review of literature on clinical pancreatology - The Pancreapedia

<strong>of</strong> 245 cases <strong>of</strong> mild acute pancreatitis. The prothrombotic PAI-1 4G allele frequency was0.49 for patients with severe acute pancreatitis and 0.57 for patients with mild acutepancreatitis, which was a significant difference. Patients with septic infectious complications(n=47) and patients with organ failure (n=55) had genotype distribution not different fromthose with mild, uncomplicated disease (n=245). The results do not support the hypothesisthat prothrombotic polymorphisms such as FVL mutation and PAI-1 4G/5G are associatedwith acute pancreatitis severity [156].Oxidative stressAcute pancreatitis is fatal when severe and oxidative stress is postulated to play an importantrole in its pathophysiology and the development <strong>of</strong> complications. Patients presenting to agastroenterology ward with early acute pancreatitis, i.e. within 72 hours <strong>of</strong> onset <strong>of</strong> pain,were included in the study. Also samples from 50 healthy controls were obtained forcomparison. Oxidative stress was estimated by levels <strong>of</strong> blood superoxide dismutase (SOD)and lipid peroxidation (thiobarbituric acid reactive substances; TBARS) and antioxidantstatus (AOS) by the ferric reducing ability <strong>of</strong> plasma (FRAP) and vitamin C at days 1, 3, and7 <strong>of</strong> admission. Oxidative stress was significantly higher in cases as compared with controlson all days and showed a gradual decrease from day 1 to 7. TBARS showed a higher fall inmild acute pancreatitis and better clinical outcome. Regarding the AOS, FRAP wassignificantly lower in cases and decreased significantly from day 1 to 3. Thus, high oxidativestress was observed during early phase <strong>of</strong> acute pancreatitis and a gradually improvingantioxidant status was associated with a better clinical outcome in patients with acutepancreatitis [157].HemoconcentrationIt was examined the relationship between early hemoconcentration and in-hospital mortalityin an observational cohort study <strong>of</strong> patients with acute pancreatitis. Data was collected from177 US hospitals from 2004 to 2005. Early hemoconcentration was defined as hemoglobin >14.6 mg/dl (hematocrit ~44 %) at any point during the first 24 hours <strong>of</strong> initial hospitalization.For transferred cases, it was linked clinical data from the first hospitalization to outcomesfrom the second hospitalization. It was then examined the impact <strong>of</strong> hospital transfer statuson the prognostic utility <strong>of</strong> hemoconcentration. It was identified 388 (2.2 %) cases asinterhospital transfers. Of these, it was successfully linked 198 (51 %) to their initialhospitalization. Early hemoconcentration was associated with increased mortality amongtransferred cases (odds ratio 7.4, 95 % confidence interval 1.6 to 35.4). However, no suchrelationship existed among non-transferred cases (odds artio 0.9, 95 % confidence interval0.7 to 1.2). Differences in outcome between transferred versus nontransferred cases werenot explained by extent <strong>of</strong> comorbid illness or initial disease severity (either APACHE II ororgan failure). It was concluded that early hemoconcentration predicted increased risk <strong>of</strong>mortality only among transferred cases despite similar levels <strong>of</strong> initial disease severity [158].Caboxypeptidase BThe concentration <strong>of</strong> carboxypeptidase B activation peptide (CAPAP) is proposed to be apredictor <strong>of</strong> severe acute pancreatitis. The activated protein C (APC)-protein C inhibitor (PCI;APC-PCI) complex in plasma could be useful in detecting the hypercoagulative condition insevere acute pancreatitis. In a prospective study, mild (n = 50) and severe (n = 9) cases <strong>of</strong>acute pancreatitis were compared with respect to levels <strong>of</strong> CAPAP and APC-PCI, and sortedin time intervals from onset <strong>of</strong> symptoms to sampling. The peak values <strong>of</strong> the C-reactiveprotein (CRP) within the 1st week were also compared. CRP detected the severe cases witha sensitivity <strong>of</strong> 0.89 and a specificity <strong>of</strong> 0.74 (cut-<strong>of</strong>f level 200 mg/l). In the interval 0-72 h,CAPAP could predict the severity <strong>of</strong> the disease in serum and urine (sensitivity 0.52/0.29,