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| 1 | Sequential organ failure assessment score is superior to other prognostic indices in acute pancreatitis显示文摘BACKGROUND Acute pancreatitis(AP)is a common surgical condition,with severe AP(SAP)potentially lethal.Many prognostic indices,including;acute physiology and chronic health evaluation II score(APACHE II),bedside index of severity in acute pancreatitis(BISAP),Glasgow score,harmless acute pancreatitis score(HAPS),Ranson’s score,and sequential organ failure assessment(SOFA)evaluate AP severity and predict mortality.AIM To evaluate these indices'utility in predicting severity,intensive care unit(ICU)admission,and mortality.METHODS A retrospective analysis of 653 patients with AP from July 2009 to September 2016 was performed.The demographic,clinical profile,and patient outcomes were collected.SAP was defined as per the revised Atlanta classification.Values for APACHE II score,BISAP,HAPS,and SOFA within 24 h of admission were retrospectively obtained based on laboratory results and patient evaluation recorded on a secure hospital-based online electronic platform.Data with<10%missing data was imputed via mean substitution.Other patient information such as demographics,disease etiology,and patient outcomes were also derived from electronic medical records.RESULTS The mean age was 58.7±17.5 years,with 58.7%males.Gallstones(n=404,61.9%),alcohol(n=38,5.8%),and hypertriglyceridemia(n=19,2.9%)were more common aetiologies.81(12.4%)patients developed SAP,20(3.1%)required ICU admission,and 12(1.8%)deaths were attributed to SAP.Ranson’s score and APACHE-II demonstrated the highest sensitivity in predicting SAP(92.6%,80.2%respectively),ICU admission(100%),and mortality(100%).While SOFA and BISAP demonstrated lowest sensitivity in predicting SAP(13.6%,24.7%respectively),ICU admission(40.0%,25.0%respectively)and mortality(50.0%,25.5%respectively).However,SOFA demonstrated the highest specificity in predicting SAP(99.7%),ICU admission(99.2%),and mortality(98.9%).SOFA demonstrated the highest positive predictive value,positive likelihood ratio,diagnostic odds ratio,and overall accuracy in predicting SAP,ICU admission,and mortality.SOFA and Ranson’s score demonstrated the highest area under receiver-operator curves at 48 h in predicting SAP(0.966,0.857 respectively),ICU admission(0.943,0.946 respectively),and mortality(0.968,0.917 respectively).CONCLUSION The SOFA and 48-h Ranson’s scores accurately predict severity,ICU admission,and mortality in AP,with more favorable statistics for the SOFA score. | Thomas Zheng Jie Teng Jun Kiat Thaddaeus Tan Samantha Baey Sivaraj K Gunasekaran Sameer P Junnarkar Jee Keem Low Cheong Wei Terence Huey Vishal G Shelat | 2021 | World Journal of Critical Care Medicine2021，10，6： | 9 |
| 2 | Cholecystectomy for asymptomatic gallstones:Markov decision tree analysis显示文摘Gallstones are a common public health problem,especially in developed countries.There are an increasing number of patients who are diagnosed with gallstones due to increasing awareness and liberal use of imaging,with 22.6%-80% of gallstone patients being asymptomatic at the time of diagnosis.Despite being asymptomatic,this group of patients are still at life-long risk of developing symptoms and complications such as acute cholangitis and acute biliary pancreatitis.Hence,while early prophylactic cholecystectomy may have some benefits in selected groups of patients,the current standard practice is to recommend cholecystectomy only after symptoms or complications occur.After reviewing the current evidence about the natural course of asymptomatic gallstones,complications of cholecystectomy,quality of life outcomes,and economic outcomes,we recommend that the option of cholecystectomy should be discussed with all asymptomatic gallstone patients.Disclosure of material information is essential for patients to make an informed choice for prophylactic cholecystectomy.It is for the patient to decide on watchful waiting or prophylactic cholecystectomy,and not for the medical community to make a blanket policy of watchful waiting for asymptomatic gallstone patients.For patients with high-risk profiles,it is clinically justifiable to advocate cholecystectomy to minimize the likelihood of morbidity due to complications. | Brian Juin Hsien Lee Qai Ven Yap Jee Keem Low Yiong Huak Chan Vishal G Shelat | 2022 | World Journal of Clinical Cases2022，10，29： | 1 |
