Protective effects of abdominal paracentesis drainage in patients with severe acute pancreatitis<b>-</b>associated liver injury: a historical cohort study_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

WANG Zhangpeng ^1,2 , WU Jun ^2,3 , JING Guangxu ^1,2 , WANG Xuyang ^2,4 , ZOU Hong ² , SUN Hongyu ^2,5 ,  TANG Lijun ^1,2

1. Department of Hepatobiliary Surgery, College of Medicine, Southwest Medical University, Luzhou, Sichuan 646000, P. R. China;
2. PLA Center of General Surgery, the General Hospital of Western Theater Command, & Pancreatic Injury and Repair Key Laboratory of Sichuan Province, Chengdu 610083, P. R. China;
3. College of Medicine, Southwest Jiaotong University, Chengdu 610083, P. R. China;
4. College of Medicine, Chongqing Medical University, Chongqing 400016, P. R. China;
5. Basic Medical Laboratory, the General Hospital of Western Theater Command, Chengdu 610083, P. R. China;

Corresponding author：

TANG Lijun, Email: tanglj2016@163.com

Keywords：

severe acute pancreatitis; ascitic fluid; abdominal paracentesis drainage; liver injury

DOI：

10.7507/1007-9424.202211011

Video：

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Objective To explore the protective effects of abdominal paracentesis drainage (APD) on pancreatitis-associated liver injury in the early phase of severe acute pancreatitis (SAP). Methods One hundred and fourteen consecutive patients with SAP, admitted to the General Hospital of Western Theater Command from January 2015 to January 2021, were included in this retrospective study. The patients were divided into the APD group (n=61) and the non-APD group (n=53) based on whether they underwent APD treatment within 72 h of admission. The variables including baseline data, liverfunction tests, inflammation indexes, severity scores and other variables of the two groups were statistically analyzed. Results The hospital mortality in the APD group was lower than that in the non-APD group (8.2% vs. 22.6%, P=0.031). These severity scores (including APACHE Ⅱ score, Ranson score and modified Marshall score) and inflammation indexes (including C-reactive protein, interleukin-6, interleukin-1 and tumor necrosis factor-α) in the APD group were all lower than those in the non-APD group (P＜0.05). In terms of liver function related indexes, the levels of alanine aminotransferase (ALT), aspartate aminotransferase (AST), γ-glutamyl transpeptidase (GGT), total bilirubin (TBIL), and direct bilirubin (DBIL) after treatment in both two groups were significantly lower than those before treatment (P＜0.05). The levels of ALT, AST, TBIL and DBIL after treatment in the APD group were lower than those in the non-APD group (P＜0.05), and the levels of prealbumin and albumin after treatment in the APD group were higher than those in the non-APD group (P＜0.05), but there were no significant differences in the levels of alkaline phosphatase, GGT and 5′ -nucleotidase after treatment in the two group (P＞0.05). Conclusion For SAP patients with ascitic fluid, application of APD can attenuate liver injury and improve liver function in the early stage of SAP.

Citation： WANG Zhangpeng, WU Jun, JING Guangxu, WANG Xuyang, ZOU Hong, SUN Hongyu, TANG Lijun. Protective effects of abdominal paracentesis drainage in patients with severe acute pancreatitis-associated liver injury: a historical cohort study. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2023, 30(4): 413-419. doi: 10.7507/1007-9424.202211011 Copy

