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Objective:To investigate the predictive value of acute gastrointestinal injury (AGI) score for the severity of acute pancreatitis (AP), infectious pancreatic necrosis and patients′ death.Methods:Clinical data of 719 patients with AP were collected from the AP database of the National Clinical Research Center for Digestive System Diseases from January 2016 to June 2018. According to the severity of the disease, they were divided into MAP group (506 cases), MSAP group (112 cases) and SAP group (101 cases). AGI, APACHEⅡ, MCTSI and BISAP scores were calcululated in the three groups. Receiver operating characteristic curve (ROC) was drawn and the area under the curve (AUC) was calculated. The predictive value of the above four scoring systems for the hospitalization days, disease severity, infectious pancreatic necrosis and death was analyzed, respectively.Results:There were no cases of infectious pancreatic necrosis or death in the MAP group, but there were 9 cases of infectious pancreatic necrosis and 2 deaths in the MSAP group and 19 cases of infectious pancreatic necrosis and 8 deaths in the SAP group. There was a strong correlation between AGI score and AP patients′ hospitalization days ( r=0.619). AUC of AGI, APACHEⅡ, MCTSI and BISAP score in predicting the AP patients′ severity (MSAP+ SAP) was 0.967 (95% CI 0.951-0.982), 0.769(95% CI 0.720-0.899), 0.842(95% CI 0.809-0.875), 0.862 (95% CI0.832-0.893). AUC for forecasting infectious pancreatic necrosis was 0.803, 0.677, 0.692, 0.724, and the 95% CI was 0.724-0.882, 0.573-0.781, 0.582-0.636, 0.801-0.812. AUC for predicting death in patients with AP were 0.915, 0.597, 0.659, 0.812, and the 95% CI were 0.843-0.986, 0.444-0.751, 0.498-0.698 and 0.882-0.926. AGI score had the highest predictive value, followed by BISAP score, and the correlation between these two scores was the closest. The predictive value of AGI combined with BISAP score for infectious pancreatic necrosis and patient death (AUC were 0.837, 0.942, 95% CI were 0.770-0.903, 0.897-0.987) was better than that of AGI and BISAP score alone. Conclusions:AGI score combined with BISAP score is more effective in predicting the severity of AP, the occurrence of infectious pancreatic necrosis or patient death.
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Objective@#To compare the therapeutic value of transnasal gastroscopy and conventional gastroscopy for infective pancreatic necrosis(IPN) through percutaneous endoscopic necrosectomy(PEN).@*Methods@#A total of 24 IPN patients who received PEN for IPN from December 2015 to March 2019 were divided into the conventional gastroscopy group (n=15) and the transnasal gastroscopy group (n=9). The clinical therapeutic indicators such as vital signs, APACHE Ⅱ score changes, operation duration, difference in preoperative and postoperative volumes of peripancreatic necrosis and other indicators were compared between the two groups.@*Results@#There was no significant difference in the variation curve fitting of APACHE Ⅱ scores between the two groups (t=0.378, P=0.710). The operation time of the transnasal gastroscopy group was significantly shorter than that of the conventional gastroscopy group (119.7±47.4 min VS 172.8±56.2 min, P=0.018). Peripancreatic necrotic volume significantly decreased after operation in the transnasal gastroscopy group (404.03±170.73 mL VS 468.9±137.37 mL, P=0.002), and in the conventional gastroscopy group (499.44±227.17 mL VS 722.50±292.96 mL, P<0.001). There was no significant difference in the decrease extent in the conventional gastroscopy group and the transnasal gastroscopy group (223.06±212.92 mL VS 64.87±54.94 mL, P= 0.094).@*Conclusion@#On the condition of poor drainage of percutaneous catheter drainage, PEN can significantly reduce the range of necrotic lesions. Transnasal gastroscopy has the advantages in operation time in PEN and clearing deep abscess cavities over conventional gastroscopy.
