Severe Acute Pancreatitis Prediction: A Model Derived From a Prospective Registry Cohort.

Background Severe acute pancreatitis (SAP) has a mortality rate as high as 40%. Early identification of SAP is required to appropriately triage and direct initial therapies. The purpose of this study was to develop a prognostic model that identifies patients at risk for developing SAP of patients managed according to a guideline-based standardized early medical management (EMM) protocol. Methods This single-center study included all patients diagnosed with acute pancreatitis (AP) and managed with the EMM protocol Methodist Acute Pancreatitis Protocol (MAPP) between April 2017 and September 2022. Classification and regression tree (CART®; Professional Extended Edition, version 8.0; Salford Systems, San Diego, CA), univariate, and logistic regression analyses were performed to develop a scoring system for AP severity prediction. The accuracy of the scoring system was measured by the area under the receiver operating characteristic curve. Results A total of 516 patients with mild (n=436) or moderately severe and severe (n=80) AP were analyzed. CART analysis identified the cutoff values: creatinine (CR) (1.15 mg/dL), white blood cells (WBC) (10.5 × 109/L), procalcitonin (PCT) (0.155 ng/mL), and systemic inflammatory response system (SIRS). The prediction model was built with a multivariable logistic regression analysis, which identified CR, WBC, PCT, and SIRS as the main predictors of severity. When CR and only one other predictor value (WBC, PCT, or SIRS) met thresholds, then the probability of predicting SAP was >30%. The probability of predicting SAP was 72% (95%CI: 0.59-0.82) if all four of the main predictors were greater than the cutoff values. Conclusions Baseline laboratory cutoff values were identified and a logistic regression-based prognostic model was developed to identify patients treated with a standardized EMM who were at risk for SAP.

Robotic assisted kidney auto-transplantation as a safe alternative for treatment of nutcracker syndrome and loin pain haematuria syndrome: A case series report.

BACKGROUND: Describe the outcomes and safety of robotic-assisted kidney auto-transplantation (RAKAT) in the treatment of nutcracker syndrome (NCS) and loin pain haematuria syndrome (LPHS). METHODS: This retrospective study included 32 cases of NCS and LPHS seen during December 2016 to June 2021. RESULTS: Three (9%) patients had LPHS and 29 (91%) NCS. All were non-Hispanic whites, and 31 (97%) women. The mean age was 32 years (SD = 10) and the BMI 22.8 (SD = 5). The RAKAT was completed in all patients, 63% had a total improvement of pain. According to the Clavien-Dindo classification, 47% presented with type 1, and 9% with type 3 complications with a mean follow-up of 10.9 months. The incidence of acute kidney injury in post-procedure was 28%. No one required blood transfusions, and there were no deaths during the follow-up. CONCLUSION: RAKAT was a feasible procedure with a similar complication rate to those reported for other surgical techniques.

Updates on the Model for End-Stage Liver Disease Score and Impact on the Liver Transplant Waiting List: A Narrative Review.

The model for end-stage liver disease (MELD) score is an established indicator of cirrhosis severity and a predictor of morbidity and mortality in patients undergoing transjugular intrahepatic portosystemic shunt (TIPS) creation and for allocation in liver transplantation. Since the adoption of the score, its use has been expanded to multiple new indications requiring model modifications, including relevant clinical and demographic variables, to increase predictive accuracy. The purpose of this report is to provide an update on the modifications made to the MELD score, comparing their performance with C statistics, advantages and disadvantages, and impact on mortality at 3 months after placing a TIPS or awaiting liver transplantation.

Albumin-Bilirubin (ALBI) Score and Systemic Immune-Inflammation Indexes Used As Pretreatment Outcome Predictors in Patients With Pancreatic Ductal Adenocarcinoma Undergoing Robotic or Open Whipple Procedures: A Logistic Regression Analysis.

Background Pancreatic ductal adenocarcinoma (PDAC) is the most common type of pancreatic cancer (PC) in the United States. In patients with resectable PC, identification of pretreatment biomarkers before surgery can help in the decision-making process by weighing the benefits of neo-adjuvant therapy, surgical procedure, and adjuvant therapy. The purpose of this study was to determine if the albumin-bilirubin (ALBI) score and immune-inflammatory marker levels can be used in combination as pretreatment predictors of mortality risk in patients undergoing the Whipple procedure (alternatively, pancreatoduodenectomy (PD)) for PDAC. Methods This retrospective study included 115 patients with PDAC who underwent open or robotic Whipple procedures between January 2013 and December 2022 at a single tertiary medical center. Logistic regression analysis was used to find the association between predictors and mortality. Machine learning algorithms were used to calculate the performance of the different models. Results Bivariate analysis showed that the variables "sex" and "body mass index (BMI)" had a potential association with mortality, although statistical significance was not achieved for sex (p = 0.07). Patients with BMIs >25 kg/m2 had a higher risk of mortality compared to patients with BMIs ≤24.9 kg/m2 (odds ratio (OR) = 2.2, 95% CI = 1.03-4.8, p = 0.04). Higher (more positive) ALBI scores (>-2.24) were also associated with increased mortality risk (OR = 4.6, 95% CI = 2-10.5, p = 0.0003). When the cutoff values of the inflammatory markers were used to categorize these variables, values greater than the cutoff values were associated with an increased risk of mortality. In the multivariate logistic regression model, an ALBI score >-2.24 (OR = 4.3, 95% CI = 1.8-10.3, p = 0.0008), neutrophil-to-lymphocyte ratio (NLR) >3.5 (OR = 3.3, 95% CI = 1.4-7.9, p = 0.007), and being a woman (OR = 2.6, 95% CI = 1.1-6.4, p = 0.03) remained influential predictors of increased mortality (c value = 0.77). Conclusion The ALBI score and the NLR are easily accessible markers; their use, combined with a patient's sex, can provide useful pre-surgical information regarding mortality risk after PD. This can aid in treatment planning as well as expedite decisions about the type of Whipple procedure, adjuvant therapy, and surveillance, which can subsequently improve a patient's outcomes and survival.