Abstracts / Pancreatology

pancreas injury is critical to develop novel therapeutic strategies. Recentevidence suggests important roles for developmental and inflammatorytranscription factors in several steps of the regeneration process.

Aims: To analyze whether and how the inflammatory transcriptionfactor NFATc1 is involved in the course of acute pancreatitis.

Materials & methods: Caerulein and L-Arginin were used toinduce acute pancreatitis in different pancreas specific transgenic micemodels with differential expression of NFATc1. Mice were sacrificed atdifferent time points after induction of acute pancreatitis to isolatepancreata for further analysis. Gene expression in mice tissue andacinar cell explants were determined by using RT-PCR, immunoblot-ting, immunofluorescence and immunohistochemical stainings. Localhistone modifications on the NFATc1 promoter were investigated byChIP analysis.

Results: Caerulein mediated acute pancreatitis initiates acinar toductal metaplasia, which goes along with activation of NFATc1 inmetaplastic areas of the pancreas. Regeneration of the pancreasrequires inactivation of NFATc1 by H3K27 trimethylation mediated bythe Polycomb protein EZH2. While pharmacological or genetic inacti-vation of NFATc1 in mice accelerates pancreas regeneration, sustainedactivation of NFATc1 overcomes transcriptional silencing and fullyprevents restoration of the organ.

Conclusion: Our results provide evidence, that transcriptional silencingof NFATc1 by EZH2 is an inevitable prerequisite for sufficient regenerationfrom acute pancreatitis.

T-041.

Application of two new classification of acute PANCREATITIS (AP): Re-vised atlanta 2012 and determinant-based classification (DBC). A pro-spective two years single center.

Andreu Romaguera, Francisco Garcia-Borobia, Sheila Serra, NataliaBejarano, Neus Garcia, Angel Corcuera, Pere Rebasa, Salvador Navarro

Parc Tauli Hospital, Spain

Background: Two new classification systems for severity have beenrecently proposed.

Both have demonstrated association with clinical outcomes in USA.Presence of infected pancreatic necrosis (IPN) is a determinant in DBC andone of other four local complications in Atlanta 2012.

Aims: Our aims were: to analyzed the association between these newclassification and clinical outcomes and to determinated better classi-fication for patients with IPN.

Patients & methods: All patients admitted for AP between 2012 and2013 were included. “Step- up approach” was applied.

Clinical outcomes evaluated were: mortality, intensive care unit(ICU) admission, need for surgical interventions, need for drains, use oftotal parenteral nutrition (TPN), use of antibiotics, hospital stay, andre-admissions. IPN were too registered. We used chia€▫square test andManna€▫Whitney’s U to compared variables according to need.

Results: 280 patients were included. Age 62 (sd 19), 142 females and138 males. Overall, higher grades of severity were associated with worse allclinical outcomes evaluated for both classification systems in ourenvironment.

Patients with infected pancreatic necrosis are majority moderate inAtlanta 2012 and severe in DBC but clinical outcomes in terms of mortality,ICU admission, need for surgical interventions, need for drains, use of TPN,use of antibiotics, hospital stay, and re-admissions are better correlationedwith severe.

Conclusion: Both new classifications corresponding with clinical out-comes but patients with infected pancreatic necrosis are better classificatedwith DBC

T-042.

Disorders of haemostasis in patients with acute necrotisingpancreatitis

Marijana Levicanin, Djordje Bajec, Andrija Antic, Stefan Kmezic, DejanRadenkovic

First Surgical Clinic, Clinical Center of Serbia, Serbia

Background: The disarrangement in the haemostatic balance resultingin a pro-coagulant state can appear as a complication of severe necrotisingpancreatitis (SAP). This state is main cause for development of DIC, whichresults in fibrin deposition in the microvascular system that may beimplicated in MOF.

Aims: The aim of this study was to evaluate events in the haemostaticactivation during SNP.

Patients & methods: In a prospective clinical study, anticoagulantproteins (protein C, antithrombin III), coagulation variables (pro-thrombin time, fibrinogen, activate partial thromboplastin time), andfibrinolytic factors (tissue plasminogen activator, plasminogen activatorinhibitor-1) were measured and correlated with outcome. Theseparameters were measured daily for first seven days and later every nextweak (2,3,4). According to treatment outcome at the end of study, twogroups of patients were compared: 26 survived and 15 non-survivedpatients.

