Management of Suspected Acute Inflammatory Pancreatopathies in a “Real-World” Setting: A Single-Centre Observational Study
Context Acute pancreatitis is defined as an acute inflammatory process in the pancreas with variable involvement of other regional tissues or remote organ systems. In Italy, the incidence ranges from 20 to 40 x100,000 inhabitants/year and the mortality rate ranges from 5 to 10%. Objective To assess the management of patients with suspected acute inflammatory pancreatopathy and to evaluate the impact of this management on clinical outcomes, including morbidity and mortality. Methods A “real-world” observational study based on the analysis of consecutive (one year) records from the Hospital Data Processing Centre: 112 cases with final diagnosis of "acute pancreatitis". Results and Conclusions Sixty-nine men and 43 women were analyzed; 91 (81.3%) patients were older than 40 years and 53 (47.3%) were older than 60 years. Two patients died. One-hundred and five patients (93.8%) had abdominal pain on admission. White blood cell count was greater than 15.0 x103/dL in 26 patients (23.2%). Hematocrit levels were greater than 40% in 30 patients (26.8%). Triglycerides were elevated in 21 patients (18.8%). In 3 of them (14.3%) levels were higher than 1,000 mg/dL. Creatinine was altered in 22 (19.6%) patients. CRP values were increased in all patients. In the majority of cases (58 patients; 51.8%) pancreatitis was of biliary origin, while alcohol accounted for 16 (14.3%) cases. Four tumors were found (3.6%). Forty patients (35.7%) were discharged in the first week, 41 (36.6%) in the second week, 19 (17.0%) in the third week, and 12 (10.7%) after 21 days. After 72 hours, acute pancreatitis was classified as mild in 80 patients (71.4%) and as severe in 32 patients (28.6%).
Image: Pancreatopathies according to etiology and age (Figure 3)
Bradley EL 3rd. A Clinically Based Classification System for Acute Pancreatitis. Summary of the International Symposium on Acute Pancreatitis, Atlanta, GA, September 11 through 13, 1992. Arch Surg 1993;128:586–90.
Bradley EL. The Necessity for a Clinical Classification of Acute Pancreatitis: The Atlanta system. In: Bradley EL, ed. Acute pancreatitis: Diagnosis and therapy. New York: Raven Press, 1994;4:27–32
Acute Pancreatitis Classification Working Group. Revision of the Atlanta Classification of Acute Pancreatitis, Documents/Atlanta Classification.doc April 9, 2008
Peter A. Banks, M.D., M.A.C.G.,1 Martin L. Freeman, M.D., F.A.C.G.,2 Practice Guidelines in Acute Pancreatitis. Am J Gastroenterol 2006;101:2379–2400. PMID:
Santhi Swaroop Vege, Todd H. Baron Management of Pancreatic Necrosis in Severe Acute Pancreatitis. Clinical Gastroenterology and Hepatology Volume 3, Issue 2, February 2005, Pages 192-196 PMID:15749609
Khan AA, Parekh D, Cho Y, et al. Improved Prediction of Outcome in Patients with Severe Acute Pancreatitis by the APACHE II Score at 48 Hours after Hospital Admission Compared with the APACHE II Score at Admission. Acute physiology and chronic health evaluation. Arch Surg 2002;137:1136–40. PMID:12361419
Uomo G, Pezzilli R, Gabrielli A, Castoldi L, Zerbi A, Frulloni L, De Rai P, Cavallini G, Di Carlo V; ProfInf-AISP Study Group. Diagnostic Assessment and Outcome of Acute Pancreatitis in Italy; Results of a Prospective Multicentre Study. ProfInf-AISP: Progetto informatizzato Pancreatite acuta, Associazione Italiana Studio Pancreas, phase II. Dig Liver Dis 2007;39:829-37. PMID:17625994.
Pezzilli R, Fantini L, Morselli-Labate AM. New Approaches for the Treatment of Acute Pancreatitis. JOP 2006;7:79-91. PMID: 16407625.
Minotti V. Apte, Ron C Pirola, and Jeremy S. Wilson, Etiopathogenesis and Epidemiology of Alcohol-Induced Acute Pancreatitis in Hans Berger, Andrew Warshaw, Narkus Buchler, Richard Kozarek, Markus Lerch, Jhon Neoptolemos, Keiko Shiratori, David Withcomb, The Pancreas an Integrated Text Book of Basic Sciences, Medicine and Surgery. Second edition 2008. Blackwell Publishing.pag. 145
Dervenis C, Johnson CD, Bassi C, Bradley E, Imrie CW, Mc Mahon MJ, Modlin I. Diagnosis, Objective Assessment of Severity, and Management of Acute Pancreatitis. Santorini Consensus Conference. Int J pancreatol 1999;25:195-210. PMID: 10453421.
Frulloni L, Coato E, Bovo P, Cavallini G. Epidemiologia della pancreatite acuta in Italia. FOCUS Ospedali D'Italia Chirurgia n. 3/4 – 2004.
