagnoses of severity markers as above were classified as the high-severity category. Data was analyzed using multivariate analysis. Results A total of 50,978 patients with AP were evaluated, with 38,947 (76%) being in the low severity and 12,031 (24%) in the high severity group. The unadjusted inpatient mortality in the high severity category (3.8%) was approximately 24 times higher than the low severity category (0.16%). In the low severity group age > 66 was associated with significantly higher mortality (Odds Ratio (OR) 4.5, 95% CI 1.28-15.37). Teaching hospital, white race and females tended to have a higher mortality in this group but did not reach statistical significance. In the high severity group significant predictors of mortality were age > 51 (OR 2.4, 95% CI 1.53-3.84), males (OR 1.5, 95% CI 1.24 - 1.83), teaching hospital (OR 1.4, 95% CI 1.12 - 1.73) and black vs. white race (OR 0.55, 95% CI 0.36 - 0.82). The predictors for increased length of stay were age > 50, white race and teaching hospital in both categories. Conclusions Our results show that there are differences in the predictive value of demographic and disease characteristics in determining outcomes of AP based on underlying disease severity. Such interactions should be taken into account in future studies.

S1370 Research Study Participation is Not Associated With Increased Complication Rates in Patients Undergoing Interventional Endoscopic Procedures Lisa Glass, James M. Scheiman, Richard S. Kwon, Grace H. Elta, Erik-Jan Wamsteker, Cyrus R. Piraka, B. Joseph Elmunzer, Amy N. Mertens, Michelle A. Anderson Background: Pancreaticobiliary specimens suitable for translational research are difficult to obtain due to low rates of subject enrollment. Fear of harm related to study participation is commonly cited by eligible subjects. We tested the hypothesis that endoscopic sampling of the pancreatobiliary system for research is associated with higher complication rates. Methods: Patients approached for a prospective study of biomarkers for the dx of pancreatic cancer between 8/2008 and 11/2009 were included. Subjects provided up to 3 additional pancreatic FNAs by EUS; or bile, pancreatic juice and/or CBD or pancreatic duct brushings by ERCP. Complications were prospectively tracked. Subjects were not included if no clinical or research samples were collected or if no ducts were cannulated at ERCP. Complication rates in subjects who provided research specimens were compared to rates in subjects who did not provide research specimens. Results: 232 patients met inclusion criteria and 134 patients (59 Women, mean age 57.7 yrs (25-85) were enrolled in the study.118 patients completed EUS (67) and/or ERCP (51) and had clinical and/or research specimens obtained and make up the study cohort. 20 (17%) patients experienced a complication, including isolated abdominal pain (9) (4 EUS/5 ERCP), acute pancreatitis (8)(6 ERCP/2 EUS), infected pseudocyst (1), bacteremia (1) and GI bleed (2)(1 EUS/1ERCP). Complications were more common in patients undergoing ERCP (13) than those having EUS (7). Overall complication rates were lower in those who had additional research sampling than in those who did not 15.6% vs 20.6%, OR 0.71(95% CI 0.26-1.90) [See Table] although this was not statistically significant. Pancreatitis rates were nearly identical in these two groups (6.9% vs 5.9%, research samples vs no research specimens). There was no association between the # FNA samples obtained and risk of a complication. Conclusion: Our data suggest there is minimal or no increased risk associated with additional sampling for research during EUS and ERCP. These data may encourage more people to enroll in translational research studies. Complications: Subjects providing research samples versus those who did not

S1373 Analysis of Prevalence, Mortality Rate and Predicting Factors for Severe Acute Pancreatitis According to the Revised Atlanta Classification Joong Ho Bae, Dong Soo Han, Yil Sik Hyun, Hye Sun Park, Sang Bong Ahn, Tae Yeob Kim, Chang Soo Eun, Yong Cheol Jeon, Joo Hyun Sohn Background & Aims: Atlanta classification states that acute pancreatitis is classified as ‘severe' if there is an evidence of organ failure at the time of admission. Since early 2008, the definition of severe acute pancreatitis has been modified, and an important addition to the previous definition comprises the fact that persistence of organ failure after 48 hours must be fulfilled in order to satisfy the modified definition. At present, 10-20% of acute pancreatitis progresses to severe acute pancreatitis, and among them mortality of 10-30% has been reported. There has been no study reporting the incidence and mortality of severe acute pancreatitis since the revision of Atlanta classification. Thus, this study aims to measure the incidence and mortality together with predicting factors for the severe acute pancreatitis, according to the revised Atlanta classification. Methods: We performed a retrospective analysis of 275 patients who were hospitalized from 2005 to 2008, after diagnosed as acute pancreatitis at Hanyang University Guri Hospital. All patients were classified as either ‘severe' or ‘nonsevere' group according to the revised Atlanta classification. The incidence and mortality of severe acute pancreatitis were obtained. Univariate and multivariate analysis were performed to determine the independent predictive factors for predicting ‘severe' acute pancreatitis. Results: The incidence and mortality of severe acute pancreatitis after the application of revised Atlanta classification were 8% (n = 24) and 33.3% (n = 8), respectively. The most common cause of severe acute pancreatitis was alcohol (58%, n = 14), and 5 out of 8 patients who died were due to alcohol-induced pancreatitis. Age, CRP, BUN and creatitine were independent predicting factors for severe acute pancreatitis. APACHE-II score was the only significant scoring system that predicted the outcome of severe acute pancreatitis. Conclusion: Since the application of the revised Atlanta classification, the incidence of severe acute pancreatitis decreased while the mortality increased. The application of the revised classification will enable prompt management of severe acute pancreatitis while preventing overtreatment of non-severe pancreatitis.

