scholarly journals Aggressive Versus Conservative Fluid Treatment for Acute Pancreatitis in Adult Patients: A Meta-Analysis of 3,127 Cases

2021 ◽  
Author(s):  
Jiyang Liao ◽  
Yang Zhan ◽  
Huachu Wu ◽  
Zhijun Yao ◽  
Xian Peng ◽  
...  
Keyword(s):  
Renal Failure ◽  
Acute Pancreatitis ◽  
Respiratory Failure ◽  
Hospital Mortality ◽  
Organ Failure ◽  
Pancreatic Necrosis ◽  
Meta Analysis ◽  
Adult Patients ◽  
Cochrane Library ◽  
Persistent Organ Failure

Abstract Background: The advantages of aggressive fluid treatment (AFT) compared to conservative fluid treatment (CFT) within 24 h for acute pancreatitis (AP) remain controversial in adult patients. A meta-analysis was undertaken to investigate whether aggressive strategies are more beneficial.Methods: We searched (on February 1, 2021) PubMed, Embase, and the Cochrane Library for eligible trials that assessed the two therapies and performed a meta-analysis. The primary endpoint was in-hospital mortality. Secondary outcomes were adverse events (e.g., renal failure and pancreatic necrosis) within 24 h of treatment.Results: Five randomized controlled trials (RCTs) and 8 observational studies involving 3,127 patients were identified. There was a significant difference in in-hospital mortality for AFT compared to CFT (OR, 1.66; P = 0.0001). The incidences of renal failure (OR, 2.38; P < 0.00001) and pancreatic necrosis (OR, 2.34; P < 0.0001) were similar and significantly different between the two groups. Patients aged > 50 years had a potentially higher utilization of mechanical ventilation and incidence of respiratory failure (OR, 4.88; P < 0.00001). Persistent organ failure, systemic inflammatory response syndrome (SIRS) and length of hospital stay did not differ significantly between the two groups. Sensitivity analysis identified two significant changes: one in persistent SIRS (OR, 2.37; P = 0.02) in patients aged > 50 years and one in the overall incidence of persistent organ failure (OR, 1.81; P = 0.02).Conclusions: Compared to CFT, AFT increases in-hospital mortality and the incidence of renal failure, pancreatic necrosis and respiratory failure with relatively strong evidence.

scholarly journals Factors Associated with Fluid Sequestration in Patients with Acute Pancreatitis: A Prospective Study in Tertiary Centre Hospital in Nepal

2021 ◽  
Vol 2021 ◽  
pp. 1-6
Author(s):  
Raju Bhandari ◽  
Krishna Sapkota ◽  
Seema Subedi ◽  
Som Kumar Shrestha ◽  
Edward Sutanto ◽  
...  
Keyword(s):  
Acute Pancreatitis ◽  
Hospital Mortality ◽  
Organ Failure ◽  
Pancreatic Necrosis ◽  
Linear Regression Analysis ◽  
University Teaching ◽  
Persistent Organ Failure ◽  
Younger Age ◽  
Significant Difference ◽  
The Difference

Background. Acute pancreatitis (AP) is associated with extensive fluid sequestration. The aim of this study was to determine association of fluid sequestration at 48 hours after hospital admission (FS48) in AP patients with demographics, clinical parameters, and outcomes of AP. Methods. A prospective observational study was carried out on all adult patients with AP admitted to Tribhuvan University Teaching Hospital, Nepal, from January to September 2017. FS48 was calculated as the difference between fluid input and output in the first 48 hours of admission. The Kruskal-Wallis test with post hoc Dunn’s test examined the difference in FS48 between mild AP, moderately severe AP, and severe AP. Linear regression analysis was used to evaluate association between FS48 with patients’ characteristics and outcomes of AP. Outcomes of AP assessed included pancreatic necrosis, persistent organ failure, length of stay, and in-hospital mortality. Results. Eighty patients (median age 44 years; 57% male) with a median FS48 of 1610 mL were evaluated. The median FS48 for mild AP, moderately severe AP, and severe AP were 1,180 mL, 2,380 mL, and 3,500 mL, respectively. There was a significant difference in pairwise comparisons between mild AP and moderately severe AP, along with mild AP and severe AP. Younger age, other etiology, and higher creatinine were independently associated with increased FS48. Increased FS48 was significantly associated with pancreatic necrosis, persistent organ failure, and in-hospital mortality. Conclusions. In our study population, younger age and higher creatinine were predictors of increased FS48. Increased FS48 was associated with poorer outcomes of AP.

