Hemoconcentration is a poor predictor of severity in acute pancreatitis

AIM: To determine whether the hematocrit (Hct) at admission or at 24 h after admission was associated with severe acute pancreatitis (AP), organ failure (OF), and pancreatic necrosis.METHODS: A total of 336 consecutive patients with a first AP episode were studied. Etiology, Hct values at admission and at 24 h, development of severe AP according to Atlanta's criteria, pancreatic necrosis, OF and mortality were recorded. Hemoconcentration was defined as Hct level ＞44% for males and ＞40% for females. The t-test and χ2 test were used to assess the association of hemoconcentration to the severity, necrosis and OF.Diagnostic accuracy was also determined.RESULTS: Biliary disease was the most frequent etiology(n = 148). Mean Hct levels at admission were 41±6%for females and 46±7% for males (P＜0.01). Seventyeight (23%) patients had severe AP, and OF developed in 45 (13%) patients. According to contrast-enhanced computed tomography scan, 36% (54/150) patients showed pancreatic necrosis. Hct levels were elevated in58% (55/96) and 61% (33/54) patients with interstitial and necrotizing pancreatitis, respectively. Neither Hct levels at admission nor hemoconcentration at 24 h were associated with the severity, necrosis or OF. Sensitivity,specificity and positive predictive values for both determinations were very low; and negative predictive values were between 61% and 86%, being the highest value for OF.CONCLUSION: Hct is not a useful marker to predict a worse outcome in acute pancreatitis. In spite of the high negative predictive value of hemoconcentration, the prognosis gain is limited due to an already high incidence of mild disease.

Clinical scenarios for the use of S100β as a marker of hepatic encephalopathy

AIM: To evaluate the association between serum concentrations of S100β in patients with cirrhosis and the presence of low grade hepatic encephalopathy(HE).METHODS: This was a cross-sectional study. The population was categorized into four groups healthy subjects, cirrhosis without HE, cirrhosis with covert hepatic encephalopathy(CHE) and cirrhosis with overt HE. Kruskal-Wallis, Mann Whitney's U with Bonferroni adjustment Spearman correlations and area under the ROC were used as appropriate.RESULTS: A total of 61 subjects were included, 46 cirrhotic patients and 15 healthy volunteers. S100β values were different among all groups, and differences remained significant between groups 1 and 2(P < 0.001), and also between groups 2 and 3(P = 0.016), but not between groups 3 and 4. In cirrhotic patients with HE S100β was higher than in patients without HE [0.18(0.14-0.28) ng/m L vs 0.11(0.06-0.14) ng/m L, P < 0.001]. There was a close correlation between serum concentrations of S100β and psychometric hepatic encephalopathy score in patients with cirrhosis without HE compared to the patients with cirrhosis with CHE(r =-0.413, P = 0.019). ROC curve analysis yielded > 0.13 ng/m L as the best cutoff value of S100β for the diagnosis of HE(sensitivity 83.3%, specificity 63.6%).CONCLUSION: Serum concentrations of S100β are higher in patients with cirrhosis than in healthy volunteers, and are further increased in the presence of hepatic encephalopathy. The results suggest that serum biomarkers such as S100β could help in the correct characterization of incipient stages of HE.

Low phase angle is associated with the development of hepatic encephalopathy in patients with cirrhosis

AIM Evaluate the association between phase angle and the development of hepatic encephalopathy in the longterm follow-up of cirrhotic patients.METHODS This was a prospective cohort study. Clinical, nutritional and biochemical evaluations were performed. MannWhitney's U and χ2 tests were used as appropriate. Kaplan-Meier curves and Cox proportional Hazards analysis were used to evaluate the prediction and incidence of hepatic encephalopathy.RESULTS Two hundred and twenty were included; the most frequent etiology of cirrhosis was hepatitis C infection, 52% of the patients developed hepatic encephalopathy(18.6% covert and 33.3% overt); the main precipitating factors were infections and variceal bleeding. KaplanMeier curves showed a higher proportion of HE in the group with low phase angle(39%) compared to the normal phase angle group(13%)(P = 0.012). Furthermore, creatinine and phase angle remained independently associated to hepatic encephalopathy in the Cox regression multivariate analysis [hazard ratio = 1.80(1.07-3.03)]. CONCLUSION In our cohort of patients low phase angle was associated with an increased incidence of hepatic encephalopathy. Phase angle is a useful nutritional marker that evaluates cachexia and could be used as a part of the integral assessment in patients with cirrhosis.

Is leptin related to systemic inflammatory response in acute pancreatitis?

瞄准：在尖锐胰腺炎评估在 leptin 和全身的发炎之间的关系。方法：有尖锐胰腺炎的连续病人被包括。身体集体索引和浆液样品在承认被获得。Leptin， TNF-alpha， IL-6， -8 和 -10 层次被 ELISA 决定。严厉根据亚特兰大标准被定义。结果：52 (29 女性) 病人们被学习。全面身体团索引在温和、严重的盒子之间是类似的，尽管有严重胰腺炎的女人有更低的身体团索引(P = 0.04 ) 并且男人证明更高的身体质量索引(P = 0.05 ) 。没有差别关于胰腺炎的严厉在 leptin 层次被发现，但是高水平趋于与增加的身体团索引和严重胰腺炎出现在男病人(P = 0.1 ) 。多，变量分析显示出的 A 在 leptin 层次和严厉之间的没有协会。与严厉联系的最强壮的 cytokine 是 IL-6。有另一 cytokines 的 leptin 的关联仅仅为 IL-8 显示出一个趋势(P = 0.058 ) 。结论：高身体团索引仅仅在男性与严厉被联系，它可能与机器人脂肪分发有关。浆液 leptin 似乎不在男性与严重结果在尖锐胰腺炎和它的协会在全身的煽动性的反应上起一个作用可能代表增加的脂肪过多的一个标记。