| 3 | Elderly patients(≥80 years)with acute calculous cholangitis have similar outcomes as non-elderly patients(<80 years):Propensity score-matched analysis显示文摘BACKGROUND Acute cholangitis(AC)is a disease spectrum with varying extent of severity.Age≥75 years forms part of the criteria for moderate(Grade II)severity in both the Tokyo Guidelines(TG13 and TG18).Aging is associated with reduced physiological reserves,frailty,and sarcopenia.However,there is evidence that age itself is not the determinant of inferior outcomes in elective and emergency biliary diseases.There is a paucity of reports comparing clinical outcomes amongst elderly patients vs non-elderly patients with AC.AIM To investigate the effect of age(≥80 years)on AC's morbidity and mortality using propensity score matching(PSM).METHODS This is a single-center retrospective cohort study of all patients diagnosed with calculous AC(January 2016 to December 2016)and≥80 years old(January 2012 to December 2016)at a tertiary university-affiliated teaching hospital.Inclusion criteria were patients who were treated for suspected or confirmed AC secondary to biliary stones.Patients with AC on a background of hepatobiliary malignancy,indwelling permanent metallic biliary stents,or concomitant pancreatitis were excluded.Elderly patients were defined as≥80 years old in our study.A 1:1 PSM analysis was performed to reduce selection bias and address confounding factors.Study variables include comorbidities,vital parameters,laboratory and radiological investigations,and type of biliary decompression,including the time for endoscopic retrograde cholangiopancreatography(ERCP).Primary outcomes include in-hospital mortality,30-d and 90-d mortality.Length of hospital stay(LOS)was the secondary outcome.RESULTS Four hundred fifty-seven patients with AC were included in this study(318 elderly,139 non-elderly).PSM analysis resulted in a total of 224 patients(112 elderly,112 non-elderly).The adoption of ERCP between elderly and non-elderly was similar in both the unmatched(elderly 64.8%,non-elderly 61.9%,P=0.551)and matched cohorts(elderly 68.8%and non-elderly 58%,P=0.096).The overall in-hospital mortality,30-d mortality and 90-d mortality was 4.6%,7.4%and 8.5%respectively,with no statistically significant differences between the elderly and non-elderly in both the unmatched and matched cohorts.LOS was longer in the unmatched cohort[elderly 8 d,interquartile range(IQR)6-13,vs non-elderly 8 d,IQR 5-11,P=0.040],but was comparable in the matched cohort(elderly 7.5 d,IQR 5-11,vs non-elderly 8 d,IQR 5-11,P=0.982).Subgroup analysis of patients who underwent ERCP demonstrated the majority of the patients(n=159/292,54.5%)had delayed ERCP(>72 h from presentation).There was no significant difference in LOS,30-d mortality,90-d mortality,and in-hospital mortality in patients who had delayed ERCP in both the unmatched and matched cohort matched cohort:in-hospital mortality[n=1/42(2.4%)vs 1/26(3.8%),P=0.728],30-d mortality[n=2/42(4.8%)vs 2/26(7.7%),P=0.618],90-d mortality[n=2/42(4.8%)vs 2/26(7.7%),P=0.618],and LOS(median 8.5 d,IQR 6-11.3,vs 8.5 d,IQR 6-15.3,P=0.929).CONCLUSION Mortality is indifferent in the elderly(≥80 years old)and non-elderly patients(<80 years old)with AC. | Kai Siang Chan Ramkumar Mohan Jee Keem Low Sameer P Junnarkar Cheong Wei Terence Huey Vishal G Shelat | 2021 | World Journal of Hepatology2021，13，4： | 1 |
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