BACKGROUND Patients with concurrent acute biliary pancreatitis(ABP)and acute cholangitis(AC)may experience exacerbated clinical consequences due to bile duct stones.However,studies exploring this topic remain limited....BACKGROUND Patients with concurrent acute biliary pancreatitis(ABP)and acute cholangitis(AC)may experience exacerbated clinical consequences due to bile duct stones.However,studies exploring this topic remain limited.AIM To compare the clinical presentation and outcomes of patients experiencing AC with and without ABP.METHODS This single-center retrospective cohort study included 358 patients with AC who underwent endoscopic retrograde cholangiopancreatography(ERCP)between January 2016 and December 2017.Patients were divided into two groups:AC with ABP(n=90)and AC without ABP(n=268).Clinical characteristics,laboratory data,ERCP results,primary study outcome[intensive care unit(ICU)admission],and secondary outcomes including 30-day mortality,length of hospital stay,and 30-day readmission rate were analyzed and compared.RESULTS All patients in the AC with ABP group had interstitial pancreatitis.The AC with ABP group had significantly higher white cell count(WBC)counts(13.1×10^(3)/μL vs 10.4×10^(3)/μL,P=0.007)and more abnormal WBC results(61.1%vs 42.3%,P=0.015).Liver biochemical tests,AC severity,ERCP success,adverse events,ICU admissions,30-day mortality,hospital stay,and readmission rates did not differ significantly between the two groups.Univariate analysis showed no significant link between concurrent ABP and ICU admission,although significance was marginal in moderate/severe ABP cases(P=0.051).In the multivariate analysis,age(P=0.035)and cardiovascular dysfunction(P<0.001)were independently associated with length of ICU stay.CONCLUSION Concurrent interstitial ABP and AC did not significantly affect outcomes.Age and cardiovascular dysfunction were stronger predictors of ICU admission and should guide clinical monitoring and management.展开更多
BACKGROUND Percutaneous cholecystostomy(PC)can be used as a bridging therapy for moderately severe acute biliary pancreatitis(MSABP).Currently,there are only a limited number of reports of MSABP using PCs.AIM To asses...BACKGROUND Percutaneous cholecystostomy(PC)can be used as a bridging therapy for moderately severe acute biliary pancreatitis(MSABP).Currently,there are only a limited number of reports of MSABP using PCs.AIM To assess the short-term outcomes of early PC in MSABP and factors associated with recurrence and death in MSABP.METHODS Patients who received conservative treatment or PC for acute biliary pancreatitis(ABP)in Liaoning Provincial People’s Hospital from January 2017 to July 2022 were collected.A total of 54 patients with MSABP who received early-stage PC and 29 patients who received conservative treatment.The short-term efficacy of PC was evaluated.Depending on whether there is a recurrence,compare the characteristics of the pre-PC and explore the factors of recurrence.Pre-PC features were compared and predictors were discussed,depending on the outcome.RESULTS After 3 days of PC treatment,patients experienced a reduction in inflammatory markers compared to the conservative group.After PC,patients were divided into non-recurrence(n=37)and recurrence(n=10)groups,and the results showed that age was an independent correlation affecting ABP recurrence[odds ratio(OR)=0.937,95%confidence interval(CI):0.878-0.999;P=0.047<0.05].Patient outcomes were divided into non-lethal(n=47)and lethal(n=7)groups,and Charlson Comorbidity Index(CCI)was a risk factor for mortality(OR=2.397,95%CI:1.139-5.047;P=0.021<0.05).CCI was highly accurate in predicting death in MSABP(area under the curve=0.86>0.7).When the Youden index maximum was 0.565,the cut-off value was 5.5,the sensitivity was 71.4%,and the specificity was 85.1%.CONCLUSION PC is an important method in the early years(<72 hours)of MSABP.Age is a protective factor against recurrence of ABP.High pre-PC CCI is significantly associated with mortality.展开更多
