Chaiqinchengqi decoction, a traditional Chinese medicine, has shown promising effects in in vitro, animal and preliminary small human studies for acute pancreatitis, but evidence of clinical practice is limited. To investigate whether Chaiqinchengqi decoction could improve clinical outcomes in patients with acute pancreatitis. Prospective, pragmatic, randomized controlled trial. (Chictr.org.cn registration number: ChiCTR2000034325) METHODS: This trial was conducted at West China Hospital of Sichuan University, China. Patients with acute pancreatitis were randomly assigned to receive either Chaiqinchengqi decoction or placebo by oral and rectal enemas in addition to guideline-directed administrations using a 1:1 ratio. The intervention of Chaiqinchengqi and placebo was determined by the grading of acute gastrointestinal injury. Patients were assessed within 24 and 48 hours, and on 3, 5, and 7 days after admission, or organ failure normalized. Survivors were followed up at 1, 3, and 6 months after discharge. Primary outcome was the duration of respiratory failure to 28 days after enrollment. Secondary outcomes included other organ failure, local complications, 6-month all-cause mortality, inflammatory indicators, and related interventions. Among 248 patients enrolled, Chaiqinchengqi decoction shortened the duration of respiratory failure compared with the placebo (median [IQR], 1.0 [0.0 to 5.0] vs 3.0 [1.0-8.0] days; median difference, -1.0; 95% CI, -2.0 to 0.0, P=.001). There were significant differences in the duration of circulatory failure, the incidence of new-onset respiratory and cardiovascular and failure, the incidence of new organ failure, severity, intensive care unit need, pain visual analogue scale, pancreatitis activity scoring system, and EQ-5D-5L. Chaiqinchengqi decoction as an adjunctive therapy significantly reduced the duration of respiratory failure and improved 6-month clinical outcomes of acute pancreatitis in addition to guideline-directed treatments. Further study is needed to elucidate the mechanism of action.

Background: The stress hyperglycemia ratio (SHR) has emerged as a promising biomarker for assessing stress-induced hyperglycemia (SH) but has not been evaluated in patients with acute pancreatitis (AP). This study investigates the role of the SHR in predicting adverse clinical outcomes in patients with AP. Methods: Adult patients with AP who were admitted within 72 h of the onset of abdominal pain were screened in the database. Eligible patients with glycated hemoglobin (HbA1c) and blood glucose were analyzed. The SHR was calculated using admission blood glucose and HbA1c levels. Patients were categorized into four groups: SHR1 (≤1.03), SHR2 (1.04–1.25), SHR3 (1.26–1.46), and SHR4 (≥1.47). The primary outcome was persistent organ failure (POF). The secondary outcomes included acute peripancreatic fluid collection (APFC) and high-dependency unit/intensive care unit (HDU/ICU) admission. Restricted cubic spline (RCS) analysis was used to assess nonlinear associations and identify SHR threshold values. Univariable and multivariable logistic regression models were used to adjust for potential confounders and evaluate the relationship between the SHR and clinical outcomes. Results: A total of 486 patients with AP were included in this study, comprising 85 with POF and 401 without POF. SHR levels and severity were significantly correlated, with the highest quartile in the greatest proportion of severe acute pancreatitis (SAP). Higher SHR levels were significantly associated with an increased risk of POF, APFC, and HDU/ICU admission. RCS analysis revealed a nonlinear relationship between the SHR and APFC (p = 0.009). Based on the RCS and quartile analysis, SHR > 1.25 was identified as the threshold for increased risk. After adjusting for confounders, SHR > 1.25 remained independently associated with higher risks of POF (OR: 2.49, 95% CI: 1.39–4.46, p = 0.002), APFC (OR: 2.85, 95% CI: 1.92–4.24, p < 0.001), and ICU admission (OR: 1.74, 95% CI: 1.12–2.69, p = 0.013). Conclusions: The SHR is independently associated with adverse clinical outcomes in AP, including POF, APFC, and HDU/ICU admission. These findings suggest that the SHR may serve as a valuable biomarker for risk stratification and early intervention in AP management.

