Research Article
Volume 8 Issue 10 - 2021
Therapeutic Way to Predicting Acute Pancreatitis Non-Necrotising (Mild) and Necrotising (Severe) at 24 Hrs
Aswini K Pujahari*
Department of Surgery (GI Surgery), AFMC, Pune and Command Hospital, AF and Professor, Department of Surgical gastroenterology, SIMS and RC, Bangalore, India
*Corresponding Author: Aswini K Pujahari, Department of Surgery (GI Surgery), AFMC, Pune and Command Hospital, AF and Professor, Department of Surgical gastroenterology, SIMS and RC, Bangalore, India.
Received: July 28, 2021; Published: September 14, 2021




Abstract

Hypothesis: Intravenous fluid therapy is established in skin burn and acute pancreatitis. Surface area and depth decide the fluid volume in burn. Acute pancreatitis is a chemical burn of pancreas and retroperitoneum, can the volume of fluid therapy determine the severity?

Introduction: Acute pancreatitis can be mild to Severe. Currently available methods to predict severe pancreatitis are complex, cumbersome and inaccurate. A simple way is required.

Materials and Methods: Patients presenting clinically as acute pancreatitis with elevated serum amylase/lipase thrice than normal were managed by intravenous fluid similar to skin burnt injury, so as to have urine output of 0.5 - 1 mL per Kg. Based on the difference between the intake and output, they were predicted as necrotising/non-necrotising at 24 hrs. Confirmation was done on CT scan after 72 hrs or at autopsy.

Results: There was 63 patients with 9 females and 54 males, age ranging from 19 - 59 years. 38 were predicted mild and 25 as severe based on the fluid deficit ranged from 0.4 lit to 9.9L after 24 hrs. the prediction was accurate in 84.126% (severe 85.185% and non-severe 83.333%) cases and inaccurate in 15.873% of cases. And on ROC the area under the curve came out to be 88% at a confidence interval of 95% with a sensitivity and specificity of 88.416 and 82.857% respectively. Patients with fluid deficit > 8.7L died.

Conclusion: Fluid deficit at 24 hrs can predict severe AP 85.2%. Fluid deficit > 8.7 L at 24 hours were fatal.

 

Keywords: Acute Pancreatitis; Predicting Severe; 24 Hrs Fluid Deficit; Non-Necrotising; Sterile Necrosis; Infected Necrosis