BACKGROUND:Serum C-reactive protein(CRP) increases and albumin decreases in patients with inflammation and infection.However,their role in patients with acute pancreatitis is not clear.The present study was to investi...BACKGROUND:Serum C-reactive protein(CRP) increases and albumin decreases in patients with inflammation and infection.However,their role in patients with acute pancreatitis is not clear.The present study was to investigate the predictive significance of the CRP/albumin ratio for the prognosis and mortality in acute pancreatitis patients.METHODS:This study was performed retrospectively with 192 acute pancreatitis patients between January 2002 and June 2015.Ranson scores,Atlanta classification and CRP/albumin ratios of the patients were calculated.RESULTS:The CRP/albumin ratio was higher in deceased patients compared to survivors.The CRP/albumin ratio was positively correlated with Ranson score and Atlanta classification in particular and with important prognostic markers such as hospitalization time,CRP and erythrocyte sedimentation rate.In addition to the CRP/albumin ratio,necrotizing pancreatitis type,moderately severe and severe Atlanta classification,and total Ranson score were independent risk factors of mortality.It was found that an increase of 1 unit in the CRP/albumin ratio resulted in an increase of 1.52 times in mortality risk.A prediction value about CRP/albumin ratio >16.28 was found to be a significant marker in predicting mortality with 92.1% sensitivity and 58.0% specificity.It was seen that Ranson and Atlanta classification were higher in patients with CRP/albumin ratio >16.28 compared with those with CRP/albumin ratio ≤16.28.Patients with CRP/albumin ratio >16.28 had a 19.3 times higher chance of death.CONCLUSION:The CRP/albumin ratio is a novel but promising,easy-to-measure,repeatable,non-invasive inflammationbased prognostic score in acute pancreatitis.展开更多
Magnetic resonance(MR)imaging plays an important role in the diagnosis and staging of acute and chronic pancreatitis and may represent the best imaging technique in the setting of pancreatitis due to its unmatched sof...Magnetic resonance(MR)imaging plays an important role in the diagnosis and staging of acute and chronic pancreatitis and may represent the best imaging technique in the setting of pancreatitis due to its unmatched soft tissue contrast resolution as well as nonionizing nature and higher safety profile of intravascular contrast media,making it particularly valuable in radiosensitive populations such as pregnant patients,and patients with recurrent pancreatitis requiring multiple follow-up examinations.Additional advantages include the ability to detect early forms of chronic pancreatitis and to better differentiate adenocarcinoma from focal chronic pancreatitis.This review addresses new trends in clinical pancreatic MR imaging emphasizing its role in imaging all types of acute and chronic pancreatitis,pancreatitis complications and other important differential diagnoses that mimic pancreatitis.展开更多
AIM To evaluate the short-and long-term results of endoscopic ultrasound-guided transmural drainage(EUS-GTD) for pancreatic fluid collection(PFC) and identify the predictive factors of treatment outcome for walled-off...AIM To evaluate the short-and long-term results of endoscopic ultrasound-guided transmural drainage(EUS-GTD) for pancreatic fluid collection(PFC) and identify the predictive factors of treatment outcome for walled-off necrosis(WON) managed by EUS-GTD alone.METHODS We investigated 103 consecutive patients with PFC who underwent EUS-GTD between September 1999 and August 2015. Patients were divided into four groups as follows: WON(n = 40), pancreatic pseudocyst(PPC; n = 11), chronic pseudocyst(n = 33), and others(n = 19). We evaluated the short-and long-term outcomes of the treatment. In cases of WON, multiple logistic regression analyses were performed to identify the predictor variables associated with the treatment success. In addition, PFC recurrence was examined in patients followed up for more than 6 mo and internal stent removal after successful EUS-GTD was confirmed.RESULTS In this study, the total technical success rate was 96.1%. The treatment success rate of WON, PPC, chronic pseudocyst, and others was 57.5%, 90.9%, 91.0%, and 89.5%, respectively. Contrast-enhanced computed tomography using the multivariate logistic regression analysis revealed that the treatment success rate of WON was significantly lower in patients with more than 50% pancreatic parenchymal necrosis(OR = 17.0; 95%CI: 1.9-150.7; P = 0.011) and in patients with more than 150 mm of PFC(OR = 27.9; 95%CI: 3.4-227.7; P = 0.002).The recurrence of PFC in the long term was 13.3%(median observation time, 38.8 mo). Mean amylase level in the cavity was significantly higher in the recurrence group than in the no recurrence group(P = 0.02).CONCLUSION The reduction of WON by EUS-GTD alone was associated with the proportion of necrotic tissue and extent of the cavity. The amylase level in the cavity may be a predictive factor for recurrence of PFC.展开更多
