Multiple Hits in Acute Pancreatitis: Components of Metabolic Syndrome Synergize Each Other's Deteriorating Effects.

Dalma Dobszai,Ferenc Izbéki,M Korbonits ,Andrea Szentesi,Márta Varga,Balázs Kui,Jan Novák ,Ville Sallinen,Elena Ramirez Maldonado,Judit Bajor,Imola Török,Tamás Takács,László Czakó,József Hamvas,Szilárd Gódi,Hunor Farkas,Andrea Párniczky,Artautas Mickevičius ,Dóra Illés,Bálint Erőss,Silvia Patrícia ,Adrienn Halász,Áron Vincze,Noémi Gede,Mária Papp

doi:10.3389/fphys.2019.01202

Abstract

IntroductionThe incidence of acute pancreatitis (AP) and the prevalence of metabolic syndrome (MetS) are growing worldwide. Several studies have confirmed that obesity (OB), hyperlipidemia (HL), or diabetes mellitus (DM) can increase severity, mortality, and complications in AP. However, there is no comprehensive information on the independent or joint effect of MetS components on the outcome of AP. Our aims were (1) to understand whether the components of MetS have an independent effect on the outcome of AP and (2) to examine the joint effect of their combinations.MethodsFrom 2012 to 2017, 1435 AP cases from 28 centers were included in the prospective AP Registry. Patient groups were formed retrospectively based on the presence of OB, HL, DM, and hypertension (HT). The primary endpoints were mortality, severity, complications of AP, and length of hospital stay. Odds ratio (OR) with 95% confidence intervals (CIs) were calculated.Results1257 patients (55.7 ± 17.0 years) were included in the analysis. The presence of OB was an independent predictive factor for renal failure [OR: 2.98 (CI: 1.33–6.66)] and obese patients spent a longer time in hospital compared to non-obese patients (12.1 vs. 10.4 days, p = 0.008). HT increased the risk of severe AP [OR: 3.41 (CI: 1.39–8.37)], renal failure [OR: 7.46 (CI: 1.61–34.49)], and the length of hospitalization (11.8 vs. 10.5 days, p = 0.020). HL increased the risk of local complications [OR: 1.51 (CI: 1.10–2.07)], renal failure [OR: 6.4 (CI: 1.93–21.17)], and the incidence of newly diagnosed DM [OR: 2.55 (CI: 1.26–5.19)]. No relation was found between the presence of DM and the outcome of AP. 906 cases (mean age ± SD: 56.9 ± 16.7 years) had data on all four components of MetS available. The presence of two, three, or four MetS factors increased the incidence of an unfavorable outcome compared to patients with no MetS factors.ConclusionOB, HT, and HL are independent risk factors for a number of complications. HT is an independent risk factor for severity as well. Components of MetS strongly synergize each other’s detrimental effect. It is important to search for and follow up on the components of MetS in AP.

Highlights

The incidence of acute pancreatitis (AP) and the prevalence of metabolic syndrome (MetS) are growing worldwide
We showed that HL is an independent risk factor for the development of newly diagnosed diabetes mellitus (DM) in AP
The components of MetS deteriorate the outcome of AP

Summary

Introduction

The incidence of acute pancreatitis (AP) and the prevalence of metabolic syndrome (MetS) are growing worldwide. The presence of MetS was previously shown to be associated with a higher risk of severe AP, higher mortality rate, and longer duration of stay in the intensive care unit (Mikolasevic et al, 2016). OB was previously shown to be independently associated with the severity of AP (Sawalhi et al, 2014) and the development of organ failure but not with mortality in AP (Smeets et al, 2019). DM was associated with a higher risk of AP (Yang et al, 2013) and negatively influenced the outcome of AP by raising the incidence of renal failure, intensive care unit admission, and length of hospital stay (LOS) (Miko et al, 2018). The presence of HTG increased severity, complication rate, and mortality in AP (Kiss et al, 2018)

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