Results: A moderate activation of the coagulation system was found inboth study groups. Distinct differences were found in protein C and AT IIIconcentration between two groups. The other measured variables did notshow differences between two groups. Multivariate analysis shows thatlevels of protein C activity were significant as prognostic factors formortality.

Conclusion: Coagulatory activation by itself is unlikely to directly causedeterioration of organ function, although it is involved in generalizedendothelial activation with consecutive mediator release and increasedleukocyte-endothelial cell interaction. This study show that low level ofprotein C activity are predictor for outcome of patients with SNP.

14 (2014) S1eS129 S61

T-043.

Early prediction of severity of acute pancreatitis using hematocrit le-vel on admission

Andrej Bajec a, Dejan Radenkovic b, Djordje Bajec b, Pavle Gregoric a,Marijana Levicanin b

a Emergency Center Belgrade,Emergency Surgeru-III Department,Serbiab First Surgical Clinic, VIII Deprtment, Serbia

Background: The early and accurate prediction of the severity of acutepancreatitis (AP) and the assessment of prognosis of the disease are veryimportant and can influence the course of disease and outcome.

Aims: The aim of this study is to reevaluate the value of hematocrit levelon admission as prediction of severity of AP.

Patients & methods: This prospective study included 91 patientstreated of acute pancreatitis in the Clinic for Emergency Surgery in timeperiod between January 2012 and April 2013. The AP was diagnosed bytypical clinical features. Patients were divided into two groups: patientswith severe (SAP) and patients with mild AP (MAP). Severity of acutepancreatitis (SAP) was defined according to Atlanta classification system.Main characteristics curves (age, gender), etiology were determined, aswell as value of hematocrit on admission. Receiver operation characteristics(ROC) analysis determined cut-off value, sensitivity and specificity ofhematocrit level ad predictor.

Abstracts / Pancreatology 14 (2014) S1eS129S62

Results: Group with SAP consisted of 33 (36%) patients and group withmild AP consisted of 58 (64%) patients. Average hematocrit level onadmission was: 44% for SAP and 41% for mild AP patients. For hematocritcut-off level on admission (44%), sensitivity and specificity for prediction ofseverity of AP were 63,5% and 85,7% respectively.

Conclusion: The assessment of AP severity can be based on hematocritlevel on admission that is higher than 44%. Among the variables available,the value of hematocrit on admission can be a useful and cost-effectivemarker which provides significant predictive power for clinical decision-making.

T-044.

Comparison of clinical course and outcome of acute pancreatitis ac-cording to two main etiologies: alcohol vs. gallstone

Tae Nyeun Kim, Sung Bum Kim, Joon Hyun Cho, Kook Hyun Kim

Yeungnam University Hospital, South Korea

Background: Studies concerning clinical course and outcome of acutepancreatitis according to etiologies were rare, especially after year 2000.

Aims: We compared clinical course and outcomes of acute pancreatitiscaused by alcohol and gallstone.

Patients & methods: Of the 128 patients diagnosed as acute pan-creatitis from January 2011 to January 2013, Various clinical data andoutcomes of 25 patients with acute pancreatitis caused by alcohol and 76patients caused by gallstone were analyzed retrospectively.

Results: Mean age of the patients in alcohol and biliary group was52.3 and 67.3 years, respectively(p¼0.05). Male proportion was sig-nificantly higher in alcohol group than biliary group(88.0% vs. 52.6%,p¼0.030). Hemoglobin, hematocrit and 24 hour C-reactive protein levelwere significantly higher in alcohol group than biliary group. ALT wassignificantly higher in biliary group than alcohol group. Development ofperipancreatic fluid collection was not significantly different betweenalcohol and biliary groups(32% vs. 18.4%, p¼0.170). Incidence of pseu-docyst formation was significantly higher in alcohol group than biliarygroup(28% vs. 7%, p¼0.009). Among severity scoring system only CTseverity index showed significant difference(p¼0.000) with a meanscore of 3.0 in alcohol group and 1.7 in biliary group. In biliary group,endoscopic sphincterotomy and stone removal were done in 27 and 23patients, respectively. Severe pancreatitis with organ failure persistingbeyond 48 hours was seen in 6 patients(24%) in alcohol group and 1patient(1.3%) in biliary group(p¼0.000). There were 2 cases of mortalityin alcohol group only.