Acute pancreatitis(AP)is a disease spectrum ranging from mild to severe with an unpredictable natural course.Majority of cases(80%)are mild and self-limiting.However,severe AP(SAP)has a mortality risk of up to 30%.Est...Acute pancreatitis(AP)is a disease spectrum ranging from mild to severe with an unpredictable natural course.Majority of cases(80%)are mild and self-limiting.However,severe AP(SAP)has a mortality risk of up to 30%.Establishing aetiology and risk stratification are essential pillars of clinical care.Idiopathic AP is a diagnosis of exclusion which should only be used after extended investigations fail to identify a cause.Tenets of management of mild AP include pain control and management of aetiology to prevent recurrence.In SAP,patients should be resuscitated with goal-directed fluid therapy using crystalloids and admitted to critical care unit.Routine prophylactic antibiotics have limited clinical benefit and should not be given in SAP.Patients able to tolerate oral intake should be given early enteral nutrition rather than nil by mouth or parenteral nutrition.If unable to tolerate per-orally,nasogastric feeding may be attempted and routine post-pyloric feeding has limited evidence of clinical benefit.Endoscopic retrograde cholangiopancreatogram should be selectively performed in patients with biliary obstruction or suspicion of acute cholangitis.Delayed step-up strategy including percutaneous retroperitoneal drainage,endoscopic debridement,or minimal-access necrosectomy are sufficient in most SAP patients.Patients should be monitored for diabetes mellitus and pseudocyst.展开更多
Pancreatitis is defined as the inflammation of the pancreas and considered the most common pancreatic disease in children and adults. Imaging plays a significant role in the diagnosis, severity assessment, recognition...Pancreatitis is defined as the inflammation of the pancreas and considered the most common pancreatic disease in children and adults. Imaging plays a significant role in the diagnosis, severity assessment, recognition of complications and guiding therapeutic interventions. In the setting of pancreatitis, wider availability and good image quality make multi-detector contrastenhanced computed tomography(MD-CECT) the most used imaging technique. However, magnetic resonance imaging(MRI) offers diagnostic capabilities similar to those of CT, with additional intrinsic advantages including lack of ionizing radiation and exquisite soft tissue characterization. This article reviews the proposed definitions of revised Atlanta classification for acute pancreatitis, illustrates a wide range of morphologic pancreatic parenchymal and associated peripancreatic changes for different types of acute pancreatitis. It also describes the spectrum of early and late chronic pancreatitis imaging findings and illustrates some of the less common types of chronic pancreatitis, with special emphasis on the role of CT and MRI.展开更多
The coronavirus disease 2019(COVID-19)is known to cause gastrointestinal symptoms.Recent studies have revealed COVID-19-attributed acute pancreatitis(AP).However,clinical characteristics of COVID-19-attributed AP rema...The coronavirus disease 2019(COVID-19)is known to cause gastrointestinal symptoms.Recent studies have revealed COVID-19-attributed acute pancreatitis(AP).However,clinical characteristics of COVID-19-attributed AP remain unclear.We performed a narrative review to elucidate relation between COVID-19 and AP using the PubMed database.Some basic and pathological reports revealed expression of angiotensin-converting enzyme 2 and transmembrane protease serine 2,key proteins that aid in the entry of severe acute respiratory syndrome coronavirus 2(SARS-CoV-2)into the pancreas.The experimental and pathological evaluation suggested that SARS-CoV-2 infects human endocrine and exocrine pancreas cells,and thus,SARS-CoV-2 may have a direct involvement in pancreatic disorders.Additionally,systemic inflammation,especially in children,may cause AP.Levels of immune mediators associated with AP,including interleukin(IL)-1β,IL-10,interferon-γ,monocyte chemotactic protein 1,and tumor necrosis factor-αare higher in the plasma of patients with COVID-19,that suggests an indirect involvement of the pancreas.In real-world settings,some clinical features of AP complicate COVID-19,such as a high complication rate of pancreatic necrosis,severe AP,and high mortality.However,clinical features of COVID-19-attributed AP remain uncertain due to insufficient research on etiologies of AP.Therefore,high-quality clinical studies and case reports that specify methods for differential diagnoses of other etiologies of AP are needed.展开更多
