bluuebunny/crossref_metadata_2025_split huggingface dataset:
21 Drug-Induced Pancreatitis: A Retrospective Cohort Study on Incidence, Etiology, Presentation and Outcomes
Authors: Salazar Miguel , Mbachi Chimezie , Elkhouly Mohamed A. , Mathew Madhu , Kumapley Rudolf , Paintsil Isaac , Simons-Linares C. Roberto 
Published: October 2019

INTRODUCTION:
Drug adverse reactions stands as a rare cause of acute pancreatitis; the incidence is mostly estimated from case reports and case series. Our aim was to determine the incidence, presentation, course, etiology (causative drugs), severity and outcome of drug induced pancreatitis in a 6-year period in a large tertiary hospital.

METHODS:
We conducted a retrospective investigation of all cases of acute pancreatitis at a large tertiary teaching hospital in Chicago, IL from January 2012 to April 2018, Diagnosis and severity of was determined according to the Revised Atlanta Classification. Patients were divided according to etiology. Regarding cases where was stablished, we further subcategorized them using the Naranjo score and Badalov et al 2008 classification to assess and determine the likelihood of drug adverse reaction as a causative factor of drug induced pancreatitis. The revised Atlanta Classification was used to determined severity of AP.

RESULTS:
A total of 531 patients with acute pancreatitis were reviewed, most common etiologies for AP were Biliary 206 (38.79%), Alcohol 179 (33.7%), Hypertriglyceridemia 55 (10.35%), DIP 16 (3.01%), post-ERCP 13 (2.44%), Idiopathic 56 (10.54%), Miscellaneous 6 (1%). DIP ranked fourth in the most common cause for acute pancreatitis. Gender distribution was 9 men (56%) and 7 women (43.7%), The most commonly associated drug was azathioprine 5 cases (31.25%) followed by Bactrim 2 cases (12.5%), all other were reported as single cases (6.25%) including: mesalamine, enalapril, L-asparaginase, isoniazid, diazepam, metformin, hydrochlorothiazide. Diazepam case was reported as an overdose. First exposure adverse reaction occurred in most cases 15 (93.75%).

CONCLUSION:
Drug induced pancreatitis stands as an uncommon cause of acute pancreatitis, diagnosis is often underestimated and made by exclusion of other more common etiologies, or by retrospective evaluation of individual cases, the number of commonly used drugs associated with drug induced pancreatitis is relatively high. The disease seems more common in patients with Crohn's disease on Azathioprine regimen.
22 Association Between Acute Pancreatitis and Cannabis Use—A U.S. Population-Based Study
Authors: Saleem Saad , Then Eric O. , Abu-Heija Ahmad , Weissman Simcha , Gaduputi Vinaya 
Published: October 2019

INTRODUCTION:
Cannabis is the most frequently used illicit drug in the world. Increase use of marijuana had caused higher rates of cannabis-related adverse effects. This study aims to assess the cannabis use as an etiology of acute pancreatitis.

METHODS:
A retrospective analysis was conducted using the de-identified data from the national health database, the Healthcare Cost and Utilization Project (HCUP). We identified the hospital encounters for “cannabis use” using international classification of Diseases (ICD-9) diagnostic codes from 2011 to 2014. We assessed the incidence of acute pancreatitis in cannabis use patients and independent predictors of acute pancreatitis by multivariate analysis. P-values less than 0.05 indicated a statistically significant association. The odds ratio and 95% confidence interval were also calculated. Data were analyzed using SPSS.