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Objective To investigate the early predictive value of several commonly used biochemical markers for predicting persistent organ failure ( POF ) in patients with hyperlipidemic acute pancreatitis ( HLAP) . Methods Clinical data of 157 patients with HLAP within 72 hours after the onset of first attack who were admitted to the Dept. of Gastroenterology in Changhai Hospital from January 2015 to December 2017 were retrospectively analyzed, including 106 cases without POF ( non POF group ) and 51 cases with POF ( POF group) . Hct, BUN, Cr, APACHEⅡand BISAP were recorded within 24 hours after admission. Receiver-operating characteristic ( ROC) curve was drawn to calculate area under the ROC curve ( AUC) and evaluate the performance of Hct, BUN, Cr, APACHEⅡand BISAP scores in predicting HLAP complicated with POF, which was compared by DeLong test. Results Values of BUN, Cr, APACHEⅡand BISAP were significantly higher in HLAP patients with POF than those without POF [(10. 30 ± 7. 43) vs (5. 34 ± 2. 26) mmol/L, (165. 31 ± 123. 93) vs (65. 61 ± 20. 82)μmol/L, (10. 22 ± 6. 22) vs (4. 61 ± 2. 99) points, (2. 61 ± 0. 87) vs (1. 42 ± 1.07) points], and the differences were all statistically significant (all P<0.05), whereas Hct was not significantly different between the two groups. The AUC of Cr and BUN for predicting POF was 0. 77(95％ CI, 0. 69-0. 86) and 0. 71 (95％ CI, 0. 61-0. 81), respectively, and the optimum predictive Cut-off values were 130 μmol/L and 8. 95 mmol/L, respectively. The sensitivity was 53％, and the specificity was 99％ and 94％;the accuracy was 84％ and 81％;negative predictive value was 81％, and positive predictive value was 96％ and 82％. DeLong test showed that predictive performance of BUN and Cr was not statistically different from that of APACHEⅡand BISAP. Conclusions Cr≥130 μmol/L and BUN≥8. 95 mmol/L can be used clinically to predict the presence of POF in HLAP, and the predictive efficacy were comparable to APACHEⅡand BISAP.
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Objective To investigate the impact of the initial fluid resuscitation with different ratio of crystalloid and colloid on the prognosis of patients with moderate severe acute pancreatitis (MSAP).Methods A retrospective analysis was made by reviewing the clinical data of 72 patients with the diagnosis of MSAP from January 2015 to July 2017 in Shanghai Changhai Hospital.According to crystalloid-colloid ratio,which was the total volume of crystalloid fluid versus colloid fluid in the first 7d at admission,patients were randomly divided into low crystalloid-colloid ratio group (＜ 4.5),middle crystalloid-colloid ratio group (4.5-7.5),and high crystalloid-colloid ratio group (＞ 7.5).The parameters of the fluid resuscitation,the cases progressing into severe acute pancreatitis (SAP),the incidence of multiple organs dysfunction syndrome (MODS) and mechanical ventilation,pancreatic necrosis and infection rate,30-day mortality,the duration of systemic inflammatory response syndrome(SIRS) and the time reaching full amount of enteral nutrition were analyzed.Results There was no statistically significant difference in gender,age,etiology and APACHE Ⅱ score within 24 h at admission in each group,which were comparable.Within the first 7 d,there were no statistic difference in the total volume of fluid infusion and the speed of resuscitation in the three groups.While the total fluid volume in the first 24 h and 72 h [(3 095 ± 1 253) ml vs (2 524 ± 751) ml,(8 005 ± 7 269) ml vs (6 667 ± 1 498)ml],the total volume of crystalloid fluid in the first 7 d [(14 485 ± 3 917) ml vs (11 544 ±2 639) ml],crystalloid-colloid ratio (12.7 ± 4.9 vs 6.0 ± 1.0),the cases of SAP (12 vs 4),MODS (41.7 ％vs 16.0％) in high ratio group were significantly higher than those in middle ratio group,but the total volume of colloid fluid was significantly lower [(996 ± 528) ml vs (1 968 ± 574) ml].In addition,the duration of SIRS [(16.5 ± 15.2) d vs (8.2 ± 6.4) d],and the time reaching full amount of enteral nutrition [(7.2 ±3.6) d vs (4.8 ± 2.4) d] in high crystalloid-colloid ratio group were higher than those in middle crystalloid-colloid ratio group (all P ＜ 0.05).Comparing with middle crystalloid-colloid ratio group,there were no significant difference in the mechanical ventilation rate,pancreatic necrosis and infection rate and 30-day mortality in high ratio group.The total volume of colloid fluid was significantly higher [(3 680 ± 1 310) vs (1 968 ±574)] and the crystalloid-colloid ratio was significantly lower [(3.2 ±0.9) vs (6.0 ± 1.0)] in low ratio group than that in middle ratio group,and there were no statistical differences on other parameters.Conclusions For the patients with MSAP,early fluid resuscitation with the crystatloid-colloid ratio of (4.5-7.5) can decrease the incidence of SAP and MODS,shorten the duration of SIRS,and promote the recovery of intestinal mucosal barrier function.
