Visceral fat and acute pancreatitis
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[P-015]. Comparison of scoring systems in predicting severity of acute pancreatitis Hyun Hee Chung, Kook Hyun Kim, Tae Nyeun Kim Internal Medicine, Yeungnam University College of Medicine, Daegu, South Korea Background/aim: Severe acute pancreatitis (AP) occurs in about 20% of the patients with AP and associated with multiple organ failure and may additionally include local complications. The early prediction of the severity and identification of patients at risk has important implications for early intensive therapy. This study was designed to evaluate the prognostic usefulness of Ranson’s, Acute Physiology and Chronic Health Evaluation (APCHE)-II scoring systems, bedside index for severity in acute pancreatitis (BISAP), CT severity index(CTSI) and C-reactive protein(CRP) in predicting the severity of AP. Methods: We analyzed the prospectively collected clinical database of 161 patients diagnosed with AP between 2009 and 2012, retrospectively. The Ranson’s, APACHE-II score, BISAP and CTSI were calculated. Severe AP was defined by persistent organ failure for more than 48 hr according to most recently revised Atlanta classification. Predictive accuracy of the scoring systems was measured by the area under the receiver-operating curve (AUC). Results: Twenty-one patients (13%) were classified as severe AP and 140 were classified as mild to moderately severe AP according to the Atlanta classification. The mortality rate was 1.9%(n¼3). AUCs for Ranson’s, BISAP, APACHE-II, CT index, and CRP (24 hours after admission) in pre- dicting severe AP are 0.69(CI 0.62w0.76), 0.74(CI 0.66w0.80), 0.78(CI 0.7w0.84), 0.69(CI 0.61w0.76) and 0.68(0.57w0.78), respectively. Although APACH-II demonstrated the highest accuracy for predicting se- vere AP, no statistically significant pairwise differences were observed between APACHE-II and the other score systems including CRP. Conclusions: In this study, various score systems and CRP had similar predictive accuracy for severity of AP. APACH-II seems to be the highest accuracy for severe AP. However, no simple scoring systems are available to reach maximal utility and unique models are needed to further improve predictive accuracy. Keywords: Severe acute pancreatitis [P-016]. Visceral fat and acute pancreatitis Serge Chooklin, Mariya Shavarova Department of Surgery, Medical University, Lviv, Ukraine Background/aim: Obesity plays an important role in acute pancreatitis (AP). Increased visceral fat has been shown to exacerbate the pro-in- flammatory milieu experienced by patients. Volume of visceral adipose tissue directly influences the severity of acute pancreatitis. Methods: Medical records of 55 patients with acute pancreatitis were reviewed. General data, acute pancreatitis etiology, admission prognostic criteria, and occurrence of complications were recorded. Patients were classified according to body mass index (BMI) as obese (BMI > 30) and non-obese (BMI 30). We examine the association between waist circumference and body mass index and the risk of acute pancreatitis. We calculate individual abdominal fat distribution parameters from CT scans by segmentation of abdominal tissues. Results: The risk for severe AP increased according to the degree of obesity. The risk of acute pancreatitis among those with a waist circum- ference of >105 cm was twofold increased compared with individuals with a waist circumference of 80.0–90.0 cm, when adjusted for confounders. Pancreatic and peripancreatic necrosis was more common in obese pa- tients, as was the incidence of infectious complications. Visceral fat volume was the volumetric fat parameter that had the most significant association with severe acute pancreatitis. There was a significant association between visceral fat volume and subsequent development of systemic complica- tions of severe acute pancreatitis. Conclusions: Obesity may predispose to a complicated course of AP. Abdominal adiposity is an independent risk factor for the development of acute pancreatitis. Visceral fat volume should be incorporated into future predictive scoring systems. Keywords: Acute pancreatitis, Obesity, Visceral fat [P-017]. The effect of early enteral nutrition on severe acute pancreatitis Yu Wang, Hong Zhang Department of EICU, 1st Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China Background/aim: Early enteral nutrition (EEN) has already been highlighted for the treatment of severe acute pancreatitis (SAP), but there is no strong evidence to suggest the appropriate time to start EEN. Methods: A clinical retrospective study was carried out on 60 patients with SAP in our hospital from Jan 2010 to Dec 2012. The patients were divided into early enteral nutrition group (EEN group, n¼20) which received nasojejunal enteral nutrition within 48 hours after admission, parenteral and enteral nutrition combined group (PNþEN group, n¼20) and total parenteral nutrition group (TPN group, n¼20). After 2-week treatment, the