Objectives: This study aims to analyze the clinical characteristics of elderly patients with acute pancreatitis (AP) and investigate the effects of age on the clinical outcomes of AP. Methods: Patients aged ≥ 18 years with AP admitted within 72 h from 1 September 2013 to 31 August 2019 were included. Patients were divided into elderly (≥60 years) and non-elderly (<60 years) groups. Clinical data and outcomes were compared. Results: A total of 756 elderly and 4896 non-elderly patients with AP were included. The elderly patients had different etiological distributions and more severe clinical markers and scores. Age was an independent risk factor for mortality [odds ratio (OR): 2.911, 95% CI: 1.801–4.706, p < 0.001], intensive care unit admission (OR: 1.739, 95% CI: 1.126–2.685, p = 0.013), persistent organ failure (OR: 1.623, 95% CI: 1.326–1.987, p < 0.001), multiple organ failure (OR: 1.757, 95% CI: 1.186–2.604, p = 0.005), and infection (OR: 2.451, 95% CI: 1.994–3.013, p < 0.001). Adjusted multiple logistic regression and trend analysis confirmed the risk of the age for the outcomes. The deaths of elderly patients showed a biphasic pattern with peaks in the first and fifth weeks, in contrast to the single peak in the first week in the non-elderly patients. Conclusions: Elderly patients with AP were associated with worse clinical outcomes. It is crucial to devote considerable attention to the optimization of therapeutic approaches to reduce late mortality in this group of patients.

Background: Xuebijing Injection (XBJ), a plant-derived traditional Chinese medicine administered as an injection, is widely used in clinical practice to treat various acute critical illnesses including severe acute pancreatitis (SAP). The mechanisms by which XBJ alleviates SAP remain elusive. Methods: Active components of XBJ were identified using UPLC-QTOF/MS. A mouse SAP model was established by intraperitoneal injections of cerulein (50 μg/kg/h × 7) followed by lipopolysaccharide (10 mg/kg). XBJ of 2.5, 5, and 10 mL/kg was co-administered twice after induction of SAP. The protective effects of XBJ on pancreatic acinar cells were further investigated in vitro. An integrated analysis of transcriptomic data from human and mouse blood, as well as mouse lung, combined with network pharmacology were employed to delineate the therapeutic mechanisms of XBJ on SAP, followed by pancreatic immunoblotting and proteomics validation. Results: Component analysis revealed 9 active ingredients of XBJ. XBJ at 10 mL/kg had the best effect and consistently decreased pancreatic, lung, and circulatory pro-inflammatory indices. XBJ dose-dependently reduced necrotic cell death activation. Transcriptomics, proteomics and network pharmacology analyses identified 14 key targets, with IL-17-related signaling pathways being the most significant. Experimental validation further confirmed that XBJ significantly reduced serum levels of key IL-17-related inflammatory cytokines (such as IL-17, IL-1β, IL-6, and TNF-α) and downregulated the mRNA expression of related inflammatory factors in pancreatic tissue. Virtual docking and surface plasmon resonance demonstrate that hydroxysafflor yellow A had the highest binding affinity with MMP-9, MAPK14, and LCN2. Crucially, subsequent pancreatic immunoblotting and proteomics analyses did not confirm significant direct modulation of these targets at the protein level within pancreatic tissue. Conclusions: XBJ attenuates SAP severity by quelling pro-inflammatory mediators, an effect chiefly attributed to modulating systemic IL-17–related signaling rather than direct pancreatic intervention.

Background: Splanchnic vein thrombosis (SVT) is a common complication of acute pancreatitis (AP), but the role of anticoagulation (AC) during acute hospitalization remains unclear. We aimed to evaluate the impact of in-hospital AC on SVT recanalization and bleeding risk. Methods: We conducted a single-center prospective cohort study (2023–2026) including patients with moderate-severe AP and CT-confirmed SVT. The primary outcome was SVT recanalization at discharge; secondary outcome was in-hospital bleeding complications. Results: Among the 258 included patients, 89 (34.5%) received AC. The median AC duration was 42 days (range 1–83). SVT recanalization did not differ between AC and non-AC groups (15.7% vs. 16.6%, p = 0.862). Bleeding risk was significantly higher with AC (27.0% vs. 9.5%, p < 0.001), driven predominantly by clinically significant hemoglobin decline (7.9% vs. 1.2%, p = 0.015), while major bleeding did not differ significantly between groups. Among the anticoagulated patients, those with recanalization had a higher rate of necrosectomy (78.6% vs. 53.3%, p = 0.080). Conclusions: In this observational cohort, in-hospital AC was not associated with improved short-term SVT recanalization but was associated with a higher incidence of bleeding complications, driven predominantly by clinically significant hemoglobin decline. These observations require confirmation in randomized trials.