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 ;x^2 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 in 58% （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.

Systemic Capillary Leak Syndrome Secondary to COVID-19 Infection: Case Report

Introduction: Systemic capillary leak syndrome (SCLS) is an increasingly recognized rare syndrome. Its diagnosis is suggested by the occurrence of edema with arterial hypotension, hemoconcentration, and paradoxical hypoalbuminemia. SCLS can be idiopathic (Clarkson syndrome) or secondary. Secondary SCLS (SSCLS) is mainly triggered by infections (especially viruses), drugs (antitumor therapy), malignancies, and inflammatory diseases. We report a case of systemic capillary leak syndrome secondary to the COVID-19 infection. Observation: A 74-year-old chronic smoker with no particular history was initially admitted to the intensive care unit (ICU) with a picture of respiratory distress secondary to a COVID-19 infection with favorable evolution, hence his transfer to the emergency services. On Day 8 of hospitalization, following the installation of arterial hypotension, not responding to filling, associated with hypoalbuminemia, and generalized edematous syndrome, and in the absence of any other explanation for this clinical picture, a SCLS secondary to COVID-19 infection was suggested. On the balance sheet, after the discovery of acute renal failure, serum creatinine went from 7.9 mg/l to 16.6 mg/l with microalbuminuria at 420 mg/24h and leukocyturia at 20 elements/mm3 without germ-evoked tubulointerstitial nephritis (TIN) secondary to a viral infection with COVID-19. The evolution was marked by the spontaneous regression of the edema and the normalization of the blood pressure figures. Discussion: The classic triad combining hypotension, hemoconcentration, and hypoalbuminemia suggests the diagnosis of SCLS once all other causes of shock have been ruled out. Hemoconcentration is less constant in SSCLS than in ISCLS. This is the case with our patient. The exact pathophysiological process of SCLS is largely unknown. Viral infections are the most common infectious cause of SCLS. The kidneys are the second-most common organs affected by the SARS-Cov-2 coronavirus infection. The presence of nephritis can be used as an indicator of SCLS, which can be a predictor of serious complications such as fluid overload, respiratory failure, and the need for ICU admission. Conclusion: In the event of COVID-19 infection, the appearance of hypotension and hypoalbuminemia with the gradual onset of generalized edema should suggest SCLS. The establishment of close monitoring is mandatory, given the risk of fatal evolution. Fortunately, for our patient, the evolution was favorable.

Effects of a carbohydrate-electrolyte beverage on blood viscosity after dehydration in healthy adults

Background The consumption of carbohydrate-electrolyte beverages （CEs） has been known to be more effective than plain water for recovery from dehydration. This phenomenon suggests that the ingestion of CEs after dehydration is better than water for maintaining body fluid and plasma volume, and for the recovery from hemoconcentration and high blood viscosity as well. High blood viscosity causes infarction and other cardiovascular events. In this study, CE was compared with water and tea for the ability to reduce increased blood viscosity after dehydration. Methods A crossover random control study was conducted to assess the effectiveness of three beverages for rehydration and decreasing of blood viscosity. Following exercise-induced dehydration of 2.2% of body weight in a permanent warm environment, 10 male subjects rested in a thermoneutral environment for 3 hours （rehydration period, REP）. The subjects ingested test beverages equal to their body weight loss during the first 20 minutes in REP. Blood and urine samples were obtained throughout the experiments to assess the rehydration effect. Results The change in blood viscosity at a shear rate of 5/s was significantly lower in CE （（-1.66±0.21） mPa.s） in comparison to water （（-0.95±0.26） mPa.s） or tea （（-0.92±0.14） mPa.s） at 60th minute during the REP. The fluid retention rate was significantly greater for CE （（77.0±3.9）%） than water （（61.2±3.4）%） and tea （（60.5±3.7）%） for 3 hours of rest in REP. Conclusions The recovery from high blood viscosity induced by dehydration was higher with CE consumption than with water or tea. These results suggest that CE is useful for normalizing increased blood viscosity due to exercise-induced dehydration.