References

  1. Delrue LJ., et al. “Acute pancreatitis: radiologic scores in predicting severity and outcome”. Abdom Imaging 35 (2010): 349-361.
  2. Zhi Zheng., et al. “A narrative review of acute pancreatitis and its diagnosis, pathogenetic mechanism, and management Affiliations expand”. The Annals of Translational Medicine's 9 (2021): 69.
  3. Ricardo Ruiz Ch. “Acute Pancreatitis”. Revista de Gastroenterología del Perú 1 (1998): 99-107.
  4. Ashok Saluja., et al. “Early Intra-Acinar Events in Pathogenesis of Pancreatitis”. Gastroenterology 156 (2019): 1979-1993.
  5. Ozan Ozcan., et al. “Protective effect of Myrtle (Myrtus communis) on burn induced skin injury”. Burns 45 (2019): 1856-1863.
  6. Göksel Sener., et al. “Leukotriene receptor blocker montelukast protects against burn-induced oxidative injury of the skin and remote organs”. Burns 31 (2005): 587-596.
  7. Levent Kabasakal., et al. “Burn-induced oxidative injury of the gut is ameliorated by the leukotriene receptor blocker montelukast”. Prostaglandins, Leukotrienes and Essential Fatty Acids - Journals 72 (2005): 431-440.
  8. Bailey and Love’s, Chapter 30, 26th Edited by Norman S. Williams, Christopher J.K. Bulstrode, P. Ronan O’Connell, CRC press (2013).
  9. Mitali Mehta and Gregory J. “Tudor Parkland Formula”. In: Stat Pearls [Internet]. Treasure Island (FL): Stat Pearls Publishing (2021).
  10. Bechien U Wu. “Editorial: fluid resuscitation in acute pancreatitis: striking the right balance”. The American Journal of Gastroenterology 106 (2011): 1851-1852.
  11. DiZerega GS. “Peritoneum, Peritoneal Healing, and Adhesion Formation”. In: diZerega G.S. (editions) Peritoneal Surgery. Springer, New York, NY (2000).
  12. Takeshi Tomoda., et al. “Combination of Diclofenac and Sublingual Nitrates Is Superior to Diclofenac Alone in Preventing Pancreatitis After Endoscopic Retrograde Cholangiopancreatography”. Gastroenterology 156 (2019): 1753-1760.e1.
  13. EJ Balthazar., et al. “Acute pancreatitis: value of CT in establishing prognosis”. Radiology2 (1990): 331-336.
  14. Emil J Balthazar. “Acute pancreatitis: assessment of severity with clinical and CT evaluation”. Radiology 223 (2002): 603-613.
  15. Sarr MG. “2012 revision of the Atlanta classification of acute pancreatitis”. Polish Archives of Internal Medicine - Medycyna Praktyczna 123 (2013): 118-124.
  16. Todd H Baron., et al. “American Gastroenterological Association Clinical Practice Update: Management of Pancreatic Necrosis Gastroenterology 158 (2020): 67-75.e1.
  17. Tyler Stevens., et al. “Acute pancreatitis: Problems in adherence to guidelines”. Cleveland Clinic Journal of Medicine 12 (2009): 697-704.
  18. Aoun E., et al. “Diagnostic accuracy of interleukin-6 and interleukin-8 in predicting severe acute pancreatitis: a meta-analysis”. Pancreatology 9 (2009): 777-785.
  19. Theodore W James and Seth D Crockett. “Management of acute pancreatitis in the first 72 hours”. Current Opinion in Gastroenterology5 (2018): 330-335.
  20. Bechien U Wu. “Editorial: fluid resuscitation in acute pancreatitis: striking the right balance”. The American Journal of Gastroenterology 106 (2011): 1851-1852.
  21. John Y Nasr., et al. “Early fluid resuscitation in acute pancreatitis: a lot more than just fluids”. Clinical Gastroenterology and Hepatology 9 (2011): 633-634.
  22. Trikudanathan G., et al. “Current controversies in fluid resuscitation in acute pancreatitis: a systematic review”. Pancreas 41 (2012): 827-834.
  23. Bechien U Wu., et al. “Lactated Ringer's solution reduces systemic inflammation compared with saline in patients with acute pancreatitis”. Clinical Gastroenterology and Hepatology 9 (2011): 710-717.e1.
  24. Mao EQ., et al. “Fluid therapy for severe acute pancreatitis in acute response stage”. Chinese Medical Journal 122 (2009): 169-173.
  25. Wu BU., et al. “Lactated Ringer’s solution reduces systemic inflammation compared with saline in patients with acute pancreatitis”. Clinical Gastroenterology and Hepatology 9 (2011): 710-717.
  26. Haydock MD., et al. “National survey of fluid therapy in acute pancreatitis: current practice lacks a sound evidence base”. World Journal of Surgery 37 (2013): 2428-2435.