scholarly journals Accuracy of angiopoietin-2 for predicting organ failure in patients with acute pancreatitis: a systematic review and meta-analysis

2021 ◽  
Vol 49 (2) ◽  
pp. 030006052098670
Author(s):  
Yongcai Lv ◽  
Yanhua Yao ◽  
Qi Liu ◽  
Jingjing Lei
Keyword(s):  
Acute Pancreatitis ◽  
Organ Failure ◽  
Meta Analysis ◽  
Characteristic Curve ◽  
Diagnostic Odds Ratio ◽  
Cochrane Library ◽  
Case Control Studies ◽  
Likelihood Ratios ◽  
Summary Receiver Operating Characteristic ◽  
Angiopoietin 2

Objective Our aim was to assess the accuracy of angiopoietin-2 (Ang-2) as a prognostic marker for acute pancreatitis (AP) with organ failure (OF). Methods We undertook a systematic search of the PubMed, Cochrane Library, Embase, Chinese Journals Full-text, Wanfang, China Biology Medicine disc, and Weipu databases to identify eligible cohort studies on the predictive value of Ang-2 for AP with OF. The main outcome measures were sensitivity and specificity. The effects were pooled using a bivariate mixed-effects model. Results Six articles with seven case-control studies (n = 650) were included. Pooled sensitivity, specificity, and positive and negative likelihood ratios with 95% confidence intervals (CI) for AP with OF were 0.93 (95%CI: 0.75–0.99), 0.85 (95%CI: 0.75–0.92), 6.40 (95%CI: 3.36–12.19), and 0.08 (95%CI: 0.02–0.36), respectively. The area under the summary receiver operating characteristic curve was 0.95 (95%CI: 0.92–0.96), and the diagnostic odds ratio was 83.18 (95%CI: 11.50–623.17). Subgroup analysis showed that admission time of AP onset (< or ≥24 hours) was a source of overall heterogeneity. Sensitivity analysis supported this finding. Conclusion Ang-2 had high diagnostic accuracy for AP with OF; the best prediction of Ang-2 may be 24 to 72 hours after onset of AP.

scholarly journals Assessment of Prophylactic Carbapenem Antibiotics Administration for Severe Acute Pancreatitis: An Updated Systematic Review and Meta-Analysis

Digestion ◽  
2022 ◽  
pp. 1-9
Author(s):  
Daxin Guo ◽  
Wei Dai ◽  
Jingyi Shen ◽  
Mengting Zhang ◽  
Yetan Shi ◽  
...  
Keyword(s):  
Acute Pancreatitis ◽  
Organ Failure ◽  
Severe Acute Pancreatitis ◽  
Pancreatic Pseudocyst ◽  
Meta Analysis ◽  
Fluid Collection ◽  
Cochrane Library ◽  
Intensive Care Unit Treatment ◽  
Significant Difference ◽  
And Control

