Search

Objective To investigate the clinical features of acute pancreatitis(AP) with metabolic syndrome(MS) and the influencing factors for prognosis.Methods A retrospective analysis was performed for the clinical data of 590 patients with AP who were admitted to The Affiliated Hospital of Southwest Medical University from January 2013 to January 2019,and according the presence or absence of MS,they were divided into MS group with 178 patients and non-MS group with 412 patients and basic clinical features were compared between the two groups.According to the severity of AP,they were divided into mild acute pancreatitis(MAP) group with 317 patients,moderate-severe acute pancreatitis(MSAP) group with 171 patients,and severe acute pancreatitis(SAP) group with 102 patients,and the component indicators of MS were compared between the three groups.The t-test was used for comparison of normally distributed continuous data between two groups,and a one-way analysis of variance was used for comparison between multiple groups;the Mann-Whitney U test was used for comparison of non-normally distributed continuous data between two groups,and the Kruskal-Wallis H test was used for comparison between multiple groups;Bonferroni correction was used for further comparison between two groups.The chi-square test was used for comparison of categorical data between groups;the trend chi-square test was used for comparison of one-way ordinal categorical data,and the Goodman-Kruskal Gamma analysis was used for two-way ordinal categorical data.An ordinal logistic regression analysis was used to investigate the correlation between body mass index(BMI) and severity of AP,and a binary logistic regression analysis was used to investigate the correlation between MS and severity of AP.Results The most common causes of MS with AP were hyperlipidemia(48.3%) and biliary disease(24.7%).The patients with SAP were more likely to have MS(χ2=141.519,P<0.001),and the patients with AP and MS tended to have a significantly higher clinical system score,significantly more local and systemic complications,significantly longer hospital stays,a significantly higher ICU admission rate,and a significantly higher mortality rate(all P<0.05).The severity of AP increased with the increase in MS components(overweight,hypertension,diabetes,and dyslipidemia),(G=0.540,P<0.001).There were significant differences between the MAP,MSAP,and SAP groups in BMI(F=9.291,P<0.001) and high-density lipoprotein cholesterol(HDL-C)(χ2=40.351,P<0.001),and the SAP group had significantly higher BMI and significantly lower HDL-C than the MAP group and the MSAP group(all P<0.05).The ordinal logistic regression analysis showed that BMI was an independent risk factor for the progression of AP(odds ratio [OR]=1.091,95% confidence interval [CI]:1.041-1.143,P<0.001).Binary logistic regression models were established based on the severity of AP,with MAP group versus non-MAP group as model 1 and SAP group versus non-SAP group as model 2.The results showed that in model 1,the incidence rate of non-MAP was 5.867 times that of MAP in patients with MS(OR=5.867,95% CI:3.072-11.207,P<0.001),and in model 2,the incidence rate of SAP was 7.214 times that of non-SAP(OR=7.214,95% CI:3.018-17.244,P<0.001).Both model 1 and model 2 showed that HDL-C was a protective factor against the progression of AP(model 1:OR=0.593,95% CI:0.387-0.910,P=0.017;model 2:OR=0.314,95% CI:0.160-0.614,P=0.001).Conclusion AP with MS on admission may suggest poor prognosis,and BMI and HDL-C are closely associated with disease progression. [ABSTRACT FROM AUTHOR]

Objective To investigate the association of hypertriglyceridemic waist(HTGW) phenotype with the severity and prognosis of acute pancreatitis(AP). Methods A total of 356 patients with AP who were admitted to The Affiliated Hospital of Southwest Medical University from September 2018 to August 2019 were enrolled as subjects and were divided into normal-waist-normal-triglyceride(NWNT)group, normal-waist-elevated-triglyceride(NWET) group, enlarged-waist-normal-triglyceride(EWNT) group, and HTGW group. The four groups were compared in terms of the clinical features including age sex, laboratory markers, disease grade, and complications. A one-way ANOVA was used for comparison of normally distributed continuous data between groups, and the least significant difference t-test was used for further comparison between two groups; the Kruskal-Wallis H test was used for comparison of non-normally distributed continuous data between multiple groups and between any two groups. The chi-square test was used for comparison of dichotomous variables between multiple groups and between any two groups; the Kruskal-Wallis H test was used for comparison of ordered polytomous variables between multiple groups, and the Mann-Whitney U rank sum test was used for comparison between two groups. Univariate and multivariate logistic regression analyses were performed to investigate the influencing factors for organ failure and pancreatic infection and necrosis. Results The HTGW group had a significantly higher neutrophil count than the NWNT group, a significantly higher C-reactive protein level than the NWNT group and the NWET group, a significantly higher creatinine level than the NWNT group, significantly higher levels of total cholesterol, triglyceride, and low-density lipoprotein than the NWNT group and the EWNT group, a significantly lower level of high-density lipoprotein than the NWNT group and the EWNT group, and a significantly higher level of blood glucose than the NWNT group(all P<0.05). The HTGW group had a significantly higher incidence rate of severe AP(SAP) than the other three groups(χ2= 189.519, P<0.001), as well as significantly higher incidence rates of infectious pancreatic necrosis and organ failure than the other three groups(χ2=11.770 and 19.457, P = 0.008 and P<0.001). The univariate logistic regression analysis showed that sex, recurrence history were the risk factors for infectious pancreatic necrosis, and after the adjustment for these risk factors, the risk of infectious pancreatic necrosis in the HTGW group was 3.347 times that in the NWNT group(95% confidence interval [CI]: 1.538-7.283, P = 0.002; body mass index, WTI, smoking, diabetes mellitus, and HTGW were the risk factors for organ failure(P<0.05), and after the adjustment for these risk factors, the risk of organ failure in the HTGW group was 4.143 times that in the NWNT group(95% CI: 1.299-13.219, P = 0.016). Conclusion HTGW is an independent risk factor for the development of SAP and may affect patients’ disease severity and complications. Such patients should be identified and diagnosed as early as possible, and improvement of dyslipidemia should be performed to improve patients’ conditions and prognosis. [ABSTRACT FROM AUTHOR]

