***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
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    Input: BACKGROUND Acute pancreatitis ( AP ) etiology and frequency vary in relation to geographic region . AIMS To determine the etiology , frequency , and mortality of AP in a Mexican population . PATIENTS AND METHODS We carried out a prospect i ve study of first episode AP patients over a period of 6 years . RESULTS A total of 605 patients with a mean age of 40 years were included in the study . Sixty-four percent of them presented with overweight and /or obesity determined through BMI . Etiology was biliary in 66.60 % , it was due to alcohol consumption in 15.90 % , hypertriglyceridemia in 7.80 % , it was post-endoscopic retro grade cholangiopancreatography ( ERCP ) in 2.10 % , and was undetermined in 7.20 % .  Pancreatic infection was suspected in 70 patients and they underwent CT-guided fine needle aspiration . Thirty-two of those patients were diagnosed with pancreatic infection in which Staphylococcus spp was the most common microorganism . Overall mortality was 5.00 % ( 2.60 % < 30 years and 10.00 % > 70 years ) . Necrosis , pancreatic infection , and mortality were more frequent in the cases in which etiology was due to alcohol ingestion . CONCLUSIONS The most frequent AP etiology was biliary , but that caused by alcohol presented with more complications . Overall mortality was 5.00 % and was higher in the elderly patients CONTEXT The assessment of the severity of pancreatitis is important for proper management of this challenging disease . A highly accurate system which could predict the severity and identify the local extent and complications of a serious inflammation , is beneficial for patient outcome . OBJECTIVE The aim was to establish the value of the computed tomography severity index in predicting the severity of acute pancreatitis and to compare it with the accuracy of the APACHE II score and serum CRP concentrations . DESIGN Prospect i ve clinical series . PATIENTS Fifty-five consecutive patients ( 37 women , 18 men ; mean age 57 years ) with a clinical and laboratory diagnosis of acute pancreatitis . INTERVENTIONS Clinical evaluation , biochemical analysis of blood and contrast-enhanced abdominal CT . MAIN OUTCOME MEASURES  Computed tomography severity index  within the first 5 days , serum CRP level , and clinical APACHE II score at 48 hours after admission . RESULTS Thirteen patients had severe pancreatitis according to the Atlanta classification . The mean values of predictive markers in the mild and the severe pancreatitis groups were : computed tomography severity index 1.26 and 6.30 ( P<0.001 ) ; APACHE II 4.14 and 8.61 ( P<0.001 ) ; and CRP 96.0 mg/L and 192.4 mg/L ( P<0.001 ) , respectively . The sensitivity , specificity , positive predictive value , negative predictive value and accuracy were calculated for the CTSI ( greater than 3 : 85 % , 98 % , 92 % , 95 % , and 95 % ) , for APACHE II ( equal to , or greater than 7 : 62 % , 86 % , 57 % , 88 % , and 80 % ) and for CRP ( equal to , or greater than 150 mg/L : 85 % , 74 % , 50 % , 94 % , and 76 % ) . CONCLUSION The computed tomography severity index is a reliable method for staging the severity of acute pancreatitis ; moreover , CT has the ability of showing the local extent of the inflammation and the occurrence of local complications BACKGROUND Statin treatment was shown to be associated with improved outcomes in several inflammatory conditions . We wanted to evaluate the effects of statin therapy on the course and outcome of acute pancreatitis ( AP ) . METHODS A prospect i ve cohort study included patients with acute pancreatitis divided into two groups according to statin use prior to hospitalization . Age , sex , etiology of AP , Ranson 's score , APACHE II score and maximal CRP were recorded . Outcome measures were hospital length of stay and mortality . Matching of patients for matched analyses was done using individual matching and propensity score matching using variables a priori associated with course and outcome of acute pancreatitis . RESULTS Inclusion criteria were met for 1062 patients of whom 92 were taking statins . Statin users were older and had higher body mass indexes . Severe disease was more common in the no-statin group than in statin group ( 20.6 % vs. 8.7 % respectively ) . All severity markers were also higher in the no-statin group . All cause mortality was not different , while cardiovascular mortality was higher in the statin group in the cohort analysis . After matching by either method , the severity of disease was