Severity assessment and new therapy in acute pancreatitis

• Project/Area Number: 16K11434
• Research Category: Grant-in-Aid for Scientific Research (C)
• Allocation Type: Multi-year Fund
• Section: 一般
• Research Field: Emergency medicine
• Research Institution: University of Occupational and Environmental Health, Japan
• Principal Investigator: Mayumi Toshihiko 産業医科大学, 医学部, 教授 (90281071)
• Co-Investigator(Kenkyū-buntansha): 松田 晋哉 産業医科大学, 医学部, 教授 (50181730)
• Project Period (FY): 2016-04-01 – 2019-03-31
• Project Status: Completed (Fiscal Year 2018)
• Budget Amount: ¥4,680,000 (Direct Cost: ¥3,600,000、Indirect Cost: ¥1,080,000); Fiscal Year 2018: ¥1,690,000 (Direct Cost: ¥1,300,000、Indirect Cost: ¥390,000); Fiscal Year 2017: ¥1,690,000 (Direct Cost: ¥1,300,000、Indirect Cost: ¥390,000); Fiscal Year 2016: ¥1,300,000 (Direct Cost: ¥1,000,000、Indirect Cost: ¥300,000)
• Keywords: 急性膵炎 / 重症度 / 多施設研究 / 重症度判定 / IL-6 / プロカルシトニン / 抗凝固薬 / antithrombin / thrombomodulin / 前向き症例集積 / DPC

Outline of Final Research Achievements

1. We evaluated the many markers for the purpose of examining utilities as a single serious marker of the acute pancreatitis and are analyzing it.
2. Multicenter study, DPC data provided the following findings.
1)The mortality of the severe pancreatitis decreased during study periods, but length of stay and the hospital charges did not decrease. 2) The Japanese severity assessment prognostic factor was equivalent to APACHEII score in a death prediction and was significantly better in predicting respiratory care, pancreatic infection, the Atlanta classification severity than APACHEII score. 3) The antimicrobial agent prophylaxis was a significant factor of the onset of invasive candidiasis. 4) Transfusion more than 6,000 ml within first 24 hours significantly decreased the mortality. 5) Urinary trypsinogen-2 was the severity index of the acute pancreatitis and was correlated well with severity score and CT Grade.

Academic Significance and Societal Importance of the Research Achievements

今まで十分明らかにされてこなかった、急性膵炎の臨床的な実状が、多施設研究やDPCデータによる日本での多数例での解析によって明らかとなった。これらの知見に基づいて、ガイドラインでの推奨などがより正しく改訂されることによって、急性膵炎の予後がさらに改善することが期待される。