BACKGROUND Acute pancreatitis(AP)remains a major cause of hospitalization and mortality with important health-related costs worldwide.Using an electronic database of a large tertiary center,we estimated the incidence,...BACKGROUND Acute pancreatitis(AP)remains a major cause of hospitalization and mortality with important health-related costs worldwide.Using an electronic database of a large tertiary center,we estimated the incidence,etiology,severity and costs of hospitalized AP cases in southern Romania.AIM To estimate the incidence,cost and tobacco usage of hospitalized AP cases in southern Romania and to update and upgrade the knowledge we have on the etiology,severity(in regard to Revised Atlanta Classification),outcome,morphology and local complications of AP.METHODS We performed an electronic health care records search on AP patients treated at Emergency University Hospital of Bucharest(Spitalul Universitar de UrgențăBucurești)between 2015 and 2022.The incidence,etiology,and severity were calculated;potential risk factors were evaluated,and the hospitalization costs of AP were documented and analyzed.The cohort of this study is part of the BUCharest-Acute Pancreatitis Index registry.RESULTS A total of 947 consecutive episodes of AP where the patients were hospitalized in the gastroenterology department were analyzed,with 79.45%as 1st episode and the rest recurrent.The majority of the patients were males(68.9%).Alcoholic(45.7%),idiopathic(16.4%)and biliary(15.2%)were the main causes.The incidence was estimated at 29.2 episodes/100000 people.The median length of stay was 7 d.The median daily cost was 747.96 RON(165 EUR).There was a high prevalence of active tobacco smokers(68.5%).The prevalence of severe disease was 11.1%.The admission rate to the intensive care unit was 4.6%,with a mortality rate of 38.6%.The overall mortality was 5.5%.CONCLUSION We estimated the incidence of AP at 29.2 episodes that required hospitalization per 100000 people.The majority of our cases were found in males(68.9%)and were related to alcohol abuse(45.7%).Out of the cases we were able to find data regarding tobacco usage,the majority were active smokers(68.5%).Most patients had a mild course(54.4%),with a mortality rate of 5.5%.Interstitial AP prevailed(45.3%).The median daily cost of hospitalization was 747.96 RON(165 EUR).展开更多
文摘BACKGROUND Patients with concurrent acute biliary pancreatitis(ABP)and acute cholangitis(AC)may experience exacerbated clinical consequences due to bile duct stones.However,studies exploring this topic remain limited.AIM To compare the clinical presentation and outcomes of patients experiencing AC with and without ABP.METHODS This single-center retrospective cohort study included 358 patients with AC who underwent endoscopic retrograde cholangiopancreatography(ERCP)between January 2016 and December 2017.Patients were divided into two groups:AC with ABP(n=90)and AC without ABP(n=268).Clinical characteristics,laboratory data,ERCP results,primary study outcome[intensive care unit(ICU)admission],and secondary outcomes including 30-day mortality,length of hospital stay,and 30-day readmission rate were analyzed and compared.RESULTS All patients in the AC with ABP group had interstitial pancreatitis.The AC with ABP group had significantly higher white cell count(WBC)counts(13.1×10^(3)/μL vs 10.4×10^(3)/μL,P=0.007)and more abnormal WBC results(61.1%vs 42.3%,P=0.015).Liver biochemical tests,AC severity,ERCP success,adverse events,ICU admissions,30-day mortality,hospital stay,and readmission rates did not differ significantly between the two groups.Univariate analysis showed no significant link between concurrent ABP and ICU admission,although significance was marginal in moderate/severe ABP cases(P=0.051).In the multivariate analysis,age(P=0.035)and cardiovascular dysfunction(P<0.001)were independently associated with length of ICU stay.CONCLUSION Concurrent interstitial ABP and AC did not significantly affect outcomes.Age and cardiovascular dysfunction were stronger predictors of ICU admission and should guide clinical monitoring and management.
