Figure - available from: Digestive Diseases and Sciences
This content is subject to copyright. Terms and conditions apply.
Peripancreatic necrosis alone with fat necrosis in the anterior renal space (triangle) and no pancreatic parenchymal necrosis (star)
Source publication
Background and Aims
Pancreatic necrosis is a risk factor for poor prognosis of acute pancreatitis (AP). However, the associations between the findings on initial contrast-enhanced computed tomography (CT) of the pancreas and infected pancreatic necrosis (IPN) are unclear.
Methods
This was a retrospective cohort study. Patients with severe AP (SAP)...
Similar publications
The purpose of the thisstudy was to evaluate the value of dual-phase multidetector computed tomography (MDCT) as a useful tool for assessing acute and chronic pancreatitis. Oedematous parenchyma, necrosis,peripancreatic inflammation and acute fluid collections are signs of acute pancreatitis on MDCT. Pancreaticparenchymal calcification, MPD dilatat...
Citations
... We found that a higher proportion of the patients with necrotizing pancreatitis (82.4%) were males when compared with 17.6% of the females with necrotizing pancreatitis (P-value: 0.005). Similarly, 32.5% of the patients with necrotizing pancreatitis were alcoholic compared to16.1% of the Citation: Mahdi Albander., et al. "Biliary Vs Non-Biliary Risk Factors of Development of Acute Necrotizing Pancreatitis as a Sequel of Acute ...
... Of all study population,19.8% were smokers and 17.8% were alcoholics. In one of the studies done in the Hospital of Nanchang University, 142 eligible patients were enrolled, with the average age of 55.87 ± 15.47 years and the majority were males (52.11%), moreover; 5.63% were patients with alcoholic pancreatitis (5.63%)[16]. Another study in Nantes University hospital in France, that included 148 patients, the average age of the patients was 54.1 years old (17.5%) with male predominance 107 (72.3%)[17].Out of the total patients who developed necrotizing pancreatitis, males were associated with 3.46 higher risk of development of NP with p-value of 0.005. Furthermore, 32.5% of these patients were alcoholics compared to 16.1% of the patients without necrotizing pancreatitis (p-value: 0.02) and diabetics 41.2% (p-value: 0.025). ...
Background: Necrotizing pancreatitis is associated with high rate of morbidity and mortality that could be a leading cause of serious complications such as cholangitis, ileus, bowel ischemia, formation of pseudoaneurysm, hemorrhage and venous thrombosis. Therefore, identification of different possible risk factors is essential as it help in early diagnosis and management. This study aimed to identify possible risk factors to develop necrotizing pancreatitis including both biliary or non biliary risk factors after presenting as case of acute pancreatitis.
Methods: This study is a retrospective cohort study which will include all patients admitted to King Saud Medical City, Riyadh Saudi Arabia, with diagnosis of acute and necrotizing pancreatitis, male and female, aged more than or equal to 18 years old A customized data collection sheet will be used to collect relevant data. A p value of less than or equal to 0.025 will considered significant.
Results: The prevalence of gallbladder disease and stones in this study was found to be 19.3% and 39.4% respectively. Around 13.1% of the subjects had a history of pancreatitis and 2.7% had developed an infection. In the overall sample, 12.01% of the patients (n = 34) had developed Necrotizing Pancreatitis (NP), (82.4%) were males (P-value: 0.005), alcoholics (32.5%) (p-value: 0.02), and (41.2%) were diabetics (23.3%; p-value: 0.025). Surprisingly, a lower proportion of the patients with NP had gallbladder disease (14.8%) or gallbladder stones (20.6%) (P-value: 0.04). In addition, the distribution of continuous variables such as WBC (P-value: 0.027), serum glucose (P-value: 0.02), blood urea nitrogen (P-value: 0.001), serum calcium (P-value: 0.001), serum lactase (P-value: 0.001), LDH (P-value: 0.0001), and serum lipase (P-value: 0.032) was significantly different for patients with and without NP. Findings of binary regression analysis showed that males (OR = 4.89; [95% CI: 2.18 - 10.96]), alcoholics (RR = 2.49; [95% CI: 1.13 - 5.53]), and diabetic patients (RR = 2.30 [95% CI: 1.09 - 4.84) were more likely to develop NP. Patients with gallbladder stones and gallbladder disease were 49% and 85% less likely to develop NP, respectively (RR = 0.41; 95% CI: 0.17 - 0.98). The significant risk factors of NP after making adjustments were found to be gender (male) (aRR = 2.89; 95% CI: 1.11 - 7.50), diabetes history (aRR = 2.17; 95% CI: 0.99 - 4.76), and history of pancreatitis (aRR = 2.59; 95% CI: 1.01 - 6.60).