<b><i>Background:</i></b> The effectiveness of prophylactic antibiotics in severe acute pancreatitis (SAP) remains a debatable issue. This meta-analysis aimed to determine the efficacy of prophylactic carbapenem antibiotics in SAP. <b><i>Methods:</i></b> This meta-analysis of prophylactic carbapenem antibiotics for SAP was conducted in PubMed, EMBASE, Web of Science, MEDLINE, and Cochrane Library up to February 2021. The related bibliographies were manually searched. The primary outcomes involved infected pancreatic or peripancreatic necrosis, mortality, complications, infections, and organ failure. <b><i>Results:</i></b> Seven articles comprised 5 randomized controlled trials and 2 retrospective observational studies, including 3,864 SAP participants. Prophylactic carbapenem antibiotics in SAP were associated with a statistically significant reduction in the incidence of infections (odds ratio [OR]: 0.27; <i>p</i> = 0.03) and complications (OR: 0.48; <i>p</i> = 0.009). Nevertheless, no statistically significant difference was demonstrated in the incidence of infected pancreatic or peripancreatic necrosis (OR: 0.74; <i>p</i> = 0.24), mortality (OR: 0.69; <i>p</i> = 0.17), extrapancreatic infection (OR: 0.64, <i>p</i> = 0.54), pulmonary infection (OR: 1.23; <i>p</i> = 0.69), blood infection (OR: 0.60; <i>p</i> = 0.35), urinary tract infection (OR: 0.97; <i>p</i> = 0.97), pancreatic pseudocyst (OR: 0.59; <i>p</i> = 0.28), fluid collection (OR: 0.91; <i>p</i> = 0.76), organ failure (OR: 0.63; <i>p</i> = 0.19), acute respiratory distress syndrome (OR: 0.80; <i>p</i> = 0.61), surgical intervention (OR: 0.97; <i>p</i> = 0.93), dialysis (OR: 2.34; <i>p</i> = 0.57), use of respirator or ventilator (OR: 1.90; <i>p</i> = 0.40), intensive care unit treatment (OR: 2.97; <i>p</i> = 0.18), and additional antibiotics (OR: 0.59; <i>p</i> = 0.28) between the experimental and control groups. <b><i>Conclusions:</i></b> It is not recommended to administer routine prophylactic carbapenem antibiotics in SAP.

Decreased Level of Serum Interleukin-8 Is Predictive of Pancreatic Necrosis in Acute Pancreatitis with Persistent Organ Failure

2016 ◽  
Vol 223 (4) ◽  
pp. e134-e135
Author(s):  
Yushun Zhang ◽  
Liming Dong ◽  
Feng Guo ◽  
Jingyuan Zhao ◽  
Zhiyong Yang ◽  
...  
Keyword(s):  
Acute Pancreatitis ◽  
Organ Failure ◽  
Pancreatic Necrosis ◽  
Interleukin 8 ◽  
Persistent Organ Failure

scholarly journals Preoxygenation before intubation in adult patients with acute hypoxemic respiratory failure: a network meta-analysis of randomized trials

Critical Care ◽  
2019 ◽  
Vol 23 (1) ◽  
Author(s):  
Ka Man Fong ◽  
Shek Yin Au ◽  
George Wing Yiu Ng
Keyword(s):  
Respiratory Failure ◽  
Data Extraction ◽  
Meta Analysis ◽  
Adult Patients ◽  
Cochrane Library ◽  
Controlled Trials ◽  
Hypoxemic Respiratory Failure ◽  
Acute Hypoxemic Respiratory Failure ◽  
Study Selection ◽  
Screening Study

Abstract Background Patients with acute hypoxemic respiratory failure are at risk for life-threatening complications during endotracheal intubation. Preoxygenation might help reduce the risk of hypoxemia and intubation-related complications. This network meta-analysis summarizes the efficacy and safety of preoxygenation methods in adult patients with acute hypoxemic respiratory failure. Methods We searched PubMed, EMBASE, and the Cochrane Library Central Register of Controlled Trials through April 2019 for randomized controlled trials (RCT) that studied the use of conventional oxygen therapy (COT), high-flow nasal cannula (HFNC), noninvasive ventilation (NIV), and HFNC and NIV as preoxygenation before intubation in patients with acute hypoxemic respiratory failure. Citations’ screening, study selection, data extraction, and risk of bias assessment were independently performed by two authors. The primary outcome was the lowest SpO2 during the intubation procedure. Results We included 7 RCTs (959 patients). Patients preoxygenated with NIV had significantly less desaturation than patients treated with COT (mean difference, MD 5.53, 95% CI 2.71, 8.34) and HFNC (MD 3.58, 95% CI 0.59, 6.57). Both NIV (odds ratio, OR 0.43, 95% CI 0.21, 0.87) and HFNC (OR 0.49, 95% CI 0.28, 0.88) resulted in a lower risk of intubation-related complications than COT. There were no significant mortality differences among the use of NIV, HFNC, COT, and HFNC and NIV during preoxygenation. Conclusions In adult patients with acute hypoxemic respiratory failure, NIV is a safe and probably the most effective preoxygenation method.

Sign in / Sign up

Export Citation Format

Share Document