1.	Mederos MA, Reber HA, Girgis MD. Acute Pancreatitis: A Review. JAMA, 2021, 325(4): 382-390.
2.	Sharma D, Jakkampudi A, Reddy R, et al. Association of systemic inflammatory and anti-inflammatory responses with adverse outcomes in acute pancreatitis: preliminary results of an ongoing study. Dig Dis Sci, 2017, 62(12): 3468-3478.
3.	Liu W, Du JJ, Li ZH, et al. Liver injury associated with acute pancreatitis: the current status of clinical evaluation and involved mechanisms. World J Clin Cases, 2021, 9(34): 10418-10429.
4.	Wang Q, Zhang X, Lei S, et al. RNA sequence analysis reveals pathways and candidate genes associated with liver injury in a rat pancreatitis model. Pancreatology, 2018, 18(7): 753-763.
5.	Kong L, Zhang H, Lu C, et al. AICAR, an AMP-activated protein kinase activator, ameliorates acute pancreatitis-associated liver injury partially through Nrf2-mediated antioxidant effects and inhibition of NLRP3 inflammasome activation. Front Pharmacol, 2021, 12: 724514. doi:10.3389/fphar.2021.724514.
6.	Ou ZB, Miao CM, Ye MX, et al. Investigation for role of tissue factor and blood coagulation system in severe acute pancreatitis and associated liver injury. Biomed Pharmacother, 2017, 85: 380-388.
7.	Wang X, Zhao X, Shi C, et al. Potential mechanisms and significance of acute pancreatitis-associated liver injury. Scand J Gastroenterol, 2006, 41(5): 604-613.
8.	Huang Z, Yu SH, Liang HY, et al. Outcome benefit of abdominal paracentesis drainage for severe acute pancreatitis patients with serum triglyceride elevation by decreasing serum lipid metabolites. Lipids Health Dis, 2016, 15: 110. doi:10.1186/s12944-016-0276-6.
9.	Huang SQ, Wen Y, Sun HY, et al. Abdominal paracentesis drainage attenuates intestinal inflammation in rats with severe acute pancreatitis by inhibiting the HMGB1-mediated TLR4 signaling pathway. World J Gastroenterol, 2021, 27(9): 815-834.
10.	Pérez S, Pereda J, Sabater L, et al. Pancreatic ascites hemoglobin contributes to the systemic response in acute pancreatitis. Free Radic Biol Med, 2015, 81: 145-155.
11.	Cen ME, Wang F, Su Y, et al. Gastrointestinal microecology: a crucial and potential target in acute pancreatitis. Apoptosis, 2018, 23(7-8): 377-387.
12.	Wen Y, Sun HY, Tan Z, et al. Abdominal paracentesis drainage ameliorates myocardial injury in severe experimental pancreatitis rats through suppressing oxidative stress. World J Gastroenterol, 2020, 26(1): 35-54.
13.	Ramudo L, Manso MA, De Dios I. Biliary pancreatitis-associated ascitic fluid activates the production of tumor necrosis factor-alpha in acinar cells. Crit Care Med, 2005, 33(1): 143-148.
14.	吴俊, 卢一琛, 黄竹, 等. 腹腔穿刺引流对重症急性胰腺炎大鼠胰腺细胞焦亡的影响及其意义. 解放军医学杂志, 2022, 47(9): 863-870.
15.	Liu WH, Ren LN, Chen T, et al. Abdominal paracentesis drainage ahead of percutaneous catheter drainage benefits patients attacked by acute pancreatitis with fluid collections: a retrospective clinical cohort study. Crit Care Med, 2015, 43(1): 109-119.
16.	Hongyin L, Zhu H, Tao W, et al. Abdominal paracentesis drainage improves tolerance of enteral nutrition in acute pancreatitis: a randomized controlled trial. Scand J Gastroenterol, 2017, 52(4): 389-395.
17.	Zhou J, Huang Z, Cheng L, et al. Abdominal paracentesis drainage (APD) attenuates acute pancreatitis-associated lung injury in patients with ascitic fluids: a retrospective study. Int J Clin Exp Med, 2016, 9: 18400-18409.
18.	杨熊, 刘若鸿, 谢川, 等. 早期腹腔穿刺引流对重症急性胰腺炎肾损伤的保护作用. 中国普通外科杂志, 2021, 30(3): 321-329.
19.	Liu L, Yan H, Liu W, et al. Abdominal paracentesis drainage does not increase infection in severe acute pancreatitis: a prospective study. J Clin Gastroenterol, 2015, 49(9): 757-763.
