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Acute Pancreatitis
Published in Stephen M. Cohn, Alan Lisbon, Stephen Heard, 50 Landmark Papers, 2021
Abdominal pain that radiates to the back, serum amylase/lipase level greater than three times the upper limit, and evidence of pancreatitis on abdominal imagining are the three most important diagnostic features. Presence of any two of these establishes a diagnosis (Tenner et al., 2013). Although the levels of both amylase and lipase are raised in the serum, the lipase level is not only superior for ruling out the disease, but it also provides a larger diagnostic window due to its longer half-life. Prognostic indices like the Ranson criteria, the Acute Physiology and Chronic Health Evaluation II (APACHE II) and the Bedside Index of Severity in Acute Pancreatitis (BISAP) are commonly used to evaluate the severity. While all scoring systems have limitations, BISAP is regarded as a reliable and easy-to-use tool to classify disease severity (Papachristou et al., 2010). Ultrasonography is valuable in cases with gallstone etiology. Since necrosis takes time to become obvious, CT and MRI have limited utility in the first 48–72 hours of symptom onset unless the diagnosis is uncertain. Contrast-enhanced CT is performed in patients with severe pancreatitis to rule out acute necrotizing pancreatitis. Use of MRI is emerging due to its ability to better identify gallstones and characterize the contents of fluid collections seen on CT.
Acute Pancreatitis
Published in Stephen M. Cohn, Peter Rhee, 50 Landmark Papers, 2019
Abdominal pain that radiates to the back, serum amylase/lipase level greater than three times the upper limit, and evidence of pancreatitis on abdominal imagining are the three most important diagnostic features. Presence of any two of these establishes a diagnosis (Tenner et al. 2013). Although the levels of both amylase and lipase are raised in the serum, the lipase level is not only superior for ruling out the disease, but also provides a larger diagnostic window due to its longer half-life. Prognostic indices like the Ranson criteria, the Acute Physiology and Chronic Health Evaluation II (APACHE II), and the Bedside Index of Severity in Acute Pancreatitis (BISAP) are commonly used to evaluate severity. While all scoring systems have limitations, BISAP is regarded as a reliable and easy-to-use tool to classify disease severity (Papachristou et al., 2010). Ultrasonography is valuable in cases with gallstone etiology. Since necrosis takes time to become obvious, CT and MRI have limited utility in the first 48 to 72 hours of symptom onset unless the diagnosis is uncertain. Contrast-enhanced CT is performed in patients with severe pancreatitis to rule out acute necrotizing pancreatitis. Use of MRI is emerging due to its ability to better identify gallstones and characterize the contents of fluid collections seen on CT.
Hepatobiliary Surgery
Published in Gozie Offiah, Arnold Hill, RCSI Handbook of Clinical Surgery for Finals, 2019
➢ RANSON criteriaCriteria on Admission: After 48 hr of admission:
Development and internal validation of a practical model to predict 30 days mortality of severe acute pancreatitis patients
Published in Annals of Medicine, 2023
Ying Chen, Qing Li, Liang Ma, Zhenzhen Cai, Jun Zhou
Nevertheless, the sensitivity and specificity of these prediction scoring systems are not high enough, and cumbersome items limit their clinical use. Some standards are not sensitive enough or high-cost, which would be unprocurable for most patients in an initial diagnosis. For example, the APACHE-II score has more than 10 variables and is complex in practical use. The Ranson criteria require 48 h hospitalization for observation, thereby resulting in a delay in triage and management [3]. Besides, pancreatic necrosis might not be discovered in early CT scans in 24 h [7]. In this case, the clinical evaluation of sensitive indicators for SAP is of great value. Up to now, no single biomarker can be competent to predict high-risk SAP in the early phase, thus complementary and combined markers are thus imperative.
Diabetes is an independent predictor of severe acute pancreatitis
Published in Postgraduate Medicine, 2022
Elif Tutku Durmuş, İbrahim Akdağ, Mehmet Yıldız
Our study also revealed that maximum CRP levels and the rate of high (≥3) Ranson scores were significantly higher among diabetic patients than non-diabetics, and these variables were found to be independent predictors for SAP. CRP is a serum marker that has an important role in the evaluation of the severity and prognosis of AP, despite its delayed increase, peaking at 72 hours after the onset of symptoms, and despite the fact that it is not an AP-specific marker. In a previous study, CRP also showed promising results for early detection of AP severity and pancreatic necrosis [23]. The Ranson criteria are among the earliest scoring systems to assess the severity of AP and the Ranson score continues to be widely used. Its limitation has been noted as the inability to obtain a complete score until at least 48 hours after the onset of symptoms [23]. Although the relationships between both high Ranson scores and high maximum CRP levels and SAP were to be expected, it is an important contribution to the literature to show that a patient’s diagnosis of concomitant DM is associated with SAP as much as and independently of these other factors. The presence of diabetes may even be superior to those factors as an independent predictor of SAP, considering the possible time lost while calculating the Ranson score and maximum CRP level.
Systemic Inflammation Response Index and Systemic Immune Inflammation Index Are Associated with Clinical Outcomes in Patients with Acute Pancreatitis?
Published in Journal of Investigative Surgery, 2022
Murat Biyik, Zeynep Biyik, Mehmet Asil, Muharrem Keskin
The severity of AP also correlates with mortality rates. Therefore, risk classification of AP patients and close monitoring of patients with SAP are of great importance. Several scoring tools are used for risk stratification in AP. Ranson criteria, Acute Physiologic Assessment and Chronic Health Evaluation II (APACHE II) score, and Bedside Index for Severity in Acute Pancreatitis (BISAP) scoring systems are among the most widely used risk stratification tools used in AP. However, currently, all scoring systems have some advantages and disadvantages and none of them is considered optimal. For instance, a 48-hour timeframe is required for the calculation of the Ranson score which may cause delays in decision making and the implementation of APACHE-II have some drawbacks outside the intensive-care unit settings. Since all of these scoring systems are complex and impractical, there is still ongoing research to find simpler and more effective tools for risk stratification in AP. Some simple hematological parameters such as neutrophil-to-lymphocyte ratio (NLR) (neutrophil count/lymphocyte count) and platelet-to-lymphocyte ratio (PLR) (platelet count/lymphocyte count) have also been investigated in this aspect and there are studies in the literature reporting that NLR [6] and PLR [1] can be used to predict AP severity.