An increased level of haemoglobin A1C predicts a poorer clinical outcome in patients with acute pancreatitis

Abstract

To compare the clinical features of acute pancreatitis (AP) in patients with and without diabetes. We retrospectively collected 318 patients with AP in two clinical centres from January 2009 to October 2010. Patients with a previous history of diabetes or with glycosylated haemoglobin A1c (HbA1c) higher than 6·5% were identified as having acute pancreatitis with diabetes (APD), while patients without a history of diabetes and in whom the HbA1c was not higher than 6·5% were considered as AP only. The clinical characteristics and prognosis data of these patients were analysed. Survival curves were plotted according to the Kaplan-Meier method. Cox proportional hazard regression was used to test the association between the clinical prognostic factors and mortality in patients with AP. In total, 318 patients with AP were enrolled. Among them, 40 had APD and 278 had AP; thus, in this study, the prevalence of diabetes in AP was 12·6% (40/318). Twenty-five per cent (10/40) of the APD cases were indentified using HbA1c. The mortality rate was significantly higher in the APD group (15·0%, 6/40) than that in the AP group (1·1%, 3/278). Survival curves showed that there was a significant survival difference between the APD group and AP group via the log-rank test. Multivariate Cox regression analysis showed that sex, age, diastolic blood pressure, body mass index (BMI) and C-peptide were significantly associated with mortality. Compared with AP patients, subjects with APD had significantly longer time from initial symptoms to admission [1·6 (95% CI: 0·5-3·2) vs 0·9 (95% CI: 0·1-2·2) days], older age of onset (57·2 ± 11·0 vs 44·3 ± 7·8 years), higher levels of glucose (13·9 ± 8·2 vs 7·3 ± 4·1 mm), higher levels of HbA1c [8·5 (95% CI: 6·6-11·4)%vs 5·9 (95% CI: 4·9-6·4)%], lower levels of C-peptide (0·882 ± 0·337 vs 2·621 ± 0·526 ng/ml) and longer duration of hospitalization (18·3 ± 4·6 vs 13·2 ± 5·1 day). Electrocardiograms showed that APD patients had a significantly higher risk of heart ischaemia than AP patients (22/40 vs 20/278). HbA1c may be a useful marker to identify unrecognised diabetes in patients with acute pancreatitis; this group of patients has a higher in hospital mortality.