greater for the patients without statins treatment . Pancreatitis related mortality was higher in the no-statin group after matching . Among patients who developed severe AP  , statin users showed lower Ranson 's and APACHE II scores and lower maximal CRP . CONCLUSIONS Prior statin treatment significantly reduces morbidity and mortality in acute pancreatitis . Further studies are needed to evaluate possible therapeutic use of statins in acute pancreatitis Objective The aim of this study was to analyse the clinical characteristics of acute pancreatitis ( AP ) in a prospect ively collected , large , multicentre cohort and to vali date the major recommendations in the IAP/APA evidence -based guidelines for the management of AP . Design Eighty-six different clinical parameters were collected using an electronic clinical research form design ed by the Hungarian Pancreatic Study Group . Patients 600 adult patients diagnosed with AP were prospect ively enrolled from 17 Hungarian centres over a two-year period from 1 January 2013 . Main Results With respect to aetiology , biliary and alcoholic pancreatitis represented the two most common forms of AP . The prevalence of biliary AP was higher in women , whereas alcoholic AP was more common in men . Hyperlipidaemia was a risk factor for severity , lack of serum enzyme elevation posed a risk for severe AP , and lack of abdominal pain at admission demonstrated a risk for mortality . Abdominal tenderness developed in all the patients with severe AP , while lack of abdominal tenderness was a favourable sign for mortality . Importantly , lung injury at admission was associated with mortality . With regard to laboratory parameters , white blood cell count and CRP were the two most sensitive indicators for severe AP . The most common local complication was peripancreatic fluid , whereas the most common distant organ failure in severe AP was lung injury . Deviation from the recommendations in the IAP/APA evidence -based guidelines on fluid replacement , enteral nutrition and timing of interventions increased severity and mortality . Conclusions Analysis of a large , nationwide , prospect i ve cohort of AP cases allowed for the identification of important determinants of severity and mortality . Evidence -based guidelines should be observed rigorously to improve outcomes in AP Background Recent data shows that patients with severe acute pancreatic might benefit from early intensive therapy , enteral nutrition and timely transfer to specialized centers . The early prophylactic use of antibiotics in AP remains controversial . The role and need for new markers in stratification of acute pancreatitis is also uncertain . This study aims to evaluate the prognostic usefulness of adipokines in prediction of the severity and outcome of acute pancreatitis ( AP ) . Methods Prospect i ve study was conducted in four clinical centers . The diagnosis and severity assessment of AP was established according to the revised 2012 Atlanta classification . Adipokines , IL-6 and CRP levels were measured at admission and on 3rd day of hospital stay and compared with the control group . The predictive accuracy of each marker was measured by area under the receiver operating curve . Results Forty healthy controls and 102 patients were enrolled in to the study . Twenty seven ( 26.5 % ) patients had mild , 55 ( 53.9 % ) - moderate and 20 ( 19.6 % ) - severe AP . Only resistin ( cut-off value 13.7 ng/ml ) and IL-6 ( cut-off value 473.4 pg/ml ) were reliable early markers of SAP . IL-6 with cut-off value of 157.0 pg/ml was a predictor of necrosis . The peripancreatic necrosis volume of 112.5 ml was a marker of SAP and 433.0 ml cut-off value could be used to predict the need of interventions . Conclusions The prognostic value of adipokines in AP is limited . Only admission resistin levels could serve as an early predictor for SAP.The Lithuanian Regional Ethics Committee approved the study protocol ( permission No. L-12 - 02/1/2/3/4 ) and all the patients and the control group provided written informed consent AIM To investigate the cause of acute pancreatitis ( AP ) by conducting a thorough investigation of drugs and their possible etiological role . METHODS We investigated the cause of AP in a large retrospective cohort of 613 adult patients admitted with AP at the Akershus University Hospital , Norway , from 2000 until 2009 , who were evaluated with st and ard ward investigations . This group was compared with a prospect ively evaluated group ( n = 57 ) admitted from January 2010 until September 2010 who investigated more extensively using medical