Research Products

• [Journal Article] Impact of Antimicrobial Prophylaxis for Severe Acute Pancreatitis on the Development of Invasive Candidiasis: A Large Retrospective Multicenter Cohort Study. (2019)
  • Author(s): Horibe M, Sanui M, Sasaki M, et al.
  • Journal Title: Pancreas. Volume: 48 Issue: 4 Pages: 537-543
  • DOI: 10.1097/mpa.0000000000001269
  • Peer Reviewed
• [Journal Article] Usefulness of urinary trypsinogen-2 and trypsinogen activation peptide in acute pancreatitis: A multicenter study in Japan. (2019)
  • Author(s): Yasuda H, Kataoka K, Takeyama Y, et al.
  • Journal Title: World J Gastroenterol. Volume: 25 Issue: 1 Pages: 107-117
  • DOI: 10.3748/wjg.v25.i1.107
  • Peer Reviewed / Open Access
• [Journal Article] Large Volume Fluid Resuscitation for Severe Acute Pancreatitis is Associated With Reduced Mortality: A Multicenter Retrospective Study. (2019)
  • Author(s): Yamashita T, Horibe M, Sanui M, et al.
  • Journal Title: J Clin Gastroenterol Volume: 53 Issue: 5 Pages: 385-391
  • DOI: 10.1097/mcg.0000000000001046
  • Peer Reviewed
• [Journal Article] The Prognosis of Severe Acute Pancreatitis Varies According to the Segment Presenting With Low Enhanced Pancreatic Parenchyma on Early Contrast-Enhanced Computed Tomography: A Multicenter Cohort Study. (2018)
  • Author(s): Kitamura K, Horibe M, Sanui M, et al.
  • Journal Title: Pancreas Volume: 46 Issue: 7 Pages: 867-873
  • DOI: 10.1097/mpa.0000000000000851
  • Peer Reviewed
• [Journal Article] Validation of the efficacy of the prognostic factor score in the Japanese severity criteria for severe acute pancreatitis: A large multicenter study. (2018)
  • Author(s): Ikeura T, Horibe M, Sanui M, et al.
  • Journal Title: United European Gastroenterol J Volume: 5 Issue: 3 Pages: 389-397
  • DOI: 10.1177/2050640616670566
  • Peer Reviewed
• [Journal Article] Continuous Regional Arterial Infusion of Protease Inhibitors Has No Efficacy in the Treatment of Severe Acute Pancreatitis: A Retrospective Multicenter Cohort Study. (2018)
  • Author(s): Horibe M, Sasaki M, Sanui M, et al
  • Journal Title: Pancreas Volume: 46 Issue: 4 Pages: 510-517
  • DOI: 10.1097/mpa.0000000000000775
  • Peer Reviewed
• [Journal Article] Time Trend of Outcomes for Severe Acute Pancreatitis After Publication of Japanese Guidelines Based on a National Administrative Database. (2018)
  • Author(s): Murata A, Mayumi T, Okamoto K, et al.
  • Journal Title: Pancreas Volume: 45 Issue: 4 Pages: 516-21
  • DOI: 10.1097/mpa.0000000000000490
  • Peer Reviewed
• [Presentation] 急性膵炎の診断と治療 Up to Date (2019)
  • Author(s): 真弓俊彦
  • Organizer: 第46回日本集中治療医学会学術集会
  • Invited
• [Presentation] 急性膵炎重症度判定基準をめぐる諸問題 動注療法多施設後ろ向き研究における急性膵炎の重症度判定基準の検討 (2018)
  • Author(s): 岩崎栄典,堀部昌靖,佐々木満仁,池浦司,濱田毅,北村勝哉,千葉宣孝,武田和憲,金井隆典,真弓俊彦
  • Organizer: 第49回日本膵臓学会大会
• [Presentation] 重症急性膵炎におけるCTでの造影不領域と予後の関係 (2018)
  • Author(s): 江崎麻衣子,山本朋納,西村哲郎,溝端康光,岩崎栄典,辻喜久,讃井將満,真弓俊彦,堀部昌靖,金井隆典
  • Organizer: 第45回日本集中治療医学会学術集会
• [Presentation] 重症急性膵炎の診断と治療最前線 (2018)
  • Author(s): 真弓俊彦
  • Organizer: 第45回日本救急医学会総会
  • Invited
• [Presentation] 急性膵炎多施設後ろ向き研究における後期合併症に対する侵襲的処置の現状と今後の展望 (2018)
  • Author(s): 岩崎栄典, 堀部昌靖, 南一洋, 福原誠一郎, 清野隆史, 松下美紗子, 片山正, 玉川空樹, 池浦司, 北村勝哉, 辻喜久, 真弓俊彦, 金井隆典
  • Organizer: 第48回日本膵臓学会大会
• [Presentation] 急性膵炎診療 UP TO DATE (2018)
  • Author(s): 真弓俊彦
  • Organizer: 第111回近畿医学研究会
  • Invited
• [Presentation] 重症急性膵炎に対する renal replacement therapy の効果・多施設観察研究 (2018)
  • Author(s): 澤野宏隆、堀部昌靖、佐々木満仁、後藤隆司、池浦司、濱田毅、尾田琢也、安田英人、真弓俊彦、讃井將満
  • Organizer: 第43回日本集中治療医学会
• [Presentation] プロテアーゼインヒビターの持続的局所動注療法は重症急性膵炎に対して効果を認めなかった (2018)
  • Author(s): 堀部昌靖、佐々木満仁、讃井將満、杉山大典、岩崎栄典、澤野宏隆、後藤隆司、池浦司、金井隆典、真弓俊彦
  • Organizer: 第43回日本集中治療医学会