基金The Institutional Ethics Committee of Liaoning Provincial People’s Hospital approved the study,No.(2023)K037.
文摘BACKGROUND Percutaneous cholecystostomy(PC)can be used as a bridging therapy for moderately severe acute biliary pancreatitis(MSABP).Currently,there are only a limited number of reports of MSABP using PCs.AIM To assess the short-term outcomes of early PC in MSABP and factors associated with recurrence and death in MSABP.METHODS Patients who received conservative treatment or PC for acute biliary pancreatitis(ABP)in Liaoning Provincial People’s Hospital from January 2017 to July 2022 were collected.A total of 54 patients with MSABP who received early-stage PC and 29 patients who received conservative treatment.The short-term efficacy of PC was evaluated.Depending on whether there is a recurrence,compare the characteristics of the pre-PC and explore the factors of recurrence.Pre-PC features were compared and predictors were discussed,depending on the outcome.RESULTS After 3 days of PC treatment,patients experienced a reduction in inflammatory markers compared to the conservative group.After PC,patients were divided into non-recurrence(n=37)and recurrence(n=10)groups,and the results showed that age was an independent correlation affecting ABP recurrence[odds ratio(OR)=0.937,95%confidence interval(CI):0.878-0.999;P=0.047<0.05].Patient outcomes were divided into non-lethal(n=47)and lethal(n=7)groups,and Charlson Comorbidity Index(CCI)was a risk factor for mortality(OR=2.397,95%CI:1.139-5.047;P=0.021<0.05).CCI was highly accurate in predicting death in MSABP(area under the curve=0.86>0.7).When the Youden index maximum was 0.565,the cut-off value was 5.5,the sensitivity was 71.4%,and the specificity was 85.1%.CONCLUSION PC is an important method in the early years(<72 hours)of MSABP.Age is a protective factor against recurrence of ABP.High pre-PC CCI is significantly associated with mortality.
文摘BACKGROUND:Serum C-reactive protein(CRP) increases and albumin decreases in patients with inflammation and infection.However,their role in patients with acute pancreatitis is not clear.The present study was to investigate the predictive significance of the CRP/albumin ratio for the prognosis and mortality in acute pancreatitis patients.METHODS:This study was performed retrospectively with 192 acute pancreatitis patients between January 2002 and June 2015.Ranson scores,Atlanta classification and CRP/albumin ratios of the patients were calculated.RESULTS:The CRP/albumin ratio was higher in deceased patients compared to survivors.The CRP/albumin ratio was positively correlated with Ranson score and Atlanta classification in particular and with important prognostic markers such as hospitalization time,CRP and erythrocyte sedimentation rate.In addition to the CRP/albumin ratio,necrotizing pancreatitis type,moderately severe and severe Atlanta classification,and total Ranson score were independent risk factors of mortality.It was found that an increase of 1 unit in the CRP/albumin ratio resulted in an increase of 1.52 times in mortality risk.A prediction value about CRP/albumin ratio >16.28 was found to be a significant marker in predicting mortality with 92.1% sensitivity and 58.0% specificity.It was seen that Ranson and Atlanta classification were higher in patients with CRP/albumin ratio >16.28 compared with those with CRP/albumin ratio ≤16.28.Patients with CRP/albumin ratio >16.28 had a 19.3 times higher chance of death.CONCLUSION:The CRP/albumin ratio is a novel but promising,easy-to-measure,repeatable,non-invasive inflammationbased prognostic score in acute pancreatitis.