history and radiological assessment . RESULTS The groups were comparable with regards to gender , age , comorbidity and severity . The most common etiology was bile stones and alcohol , occurring in 60 % in both groups . The prospect i ve group was examined more thoroughly with regards to the use of alcohol and medicines . An increased number of radiological investigations during hospital stay and at follow-up were also performed . A more extensive use of radiological evaluation did not increase the detection frequency of bile stones . In the prospect i ve group , more than half of the patients had two or more possible causes of pancreatitis , being mostly a combination of bile stones and drugs . No possible cause was found in only 3.5 % of these patients , compared with 29.7 % in the retrospective group . CONCLUSION A detailed medical history and extensive radiological evaluation may determine a possible etiology in almost all cases of AP . Many patients have several possible risk factors , and uncertainty remains in establishing the definitive etiology OBJECTIVES : The aims of this study were to define the indications for , and to evaluate the cost-effectiveness of , nutritional support in patients with acute pancreatitis . METHODS : All admissions during the 12-month period from January through December 2000 , were entered into a common management protocol consisting of an initial 48-h fast with i.v . fluids and analgesics . After 48 h , those patients who were improving were restarted on oral feeding ( group O ) . The remaining patients were r and omized to receive naso-jejunal ( group EN ) or parenteral feeding ( group TPN ) . The r and omization study was continued until 50 patients had been accrued . Outcomes in the three groups were compared with respect to length of hospital stay , duration of feeding , complications , and hospital costs . RESULTS : A total of 156 admissions were evaluated in the first 12 months . Of these , 87 % patients had mild disease , 10 % moderate , and 3 % severe ; 62 % were related to alcohol abuse , 18 % gallstones , and 8 % idiosyncratic drug reactions . Of the patients , 75 % improved on 48 h bowel rest and i.v . fluids , and were discharged within 4 days . The remainder were r and omized to jejunal elemental ( n = 26 ) or parenteral ( n = 27 ) feeding . Duration of feeding was shorter with EN ( 6.7 vs 10.8 days , p < 0.05 ) and nutrition costs were lower , representing an average cost saving of $ 2362.00 per patient fed . EN was less effective in meeting estimated nutritional requirements ( 54 vs 88 % , p < 0.0001 ) , but metabolic ( p < 0.003 ) and septic complications ( p = 0.01 ) were lower . Subgroup analysis of patients with severe disease showed similar findings . CONCLUSION : Despite concerns that metabolic expenditure is increased and that food-stimulated pancreatic secretion might exacerbate the disease process , hypocaloric enteral feeding seems to be safer and less expensive than parenteral feeding and bowel rest in patients with acute pancreatitis BACKGROUND / OBJECTIVES Acute pancreatitis has a highly variable clinical course . Early and reliable predictors for the severity of acute pancreatitis are lacking . Proteinuria appears to be a useful predictor of disease severity and outcome in a variety of clinical conditions . This study aims to investigate the predictive value of proteinuria on admission for the severity of acute pancreatitis compared with other commonly used predictors ; the APACHE II score , Modified Glasgow score and C-reactive protein ( CRP ) . METHODS This is a post-hoc analysis of 64 patients admitted with acute pancreatitis treated in one teaching hospital , who participated in a previous r and omized trial . Proteinuria was defined as a Protein/Creatinine ( P/C ) ratio > 23 mg/mmol . The primary endpoint was severe acute pancreatitis . Secondary endpoints included infectious complications , need for invasive intervention , ICU stay and in-hospital mortality . RESULTS Proteinuria was present in 30/64 patients ( 47 % ) . Eleven patients ( 17 % ) had severe acute pancreatitis . There was no difference in incidence of severe acute pancreatitis between patients 
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Results : Aging greatly influences the outcome of AP .
Conclusion : Our analysis shows a likelihood of severe pancreatitis , as well as , pancreatitis-associated mortality is more common with advanced age .
Importantly , the rapid elevation of mortality above the age of 59 suggests the involvement of additional deteriorating factors such as co-morbidity in elderly