Objective To investigate the blood lipid parameters for the early prediction of severe acute pancreatitis( SAP) and their predictive value. Methods A retrospective analysis was performed for the clinical data of 425 patients with acute pancreatitis( AP) who were admitted to The Affiliated Hospital of Southwest Medical University from January 2017 to January 2019,among whom there were 229 patients with mild acute pancreatitis( MAP),161 patients with moderate-severe acute pancreatitis( MSAP),and 35 patients with severe acute pancreatitis( SAP). Blood lipid levels were collected for all patients within the first 24 hours after admission. A one-way analysis of variance and the Kruskal-Wallis H test were used for comparison of continuous data between multiple groups. A logistic regression analysis was used for the variables with statistical significance determined by the univariate analysis. The Spearman correlation was used to investigate the correlation between data. The receiver operating characteristic( ROC) curve was used to evaluate the diagnostic efficiency of indices,and Med Calc software was used to investigate whether there was a significant difference in diagnostic efficiency. Results There were significant differences in apolipoprotein A1( ApoA1) and apolipoprotein B-to-apolipoprotein A1( Apo B/A1) ratio between the patients with different severities of acute pancreatitis( F = 46. 290,χ2= 9. 130,both P < 0. 05). Apo B/A1 ratio was positively correlated with Atlanta grade,Ranson score,MCTSI score,and BISAP score( r = 0. 296,0. 129,0. 303,and 0. 284,all P < 0. 05). ApoA1 was negatively correlated with Atlanta grade,Ranson score,MCTSI score,and BISAP score( r =-0. 407,-0. 176,-0. 338,and-0. 285,all P < 0. 05). Apo B/A1 ratio was an independent risk factor for SAP( odds ratio = 4. 493,95% confidence interval [CI]: 1. 399-14. 427,P = 0. 012),while ApoA1 was an independent protective factor for SAP( odds ratio = 0. 004,95% CI: 0-0. 034,P < 0. 001). Apo B/A1 ratio had an area under the ROC curve ( AUC) of 0. 763( 95% CI: 0. 675-0. 851,P <0. 001) in predicting SAP,and ApoA1 had an AUC of 0. 862( 95% CI: 0. 809-0. 916,P <0. 001) in predicting SAP,suggesting that ApoA1 had a higher diagnostic value( Z = 2. 183,P = 0. 029). Conclusion Both serum ApoB/A1 ratio and ApoA1 have a certain value in predicting SAP,and ApoA1 has a higher predictive value than ApoB/A1 ratio. [ABSTRACT FROM AUTHOR]