S1371 Admission Systemic Inflammatory Response Syndrome (SIRS) Score Predicts the Development of Primary Intra-Abdominal Infection in Patients With Acute Pancreatitis Rupjyoti Talukdar, Santhi Swaroop Vege, Magdalen A. Clemens Background and aim: Presence of organ failure in acute pancreatitis (AP) is known to be associated with infected necrosis and high mortality. However, there are no known predictors of intra-abdominal infection in AP at admission. The aim of this study is to assess the capability of simple baseline parameters at admission to predict intra-abdominal infection. Methods: We prospectively studied 274 consecutive patients with acute pancreatitis (AP) directly admitted to Mayo Clinic hospitals over a two year period. We identified the patients who had microbiologically confirmed infections of pancreatic necrosis and peripancreatic fluid collections; and defined primary intra-abdominal infection as any infection that developed prior to any abdominal intervention. We recorded admission hematocrit, BMI, serum BUN/creatinine and SIRS score; and used univariate and multivariate conditional logistic regression analysis to assess if these parameters could predict development of intraabdominal infections. We expressed the results as odds ratio (OR) [95% confidence intervals (CI)] and considered a 'p' value of < 0.05 as statistically significant. Results: Overall, 44 (16.1%) patients had infections. 26 (9.5%) had intra-abdominal infection, of whom 20 (79.9%) had primary intra-abdominal infection. Among patients with primary intra-abdominal infection, 8 (40%) had gram positive, 1 (5%) gram negative and 11 (55%) mixed

S1374 The Causes and Outcome of Pancreatitis Associated With Serum Lipase Exceeding 10,000 Daniel Cornett, Bret J. Spier, Patrick Pfau Background: The relative cause of pancreatitis nor the clinical outcome in patients with markedly elevated serum lipase concentration has not been studied nor reported. Aim: The goal of this investigation was to describe the etiology and clinical outcome of patients

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AGA Abstracts

test (Roche) was used. To study platelets morphology, the two dimension analysis have been used (ADVIA 2120, Siemens). Results: At day 1 (hospital admission) number of CD41 molecules on platelets was significantly (p<0.01) higher both in M-AP (58595±7322) and S-AP (62213±11740) patients, than in the control (46152±9262). At day 30, the number of CD41 molecules was normalized only in M-AP group. Measurement with TRAP showed significant increase of GPIIb at day 1 and 30, only in S-AP patients. At day 30, platelet reactivity expressed by the number of CD62P was higher than at day 1 (7227±2614 vs 6448±2541) and still significantly higher than in control group (1642±283) (p<0.001). Concentration of b-TG was significantly higher (p<0.001) in the M-AP patients (day 1: 120±74; day 30: 143±85 UI/ml) and S-AP (day 1: 137±54, day 30: 161±64 UI/ml) than in control group (62±14 UI/ml). The population of youngest, most active platelets (L-PLT) was significantly increased in both groups of AP patients (M-AP: 7200/μl±3300; S-AP: 8200/ μl±4600; control: 4500/μl±1700), but at day 30 L-PLT was significantly higher in S-AP patients, than in MAP (9400/μl±6200 vs 6000/μl±1600). Similarly, decrease of MPC correlated with platelet degranulation, was more evident in S-AP group at day 1 and day 30 (S-AP: day 1 - 23 g/dl±1.5; day 30 - 23 g/dl±2.3; MAP: day 1 - 24 g/dl±1.2; day 30 25 g/dl±1,9; control: 28±1.6). Conclusions: At the admission, platelets are highly activated in patients with both, M-AP and S-AP. At the day 30, despite normal resting activity in MAP, platelets of patients with M-AP and S-AP retained high potential for activation, expressed by increased level of P-selectin (CD62P) after TRAP activation. It is consistent with remained high level of b-TG and increased platelets turnover.