levels of serum C-reactive protein, albumin, prealbumin, hemoglobin, incidence of infections, incidence of MODS, duration of hos- pital stay, APACHE II score and SOFA score were evaluated. Results: The levels of albumin, prealbumin, C-reactive protein, APACHE II score and SOFA score in EEN group were (39.6810.81)g/L, (244.23102.02)g/L, (29.2123.51)mmol/L, (7.453.69) and (2.391.57) respectively, which were significantly improved compared with PNþEN group and TPN group (P<0.05); The hemoglobin decline in EEN group was significantly lower than those in PNþEN group and TPN group (P<0.05); The infection rate in EEN group (25%) was significantly lower than those in PNþEN group (60%) and TPN group (60%) (P<0.05); The incidence of MODS in EEN group was significantly lower than that in TPN group (15% vs 55%, P<0.05); The mean length of hospital stay in EEN group was signifi- cantly less than that in PNþEN group [(29.6516.80)d vs (31.7320.60)d, P<0.05)]. Conclusions: Start of enteral nutrition within 48 hours after admission can improve the nutrition status of the patients, and decrease the systemic inflammatory response and secondary infection. Keywords: Severe acute pancreatitis, Early enteral nutrition, Parenteral nutrition, C reactive protein, APACHE II [P-018]. Outcome of critically ill patients and severity of acute pancreatitis and acute kidney injury Maxim Ilynskiy, Irina Aleksandrova, Sergey Rei, Vladimir Kiselev, Gennadiy Berdnikov, Ludmila Marchenkova Acute Endotoxicosis, Hospital Research Institute for Emergency Medicine Named after N.v. Sklifosovsky, Moscow, Russian Federation Background/aim: The systemic determinant of severity in a new classification of acute pancreatitis (AP) is based on identification of pa- tients with persistent organ failure (OF). Development of acute kidney injury (AKI) in critically ill patients is associated with significant mortality and in fatal AP renal dysfunction is one of the most frequently occurring complications, along with pulmonary and cardiovascular dysfunction. The aim of the current retrospective study was to examine the asso- ciation between severity of AKI and outcome in ICU patients with AP. Methods: This study included 152 patients who were admitted to the ICU between 2002 and 2009. Admissions transferred from other hospitals Abstracts / Pancreatology 13 (2013) S1–S80 S20
Transcript of Visceral fat and acute pancreatitis
ology 13 (2013) S1–S80
[P-015].
Comparison of scoring systems in predicting severity of acutepancreatitis
Hyun Hee Chung, Kook Hyun Kim, Tae Nyeun Kim
Internal Medicine, Yeungnam University College of Medicine, Daegu,South Korea
Background/aim: Severe acute pancreatitis (AP) occurs in about 20% ofthe patients with AP and associated with multiple organ failure and mayadditionally include local complications. The early prediction of theseverity and identification of patients at risk has important implicationsfor early intensive therapy.
This study was designed to evaluate the prognostic usefulness ofRanson’s, Acute Physiology and Chronic Health Evaluation (APCHE)-IIscoring systems, bedside index for severity in acute pancreatitis (BISAP),CT severity index(CTSI) and C-reactive protein(CRP) in predicting theseverity of AP.
Methods: We analyzed the prospectively collected clinical database of161 patients diagnosed with AP between 2009 and 2012, retrospectively.The Ranson’s, APACHE-II score, BISAP and CTSI were calculated. Severe APwas defined by persistent organ failure for more than 48 hr according tomost recently revised Atlanta classification. Predictive accuracy of thescoring systems was measured by the area under the receiver-operatingcurve (AUC).
Results: Twenty-one patients (13%) were classified as severe AP and140 were classified as mild to moderately severe AP according to theAtlanta classification. The mortality rate was 1.9%(n¼3). AUCs for Ranson’s,BISAP, APACHE-II, CT index, and CRP (24 hours after admission) in pre-dicting severe AP are 0.69(CI 0.62w0.76), 0.74(CI 0.66w0.80), 0.78(CI0.7w0.84), 0.69(CI 0.61w0.76) and 0.68(0.57w0.78), respectively.Although APACH-II demonstrated the highest accuracy for predicting se-vere AP, no statistically significant pairwise differences were observedbetween APACHE-II and the other score systems including CRP.
Conclusions: In this study, various score systems and CRP had similarpredictive accuracy for severity of AP. APACH-II seems to be the highestaccuracy for severe AP. However, no simple scoring systems are available toreach maximal utility and unique models are needed to further improvepredictive accuracy.
Keywords: Severe acute pancreatitis
[P-016].
Visceral fat and acute pancreatitis
Serge Chooklin, Mariya Shavarova
Department of Surgery, Medical University, Lviv, Ukraine
Background/aim: Obesity plays an important role in acute pancreatitis(AP). Increased visceral fat has been shown to exacerbate the pro-in-flammatory milieu experienced by patients. Volume of visceral adiposetissue directly influences the severity of acute pancreatitis.