Conclusion: Risk factors that were correlated positively with development of Necrotizing pancreatitis (NP) after an acute pancreatitis (AP) episode were being male (RR = 3.46), alcoholic (RR = 2.49), and have diabetes mellitus (RR = 2.3), initial presentation with septic picture (RR = 3.83). on the other hand, patients with gallbladder disease or stone were less likely to develop NP as a sequel of AP.
Keywords: Necrotizing Pancreatitis; Risk Factors; Biliary; Non Biliary.
... Computed tomography is the "gold" standard when diagnosing pancreatic necrosis and other complications of AP. Therefore, the role of CT in predicting AP severity and the course of disease is significant [21]. Timing of initial and repeated CT in AP management is still a topic of ongoing discussions [17,21]. ...
... Therefore, the role of CT in predicting AP severity and the course of disease is significant [21]. Timing of initial and repeated CT in AP management is still a topic of ongoing discussions [17,21]. According to IAP/APA guidelines, initial CT should be assessed at least 72-96 h after symptom presentation [6]. ...
... In most of the cases, as recommended, intravenous antibiotic prophylaxis was not given. If infected pancreatic necrosis is diagnosed, the guidelines recommended starting with minimally invasive treatment [17,21]. However, interventional treatment should be avoided in the first weeks and postponed, if clinical status allows, for at least four weeks. ...
Background and Objectives: The course and clinical outcomes of acute pancreatitis (AP) are highly variable. Up to 20% of patients develop pancreatic necrosis. Extent and location of it might affect the clinical course and management. The aim was to determine the clinical relevance of the extent and location of pancreatic necrosis in patients with AP. Materials and Methods: A cohort of patients with necrotizing AP was collected from 2012 to 2018 at the Hospital of Lithuanian University of Health Sciences. Patients were allocated to subgroups according to the location (entire pancreas, left and right sides of pancreas) and extent (<30%, 30–50%, >50%) of pancreatic necrosis. Patients were reviewed for demographic features, number of performed surgical interventions, local and systemic complications, hospital stay and mortality rate. All contrast enhanced computed tomography (CECT) scans were evaluated by at least two experienced abdominal radiologists. All patients were treated according to the standard treatment protocol based on current international guidelines. Results: The study included 83 patients (75.9% males (n = 63)) with a mean age of 53 ± 1.7. The volume of pancreatic necrosis exceeded 50% in half of the patients (n = 42, 51%). Positive blood culture (n = 14 (87.5%)), multiple organ dysfunction syndrome (n = 17 (73.9%)) and incidences of respiratory failure (n = 19 (73.1%)) were significantly more often diagnosed in patients with pancreatic necrosis exceeding 50% (p < 0.05). Patients with >50% of necrosis were significantly (p < 0.05) more often diagnosed with moderately severe (n = 24 (41.4%)) and severe (n = 18 (72%)) AP. The number of surgical interventions (n = 18 (72%)) and ultrasound-guided interventions (n = 26 (65%)) was also significantly higher. In patients with whole-pancreas necrosis, incidence of renal insufficiency (n = 11 (64.7%)) and infected pancreatic necrosis (n = 19 (57.6%)) was significantly higher (p < 0.05). Conclusions: The clinical course and outcome were worse in the case of pancreatic necrosis exceeding 50%, rendering the need for longer and more complex treatment.
... We receive more than 200 patients with severe acute pancreatitis each year from ICUs across the country. During the ongoing COVID-19 pandemic, our team often faces great trials and pressures, since infections are one of the leading causes of severe acute pancreatitis-related death (Ding et al., 2019). In this study, to avoid overuse and misuse of antibiotics, we first analyzed bacteria distribution and drug-resistance characteristics and then attempted to elucidate the underlying molecular mechanism using whole-genome sequencing (WGS). ...