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Objective To evaluate the therapeutic effect of percutaneous endoscopic necrosectomy (PEN) in treating infectious pancreatic necrosis (IPN).Methods A retrospective review of clinical data of 6 patients with IPN who received PEN in Changhai Hospital, Second Military Medical University from Dec 2015 to Sep 2016 was performed.Clinical parameters were recorded, including basic information, severity evaluation and therapeutic methods and times.In addition, vital sign parameters and inflammatory marks before and after PEN treatment were compared.Results There were 4 patients with severe acute pancreatitis (SAP) and 2 patients with moderately severe acute pancreatitis (MSAP) in these 6 patients with IPN.Mean APACHEⅡ score was 12 (10~15), and mean MCTSI scores was 9.3(8~10).All 6 patients received a total of 13 times PEN treatments, with a mean of 2.2(1~3) times.Each patient was treated with a mean of 2.5(1~4) drainage tubes placed in the peripancreatic abscess after PEN treatment, and the mean time for drainage was 139 d(106~183 d).Besides, the mean hospitalization time was 116 d (48~223 d).All the patients′ condition was improved significantly after PEN treatment, including reduced heart rate, body temperature and inflammatory markers, without bleeding or other serious complications.Only 1 patient had pancreatic fistula after treatment, and no patients needed open abdominal drainage surgery.Patients with higher MCTSI scores likely required more times of PEN and more drainage catheters, longer length of drainage and hospital stay.Conclusions PEN was safe and effective for treating patient with IPN, but those with higher MCTSI scores were associated with more PEN treatments, more drainage tubes, and longer time of drainage and hospitalization.
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Objective To investigate the risk factors for failure of percutaneous catheter drainage (PCD) for patients with infective pancreatic necrosis (IPN).Methods A retrospective review of medical records of patients with IPN who received PCD at Pancreatic Intensive Care Unit (PICU) of Changhai Hospital from April 2010 to June 2014 was performed.The patients were divided into 2 groups:(1) PCD success group (n =48) and (2) PCD failure group (n =12).The potential parameters for failure of PCD were recorded,which included age,sex,etiology,length of hospital stay,outcome,MCTSI,APACHE Ⅱ scores,number of organ failure,duration of use of antibiotics,duration of use of PPIs,if delayed fluid resuscitation occurred,start of enteral nutrition,nutrition status,etc,and univariate and multivariate logistic regression analysis was used.Results Univariate analysis showed MCTSI,number of organ failure,malnutrition,use of PPIs (more than two weeks),delayed enteral nutrition,delayed fluid resuscitation,the number of drainage catheter,number of aspiration,multi-drug resistant infections of drainage fluid were risk factors for failure of PCD;while multivariate logistic regression analysis showed that MCTSI (OR =3.33;95％ CI 1.52 ～ 7.29;P =0.003);multi-drug resistant infections of drainage fluid (OR =8.62;95 ％ CI 1.11 ～ 67.19;P =0.040) were risk factors for failure of PCD.Conclusions MCTSI and multi-drug resistant infections of drainage fluid can significantly influence the success rate of PCD.PCD should be carefully considered for patients with high score of MCTSI and multi-drug resistant infections of drainage fluid.