文摘Magnetic resonance(MR)imaging plays an important role in the diagnosis and staging of acute and chronic pancreatitis and may represent the best imaging technique in the setting of pancreatitis due to its unmatched soft tissue contrast resolution as well as nonionizing nature and higher safety profile of intravascular contrast media,making it particularly valuable in radiosensitive populations such as pregnant patients,and patients with recurrent pancreatitis requiring multiple follow-up examinations.Additional advantages include the ability to detect early forms of chronic pancreatitis and to better differentiate adenocarcinoma from focal chronic pancreatitis.This review addresses new trends in clinical pancreatic MR imaging emphasizing its role in imaging all types of acute and chronic pancreatitis,pancreatitis complications and other important differential diagnoses that mimic pancreatitis.
文摘AIM To evaluate the short-and long-term results of endoscopic ultrasound-guided transmural drainage(EUS-GTD) for pancreatic fluid collection(PFC) and identify the predictive factors of treatment outcome for walled-off necrosis(WON) managed by EUS-GTD alone.METHODS We investigated 103 consecutive patients with PFC who underwent EUS-GTD between September 1999 and August 2015. Patients were divided into four groups as follows: WON(n = 40), pancreatic pseudocyst(PPC; n = 11), chronic pseudocyst(n = 33), and others(n = 19). We evaluated the short-and long-term outcomes of the treatment. In cases of WON, multiple logistic regression analyses were performed to identify the predictor variables associated with the treatment success. In addition, PFC recurrence was examined in patients followed up for more than 6 mo and internal stent removal after successful EUS-GTD was confirmed.RESULTS In this study, the total technical success rate was 96.1%. The treatment success rate of WON, PPC, chronic pseudocyst, and others was 57.5%, 90.9%, 91.0%, and 89.5%, respectively. Contrast-enhanced computed tomography using the multivariate logistic regression analysis revealed that the treatment success rate of WON was significantly lower in patients with more than 50% pancreatic parenchymal necrosis(OR = 17.0; 95%CI: 1.9-150.7; P = 0.011) and in patients with more than 150 mm of PFC(OR = 27.9; 95%CI: 3.4-227.7; P = 0.002).The recurrence of PFC in the long term was 13.3%(median observation time, 38.8 mo). Mean amylase level in the cavity was significantly higher in the recurrence group than in the no recurrence group(P = 0.02).CONCLUSION The reduction of WON by EUS-GTD alone was associated with the proportion of necrotic tissue and extent of the cavity. The amylase level in the cavity may be a predictive factor for recurrence of PFC.
文摘Acute pancreatitis(AP)is a disease spectrum ranging from mild to severe with an unpredictable natural course.Majority of cases(80%)are mild and self-limiting.However,severe AP(SAP)has a mortality risk of up to 30%.Establishing aetiology and risk stratification are essential pillars of clinical care.Idiopathic AP is a diagnosis of exclusion which should only be used after extended investigations fail to identify a cause.Tenets of management of mild AP include pain control and management of aetiology to prevent recurrence.In SAP,patients should be resuscitated with goal-directed fluid therapy using crystalloids and admitted to critical care unit.Routine prophylactic antibiotics have limited clinical benefit and should not be given in SAP.Patients able to tolerate oral intake should be given early enteral nutrition rather than nil by mouth or parenteral nutrition.If unable to tolerate per-orally,nasogastric feeding may be attempted and routine post-pyloric feeding has limited evidence of clinical benefit.Endoscopic retrograde cholangiopancreatogram should be selectively performed in patients with biliary obstruction or suspicion of acute cholangitis.Delayed step-up strategy including percutaneous retroperitoneal drainage,endoscopic debridement,or minimal-access necrosectomy are sufficient in most SAP patients.Patients should be monitored for diabetes mellitus and pseudocyst.