  27. Elisabeth De Waele., et al. “How to deal with severe acute pancreatitis in the critically ill”. Current Opinion in Critical Care 25 (2019): 150-156.
  28. Enver Zerem. “Treatment of severe acute pancreatitis and its complications”. World Journal of Gastroenterology 38 (2014): 13879-13892.
  29. GV Rodoman., et al. “[DIC-syndrome-related mortality in acute necrotic pancreatitis]”. Khirurgiia 5 (2018): 19-27.
  30. Mohammad Shafi Kuchay., et al. “Heparin and insulin in the management of hypertriglyceridemia-associated pancreatitis: case series and literature review”. Archives of Endocrinology and Metabolism 61 (2017): 198-201.
  31. Rajat Garg and Tarun Rustagi. “Management of Hypertriglyceridemia Induced Acute Pancreatitis”. BioMed Research International (2018): 4721357.
  32. Quentin M Nunes., et al. “The heparin-binding proteome in normal pancreas and murine experimental acute pancreatitis”. PLoS One 14 (2019): e0217633.
  33. Qiu Qiu., et al. “The efficacy of low molecular weight heparin in severe acute pancreatitis: A systematic review and meta-analysis of randomized controlled trials”. Journal of Digestive Diseases 20 (2019): 512-522.
  34. Enrique de-Madaria. “[Latest advances in acute pancreatitis]”. Clinical Gastroenterology and Hepatology 1 (2015): 100-105.
  35. FG Brivet., et al. “Pro- and anti-inflammatory cytokines during acute severe pancreatitis: an early and sustained response, although unpredictable of death. Parisian Study Group on Acute”. Pancreatiti Critical Care Medicine 27 (1999): 749-755.
  36. Allison L Yang. “Nutrition and Acute Pancreatitis”. Journal of Clinical Medicine 10 (2021): 836.
  37. Attila Oláh and Laszlo Romics Jr. “Enteral nutrition in acute pancreatitis: a review of the current evidence”. World Journal of Gastroenterology 20 (2014): 16123-16131.
  38. Jianbo Song., et al. “Enteral nutrition provided within 48 hours after admission in severe acute pancreatitis: A systematic review and meta-analysis”. Medicine 97 (2018): e11871.
  39. Piet J Lodewijkx., et al. “Nutrition in acute pancreatitis: a critical review”. Expert Review of Gastroenterology and Hepatology 10 (2016): 571-580.
  40. Beata Jabłońska and Sławomir Mrowiec. “Nutritional Support in Patients with Severe”. Acute Pancreatitis-Current Standards Nutrients 5 (2021): 1498.
  41. Hideto Yasuda., et al. “Etiology and mortality in severe acute pancreatitis: A multicenter study in Japan”. Pancreatology3 (2020): 307-317.
  42. JJ Powell., et al. “Survey of antibiotic prophylaxis in acute pancreatitis in the UK and Ireland”. British Journal of Surgery 86 (1999): 320-322.
  43. C Bassi., et al. “Antibiotic therapy for prophylaxis against infection of pancreatic necrosis in acute pancreatitis”. Cochrane Database of Systematic Reviews 4 (2003): CD002941.
  44. Villatoro E., et al. “Antibiotic therapy for prophylaxis against infection of pancreatic necrosis in acute pancreatitis”. Cochrane Database of Systematic Reviews4 (2006): CD002941.
  45. Eduardo Villatoro., et al. “Antibiotic therapy for prophylaxis against infection of pancreatic necrosis in acute pancreatitis”. Cochrane Database of Systematic Reviews 5 (2010): CD002941.
  46. Cheng Zhu., et al. “Intra-abdominal infection in acute pancreatitis in eastern China: microbiological features and a prediction model”. Annals of Translational Medicine 9 (2021): 477.
  47. Mark C van Baal., et al. “Dutch Pancreatitis Study Group) The role of routine fine-needle aspiration in the diagnosis of infected necrotizing pancreatitis”. Surgery 155 (2014): 442-448.
  48. Pramod Kumar Garg., et al. “Association of extent and infection of pancreatic necrosis with organ failure and death in acute necrotizing pancreatitis”. Clinical Gastroenterology and Hepatology 3 (2005): 159-166.
  49. Antonio Carnovale., et al. “Mortality in Acute Pancreatitis: Is It an Early or a Late Event? Antonio Carnovale1 JOP”. JOP Journal of the Pancreas5 (2005): 438-444.
Citation: Aswini K Pujahari. “Therapeutic Way to Predicting Acute Pancreatitis Non-Necrotising (Mild) and Necrotising (Severe) at 24 Hrs”. EC Gastroenterology and Digestive System 8.10 (2021): 25-39.