RESULTS:
A total of 410385 cannabis use admissions were identified - 5469 (1.3%) acute pancreatitis with history of cannabis use (study group) and 404916 (98.7%) without acute pancreatitis in cannabis use population (control group). Comparing study group with control group, age - mean with standard deviation 39.8 + 11.81 yrs vs. 36.09 + 14.05 (P < 0.001) , sex - male 3901 (71.3%) vs. 252486 (62.4%) (P < 0.0001, Odds ratio [OR] = 1.50, Confidence interval (CI); 1.41–1.59), race - African American 1765 (32.3%) vs. 113524 (28%) (P < 0.0001, OR = 1.22, CI; 1.15–1.30), smoking 3909 (71.5%) vs. 222558 (55%) (P < 0.0001, OR = 2.05, CI; 1.93–2.18), Alcohol 1959 (35.8%) vs. 54876 (13.6%) (P < 0.0001, OR = 3.56, CI; 3.37–3.77), acute pancreatitis 5469 (1.3%) vs. 4334 (0.7%) OR = 1.80 CI 1.73–1.87, P < 0.001). The odds of developing acute pancreatitis among cannabis use patient was significantly higher (P < 0.001, adjusted odds ratio [aOR] = 1.20, CI; 1.14–1.25) (shown in Figure 1).

CONCLUSION:
This study showed that up to 20% increased likelihood of acute pancreatitis among the cannabis use patients. Older age, male sex, African American race, alcohol, smoking and cannabis use showed greater odds of developing acute pancreatitis.
24 A Comparison of EUS and MRCP to Diagnose Choledocholithiasis
Authors: Aamar Ali , Kolli Sree , Aloreidi Khalil , Barakat Mohamed , Ramai Daryl , Shahnazarian Vahe , Ofosu Andrew , Reddy Madhavi , Quintero Eduardo 
Published: October 2019

INTRODUCTION:
ASGE recommends EUS or MRCP for patients at intermediate risk for choledocholithiasis. Numerous studies have compared diagnostic yield of EUS and MRCP for choledocholithiasis. Two systematic reviews showed no significant difference in the two modalities. Diagnostic yield of both modalities is high for large stones. However, EUS is more sensitive in diagnosing small stones.

METHODS:
This is a retrospective study that includes the patients who had ERCP for suspected choledocholithiasis. Basic demographics, clinical, laboratory, imaging and endoscopic data was collected. The imaging modalities including abdominal ultrasound, CT, MRCP and EUS were compared using choledocholithiasis on ERCP as the gold standard. Performance characteristics such as sensitivity, specificity, positive predictive value, negative predictive value, positive and negative likelihood ratio and accuracy were calculated.

RESULTS:
During the study period, a total of 137 patients had ERCP for suspected choledocholithiasis. The mean age (±SD) was 53 ± 21 years. 81 (59%) were female and 78 (56.9%) were African American. 60 (43.8%) had EUS, 50 (36.5%) had MRCP, 74 (54%) had CT abdomen, 120 (87.6%) had abdominal ultrasound. Sensitivity, specificity, PPV, NPV, positive likelihood ratio, negative likelihood ratio and accuracy for EUS vs MRCP were 90 vs 85, 46 vs 78, 88 vs 95, 50 vs 54, 1.65 vs 3.84, 0.22 vs 0.19, 82 vs 84, respectively.

CONCLUSION:
The diagnostic yield of EUS and MRCP is high and comparable. Preference for EUS or MRCP may depend on availability, patient preference and probability of choledocholithiasis. Specificity and NPV of both modalities were low for detecting sludge. ERCP may be helpful in these cases if clinical suspicion for choledocholithiasis remains high.
25 Very High Rates of Pancreatic Fluid Collections in Patients With the Triad of Hypertriglyceridemia-Induced Acute Pancreatitis and Diabetes Ketoacidosis
Authors: Estevez Jaqueline , Simons-Linares Roberto , Stevens Tyler , Chahal Prabhleen 
Published: October 2019

INTRODUCTION:
The triad of hypertriglyceridemia (HTG) induced acute pancreatitis (AP) coexisting with diabetes ketoacidosis (DKA) has been reported. Patients with the triad are a special subgroup of AP patients that may need different management due to potential life-threatening conditions presenting all at once. Outcomes of pancreatic fluid collections (PFCs) in this population has not yet been studied. We sought to investigate AP mortality, morbidity and PFC outcomes in patients with the triad.