Conclusion: Proportion of severe pancreatitis and pseudocyst for-mation are significantly higher in acute alcoholic pancreatitis than biliarypancreatitis.

T-045.

Factors predicting outcome in severe acute pancreatitis

Shamil Galeev, Michael Rubtsov, Yakubbay Abdullaev

Saint Luke Clinical Hospital, Russia

Background: There are few relevant methods for predicting of fataloutcome and prolonged ICU stay in acute pancreatitis. According to liter-ature data, most scoring systems (Ranson, APACHE etc.) serve as predictorsof severity and outcome simultaneously.

Aims: To detect and compare precursors associated with severe pan-creatitis and unfavorable disease outcome.

Materials & methods: A retrospective study of 89 patients withacute pancreatitis in 9 year period (2000-2009) was done. 71 patientssuffered from severe disease, 17 had mild pancreatitis confirmed by CT

with contrast-enhancement. There were different clinical, laboratoryand instrumental data analyzed for detection severity and outcomemarkers.

Results: Univariate analysis showed that 5 signs are useful for severepancreatitis prediction: APACHE � 8, CRP � 120 mg/l, serum amylase <250 U/l, procalcitonin � 0,5 ng/ml, pleural effusion (on chest X-ray).Outcome prediction model also included 5 variables, conjoined into 3groups: 1. early pancreatitis-specific organ failure (PO2/FiO2 < 250, cre-atinine > 150 mcmol/l, pressure-adjusted heart rate � 10); 2. CT data(extended pancreatic necrosis); 3. infected necrosis. Outcome predictionaccuracy of this model amounted to 88,3% (sensitivity-93,3%; specificity-84,2%).

Conclusion: Patients with severe pancreatitis mainly die due to sys-temic complications. It seems possible to identify outcome predictorsduring first few days after admission. Besides, our data suggest: severitypredictors and precursors of outcome in acute pancreatitis are different.

T-046.

First surgical clinic, clinical centre of Serbia, eight departement

Andrija Antic, Dejan Radenkovic, Marijana Levicanin, Stefan Kmezic,Djordje Bajec

First Surgical Clinic, Clinical centre of Serbia, Eight departement, Serbia

Background: The right management of severe narcotizing pan-creatitis (SNP) can prevent occurrence and development of fearedcomplications such as infected pancreatic necrosis and organ failure(OF).

Aims: The aim of this study was to demonstrate the relation betweenpancreatic necrosis leading to OF and multiple organ failure (MOF).

Patients & methods: This is prospective study that includes 71patients with SNP. All patients were diagnosed with NP, which wasconfirmed by contrast-enhanced CT and/or by intraoperative find-ings (41 patients). The bacterial status of necrotic areas was assessedby intraoperative smears (41 patients) and/or bacterial culturesobtained from sonographically guided fine-needle aspiration.The Atlanta classification system was used to define the occurrence of(OF).

Results: In 29 patients (41%) pancreatic infection occurred while in42 patients (59%) the necrosis remained sterile. OF occurred in 79% ofpatients with infected and in 55% of patients with sterile necrosis anddifferences were statistically significant (p¼ 0,033). MOF was observedin 38% of the patients with infected necrosis, compared with 17% of thepatients in the sterile group and differences were statistically significant(p¼0,043).

Conclusion: The higher incidence of OF and MOF is expected withinthe group of patients with infected pancreatic necrosis. The severity ofillness is increased by OF, which has strong impact to outcome ofpatients with SNP.

T-047.

Visceral adipose tissue and acute pancreatitis

Serge Chooklin, Mariay Shavarova

Regional Clinical Hospital, Lviv, Ukraine

Background: Obesity is one of the most important risk factors fordeveloping severe acute pancreatitis. Some reports indicated that obesity hasrelationships with the local complication rate, organ dysfunction, and mor-tality in acute pancreatitis. A large amount of necrotic visceral adipose tissue