Infected pancreatic necrosis (IPN) is a key risk factor in the progression of severe acute pancreatitis, and use of antibiotics is one of the main clinical actions. However, early prophylactic or unreasonable use of antibiotics promotes drug resistance in bacteria and also delays optimum treatment. To explore genomic evidence of rational antibiotic use in intensive care units, we isolated Klebsiella pneumoniae from IPN samples that showed the highest positive-culture rate in 758 patients. Based on whole-genome sequencing from eight strains, 42 antibiotic-resistant genes were identified in the chromatin and 27 in the plasmid, which included classic resistance-mechanism factors such as β-lactamases [16.67% (7/42) in the chromatin and 25.93% (7/27) in the plasmid]. The K. pneumoniae isolates were identified to be resistant to multiple antibiotics used in clinics. In vivo and in vitro, ceftazidime-avibactam (CZA) plus aztreonam (ATM) (2.5:1) showed more significant antibacterial effectiveness than CZA alone. The isolated K. pneumoniae were of three different types according to the resistance phenotypes for CZA and ATM. Those co-harboring bla NDM-5, bla CTX-M-15, bla OXA-1, and bla SHV-187 showed higher resistance to CAZ than bla NDM-5. Those co-harboring bla CTX-M-65, bla SHV-182, and bla TEM-181 were significantly less resistant to β-lactam than to other extended-spectrum β-lactamases. However, β-lactamases were inhibited by avibactam (AVI), except for NDM-5. ATM plus AVI showed a significant inhibitory effect on K. pneumoniae, and the minimum dosage of ATM was < 1 mg/L. In conclusion, we propose that ATM plus AVI could be a major therapy for complex infectious diseases caused by multidrug-resistant K. pneumoniae.
... 28 A recent analysis of patients with only necrotic SAP found the number of necrotic collections independently associating with the risk of IPN. 31 Results from these previous reports and those of the present study warrant clinician to consider widespread necrotic collections as if they are infected with low threshold. An increased proportion of pancreatic parenchymal necrosis has previously been associated with an increased risk of IPN, but our study failed to show such association. ...
Background
In patients with severe acute pancreatitis (SAP), infected pancreatic necrosis (IPN) is associated with a worsened outcome. We studied risk factors and consequences of IPN in patients with necrotizing SAP.
Methods
The study consisted of a retrospective cohort of 163 consecutive patients treated for necrotizing SAP at a university hospital intensive care unit (ICU) between 2010 and 2018.
Results
All patients had experienced at least one persistent organ failure and approximately 60% had multiple organ failure within the first 24 h from admission to the ICU. Forty-seven (28.8%) patients had IPN within 90 days. Independent risk factors for IPN were more extensive anatomical spread of necrotic collections (unilateral paracolic or retromesenteric (OR 5.7, 95% CI 1.5–21.1) and widespread (OR 21.8, 95% CI 6.1–77.8)) compared to local collections around the pancreas, postinterventional pancreatitis (OR 13.5, 95% CI 2.4–76.5), preceding bacteremia (OR 4.8, 95% CI 1.3–17.6), and preceding open abdomen treatment for abdominal compartment syndrome (OR 3.6, 95% CI 1.4–9.3). Patients with IPN had longer ICU and overall hospital lengths of stay, higher risk for necrosectomy, and higher readmission rate to ICU.
Conclusions
Wide anatomical spread of necrotic collections, postinterventional etiology, preceding bacteremia, and preceding open abdomen treatment were identified as independent risk factors for IPN.
... While Ding et al. [45] reported a non-significant effect of FLD on pancreatic necrosis infection (OR = 0.971; 95% CI: 0.45-2.08), another study reported an increased risk of infection in AP patients with FLD (46.5% vs. 38%, p < 0.05) [18]. ...
The prevalence of fatty liver disease (FLD) and that of non-alcoholic fatty liver disease (NAFLD) share some risk factors known to exacerbate the course of acute pancreatitis (AP). This meta-analysis aimed to investigate whether FLD or NAFLD carry a higher risk of untoward outcomes in AP. In accordance with PRISMA guidelines, we performed a systematic search in seven medical databases for cohort studies that compared the outcomes of AP for the presence of FLD or NAFLD, and we calculated pooled odds ratio (OR) or weighted mean difference (WMD) with 95% confidence interval (CI). We included 13 articles in our meta-analysis. AP patients with FLD were more likely to die (5.09% vs 1.89%, OR = 3.56, CI = 1.75–7.22), develop severe AP (16.33% vs 7.87%, OR = 2.67, CI = 2.01-3.56), necrotizing pancreatitis (34.83% vs 15.75%, OR = 3.08, CI = 2.44-3.90) and had longer in-hospital stay (10.8 vs 9.2 days, WMD = 1.46, OR = 0.54–2.39). Patients with NAFLD were more likely to have severe AP and longer hospital stay. Both FLD and NAFLD proved to be independent risk factors of a more severe disease course (OR = 3.68, CI = 2.16–6.29 and OR = 3.39, CI = 1.52–7.56 for moderate/ severe vs. mild AP, respectively). FLD and NAFLD worsen the outcomes of AP, which suggests that incorporating FLD or NAFLD into prognostic scoring systems of AP outcomes might improve the prediction of severity and contribute to a more individualized patient care.