Objective To investigate the clinical and prognostic features of acute alcoholic pancreatitis. Methods A total of 467 patients with incipient acute pancreatitis (AP) who were admitted to The Affiliated Hospital of Southwest Medical University from July 2013 to July 2018 were enrolled as subjects, and among these patients, 182 with alcoholic AP were enrolled as alcoholic group and 285 with biliary AP were enrolled as biliary group. The two groups were compared in terms of the clinical features such as age, sex, laboratory markers, disease grade, complications, and prognostic indices. The independent samples t-test was used for comparison of normally distributed continuous data between two groups, and the Mann-Whitney U test was used for comparison of non-normally distributed continuous data between two groups. The chi-square test or the Fisher’s exact test was used for comparison of categorical data between two groups, and the Mann-Whitney U test was used for comparison of ranked data between two groups. Results Compared with the biliary group, the alcoholic group had significantly higher constituent ratio of male patients (74.2% vs 48.1%, χ2 =31.124, P＜0.001) and proportion of patients with fatty liver disease (34.1% vs 24.9%, χ2=4.569, P=0.033). The biliary group had a significantly higher proportion of patients with hypertension than the alcoholic group (23.5% vs 15.4%, χ2=4.524, P=0.033). Compared with the biliary group, the alcoholic group had significantly higher levels of creatinine and triglyceride (Z=-4.828, t=7.916, both P＜0.001), proportion of patients with severe AP (34.6% vs 15.1%, Z=-4.787, P＜0.001), and CTSI score (4.6±1.7 vs 4.2±1.5, t=2.672, P=0.008). Compared with the biliary group, the alcoholic group had significantly higher probabilities of acute peripancreatic fluid accumulation (61.0% vs 49.8%, χ2=5.045, P＜0.05), pancreatic pseudocyst (11.5% vs 4.2%, χ2=8.881, P＜0.05), infectious pancreatic necrosis (37.9% vs 19.6%, χ2=18.899, P＜0.05), and renal failure (19.2% vs 8.4%, χ2=11.758, P＜0.05). Compared with the biliary group, the alcoholic group had significantly longer time to intestinal function recovery, time to relief of abdominal pain, and length of hospital stay (t=-4.078, -3.357, and -2.527, all P＜0.05). There was a significant difference in mortality rate between the alcoholic group and the biliary group (7.1% vs 3.2%, χ2=3.929, P=0.047). Conclusion Compared with the biliary group, the alcoholic group has a higher risk of complications, worse clinical manifestations, and a higher mortality rate. Therefore, alcohol abstinence education should be performed for this population, especially men, in order to reduce adverse outcomes. [ABSTRACT FROM AUTHOR]

ObjectiveTo investigate the etiology and clinical features of acute pancreatitis (AP) in children. MethodsA total of 105 children with AP who were admitted to The Affiliated Hospital of Southwest Medical University from January 2013 to December 2018 were enrolled, and according to the severity of AP, they were divided into mild acute pancreatitis (MAP) group with 77 children, moderate-severe acute pancreatitis (MSAP) group with 25 children, and severe acute pancreatitis (SAP) group with 3 children, and a comparative analysis was performed for the MAP group and the MSAP group. According to age, the children were divided into young age group with 36 children aged 2-9 years and old age group with 69 children aged 10-17 years, and according to the presence or absence of recurrence, they were divided into recurrence group with 17 children and non-recurrence group with 88 children; a comparative analysis was also performed. A total of 105 adults with incipient AP were randomly selected from databases and were enrolled as control group, and the groups were compared in terms of general data, etiology, laboratory markers, disease severity, complications, and treatment outcome. The t-test was used for comparison of normally distributed continuous data between groups, and the corrected t-test was used in case of heterogeneity of variance; the Mann-Whitney U test was used for comparison of non-normally distributed data and ranked data between groups; the chi-square test was used for comparison of categorical data between groups; the trend chi-square test was used for unidirectional ordered categorical variables, and a Goodman-Kruskal Gamma analysis was used for bidirectional ordered categorical variables; the Kaplan-Meier method and the log-rank test were used for the comparison of cumulative risk. ResultsAs for etiology, among the 105 children with AP, 31 (29.5%) had idiopathic AP, 27(25.7%) had biliary AP, 20 (19.0%) had trauma, 11(105%) had hyperlipidemic AP, 10(95%) had viral infection, and 6(5.7%) had drug-induced AP, and there was a significant difference in the constituent ratio of etiology between the pediatric patients and the adult patients (χ2=99.282, P＜0.001). Compared with the adult patients, the pediatric patients had significantly lower severity (Z=-2.325, P＜0.02) and proportion of individuals with pancreatic necrosis (3.8% vs 12.4%, χ2=5184, P＜0.023). Compared with the MSAP group at 24 hours after admission, the MAP group had significantly lower C-reactive protein, blood lipase, white blood cell count, and blood glucose (Z=-6.406, -3.096, and -2.762, t=3.298, all P＜0.05) and a significantly higher blood calcium level (t=3.43, P=0.001). During follow-up, 17 children (16.2%) developed AP again, and the recurrence rate increased with an increase in disease severity (χ2=6.503, P=0.011). Recurrent AP was often observed in girls (82.4%) (χ2=12.241, P＜0.001), and the children with first-onset AP and pancreatic necrosis had a higher recurrence rate (χ2=6.572, P=001). Hyperlipidemia was the most common cause of acute recurrent pancreatitis (ARP) in children (χ2=5.533, P=0.019), and hyperlipidemic AP had the highest risk of recurrence over time, while viral and drug-induced AP had the lowest risk of recurrence (P=0028). ConclusionIdiopathic and biliary AP are the main causes of AP in children, and compared with adults, children tend to have milder disease conditions and a better prognosis. Female sex and first-onset AP with pancreatic necrosis and hyperlipidemia are high-risk factors for ARP. [ABSTRACT FROM AUTHOR]