20.	Banks PA, Bollen TL, Dervenis C, et al. Classification of acute pancreatitis-2012: revision of the Atlanta classification and definitions by international consensus. Gut, 2013, 62(1): 102-111.
21.	Luo C, Huang Q, Yuan X, et al. Abdominal paracentesis drainage attenuates severe acute pancreatitis by enhancing cell apoptosis via PI3K/AKT signaling pathway. Apoptosis, 2020, 25(3-4): 290-303.
22.	陈振宇, 黄启林, 孙红玉, 等. 腹腔穿刺引流对早期重症急性胰腺炎大鼠肝脏TLR4表达的影响. 基础医学与临床, 2020, 40(10): 1342-1347.
23.	Folch-Puy E. Importance of the liver in systemic complications associated with acute pancreatitis: the role of Kupffer cells. J Pathol, 2007, 211(4): 383-388.
24.	Wang Y, Liu W, Liu X, et al. Role of liver in modulating the release of inflammatory cytokines involved in lung and multiple organ dysfunction in severe acute pancreatitis. Cell Biochem Biophys, 2015, 71(2): 765-776.
25.	Miyahara S, Isaji S. Liver injury in acute pancreatitis and mitigation by continuous arterial infusion of an antibiotic via the superior mesenteric artery. Pancreas, 2001, 23(2): 204-211.
26.	Luan ZG, Zhang H, Ma XC, et al. Therapeutic treatment with ethyl pyruvate attenuates the severity of liver injury in rats with severe acute pancreatitis. Pancreas, 2012, 41(5): 729-737.
27.	Woreta TA, Alqahtani SA. Evaluation of abnormal liver tests. Med Clin North Am, 2014, 98(1): 1-16.
28.	Newsome PN, Cramb R, Davison SM, et al. Guidelines on the management of abnormal liver blood tests. Gut, 2018, 67(1): 6-19.
29.	Sakka SG. Assessing liver function. Curr Opin Crit Care, 2007, 13(2): 207-214.
30.	Boivineau G, Gonzalez JM, Gasmi M, et al. Sphincter of Oddi dysfunction. J Visc Surg, 2022, 159(1S): S16-S21. doi: 10.1016/j.jviscsurg.2022.01.008.
31.	Hoekstra LT, de Graaf W, Nibourg GA, et al. Physiological and biochemical basis of clinical liver function tests: a review. Ann Surg, 2013, 257(1): 27-36.
32.	Yin C, Lu S, Wei D, et al. Effects of nutritional support combined with insulin therapy on serum proteins, inflammatory factors, pentraxin-3, and serum amylase levels in patients with diabetic ketoacidosis complicated with acute pancreatitis. Medicine (Baltimore), 2021, 100(51): e27920. doi:10.1097/md.0000000000027920.
33.	Hong W, Lin S, Zippi M, et al. Serum Albumin is independently associated with persistent organ failure in acute pancreatitis. Can J Gastroenterol Hepatol, 2017, 2017: 5297143. doi:10.1155/2017/5297143.
34.	Wang W, Huang Y, Lan Y, et al. The application of a structural nutritional care management model in severe acute pancreatitis patients undergoing early enteral nutrition via nasal jejunal nutrition tubes. Am J Transl Res, 2021, 13(7): 8200-8206.
35.	Ocskay K, Vinkó Z, Németh D, et al. Hypoalbuminemia affects one third of acute pancreatitis patients and is independently associated with severity and mortality. Sci Rep, 2021, 11(1): 24158. doi:10.1038/s41598-021-03449-8.
36.	Yang J, Fier A, Carter Y, et al. Liver injury during acute pancreatitis: the role of pancreatitis-associated ascitic fluid (PAAF), p38-MAPK, and caspase-3 in inducing hepatocyte apoptosis. J Gastrointest Surg, 2003, 7(2): 200-207.
37.	Zhang XP, Wang L, Zhang J. Study progress on mechanism of severe acute pancreatitis complicated with hepatic injury. J Zhejiang Univ Sci B, 2007, 8(4): 228-236.
38.	Yuan X, Luo C, Wu J, et al. Abdominal paracentesis drainage attenuates intestinal mucosal barrier damage through macrophage polarization in severe acute pancreatitis. Exp Biol Med (Maywood), 2021, 246(18): 2029-2038.