PubMed Indexed Article


EC Pharmacology and Toxicology
LC-UV-MS and MS/MS Characterize Glutathione Reactivity with Different Isomers (2,2' and 2,4' vs. 4,4') of Methylene Diphenyl-Diisocyanate.

PMID: 31143884 [PubMed]

PMCID: PMC6536005


EC Pharmacology and Toxicology
Alzheimer's Pathogenesis, Metal-Mediated Redox Stress, and Potential Nanotheranostics.

PMID: 31565701 [PubMed]

PMCID: PMC6764777


EC Neurology
Differences in Rate of Cognitive Decline and Caregiver Burden between Alzheimer's Disease and Vascular Dementia: a Retrospective Study.

PMID: 27747317 [PubMed]

PMCID: PMC5065347


EC Pharmacology and Toxicology
Will Blockchain Technology Transform Healthcare and Biomedical Sciences?

PMID: 31460519 [PubMed]

PMCID: PMC6711478


EC Pharmacology and Toxicology
Is it a Prime Time for AI-powered Virtual Drug Screening?

PMID: 30215059 [PubMed]

PMCID: PMC6133253


EC Psychology and Psychiatry
Analysis of Evidence for the Combination of Pro-dopamine Regulator (KB220PAM) and Naltrexone to Prevent Opioid Use Disorder Relapse.

PMID: 30417173 [PubMed]

PMCID: PMC6226033


EC Anaesthesia
Arrest Under Anesthesia - What was the Culprit? A Case Report.

PMID: 30264037 [PubMed]

PMCID: PMC6155992


EC Orthopaedics
Distraction Implantation. A New Technique in Total Joint Arthroplasty and Direct Skeletal Attachment.

PMID: 30198026 [PubMed]

PMCID: PMC6124505


EC Pulmonology and Respiratory Medicine
Prevalence and factors associated with self-reported chronic obstructive pulmonary disease among adults aged 40-79: the National Health and Nutrition Examination Survey (NHANES) 2007-2012.

PMID: 30294723 [PubMed]

PMCID: PMC6169793


EC Dental Science
Important Dental Fiber-Reinforced Composite Molding Compound Breakthroughs

PMID: 29285526 [PubMed]

PMCID: PMC5743211


EC Microbiology
Prevalence of Intestinal Parasites Among HIV Infected and HIV Uninfected Patients Treated at the 1o De Maio Health Centre in Maputo, Mozambique

PMID: 29911204 [PubMed]

PMCID: PMC5999047


EC Microbiology
Macrophages and the Viral Dissemination Super Highway

PMID: 26949751 [PubMed]

PMCID: PMC4774560


EC Microbiology
The Microbiome, Antibiotics, and Health of the Pediatric Population.

PMID: 27390782 [PubMed]

PMCID: PMC4933318


EC Microbiology
Reactive Oxygen Species in HIV Infection

PMID: 28580453 [PubMed]

PMCID: PMC5450819


EC Microbiology
A Review of the CD4 T Cell Contribution to Lung Infection, Inflammation and Repair with a Focus on Wheeze and Asthma in the Pediatric Population

PMID: 26280024 [PubMed]

PMCID: PMC4533840


EC Neurology
Identifying Key Symptoms Differentiating Myalgic Encephalomyelitis and Chronic Fatigue Syndrome from Multiple Sclerosis

PMID: 28066845 [PubMed]

PMCID: PMC5214344


EC Pharmacology and Toxicology
Paradigm Shift is the Normal State of Pharmacology

PMID: 28936490 [PubMed]

PMCID: PMC5604476


EC Neurology
Examining those Meeting IOM Criteria Versus IOM Plus Fibromyalgia

PMID: 28713879 [PubMed]

PMCID: PMC5510658


EC Neurology
Unilateral Frontosphenoid Craniosynostosis: Case Report and a Review of the Literature

PMID: 28133641 [PubMed]

PMCID: PMC5267489


EC Ophthalmology
OCT-Angiography for Non-Invasive Monitoring of Neuronal and Vascular Structure in Mouse Retina: Implication for Characterization of Retinal Neurovascular Coupling

PMID: 29333536 [PubMed]

PMCID: PMC5766278


EC Neurology
Longer Duration of Downslope Treadmill Walking Induces Depression of H-Reflexes Measured during Standing and Walking.