METHODS:
We perform a cohort study of a prospectively maintained database of patients admitted with AP at a tertiary center in the last 15 years. We strictly included patients who met AP diagnosis by Revised Atlanta Classification. Study groups were: AP-only vs. HTG-AP + DKA, AP + DKA, and HTG-AP. Primary outcome was inpatient mortality, morbidity (SIRS, ICU, AKI, ARDS), severity of AP and complication of AP. Multivariable logistic regression models were constructed using STATA software version 9.4.

RESULTS:
Over two thousand patients were reviewed, of whom 124 patients had the triad (HTG-AP, DKA), 100 had HTG-AP only (triglyceride levels >1,000 mg/dL), 67 had AP + DKA and we included 101 with AP-only (control) for the analysis. Patients with HTG-AP + DKA had higher rates of PFCs 59% compared to AP-only 22%, HTG-AP 29% and AP + DKA 20% (P < 0.001). HTG-AP + DKA were more likely to have acute peripancreatic fluid collections (APFC) 46% compared to AP-only 17%, HTG-AP 19% and AP + DKA 13% (P < 0.001). HTG-AP were more likely to have pseudocysts 11% compared to AP-only 4%, HTG-AP + DKA 4%, and AP + DKA 2% (P = 0.06). No difference in PFC drainage was found (P = 0.97). Patients with AP+DKA were more likely to develop AKI 63% compared to AP-only 8%, HTG-AP + DKA 34% and HTG-AP 33% (P < 0.001). HTG-AP patients were more likely to have ARDS 25% compared to AP-only 2%, AP + DKA 10% and HTG-AP + DKA 17% (P < 0.001). HTG-AP were more likely to require enteral tube feeding and total parenteral nutrition (Table 1). No difference inpatient mortality was found.

CONCLUSION:
Patients with the triad of HTG-AP + DKA have significantly higher rates of pancreatic fluid collections. But PFCs seems to resolve in its own as there was not difference in interventions for the PFCs. Less aggressive strategy for PFCs management in this patient population can be followed.
27 Assessment of the Impact of Hypertriglyceridemia on Organ Failure During Acute Pancreatitis: A Different Perspective
Authors: Estevez Jaqueline , Simons-Linares Roberto , Chahal Prabhleen 
Published: October 2019

INTRODUCTION:
Hypertriglyceridemia (HTG) may impact acute pancreatitis (AP) outcomes. This study investigates the effect of different serum triglycerides (TG) thresholds on the development of persistent or multiple organ failures in patients with AP.

METHODS:
Cohort study of a prospectively maintained database of patients admitted with AP at a tertiary center in the last 15 years. We strictly included patients who met AP diagnosis by Revised Atlanta Classification. Severity of HTG was determined by the American Endocrine Society guidelines. Control group: AP (including all common etiologies, except HTG-induced AP). Study groups included other common HTG scenarios: 1) HTG-AP (i.e. HTG-induced AP), 2) HTG-AP + DKA (i.e. Triad), and 3) AP + diabetes ketoacidosis (AP-DKA). We assessed the levels of TG and its impact on organ failure. Multivariable logistic regression models were constructed using STATA software version 9.4.

RESULTS:
2,654 patients were reviewed, of whom 124 patients had the triad (HTG-AP, DKA), 100 had HTG-AP only (triglyceride levels >1,000 mg/dL), 67 had AP + DKA and we included 101 with AP-only as control for the analysis. Overall, any level of hypertriglyceridemia in all of the three study groups (HTG related syndromes) had higher odds for developing organ failure when compared to the control group (Table 1). All study groups had higher odds to develop ARDS, AKI, ileus, and shock. The highest odds ratios for organ failures were: HTG-AP patients with moderate levels of HTG were almost 25 times more likely to develop ARDS. AP-DKA patients with moderate levels of HTG were 32 times more likely to develop AKI. HTG-AP patients with severe HTG levels were 16 times more likely to develop ileus. HTG-AP patients with moderate HTG levels were 7 times more likely to develop shock. Interestingly, all study groups had lower odds to develop SIRS, persistent SIRS at 24 or48 hrs, and myocardial infarction (MI) (Table 1).