... Imaging protocols vary by institution, however, a typical CT protocol for evaluation of acute pancreatitis is a singlephase study in the pancreatic parenchymal phase (40 s after the initiation of IV contrast) [16,22] or portal venous phase (60-80 s) [23,24] from the top of the diaphragm and including the entire abdomen. A bolus intravenous injection of non-ionic 100-120 mL of iodinated contrast material (at a dose of 1.3-1.5 ml/kg) is performed by using a pressure injector at the rate of 3-5 ml/s [16,[23][24][25][26]. This may be followed by a saline chase of 20 ml normal saline at a rate of 2.5-3 ml/s [24,25] to improve contrast enhancement and the efficiency of contrast medium utilization [26]. ...
... A bolus intravenous injection of non-ionic 100-120 mL of iodinated contrast material (at a dose of 1.3-1.5 ml/kg) is performed by using a pressure injector at the rate of 3-5 ml/s [16,[23][24][25][26]. This may be followed by a saline chase of 20 ml normal saline at a rate of 2.5-3 ml/s [24,25] to improve contrast enhancement and the efficiency of contrast medium utilization [26]. Images are typically reconstructed at 3-mm intervals in the axial planes. ...
... Arterial phase can be performed at 25-30 s after the initiation of IV contrast or with the use of bolus triggering technique with attenuation monitored within the aorta. [24,25]. However, for evaluating severity of pancreatic and extra-pancreatic changes, an initial dual-phase abdominal CT performed 72 h or more after onset of symptoms of acute pancreatitis has not been shown to be superior to singlephase CT [24]. ...
Acute pancreatitis is an increasingly common condition and can result in significant morbidity and mortality. Contrast enhanced computed tomography (CECT) is the primary initial imaging modality in the characterization of acute pancreatitis. In this article, we provide sample CECT technical acquisition parameters for pancreatic imaging. We also review the classification systems for acute pancreatitis and give examples of common and uncommon complications of acute pancreatitis. © 2019, Springer Science+Business Media, LLC, part of Springer Nature.
... Most often, early multiple organ failure occurs in patients with extended necrosis, which is another risk factor for infection [43,44]. The high incidence of pancreatic infection in patients with extended necrosis, especially in combination with dynamic intestinal obstruction in the early phase of the disease, is also indicated by Moran et al. [45]. ...
Controlling infection is crucial in treating patients with acute pancreatitis (AP). The infectious process in AP often predisposes to subsequent sepsis by damaging not only the pancreas, but retroperitoneal tissues as well. Among other AP-associated factors, are the rapidly developing immune imbalance, the poor penetration of antimicrobial agents into necrotic tissue, and the impossibility of a single surgical debridement. Antibacterial and antifungal therapy for patients with infected necrosis and AP-associated extra-pancreatic infections remains a complex and largely unresolved problem, partially due to the high occurrence of multiresistant pathogens. The preventive use of antimicrobial agents has been discussed in the literature; however, the lack of consistent results makes it difficult to develop a unified strategy and clinical guidelines on this specific issue. Recent meta-analyses provide no conclusive evidence that antibacterial prophylaxis reduces the infection rate, mortality, or the need for surgical treatment in patients with necrotizing pancreatitis. We found only two studies indicating the benefits of using carbapenems for prophylactic purposes and one meta-analysis indicating a reduction in mortality under antibiotic treatment started no later than 72 h after the onset of the attack. Selective bowel decontamination is considered as one of the preventive anti-infection measures, although the available data may not be fully reliable.
The main indications for antibacterial therapy in patients with AP are confirmed infected necrosis or extra-pancreatic infection, as well as clinical symptoms of suspected infection. Intra-arterial administration or local treatment with antibiotics can increase the efficacy of antibacterial therapy. No randomized studies on antifungal prophylaxis in AP are available; some reports though recommend using such therapy among patients at high risk of invasive candidiasis.