1. Mederos MA, Reber HA, Girgis MD. Acute Pancreatitis: A Review. JAMA, 2021, 325(4): 382-390.
2. Sharma D, Jakkampudi A, Reddy R, et al. Association of systemic inflammatory and anti-inflammatory responses with adverse outcomes in acute pancreatitis: preliminary results of an ongoing study. Dig Dis Sci, 2017, 62(12): 3468-3478.
3. Liu W, Du JJ, Li ZH, et al. Liver injury associated with acute pancreatitis: the current status of clinical evaluation and involved mechanisms. World J Clin Cases, 2021, 9(34): 10418-10429.
4. Wang Q, Zhang X, Lei S, et al. RNA sequence analysis reveals pathways and candidate genes associated with liver injury in a rat pancreatitis model. Pancreatology, 2018, 18(7): 753-763.
5. Kong L, Zhang H, Lu C, et al. AICAR, an AMP-activated protein kinase activator, ameliorates acute pancreatitis-associated liver injury partially through Nrf2-mediated antioxidant effects and inhibition of NLRP3 inflammasome activation. Front Pharmacol, 2021, 12: 724514. doi:10.3389/fphar.2021.724514.
6. Ou ZB, Miao CM, Ye MX, et al. Investigation for role of tissue factor and blood coagulation system in severe acute pancreatitis and associated liver injury. Biomed Pharmacother, 2017, 85: 380-388.
7. Wang X, Zhao X, Shi C, et al. Potential mechanisms and significance of acute pancreatitis-associated liver injury. Scand J Gastroenterol, 2006, 41(5): 604-613.
8. Huang Z, Yu SH, Liang HY, et al. Outcome benefit of abdominal paracentesis drainage for severe acute pancreatitis patients with serum triglyceride elevation by decreasing serum lipid metabolites. Lipids Health Dis, 2016, 15: 110. doi:10.1186/s12944-016-0276-6.
9. Huang SQ, Wen Y, Sun HY, et al. Abdominal paracentesis drainage attenuates intestinal inflammation in rats with severe acute pancreatitis by inhibiting the HMGB1-mediated TLR4 signaling pathway. World J Gastroenterol, 2021, 27(9): 815-834.
10. Pérez S, Pereda J, Sabater L, et al. Pancreatic ascites hemoglobin contributes to the systemic response in acute pancreatitis. Free Radic Biol Med, 2015, 81: 145-155.
11. Cen ME, Wang F, Su Y, et al. Gastrointestinal microecology: a crucial and potential target in acute pancreatitis. Apoptosis, 2018, 23(7-8): 377-387.
12. Wen Y, Sun HY, Tan Z, et al. Abdominal paracentesis drainage ameliorates myocardial injury in severe experimental pancreatitis rats through suppressing oxidative stress. World J Gastroenterol, 2020, 26(1): 35-54.
13. Ramudo L, Manso MA, De Dios I. Biliary pancreatitis-associated ascitic fluid activates the production of tumor necrosis factor-alpha in acinar cells. Crit Care Med, 2005, 33(1): 143-148.
14. 吴俊, 卢一琛, 黄竹, 等. 腹腔穿刺引流对重症急性胰腺炎大鼠胰腺细胞焦亡的影响及其意义. 解放军医学杂志, 2022, 47(9): 863-870.
15. Liu WH, Ren LN, Chen T, et al. Abdominal paracentesis drainage ahead of percutaneous catheter drainage benefits patients attacked by acute pancreatitis with fluid collections: a retrospective clinical cohort study. Crit Care Med, 2015, 43(1): 109-119.
16. Hongyin L, Zhu H, Tao W, et al. Abdominal paracentesis drainage improves tolerance of enteral nutrition in acute pancreatitis: a randomized controlled trial. Scand J Gastroenterol, 2017, 52(4): 389-395.
17. Zhou J, Huang Z, Cheng L, et al. Abdominal paracentesis drainage (APD) attenuates acute pancreatitis-associated lung injury in patients with ascitic fluids: a retrospective study. Int J Clin Exp Med, 2016, 9: 18400-18409.
18. 杨熊, 刘若鸿, 谢川, 等. 早期腹腔穿刺引流对重症急性胰腺炎肾损伤的保护作用. 中国普通外科杂志, 2021, 30(3): 321-329.
19. Liu L, Yan H, Liu W, et al. Abdominal paracentesis drainage does not increase infection in severe acute pancreatitis: a prospective study. J Clin Gastroenterol, 2015, 49(9): 757-763.
