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Severe Alcoholic Pancreatitis-Associated Acute Lung Injury in Veterans: Risks, Mechanisms, Prediction, and Therapeutic Relevance

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[Technical Report, Final Report]

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Background Acute pancreatitis is a painful, potentially life-threatening condition of the pancreas with an unpredictable course. In this study we hope to identify and propose simple and reliable ways to predict and treat acute pancreatitis. Hypothesis Alcohol increases systemic bioavailability of unsaturated fatty acidsUFAs. This, along with the resulting hypocalcemia and hypoalbuminemia worsen cell injury. We propose to test a novel yet simple ratio as a reliable predictor and therapeutic target in the management of alcoholic AP. Objective To compare the Serum free fatty acid Serum calcium x albumin ratio as a predictor of severe alcoholic pancreatitis in veterans vs. other classical and proposed predictors. Methods Patients admitted with acute pancreatitis are enrolled and laboratory results are recorded. Total of 103 patients and controls were enrolled. Serum samples obtained and sent to Mayo Clinic, Site 1, for analysis of FFA and circulating dead inflammatory cells. Echocardiogram done within 24 hours of admission. Control groups include patients who abuse alcohol but do not have pancreatitis and healthy patients. We studied the strength of associations of various risk factors for severe acute pancreatitis in comparison to the Serum free fatty acid Serum calcium x albumin ratio. Conclusion The 20-50-fold increase in serum FAEEs during alcoholic pancreatitis greatly exceeds the 2-4-fold increase in parent NEFAs which FAEEs mirror. These large changes in FAEEs resulting from their release from a visceral pool, are sustained, and independent of ethanol. These characteristics may allow FAEEs to be tested as biomarkers in challenging clinical scenarios, including the diagnosis, prognosis, and resolution of alcoholic pancreatitis.

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  • Medicine and Medical Research

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[A, Approved For Public Release]