Epidemiological trends in acute pancreatitis:A retrospective cohort in a tertiary center over a seven year period

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).

Predictive value of C-reactive protein/albumin ratio in acute pancreatitis

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.

Diagnosis,severity stratification and management of adult acute pancreatitis–current evidence and controversies

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.

Review on acute pancreatitis attributed to COVID-19 infection

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.