Risk factors of recurrent acute pancreatitis and progression to chronic pancreatitis after the first attack of acute pancreatitis

Abstract

Background/aims: Estimation of recurrent acute pancreatitis (RAP) and progression to chronic pancreatitis (CP) in patients with the first attack of AP is still a huge clinical challenge. We aim to elucidate risk factors for the RAP and progression to CP. Methods: Medical records of patients with the first attack of AP between 2007 and 2016 were retrospectively reviewed. Total of 60 patients with RAP and randomly selected 120 patients with single episode AP were included. Results: On the comparison between single episode AP and RAP, younger age(42.8±11.9 vs 57.6±17.2), male(76.7 vs 56.7%), alcohol(88.3 vs 55.0%), smoking(71.7 vs 37.5%), moderately severe/severe grade of Atlanta classification(58.3 vs 32.5%), higher CT severity index(CTSI)(3.37±2.31 vs 2.62±1.89), higher Triglyceride(TG)(480 vs 245 mg/dL) were related to RAP. On the multivariate analysis, younger age(OR 0.975; 95%CI 0.953-0.997), alcohol(OR 2.817; 95%CI 2.010-6.561), CTSI(OR 1.196; 95%CI 1.063-1.345) were significant risk factors of recurrence of AP after first attack. In addition, among 60 patients with RAP, 24 patients showed CP feature and the median time to progression to CP was estimated to be 1247 days.(range 879-1614). Cox regression analysis presented that higher CTSI(OR 1.390; 95%CI 1.156-1.167), short interval to recurrence(< 1yr)(OR 2.872; 95%CI 1.193-6.914) and two or more recurrence(OR 4.198; 95%CI 1.611-10.937) were significant risk factors of progression to CP after first attack of AP. Conclusions: Younger age, higher CTSI, alcohol consumption were significantly related to RAP. Higher CTSI and short interval to recurrence, two or more recurrence were associated with progression to CP after recurrent episodes.