文摘Pancreatitis is defined as the inflammation of the pancreas and considered the most common pancreatic disease in children and adults. Imaging plays a significant role in the diagnosis, severity assessment, recognition of complications and guiding therapeutic interventions. In the setting of pancreatitis, wider availability and good image quality make multi-detector contrastenhanced computed tomography(MD-CECT) the most used imaging technique. However, magnetic resonance imaging(MRI) offers diagnostic capabilities similar to those of CT, with additional intrinsic advantages including lack of ionizing radiation and exquisite soft tissue characterization. This article reviews the proposed definitions of revised Atlanta classification for acute pancreatitis, illustrates a wide range of morphologic pancreatic parenchymal and associated peripancreatic changes for different types of acute pancreatitis. It also describes the spectrum of early and late chronic pancreatitis imaging findings and illustrates some of the less common types of chronic pancreatitis, with special emphasis on the role of CT and MRI.
文摘The coronavirus disease 2019(COVID-19)is known to cause gastrointestinal symptoms.Recent studies have revealed COVID-19-attributed acute pancreatitis(AP).However,clinical characteristics of COVID-19-attributed AP remain unclear.We performed a narrative review to elucidate relation between COVID-19 and AP using the PubMed database.Some basic and pathological reports revealed expression of angiotensin-converting enzyme 2 and transmembrane protease serine 2,key proteins that aid in the entry of severe acute respiratory syndrome coronavirus 2(SARS-CoV-2)into the pancreas.The experimental and pathological evaluation suggested that SARS-CoV-2 infects human endocrine and exocrine pancreas cells,and thus,SARS-CoV-2 may have a direct involvement in pancreatic disorders.Additionally,systemic inflammation,especially in children,may cause AP.Levels of immune mediators associated with AP,including interleukin(IL)-1β,IL-10,interferon-γ,monocyte chemotactic protein 1,and tumor necrosis factor-αare higher in the plasma of patients with COVID-19,that suggests an indirect involvement of the pancreas.In real-world settings,some clinical features of AP complicate COVID-19,such as a high complication rate of pancreatic necrosis,severe AP,and high mortality.However,clinical features of COVID-19-attributed AP remain uncertain due to insufficient research on etiologies of AP.Therefore,high-quality clinical studies and case reports that specify methods for differential diagnoses of other etiologies of AP are needed.
文摘BACKGROUND Acute pancreatitis(AP)remains a major cause of hospitalization and mortality with important health-related costs worldwide.Using an electronic database of a large tertiary center,we estimated the incidence,etiology,severity and costs of hospitalized AP cases in southern Romania.AIM To estimate the incidence,cost and tobacco usage of hospitalized AP cases in southern Romania and to update and upgrade the knowledge we have on the etiology,severity(in regard to Revised Atlanta Classification),outcome,morphology and local complications of AP.METHODS We performed an electronic health care records search on AP patients treated at Emergency University Hospital of Bucharest(Spitalul Universitar de UrgențăBucurești)between 2015 and 2022.The incidence,etiology,and severity were calculated;potential risk factors were evaluated,and the hospitalization costs of AP were documented and analyzed.The cohort of this study is part of the BUCharest-Acute Pancreatitis Index registry.RESULTS A total of 947 consecutive episodes of AP where the patients were hospitalized in the gastroenterology department were analyzed,with 79.45%as 1st episode and the rest recurrent.The majority of the patients were males(68.9%).Alcoholic(45.7%),idiopathic(16.4%)and biliary(15.2%)were the main causes.The incidence was estimated at 29.2 episodes/100000 people.The median length of stay was 7 d.The median daily cost was 747.96 RON(165 EUR).There was a high prevalence of active tobacco smokers(68.5%).The prevalence of severe disease was 11.1%.The admission rate to the intensive care unit was 4.6%,with a mortality rate of 38.6%.The overall mortality was 5.5%.CONCLUSION We estimated the incidence of AP at 29.2 episodes that required hospitalization per 100000 people.The majority of our cases were found in males(68.9%)and were related to alcohol abuse(45.7%).Out of the cases we were able to find data regarding tobacco usage,the majority were active smokers(68.5%).Most patients had a mild course(54.4%),with a mortality rate of 5.5%.Interstitial AP prevailed(45.3%).The median daily cost of hospitalization was 747.96 RON(165 EUR).
