Can we predict death using scoring systems in patients with local peritonitis ? A retrospective study.

INTRODUCTION: Prognostic scores in patients with local peritonitis (LP) have not yet been studied exhaustively. AIM: We, therefore, aimed in this study to evaluate the ability of several scoring systems to predict death in LP. MATERIALS AND METHODS: A retrospective analysis including 68 patients with LP was conducted at Prof. Dr. Stoyan Kirkovich University Hospital in Stara Zagora from January 2017 to August 2021. Clinical and laboratory data needed for calculating the scoring systems were collected at admission or postoperatively. We compared the prognostic performance of WSES SSS, MPI, SIRS, and qSOFA using area under the receiver operation characteristics (AUROC) curves and bivariate correlation analysis. RESULTS: The observed mortality rate was 8.8%. Among all scores, MPI showed the best prognostic performance (AUROC=0.805, 95% CI 0.660-0.950). A threshold MPI >25 points permitted prediction of adverse outcome with a sensitivity of 66.7% and a specificity of 80.6%. The only significant correlation was found between outcome and MPI (p=0.012, r=0.302). Conclusions: The MPI has the ability to prognosticate mortality in patients with LP unlike WSES SSS, qSOFA and SIRS.

Increased Circulating CD4+CD25+CD127low/neg Regulatory T-cells as a Prognostic Biomarker in Acute Pancreatitis.

OBJECTIVE: Early detection of severe forms with unfavorable outcome is the cornerstone that could provide reduction of morbidity and mortality in acute pancreatitis (AP). METHODS: The percentage of circulating CD4CD25CD127 regulatory T-cells (Tregs) was determined at admission, on the 48th hour, and on the fifth day in 72 patients with AP. We divided patients in 2 groups-Sev1, which includes 19 patients (26.4%) with moderate AP and 39 patients (54.2%) with mild disease, and Sev2, which includes 14 patients (19.4%) with severe AP. Seven patients (9.7%) developed septic complications. The mortality in our group was 9.7%. RESULTS: The patients in Sev2 had higher percentage of Tregs at admission and on the fifth day compared with patients in Sev1 (P = 0.007 and P = 0.033, respectively). There was no significant difference in percentage of Tregs at admission, on the 48th hour, and on the fifth day in patients who developed and did not develop infected necrosis (P = 0.50, P = 0.72, and P = 0.92, respectively). Patients with poor outcome had elevated percentage of Tregs on the fifth day (P = 0.045). CONCLUSIONS: The percentage of circulating Tregs may be implicated in the development of early immune suppression in AP. Elevated percentage of circulating Tregs at admission in AP is an independent prognostic biomarker for severe disease.

Pathophysiological mechanisms of acute pancreatitis define inflammatory markers of clinical prognosis.

Development of acute pancreatitis illustrates the need to understand the basic mechanisms of disease progression to drive the exploration of therapeutic options. Cytokines play a major role in the pathogenesis of acute pancreatitis as underlying systemic inflammatory response, tissue damage, and organ dysfunction. However, little is known about circulating concentrations of these inflammatory markers and their real impact on clinical practice. Experimental studies have suggested that the prognosis for acute pancreatitis depends on the degree of pancreatic necrosis and the intensity of multisystem organ failure generated by the systemic inflammatory response. This suggests an intricate balance between localized tissue damage with proinflammatory cytokine production and a systemic anti-inflammatory response that restricts the inappropriate movement of proinflammatory agents into the circulation. Implication of such mediators suggests that interruption or blunting of an inappropriate immune response has the potential to improve outcome. A detailed understanding of pathophysiological processes and immunological aspects in patients with acute pancreatitis is the basis for the development of therapeutic strategies that will provide significant reductions in morbidity and mortality.