30 Systematic Review on Viral Hepatitis-Induced Acute Pancreatitis
Bibliographic record
Abstract
INTRODUCTION: Viral hepatitis that concomitantly causes acute pancreatitis (AP) has been reported but not comprehensively studied. We sought to investigate the frequency of viral hepatitis that concomitantly causes AP, its impact on AP and the clinical features of the disease. METHODS: A comprehensive review of PubMed's database of English language until April 12 th , 2019 was performed using all relevant MeSH (medical subject headings) keywords. AP diagnosis and severity were defined as per the Revised Atlanta Classification (RAC). Viral infections were diagnosed by serology and/or histology. A diagnosis of viral infection, with a concurrent AP diagnosis, a temporal resolution of both entities and the attempt to exclude the most common etiologies of AP defined viral induced AP. Graft pancreatitis studies and non-English publications were excluded. Two independent blinded reviewers (Z.I, C.R.S.L.) reviewed the publications. Bias risk was assessed with the Murad tool derived from the Newcastle-Ottawa scale. RESULTS: 71 cases of viral hepatitis causing concomitant AP were found. 20 AP cases were attributed to Hepatitis A virus (HAV), 16 AP cases to Hepatitis B virus (HBV), and 35 AP cases to Hepatitis E virus (HEV). Mean ages were 24.3 ± 1.9, 40.5 ± 3.1, and 31.5 ± 3.05 for HAV, HBV, HEV cases respectively. Male to female ratio were 2.25:1, 4.33:1 and 8:1 respectively. 37.5% of HBV AP patients were immunocompromised (IC). Latency of AP from jaundice onset was 6.7 (range: 0–21), 11.9 (0–60), 8.8 (0–37) days respectively. Mean AST levels were 1042 (44–5520), 1550 (514–3200), 362 (71–3690) and ALT levels were 1406 (20–6680), 1894 (72–7521), 1093 (103–5214) respectively. AP severity: mild and moderately severe AP were reported in 80% of HAV-attributed cases, 31.3% of HBV-attributed cases and 82.9% of HEV-attributed cases. Severe AP was reported in 20%, 66.7% and 14.3% of HAV, HBV and HEV-attributed cases respectively. Mortality was reported in 25% of HAV-attributed cases, 56.3% of HBV-attributed cases and 11.8% of HEV-attributed cases. Only one case of HCV-attributed AP was reported. Findings are summarized in Table 1. CONCLUSION: Viral hepatitis causing concomitant AP is a rare entity and outcomes vary depending on the type of hepatitis virus. HEV AP appears to have a male predominance. Over one-third of HBV attributed AP occurred in IC patients, with higher mortality. Direct acinar injury by active viral replication has been suggested as the mechanism of injury.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.006 | 0.026 |
| Meta-epidemiology (narrow) | 0.002 | 0.001 |
| Meta-epidemiology (broad) | 0.008 | 0.007 |
| Bibliometrics | 0.017 | 0.015 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.003 | 0.002 |
| Open science | 0.002 | 0.002 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.012 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".