Heat shock protein 70 gene polymorphism and hospital outcomes in patients with acute pancreatitis.

Unnikrishnan, L S (2013) Heat shock protein 70 gene polymorphism and hospital outcomes in patients with acute pancreatitis. Masters thesis, Christian Medical College, Vellore.

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Abstract

INTRODUCTION : Acute pancreatitis is defined as a process involving inflammation of pancreas, the surrounding tissues as well as distant organs. Incidence of acute pancreatitis differ in different parts of the world, possibly due to the differnce in the consumption of alcohol in different places as well as difference in the incidence of gall stones in different parts of world. Previous studies reported the occurence of acute pancreatitis ranging from 4.9 to 35 per 1 lakh populations. Severe disease was reported in about 20% of individuals and may be associated with mortality close to 20%. There are varied aetiologies for acute pancreatitis. In one study Steer M L et al, found that in 45 percent of cases, cholelithiasis was the cause followed by ethanol in 35 percent ,rest in 10%. In about 10%, a specific cause could not be found and was grouped under idiopathic(5) . In India, the aetiological spectrum of mild pancreatitis included the following: alcoholism in 41.1%, gallstones in 23.5%, trauma in 17.6%, idiopathic in 11.7% and post-endoscopic retrograde cholangiopancreatography in 5.8%. Acute pancreatitis patients, usually present with pain abdomen and vomiting. Pain typically starts in epigastrium and may be radiating to the back also. Abdominal examination may reveal tenderness in the epigastrium. In mild cases, usually there will be an uneventful recovery and may require only few days of admission in hospital. In severe cases, pain may be severe with increase in heart rate, tachypnoea, decreased urine output and hypotension. There can be various signs on abdominal examination like cullens and Gray Turners signs. In severe cases death also can occur. Such patients can be grouped as severe acute pancreatitis when they present with /develop organ failure and or with local complications such as fluid collections, necrosis, abscess, or pseudocyst. AIM : To determine whether there is any association between Heat Shock Protein 70 gene polymorphisms and severity of illness and hospital outcomes in patients with acute pancreatitis admitted to a tertiary care hospital. CONCLUSIONS : Alcohol was the most common cause for acute pancreatitis in this study followed by biliary stones.Male gender is affected more than females.Severe Acute Pancreatitis were observed in more than half of the study population.Local complications were present in 41.73% of study population of which acute fluid collection was the commonest followed by pseudocyst, necrosis and abscess. Organ failure was present in one fourth of the study population. Respiratory insufficiency was the most common organ failure followed by cardiovascular, renal and gastrointestinal complication Klebsiella was the most common organism grown in patient with infection. The mortality in acute severe pancreatitis was 20 %. One tenth of the total population studied had recurrent acute pancreatitis with biliary stones as the most common aetiology after excluding the idiopathic group. Homozygous TT rs 2227956 gene polymorphism showed statistically significant correlation with the need for pressure support ,length of ICU stay and it also showed a trend towards significance for overall organ failure, overall severity of the disease and pulmonary insufficiency. There is a possibility that those who are having homozygous TT allele with rs 2227956 genetic polymorphism are at risk for a severe course of disease if they have an episode of acute pancreatitis.

Item Type: Thesis (Masters)
Uncontrolled Keywords: Heat shock protein 70 gene ; polymorphism ; hospital outcomes ; patients ; acute pancreatitis.
Subjects: MEDICAL > Gastroenterology
Depositing User: Kambaraman B
Date Deposited: 14 Jul 2017 06:25
Last Modified: 14 Jul 2017 06:25
URI: http://repository-tnmgrmu.ac.in/id/eprint/1640

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