20. Banks PA, Bollen TL, Dervenis C, et al. Classification of acute pancreatitis-2012: revision of the Atlanta classification and definitions by international consensus. Gut, 2013, 62(1): 102-111.
21. Luo C, Huang Q, Yuan X, et al. Abdominal paracentesis drainage attenuates severe acute pancreatitis by enhancing cell apoptosis via PI3K/AKT signaling pathway. Apoptosis, 2020, 25(3-4): 290-303.
22. 陈振宇, 黄启林, 孙红玉, 等. 腹腔穿刺引流对早期重症急性胰腺炎大鼠肝脏TLR4表达的影响. 基础医学与临床, 2020, 40(10): 1342-1347.
23. Folch-Puy E. Importance of the liver in systemic complications associated with acute pancreatitis: the role of Kupffer cells. J Pathol, 2007, 211(4): 383-388.
24. Wang Y, Liu W, Liu X, et al. Role of liver in modulating the release of inflammatory cytokines involved in lung and multiple organ dysfunction in severe acute pancreatitis. Cell Biochem Biophys, 2015, 71(2): 765-776.
25. Miyahara S, Isaji S. Liver injury in acute pancreatitis and mitigation by continuous arterial infusion of an antibiotic via the superior mesenteric artery. Pancreas, 2001, 23(2): 204-211.
26. Luan ZG, Zhang H, Ma XC, et al. Therapeutic treatment with ethyl pyruvate attenuates the severity of liver injury in rats with severe acute pancreatitis. Pancreas, 2012, 41(5): 729-737.
27. Woreta TA, Alqahtani SA. Evaluation of abnormal liver tests. Med Clin North Am, 2014, 98(1): 1-16.
28. Newsome PN, Cramb R, Davison SM, et al. Guidelines on the management of abnormal liver blood tests. Gut, 2018, 67(1): 6-19.
29. Sakka SG. Assessing liver function. Curr Opin Crit Care, 2007, 13(2): 207-214.
30. Boivineau G, Gonzalez JM, Gasmi M, et al. Sphincter of Oddi dysfunction. J Visc Surg, 2022, 159(1S): S16-S21. doi: 10.1016/j.jviscsurg.2022.01.008.
31. Hoekstra LT, de Graaf W, Nibourg GA, et al. Physiological and biochemical basis of clinical liver function tests: a review. Ann Surg, 2013, 257(1): 27-36.
32. Yin C, Lu S, Wei D, et al. Effects of nutritional support combined with insulin therapy on serum proteins, inflammatory factors, pentraxin-3, and serum amylase levels in patients with diabetic ketoacidosis complicated with acute pancreatitis. Medicine (Baltimore), 2021, 100(51): e27920. doi:10.1097/md.0000000000027920.
33. Hong W, Lin S, Zippi M, et al. Serum Albumin is independently associated with persistent organ failure in acute pancreatitis. Can J Gastroenterol Hepatol, 2017, 2017: 5297143. doi:10.1155/2017/5297143.
34. Wang W, Huang Y, Lan Y, et al. The application of a structural nutritional care management model in severe acute pancreatitis patients undergoing early enteral nutrition via nasal jejunal nutrition tubes. Am J Transl Res, 2021, 13(7): 8200-8206.
35. Ocskay K, Vinkó Z, Németh D, et al. Hypoalbuminemia affects one third of acute pancreatitis patients and is independently associated with severity and mortality. Sci Rep, 2021, 11(1): 24158. doi:10.1038/s41598-021-03449-8.
36. Yang J, Fier A, Carter Y, et al. Liver injury during acute pancreatitis: the role of pancreatitis-associated ascitic fluid (PAAF), p38-MAPK, and caspase-3 in inducing hepatocyte apoptosis. J Gastrointest Surg, 2003, 7(2): 200-207.
37. Zhang XP, Wang L, Zhang J. Study progress on mechanism of severe acute pancreatitis complicated with hepatic injury. J Zhejiang Univ Sci B, 2007, 8(4): 228-236.
38. Yuan X, Luo C, Wu J, et al. Abdominal paracentesis drainage attenuates intestinal mucosal barrier damage through macrophage polarization in severe acute pancreatitis. Exp Biol Med (Maywood), 2021, 246(18): 2029-2038.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Protective effects of abdominal paracentesis drainage in patients with severe acute pancreatitis-associated liver injury: a historical cohort study

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