Ministero della Salute. Quaderni del Ministero della Salute. Maggio-Giugno 2011.
Fagenholz PJ, Fernandez del Castello C, Stuart Harris N, Pelletier AJ, Camargo CA. Direct Medical Costs of Acute Pancreatitis Hospitalizations in the United States. Pancreas 2007;35:302-7. PMID: 18090234
Matos C, Bali MA, Delhaye M, Deviere J. Magnetic Resonance Imaging in the Detection of Pancreatitis and Pancreatic Neoplasms. Best Pract res Clin Gastroenterol 2006;20:157-78. PMID:16473806
Uomo G, Pezzilli R, Cavallini G, Management of Acute Pancreatitis in Clinical Practice. ProInf-AISP. Study Group. Progetto Informatizzato Pancreatine Acuta-Associazione Italiana Studio Pancreas. Ital J Gastroenterol Hepatol 1999;31:635-42. PMID: 10604108
Takeda K, Takada T, Kawarada Y, Hirata K, Mayumi T, Yoshida M, Sekimoto M, Hirota M, Rimura T, Isaji S, Koizumi M, Otsuki M, Matsuno S; JPN. JPN Guidelines for the Management of Acute Pancreatitis: Medical Management of Acute Pancreatitis. J Hepatobiliary Pancreat Surg 2006;13:42-7. PMID: 16463210
Ayub K, Imada AK, Slavin J. Endoscopic Retrograde Cholangiopancreatography in Gallstone-Associated Acute Pancreatitis. Cochrane Database of Systematic Reviews 2004, Issue 3, art n. CD003630. PMID: 15495060
Orìa A, Cimmino D, OcampoC, Silva W, Kohan G, Zandalazini H, Szelagowski C, Chiappetta L. Early Endoscopic Intervention versus Early Conservative Management in Patient with Acute Gallstone Pancreatitis and Biliopancreatic Obstruction: a Randomized Clinical Trial. Ann Surg 2007;245:10-7. PMID:17197959
Billi P, Barakat B, D’Imperio N, Pezzilli R. Relapses of Biliary Acute Pancreatitis in Patients with Previous Attack of Biliary Pancreatitis and Gallbladder in situ. Dig Liver Dis 2003;35:635-5. PMID: 14563188.
Gullo L. Migliori M, Olah A et al. Acute Pancreattatis in Five European Countries: Etiology and Mortality. Pancreas 2002; 24, 223-7. PMID:11893928
Lankisch PG, Assmus C, Lehnick D Maissoneuve P, Lowenels AB. Acute Pancreatitis: Does Gender Matter? Dig Dis Sci 2001; 46:2470-4. PMID:11713955
Working Party of the British Society of Gastroenterology; Association of Surgeons of great Britain and Ireland; Pancreatic Society of Great Britain and Ireland; Association of upper GI Surgeons of Great Britain and Ireland. UK Guidelines for the Management of Acute Pancreatitis. Gut 2005; 54 Suppl 3:1-9. PMID: 15831893
Sun B, Li Hl, Gao Y, Jiang HC. Factors Predisposing to Severe Acute Pancreataitis Evaluation and Prevention. World J Gastroenterol. 2003;9: 1102-05. PMID:12717866
Martínez J, Johnson CD, Sánchez-Payá J, de Madaria E, Robles-Díaz G, Pérez-Mateo M.. Obesity is a Definitive Risk Factor of Severity and Mortality in Acute Pancreatitis: an Updated Meta Analysis. Pancreatology 2006; 6; 206-9. PMID:16549939
Halonen KI, Leppaniemi AK, Puolakkainen PA, Lundin JE, Kemppainen EA, Hietaranta AJ, Haapiainen RK., Severe Acute Pancreatitis: Prognostic Factor in 270 Consecutive Patients. Pancreas 2000; 21:266-71. PMID:11039471
Poves Prim I, Fabregat Pous J, García Borobia FJ, Jorba Martí R, Figueras Felip J,
Jaurrieta Mas E. Early Onset of Organ Failure is the Best Predictor of Mortality in Acute Pancreatitis. Rev. Esp. Enfedrm. Dig. 2004; 96: 705-9; 709-713. PMID: 15537377
Talukdar R, Clemens M, Swaroop S. Moderately Severe Acute Pancreatitis. Prospective Validation of this New Subgroup of Acute Pancreatitis. Pancreas 2012; 41(2):306-309. PMID: 22015971
Copyright (c) 2014 Daniele De Nuzzo, Alessia Miconi, Paola Pierantognetti
This work is licensed under a Creative Commons Attribution 4.0 International License.As a member of Publisher International Linking Association, PILA, iMedPub Group’s JOP follows the Creative Commons Attribution License and Scholars Open Access publishing policies. Journal of the Pancreas is the Council Contributor Member of Council of Science Editors (CSE) and following the CSE slogan Education, Ethics, and Evidence for Editors.