Acute pancreatitis (AP) is a potentially life-threatening inflammatory disease of the pancreas, with clinical management determined by the severity of the disease. Diagnosis, severity prediction, and prognosis assessment of AP typically involve the use of imaging technologies, such as computed tomography, magnetic resonance imaging, and ultrasound, and scoring systems, including Ranson, Acute Physiology and Chronic Health Evaluation II, and Bedside Index for Severity in AP scores. Computed tomography is considered the gold standard imaging modality for AP due to its high sensitivity and specificity, while magnetic resonance imaging and ultrasound can provide additional information on biliary obstruction and vascular complications. Scoring systems utilize clinical and laboratory parameters to classify AP patients into mild, moderate, or severe categories, guiding treatment decisions, such as intensive care unit admission, early enteral feeding, and antibiotic use. Despite the central role of imaging technologies and scoring systems in AP management, these methods have limitations in terms of accuracy, reproducibility, practicality and economics. Recent advancements of artificial intelligence (AI) provide new opportunities to enhance their performance by analyzing vast amounts of clinical and imaging data. AI algorithms can analyze large amounts of clinical and imaging data, identify scoring system patterns, and predict the clinical course of disease. AI-based models have shown promising results in predicting the severity and mortality of AP, but further validation and standardization are required before widespread clinical application. In addition, understanding the correlation between these three technologies will aid in developing new methods that can accurately, sensitively, and specifically be used in the diagnosis, severity prediction, and prognosis assessment of AP through complementary advantages.
Background:
Hypertriglyceridemia is a common cause of acute pancreatitis. Pregnant women are at risk of developing hypertriglyceridemia-induced acute pancreatitis (HTG-AP); however, whether pregnancy increases the risk of infected pancreatic necrosis (IPN) is unknown.
Aim:
We aimed to assess the association between pregnancy and IPN.
Methods:
This 10-year retrospective cohort study was conducted at Jinling Hospital. Adult female patients of childbearing age with HTG-AP between January 2013 and September 2022 were screened. Logistic regression analyses were performed to assess the risk factors for IPN. Patients admitted within 7 days were assigned to the training and validation sets to develop a dynamic nomogram for IPN prediction.
Results:
489 patients were included, and 144 developed IPN. Logistic regression analyses revealed pregnancy (OR: 2.578 95% CI: 1.474-4.510) as an independent risk factor for IPN. Gestation weeks, ARDS, albumin level, and serum creatinine level were selected as the predictors of the dynamic nomogram for IPN prediction, with good discrimination in the training set (AUC 0.867 95% CI: 0.794-0.940) and validation set (AUC 0.957 95% CI: 0.885-1.000).
Conclusion:
Pregnancy increases the risk of IPN in adult patients of childbearing age with HTG-AP, and the dynamic nomogram may help risk stratification for IPN.
Purpose:
To determine the correlation between the pancreatic necrosis volume (PNV) and readmission as well as reintervention.
Method:
This was a retrospective cohort study that included necrotizing pancreatitis (NP) patients who were examined with contrast-enhanced computed tomography (CT) one week before discharge. The PNV was calculated manually based on the postprocessing workstation software. Multivariate logistic regression analysis was employed to determine the independent risk factors for readmission and reintervention.
Results:
A total of 167 NP patients were included. Among them, 94 (56.3%) patients were readmitted after discharge, and 55 (32.9%) patients needed further invasive intervention. The median PNV of all patients was 376.6 (interquartile range (IQR), 129.3-820.5) cm3, and the PNV was significantly higher in patients needing readmission or reintervention. Multivariate analysis showed that PNV ≥ 620 cm3 (adjusted odds ratio (adjOR), 3.08; 95% confidence interval (CI), 1.47-6.43; P = 0.003) and modified computed tomography severity index (CTSI) score ≥ 7 points (adjOR, 6.36; 95% CI, 2.05-10.70; P = 0.001) were independently associated with readmission. Stent or drainage tube placement at discharge (adjOR, 2.94; 95% CI, 1.27-6.77; P = 0.011), PNV ≥ 620 cm3 (adjOR, 5.11; 95% CI, 2.19-11.95; P < 0.001), pancreatic parenchymal necrosis (adjOR, 3.37; 95% CI, 1.42-7.96; P = 0.006), and modified CTSI score ≥ 7 points (adjOR, 4.23; 95% CI, 1.46-12.27; P = 0.008) were independent risk factors for reintervention.
Conclusions:
The PNV is a useful tool for quantifying pancreatic necrosis and is strongly associated with readmission and reintervention. Additional prospective studies with larger sample sizes are needed to confirm these findings.
