Introduction

Severe acute respiratory syndrome coronavirus 2 (SARS-COV-2), the causative virus for coronavirus disease-2019 (COVID-19), primarily affects lung tissues causing severe acute respiratory distress syndrome. SARS-CoV-2 is believed to cause acute pancreatitis (AP) through direct viral invasion (through ACE2 receptors) or the systemic inflammatory immune response (SIIR) through cytokine storm. This study was conducted to assess the impact of COVID-19 infection on clinical outcomes, including mortality, in patients admitted with acute pancreatitis.

Aims & Methods

The national inpatient sample (NIS) 2020 was queries for hospitalizations with the discharge diagnosis of acute pancreatitis. Patients who were diagnosed with COVID-19 infection upon hospitalization were identified. Their baseline characteristics and clinical outcomes were compared to patients with AP and no COVID-19 infection. Chi-square and the student's t-test were used for the statistical analysis. Multivariate analysis to assess mortality predictors in patients with AP was then performed.

Results

Out of 258965 AP hospitalizations included in the analysis, 2725 patients had COVID-19 infection. There was a higher percentage of Hispanics in the COVID-19 AP compared to the non-COVID-19 AP group. Peripheral vascular disease, chronic pulmonary disease, alcohol use, drug use, and smoking were more prevalent in the non-COVID group. There was no difference in the burden of comorbidity between the two groups, as estimated by Carlson’s comorbidity index (p 0.7597) (Table 1). In-hospital mortality was higher in the COVID-19 AP group compared to the non-COVID-19 AP group (2.2% vs. 0.6%, p <0.0001). The multivariate logistic regression analysis showed higher odds of mortality in patients with COVID-19 infection (OR 3.97, CI 2.17-7.26. p <0.0001).

Conclusion

COVID-19 clinical course varies individually from asymptomatic to severe multiorgan failure and death. A meta-analysis of 2419 patients concluded that COVID-19 significantly increased the odds of mortality in AP. It also showed that COVID-19 was associated with an increased incidence of severe pancreatitis, necrotizing pancreatitis, and a longer length of stay in AP. Another study showed that COVID-19 virus had been isolated in stool samples and pancreatic pseudocysts in patients with AP, which further supports the morbid effect of the virus on AP. A meta-analysis of 19 studies has shown a similar pattern of cytokine levels alteration in both severe AP and COVID-19, which leads to further exacerbation in the cytokine storm leading to multi-organ failure and death.
Our study showed that COVID-19 infection is independently associated with increased mortality among patients admitted with acute pancreatitis.

Introduction

Acute Pancreatitis (AP) is a common gastrointestinal disease with an incidence of 34 per 100,000 and mortality of up to 30% in its severe form. Frequently, AP is complicated locally and systemically. Splanchnic Venous Thrombosis (SVT) is a well-known local vascular complication of AP involving the portal vein (PV), the splenic vein (SV), and the superior mesenteric vein (SMV) in combination or alone.

Aims & Methods

The aim is to study and analyze pancreatitis-related SVT patients' epidemiological data and characteristics at the Institute of Pancreatic Diseases, Semmelweis University.From the Institute of Pancreatic Diseases, out of a total of 1141 patients hospitalized with AP between 1st January 2022 and 21st February 2024, we found 45 patients' data with pancreatitis-related thrombosis using the international code for diseases. We extracted the individual data of 45 patients from E-Med Solution and EESZT and further analyzed it. 19 patients were excluded based on inclusion and exclusion criteria.

Results

From the total of 1,141 patients, 26 were with pancreatitis-related SVT. Among these, 19 (73%) were male and 7 (27%) were female. Regarding the severity, 19 patients experienced moderate acute pancreatitis (AP), while 7 had severe AP. The most common etiologies were alcohol consumption (41%), biliary (14%), and hypertriglyceridemia (14%). The average age of the patient population was 48.3 years (SD 13.5), with male patients averaging 44.7 years (SD 10.2) and female patients averaging 58 years (SD 16.2). The average length of hospitalization was 14.5 days (SD10.4). The average BMI of the patient population was 28.4 kg/m2 (SD 4.8). Of 7 severe AP patients, 6 were males with alcoholic etiology, an average BMI of 28.9 kg/m2 (SD 3.2) and higher on admission mean Procalcitonin of 1.1 ng/mL(SD 1.23) (Vs 0.81ng/mL (SD 2.08)).
The splenic vein (SpV) was the most affected vessel, involved in 11 patients (42%), followed by superior mesenteric vein (SMV) in 3 patients (11%) and portal vein (PV) in 2 patients (7%) and 10 patients (38%) with two or more vessels involved of SpV, SMV, and PV. Of the 26 patients, 17 (65%) showed recanalization after receiving LMWH (57%) and DOAC (68%) therapy after discharge. The splenic vein recanalized the highest (68%) among the vessels.