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Objective To evaluate the value of medical treatment in the management of SAP.Methods From January 2000 to December 2011,a total of 1064 cases out of 931 SAP patients were admitted and retrospectively analyzed.The etiologies,severity score,complication rates,therapies,effectiveness and costs of those SAP cases were summarized.Results There were 559 males and 372 females with a mean age of (51 ± 15)years old.The main cause was biliary tract disease (58.3％),followed by fat-rich diet (31.2％),hyperlipidemia (13.6％) and alcohol (7.1％).At the time of admission,95.5％ of SAP patients presented with level D disease according to Balthazar CT severity index,26.0％ had a Ranson score ≥3 and 30.1％ had an APACHE Ⅱ score ≥ 8.There were 42.7％ cases complicated with systemic inflammatory response syndrome (SIRS).Acute lung injury and acute respiratory distress syndrome (ARDS),acute kidney injury,shock or heart failure,acute liver dysfunction,and diffuse intravascular clotting (DIC)occurred in 24.0％,8.1％,5.4％,3.2％,and 1％ of all patients,respectively.Other complications of SAP included abdominal cavity bleeding (n =17),pseudocyst bleeding (n =9),pancreatic abscess (n =78) and gastrointestinal fistula (n =33).Totally 25 (2.3％) patients died in hospital and 36 (3.4％) patients were discharged against advice,with an overall treatment success rate of 94.3％.The mean hospital stay was (23.7 ± 19.2) d,and the average cost was 52.3 thousands of RMB.Conclusions A comprehensive treatment pathway relying on medical treatment,focusing on organ function support and assisted by miniinvasive intervention may improve the treatment success rate of SAP,which is worth of further application.
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Objective To investigate the relationship between alcohol and smoking and the development of pancreatic calcification in chronic pancreatitis (CP) in China. Methods The patients were divided into two groups according to the presence of pancreatic calcification at admission and the data were analyzed; furthermore, the discharged patients without pancreatic calcification were divided into two groups as newly diagnosed pancreatic calcification group and persistent non-pancreatic calcification group. Logistic regression and Cox proportional-hazards model was used for multivariate analysis of the risk factors for pancreatic calcification. Results From January1997 to July 2007, 449 patients with CP were enrolled and followed up successfully. 248 patients presented with pancreatic calcification at admission; among the 201 patients presented without pancreatic calcification, 13 patients developed pancreatic calcification after discharge. Patients with pancreatic calcification had a young age at onset, long CP history, higher incidence of diabetes mellitus and diarrhea. Age at onset ≤ 40, alcohol intake over 20 g/day, and diabetes mellitus and diarrhea were risk factors for pancreatic calcification. The only risk factor of development of pancreatic calcification after discharge was excessive alcohol intake (OR: 3.2). Conclusions Alcohol intake increased the risk of pancreatic calcifications, suggesting the patients abstain from alcohol intake. Further studies are necessary to clarify the role of smoking.
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Objective To determine the efficacy of therapeutic endoscopic retrograde cholangio-pan-creatography (ERCP) in treatment of pain of chronic pancreatitis (CP). Methods The data of CP patients accompanying with pain, who received therapeutic ERCP from 1997 to 2006, were retrospectively analyzed.The diagnosis of CP was made based on the criteria from 2002 Asia-Pacific Consensus, and the effect of ther-apy was evaluated. Results Of 253 patients who received therapeutic ERCP, follow-up data were obtained from 214 patients ( 144 males and 70 females, ages ranging from 6.5 to 78.0 years, mean age 40. 5 years).The mean follow-up period was 41.9 months (12～131 months). Twenty-eight patients (13. 1% ) under-went surgery after ERCP. Relief rates of pain in patients who underwent ERCP with or without operation were 71.4% and 83.9% (P >0. 05 ) respectively. The overall relief rate of ERCP was 73%. The incidence of major complications related to the procedure was 14.9% (71/476) in terms of ERCP sessions, including post-ERCP pancreatitis in 12. 6%, mild cholangitis in 2. 1% and hemorrhage in 0. 2%. All complications sub-sided with conservative medical managements in 2 to 20 days. No perforation or death related to the procedure occurred. Conclusion Therapeutic ERCP is a mean of effective management of pain in patients with CP.