PMID: 31032493 [PubMed]

PMCID: PMC6483108


EC Microbiology
Onchocerciasis in Mozambique: An Unknown Condition for Health Professionals.

PMID: 30957099 [PubMed]

PMCID: PMC6448571


EC Nutrition
Food Insecurity among Households with and without Podoconiosis in East and West Gojjam, Ethiopia.

PMID: 30101228 [PubMed]

PMCID: PMC6086333


EC Ophthalmology
REVIEW. +2 to +3 D. Reading Glasses to Prevent Myopia.

PMID: 31080964 [PubMed]

PMCID: PMC6508883


EC Gynaecology
Biomechanical Mapping of the Female Pelvic Floor: Uterine Prolapse Versus Normal Conditions.

PMID: 31093608 [PubMed]

PMCID: PMC6513001


EC Dental Science
Fiber-Reinforced Composites: A Breakthrough in Practical Clinical Applications with Advanced Wear Resistance for Dental Materials.

PMID: 31552397 [PubMed]

PMCID: PMC6758937


EC Microbiology
Neurocysticercosis in Child Bearing Women: An Overlooked Condition in Mozambique and a Potentially Missed Diagnosis in Women Presenting with Eclampsia.

PMID: 31681909 [PubMed]

PMCID: PMC6824723


EC Microbiology
Molecular Detection of Leptospira spp. in Rodents Trapped in the Mozambique Island City, Nampula Province, Mozambique.

PMID: 31681910 [PubMed]

PMCID: PMC6824726


EC Neurology
Endoplasmic Reticulum-Mitochondrial Cross-Talk in Neurodegenerative and Eye Diseases.

PMID: 31528859 [PubMed]

PMCID: PMC6746603


EC Psychology and Psychiatry
Can Chronic Consumption of Caffeine by Increasing D2/D3 Receptors Offer Benefit to Carriers of the DRD2 A1 Allele in Cocaine Abuse?

PMID: 31276119 [PubMed]

PMCID: PMC6604646


EC Anaesthesia
Real Time Locating Systems and sustainability of Perioperative Efficiency of Anesthesiologists.

PMID: 31406965 [PubMed]

PMCID: PMC6690616


EC Pharmacology and Toxicology
A Pilot STEM Curriculum Designed to Teach High School Students Concepts in Biochemical Engineering and Pharmacology.

PMID: 31517314 [PubMed]

PMCID: PMC6741290


EC Pharmacology and Toxicology
Toxic Mechanisms Underlying Motor Activity Changes Induced by a Mixture of Lead, Arsenic and Manganese.

PMID: 31633124 [PubMed]

PMCID: PMC6800226


EC Neurology
Research Volunteers' Attitudes Toward Chronic Fatigue Syndrome and Myalgic Encephalomyelitis.

PMID: 29662969 [PubMed]

PMCID: PMC5898812


EC Pharmacology and Toxicology
Hyperbaric Oxygen Therapy for Alzheimer's Disease.

PMID: 30215058 [PubMed]

PMCID: PMC6133268


News and Events


September Issue Release

We always feel pleasure to share our updates with you all. Here, notifying you that we have successfully released the September issue of respective journals and the latest articles can be viewed on the current issue pages.

Submission Deadline for upcoming Issue

Ecronicon delightfully welcomes all the authors around the globe for effective collaboration with an article submission for the upcoming issue of respective journals. Submissions are accepted on/before September 28, 2021.

Certificate of Publication

Ecronicon honors with a "Publication Certificate" to the corresponding author by including the names of co-authors as a token of appreciation for publishing the work with our respective journals.

Best Article of the Issue

Editors of respective journals will always be very much interested in electing one Best Article after each issue release. The authors of the selected article will be honored with a "Best Article of the Issue" certificate.

Certifying for Review

Ecronicon certifies the Editors for their first review done towards the assigned article of the respective journals.

Latest Articles

The latest articles will be updated immediately on the articles in press page of the respective journals.

Immediate Assistance

The prime motto of this team is to clarify all the queries without any delay or hesitation to avoid the inconvenience. For immediate assistance on your queries please don't hesitate to drop an email to editor@ecronicon.uk