Conclusion

In our analysis, splenic vein is the most involved vessel among the splanchnic veins and also the vessel with highest recanalization after anticoagulant therapy. Our data clearly shows anticoagulant therapy has a better outcome in patients with acute pancreatitis-related SVT. Therefore, dynamic changes of SVT should be closely monitored, and antithrombotic therapy should be rapidly initiated to prevent the further extension of thrombosis and subsequent complications. Unfortunately, major guidelines on the management of AP are silent on this aspect.Hence further studies are necessary to improve the standard of care for the AP patients with SVT.

Introduction

Infected necrotizing pancreatitis (INP) is associated with an increased risk of organ failure and mortality. In a previous meta-analysis, procalcitonin (PCT) was found to have the most robust connection to INP. Herein, we aimed to identify early predictors for INP.

Aims & Methods

A systematic search was conducted in Medline (via Pubmed), Embase, and Central databases on 27.10.2022 (PROSPERO no.: CRD42022370672). The selected studies confirmed infection by computed tomography imaging with the presence of gas in the necrotic collection or by examination of the sample acquired by an intervention using Gram staining or culture. Any laboratory biomarkers were included for the index test that were compared between sterile necrotizing pancreatitis and INP. The random effect model was used to gain pooled estimates with 95% CI, and we fitted the SROC curve. Heterogeneity among the studies was evaluated.

Results

We included 14 observational studies involving 1,591 patients, in the analysis 9 studies with 758 patients were included. In the disease’s early phase, within the first 72 hours after admission, the pooled area under the ROC curve (AUC) of C-reactive protein (CRP) was 0.70 (95% confidence interval (CI) = 0.63, 0.77), and for PCT, it was 0.70 (95% CI = 0.57, 0.83), and for white blood cell count (WBC), it was 0.61 (95% CI = 0.47, 0.75). After the first 72 hours, in the late phase, the pooled AUC of CRP showed an elevated level of 0.88 (95% CI = 0.75, 1.00), and for PCT, it was 0.86 (95% CI = 0.60, 1.00). No significant heterogeneity was observed.

Conclusion

The predictive value of CRP and PCT for infection is intermediate in the early phase but very good in the late phase of the disease. Based on these results, in case of persistently high CRP and PCT, infection is likely, and initiation of antibiotics is recommended.

Disclosure

The authors declare no conflict of interest.

Introduction

The transition from acute pancreatitis (AP) to recurrent (RAP) and chronic (CP) pancreatitis poses significant clinical challenges.

Aims & Methods

This systematic review and meta-analysis aimed to identify risk factors associated with this progression. Following the protocol registration on PROSPERO (CRD42022368931), we searched Medline, Embase, and Cochrane databases up to December 19th, 2023, for studies examining risk factors for the evolution of AP into RAP or CP. Pooled odds ratios (OR) with 95% confidence intervals (CI) were calculated using the random effects model. Heterogeneity was evaluated using the I² statistic. The risk of bias assessment was performed using the Quality in Prognostic Studies (QUIPS) tool.

Results

A total of 124 articles were included in the meta–analysis, and several risk factors were identified for the progression of AP into RAP and CP. We found the following risk factors of AP recurrence: male gender, smoking, alcoholic etiology, hypertriglyceridemia, diabetes mellitus, pseudocyst, etc. The pooled OR for the male gender was 1.49 (95% CI: 1.31-1.62, I²=25%), for smoking was 1.47 (95% CI: 1.22-1.71, I²=57%), for alcoholic etiology was 1.78 (95% CI: 1.45-2.14, I²=78%), for hypertriglyceridemia was 2.48 (95% CI: 2.16-2.83, I²=9%), for diabetes mellitus was 1.51 (95% CI: 1.21-1.75, I²=0%), for pseudocyst was 2.23 (95% CI: 1.61-3.12, I²=0%). We also found risk factors of RAP progression into CP. The risk of bias was moderate in the majority of the included studies.

Conclusion

These findings suggest that addressing modifiable risk factors might be key in preventing the progression of pancreatitis

Introduction

Acute pancreatitis (AP) is a common gastrointestinal disorder with significant morbidity and mortality in severe cases. Pre-existing comorbidities and newly developed complications, like heart failure may influence outcomes in AP patients.