CONCLUSION:
Increased TG levels were associated with the development of multiple organ failure among AP patients, particularly in the settings of HTG-induced AP, the Triad of HTG-AP-DKA, and AP-DKA. Interestingly, HTG did not correlate with SIRS (transient or persistent), which one could have expected. It seems that the severe organ failure is driven by direct lipotoxicity from HTG rather than pancreatitis-inflammation (i.e. SIRS).
29 Cannabis Use Is Associated With Worse Outcomes in Acute Pancreatitis: Analysis of a Large Database
Authors: Salazar Miguel , Saleh Mohannad Abou , Barkin Jodie A. , Elkhouly Mohamed A. , Mansoor Emad , Barkin Jamie S. , Simons-Linares Roberto 
Published: October 2019

INTRODUCTION:
Cannabis continues to be legalized in the United States and there is also increasing inconclusive evidence about the impact of cannabis in acute pancreatitis (AP). The aim of this study was to investigate the impact of cannabis use among all patients with AP.

METHODS:
We queried a commercial database (Explorys Inc, Cleveland, OH, USA), an aggregate of electronic health record data from 26 major integrated US healthcare systems. We identified a cohort of patients with a Systematized Nomenclature of Medicine—Clinical Terms (SNOMED-CT) diagnosis of AP. We then identified cannabis-user (CU) patients and compared them with non-CU. Logistic regression models were constructed.

RESULTS:
Of the 62,817,650 individuals in the database, we identified 308,350 (0.49%) individuals with AP. Out of those, 14,740 (0.05%) individuals were CU. Interestingly, CU were more likely to be male [OR 1.79; 95% CI: 1.73–1.85, P < 0.0001], African American [OR 2.55; 95% CI: 2.46–2.64, P < 0.0001], younger (<65 years old) [OR 9.49; 95% CI 8.86–10.16, P < 0.0001], tobacco smokers [OR 2.08; 95% CI: 1.98–2.19, P < 0.0001], alcohol consumers [OR 2.00; 95% CI: 1.94–2.07, P < 0.0001] and obese [OR 1.13; 95% CI: 1.08–1.19, P < 0.0001] (Table 1, Figure 1). CU were more likely to have SIRS [OR 1.43; 95% CI: 1.37–1.49, P < 0.0001], AKI [OR 1.45; 95% CI: 1.40–1.50, P < 0.0001], acute respiratory failure [OR 1.45; 95% CI: 1.38–1.51, P < 0.0001], ileus [OR 1.28; 95% CI: 1.20–1.37, P < 0.0001], shock [OR 1.23; 95% CI: 1.16–1.32, P < 0.0001], sepsis [OR 1.31; 95% CI: 1.23–1.39, P < 0.0001], altered mental status [OR 2.00; 95% CI: 1.90–2.10, P < 0.0001], enteral tube feeding requirement [OR 1.46; 95% CI: 1.34–1.60, P < 0.0001], portal vein thrombosis (PVT) [OR 1.35; 95% CI: 1.17–1.56, P < 0.0001], pulmonary embolism (PE) [OR 1.21; 95% CI: 1.12–1.31, P < 0.0001], to receive opiates [OR 1.87; 95% CI: 1.79–1.96, P < 0.0001], to undergo abdominal CT scan [OR 1.59; 95% CI: 1.54–1.64, P < 0.0001], and less likely to have cholangitis [OR 0.35; 95% CI: 0.31–0.41, P < 0.0001], to undergo MRCP [OR 0.65; 95% CI: 0.57–0.75, P < 0.0001], ERCP [OR 0.51; 95% CI: 0.48–0.55, P < 0.0001] (Table 2).

CONCLUSION:
Cannabis users have worse outcomes in AP and this could be potentially explained by tobacco smoking, obesity and alcohol consumption rates that were higher in CU. Further studies to corroborate our findings are needed, especially looking at the route, frequency, modality and amount of cannabis intake in patients with AP.
36 Integrated Molecular Pathology as a Predictor of Malignant Transformation of Pancreatic Cysts: A 6-Year Follow-Up
Authors: Ku Lawrence , Yoo Timothy , Sikavi Cameron S. , Kung Jonathan , Hou Linda A. , Reicher Sofiya , Eysselein Viktor E. 
Published: October 2019

INTRODUCTION:
2018 ACG guidelines recommend surgical evaluation for pancreatic cysts with high-risk features. Integrated Molecular Pathology (IMP) combines molecular and biochemical analysis with cytology to improve prediction of malignant transformation. We aim to characterize the long-term performance of IMP.