Methods: Medical records of 55 patients with acute pancreatitis werereviewed. General data, acute pancreatitis etiology, admission prognosticcriteria, and occurrence of complications were recorded. Patients wereclassified according to body mass index (BMI) as obese (BMI > 30) andnon-obese (BMI � 30). We examine the association between waistcircumference and body mass index and the risk of acute pancreatitis. Wecalculate individual abdominal fat distribution parameters from CT scansby segmentation of abdominal tissues.
Results: The risk for severe AP increased according to the degree ofobesity. The risk of acute pancreatitis among those with a waist circum-ference of>105 cmwas twofold increased comparedwith individuals witha waist circumference of 80.0–90.0 cm, when adjusted for confounders.Pancreatic and peripancreatic necrosis was more common in obese pa-tients, as was the incidence of infectious complications. Visceral fat volumewas the volumetric fat parameter that had the most significant associationwith severe acute pancreatitis. There was a significant association between
Abstracts / PancreatS20
visceral fat volume and subsequent development of systemic complica-tions of severe acute pancreatitis.
Conclusions: Obesity may predispose to a complicated course of AP.Abdominal adiposity is an independent risk factor for the development ofacute pancreatitis. Visceral fat volume should be incorporated into futurepredictive scoring systems.
Keywords: Acute pancreatitis, Obesity, Visceral fat
[P-017].
The effect of early enteral nutrition on severe acute pancreatitis
Yu Wang, Hong Zhang
Department of EICU, 1st Affiliated Hospital of Anhui MedicalUniversity, Hefei, Anhui, China
Background/aim: Early enteral nutrition (EEN) has already beenhighlighted for the treatment of severe acute pancreatitis (SAP), but thereis no strong evidence to suggest the appropriate time to start EEN.
Methods: A clinical retrospective study was carried out on 60 patientswith SAP in our hospital from Jan 2010 to Dec 2012. The patients weredivided into early enteral nutrition group (EEN group, n¼20) whichreceived nasojejunal enteral nutrition within 48 hours after admission,parenteral and enteral nutrition combined group (PNþEN group, n¼20)and total parenteral nutrition group (TPN group, n¼20). After 2-weektreatment, the levels of serum C-reactive protein, albumin, prealbumin,hemoglobin, incidence of infections, incidence of MODS, duration of hos-pital stay, APACHE II score and SOFA score were evaluated.
Results: The levels of albumin, prealbumin, C-reactive protein, APACHEII score and SOFA score in EEN group were (39.68�10.81)g/L,(244.23�102.02)g/L, (29.21�23.51)mmol/L, (7.45�3.69) and (2.39�1.57)respectively, which were significantly improved compared with PNþENgroup and TPN group (P<0.05); The hemoglobin decline in EEN group wassignificantly lower than those in PNþEN group and TPN group (P<0.05);The infection rate in EEN group (25%) was significantly lower than those inPNþEN group (60%) and TPN group (60%) (P<0.05); The incidence ofMODS in EEN group was significantly lower than that in TPN group (15% vs55%, P<0.05); The mean length of hospital stay in EEN group was signifi-cantly less than that in PNþEN group [(29.65�16.80)d vs (31.73�20.60)d,P<0.05)].
Conclusions: Start of enteral nutritionwithin 48 hours after admissioncan improve the nutrition status of the patients, and decrease the systemicinflammatory response and secondary infection.
Keywords: Severe acute pancreatitis, Early enteral nutrition, Parenteralnutrition, C reactive protein, APACHE II
[P-018].
Outcome of critically ill patients and severity of acute pancreatitis andacute kidney injury
Maxim Ilynskiy, Irina Aleksandrova, Sergey Rei,Vladimir Kiselev, Gennadiy Berdnikov, Ludmila Marchenkova
Acute Endotoxicosis, Hospital Research Institute for EmergencyMedicine Named after N.v. Sklifosovsky, Moscow, Russian Federation
Background/aim: The systemic determinant of severity in a newclassification of acute pancreatitis (AP) is based on identification of pa-tients with persistent organ failure (OF). Development of acute kidneyinjury (AKI) in critically ill patients is associated with significant mortalityand in fatal AP renal dysfunction is one of the most frequently occurringcomplications, along with pulmonary and cardiovascular dysfunction.
The aim of the current retrospective study was to examine the asso-ciation between severity of AKI and outcome in ICU patients with AP.
Methods: This study included 152 patients who were admitted to theICU between 2002 and 2009. Admissions transferred from other hospitals