Aims & Methods

This study aimed to evaluate the impact of pre-existing and newly developed cardiac conditions on in-hospital and post-discharge mortality in patients with acute pancreatitis. A single-center registry analysis of the Hungarian Pancreatic Study Group Acute Pancreatitis Registry was conducted at Semmelweis University, Budapest, Hungary, involving 1,316 patients diagnosed with acute pancreatitis between 2021-2024. Data on pre-existing chronic heart failure (CHF), atrial fibrillation (AF), stroke history, and newly developed acute heart failure (AHF) were collected. Electrocardiogram (ECG) findings, including QTc prolongation, were also analyzed. In-hospital mortality and post-discharge mortality within one year were assessed. Odds ratios (OR) with 95% confidence intervals (CI) were calculated to quantify the strength of associations.

Results

Of the 1316 patients, 45% were female, the average age was 55.8 (range: 18-95) years, 8% had severe, 25% had moderate, and 65% had mild AP. Regarding cardiovascular background, pre-existing CHF and stroke history did not show a significant association with increased in-hospital mortality in AP (OR: 1.85, 95% CI: 0.63-5.44 and OR: 1.21, 95% CI: 0.36-4.02, respectively). Although AP patients with pre-existing AF had four-fold higher odds of in-hospital mortality (OR: 4.01, 95% CI: 1.92-8.34). Assessing in-hospital cardiovascular alterations, newly discovered AF was not significantly associated with increased in-hospital mortality (OR: 4.40, 95% CI: 0.97-20.02). Moreover, QTc prolongation on ECG was not significantly associated with in-hospital mortality (OR: 2.10, 95% CI: 0.61-7.25) or post-discharge mortality within one year after AP (OR: 1.65, 95% CI: 0.20-13.74). However, AP patients with newly developed AHF had a 25-times higher odds of in-hospital mortality (OR: 25.81, 95% CI: 12.13-54.98) and a 4-times higher odds for post-discharge mortality within one year (OR: 4.93, 95% CI: 1.01-24.26).

Conclusion

Pre-existing AF and newly developed AHF are significantly associated with increased in-hospital mortality in patients AP, moreover, newly developed AHF is also associated with increased post-discharge mortality within one year. These findings highlight the importance of cardiac monitoring and management in AP patients to improve outcomes.

Introduction

Although the mortality rate of severe acute pancreatitis (SAP) has improved, it remains high. Especially, disseminated intravascular coagulation (DIC) can be a fatal factor. The purpose of this study was to analyze the factors associated with the mortality of SAP with DIC and to explore measures that contribute to improving the mortality rate.

Aims & Methods

We retrospectively collected data on 131 consecutive patients with SAP complicated by DIC at 9 institutions from April 2011 to March 2021. We collected data on patient background and treatment for pancreatitis (medications, enteral nutrition, tracheal intubation, and arterial injection therapy, etc.) after treatment initiation. We excluded nine patients who died within 48 hours of treatment initiation and eight patients with missing data due to hospital transfer, and analyzed the mortality rate and factors associated with mortality in 114 cases of SAP with DIC.

Results

The median DIC score at diagnosis according to the Japanese Association for Acute Medicine criteria (JAAM criteria) was 5 (4-8), there were 85 males, and the median age was 71.0 (16-93) years. The median Japanese severity score for acute pancreatitis (AP) was 2 (0-9), and the mortality rate was 11.4% (13/114). Univariate analysis identified age 70 years or older (OR 4.3), DIC secession at day 7 (OR 0.12), arterial injection therapy (OR 5.17), and walled-off necrosis (WON) complication (OR 5.38) as significant factors associated with mortality. Multivariate analysis revealed that age 70 years or older (OR 4.3 [95%CI: 1.58-11.7]), DIC secession at day 7 (OR 0.06 [0.008-0.320]), and WON complication (OR 10.1 [1.85-81.4]) were independent prognostic factors. Factors contributing to DIC secession at day 7 were the use of recombinant thrombomodulin (rTM) (OR 2.42 [1.02-5.71], 60 patients with rTM and 54 patients without rTM) and a SOFA score of 5 or less at baseline (OR 2.65 [1.13-2.65]). Factors associated with WON complication were arterial injection therapy (OR 4.37 [1.27-15.0]) and enteral nutrition administration (OR 4.66 [1.70-12.8]).

Conclusion

The mortality rate of SAP complicated by DIC was 11.4%, and over 70 years of age, WON complication, and failure to secession DIC by day 7 were associated with mortality. Because the use of rTM improves the rate of DIC secession at day 7, it may improve the mortality rate in SAP complicated by DIC.