METHODS:
All pancreatic cystic lesions from prospectively acquired patients with EUS-FNA and IMP (PancraGEN, Interpace Diagnostics) from 9/2010 to 9/2013 were retrospectively analyzed. Known pancreatic adenocarcinoma, serous cystadenoma, or pseudocyst were excluded. Data on patient demographics; EUS and cross-sectional imaging; cyst fluid biochemical and molecular analysis; and cytology were collected. Cystic lesions with low malignant potential were classified as “benign” or “statistically indolent” by IMP and “statistically higher risk” or “aggressive” for those with high malignant potential. Final diagnosis was based on surgical pathology when available, repeat biopsy or imaging, and on length of clinical follow up.

RESULTS:
69 patients with mean age 69.9; 36.2% male were included. Median follow-up was 68.5 months (0.4–99.6); 3 patients were lost to follow-up. Average cyst size was 2.3 cm (0.2–15.3). 22/69 (31.9%) cysts were in the head, 13/69 (18.8%) in the neck, 23/69 (33.3%) in the body, and 11/69 (15.9%) in the tail of the pancreas. 10 patients underwent resection or enucleation. IMP classified 38/69 (55.1%) as benign, 27/69 (39.1%) as statistically indolent, 1/69 (1.4%) as statistically higher risk, 2/69 (2.9%) as aggressive, and 1/69 (1.4%) as indeterminate. Final diagnosis was pancreatic adenocarcinoma in 5/69 (7.2%), mucinous cystadenoma in 10/69 (14.5%), branch type IPMN in 37/69 (53.6%), serous cystadenoma in 13/69 (18.8%), and indeterminate in 4/69 (5.8%). Final diagnosis of adenocarcinoma was in 2/38 (5.3%) classified as benign by IMP, 2/27 (7.4%) statistically indolent lesions, 0/1 (0%) statistically higher risk lesions, 1/2 (50%) aggressive lesions, and 0/1 (0%) indeterminate lesions. A composite of high malignant potential on IMP or high-risk features based on ACG guidelines yielded a sensitivity of 100%, specificity of 81.3%, PPV of 29.4%, and NPV of 100% (Table 1).

CONCLUSION:
Combining high-risk features based on ACG guidelines with IMP is a valuable predictor of malignant transformation of pancreatic cysts, with high sensitivity and NPV based on median 6-year follow-up, which to our knowledge is the longest reported thus far.
39 Impact of Cannabis Use on Chronic Pancreatitis: A 10-Year Analysis of the National Inpatient Sample Database
Authors: Mbachi Chimezie , Kroner Paul T. , Barkin Jodie A. , Wang Yuchen , Demetria Melchor V. , Barkin Jamie S. , Simons-Linares Roberto 
Published: October 2019

INTRODUCTION:
Chronic pancreatitis (CP) is a debilitating chronic disease and significantly impacts patient's quality of life. There is evidence that cannabinoids reduce markers of inflammation and fibrosis in pancreatic stellate cells; Cannabis is becoming increasingly popular and there are currently 33 states in the US that have approved medical cannabis while 10 states have approved cannabis for recreational use. We investigated the national trends in prevalence, mortality, length of stay (LOS), hospitalization charges and cost of chronic pancreatitis patients and compared between cannabis-exposed (CE) and non-cannabis-exposed (non-CE).

METHODS:
The National Inpatient Sample (NIS) database from 2005 to 2014 was queried for all patients with a primary discharge diagnosis of CP as per the International Classification of Diseases 9th revision (ICD-9) code 5771. Active exposure to cannabis was ascertained based on ICD-9 code 304.3X and 305.2X. We compared CE vs. non-CE patients. Outcomes included in-hospital mortality, length of stay (LOS), inflation adjusted charges and cost. Propensity match analysis for age, gender, race, median income quartile, hospital characteristics and Elixhauser comorbidity index and multivariable logistic regression models were performed using STATA 14 software.

RESULTS:
Over 31,481 patients with CP as the primary diagnosis were analyzed. Cannabis-exposure prevalence was 1.4% (447 patients). The mean age of CP patients was 49. Patients exposed to cannabis were younger (42 vs 49-year-old, P < 0.001) and mostly males (69% vs 49.7%, P < 0.001). After adjusting for these factors, CE patients had lower total charges compared to non-CE (US$ 21,589 vs. 30,291 P < 0.001) (Figure 1a). CE patients were also hospitalized for fewer number of days when compared to non-CE patients (3.84 vs 5.19 days). There was a significant downward trend in the prevalence of chronic pancreatitis admissions (P < 0.001) amongst non-CE patients while there was an upward trend in the prevalence of chronic pancreatitis admissions amongst CE patients (Figure 2a, b). Interestingly, after matching for age, gender and comorbidities – CE patients had lower inpatient mortality (P = 0.059).

CONCLUSION:
In patients admitted with a primary diagnosis of CP, CE patients had fewer length of stay, hospitalization cost and inpatient mortality. The interplay of these factors remains unknown and studies looking at cannabis strength/dose, route and consumption frequency are needed.
40 Predictors of Acute Respiratory Distress Syndrome in Patients Hospitalized With Acute Pancreatitis
Authors: Gajendran Mahesh , Loganathan Priyadarshini , Collins Laura , Prakash Bharat , Umapathy Chandraprakash , Gupta Vineet 
Published: October 2019

INTRODUCTION:
Acute Pancreatitis (AP) has been associated with organ failures and systemic complications, with acute respiratory failure (ARF) being the most common followed by acute kidney injury (AKI). Population-based data on the effect of ARF in AP is limited. Previous studies are derived from single-tertiary care referral centers, which do not represent the community setting of all patients with AP, but rather a “sicker” group of patients. The aims of this study are: (1) to measure the prevalence of ARF in AP, (2) to analyze the trends of ARF in AP patients, (3) to investigate the clinical predictors for ARF in patients with AP, and (4) to measure the outcome comparisons such as length of stay in hospital, hospital cost, and mortality for patients with and without ARF.

METHODS:
This is a retrospective cohort study using the Nationwide Inpatient Sample (NIS) database from the year 2005 to 2014. The study population consisted of all hospitalizations with a primary or secondary discharge diagnosis of AP using the ICD-9-CM code 577.0. Patients with ARF were identified through querying the ICD-9 CM codes 518.5, 518.81, or 518.82.

RESULTS:
During the 10-year period from 2005 to 2014, there were approximately 4.2 million hospitalizations with a discharge diagnosis of AP, out of which 5.1% were associated with ARF. The mortality rate in patients with AP-ARF is 26.1% when compared with the overall mortality rate of 2% in AP patients. A significant proportion of patients with AP-ARF also had co-existing organ failures, mainly acute renal failure (56% vs. 10.1%), hematological dysfunction (19.3% vs. 5.2%), cardiogenic shock (12% vs. 2.5%) and hepatic failure (13.8% vs. 2.3%). Patients with severe sepsis/septic shock are the strongest predictor for developing ARF with an odds ratio (OR) of 9.5, followed by acute renal failure (OR 4.2), hepatic dysfunction (OR 2.4) and cardiogenic shock (OR 2.3). The occurrence of ARF was also associated with increased length of stay (19.9 days vs 6.4 days), increased need for mechanical ventilation (65.5% vs 0.8%), and increased hospital charges ($237,082 vs $55,961) compared to AP patients without ARF.

CONCLUSION:
In this study, we demonstrate that ARF is a significant risk factor for increased hospital mortality, greater length of stay and higher hospitalization charges in patients with AP. This underlines significantly higher resource utilization in patients with a dual diagnosis of AP-ARF.