First-attack Acute Pancreatitis Research Articles

Incidence and risk factors of fasting hyperglycaemia following first-attack acute pancreatitis before discharge: a retrospective study

BackgroundPancreatic endocrine insufficiency is more likely to occur after acute pancreatitis (AP), but the risk factors affecting pancreatic endocrine function remain controversial. Therefore, exploring the incidence and risk factors of fasting hyperglycaemia following first-attack AP is important.MethodsData were collected from 311 individuals with first-attack AP without previous diabetes mellitus (DM) or impaired fasting glucose (IFG) history treated in the Renmin Hospital of Wuhan University. Relevant statistical tests were performed. A two-sided p-value < 0.05 was considered statistically significant.ResultsThe incidence of fasting hyperglycaemia in individuals with first-attack AP was 45.3%. Univariate analysis showed that age (χ2 = 6.27, P = 0.012), aetiology (χ2 = 11.184, P = 0.004), serum total cholesterol (TC) (χ2 = 14.622, P < 0.001), and serum triglyceride (TG) (χ2 = 15.006, P < 0.001) were significantly different between the hyperglycaemia and non-hyperglycaemia groups (P < 0.05). The serum calcium concentration (Z=-2.480, P = 0.013) was significantly different between the two groups (P < 0.05). Multiple logistic regression analysis showed that age- ≥60 years (P < 0.001, OR = 2.631, 95%Cl = 1.529–4.527) and TG ≥ 5.65 mmol/L (P < 0.001, OR = 3.964, 95%Cl = 1.990–7.895) were independent risk factors for fasting hyperglycaemia in individuals with first-attack AP (P < 0.05).ConclusionsOld age, serum triglycerides, serum total cholesterol, hypocalcaemia, and aetiology are associated with fasting hyperglycaemia following first-attack AP. Age ≥ 60 years and TG ≥ 5.65 mmol/L are independent risk factors for fasting hyperglycaemia following first-attack AP.

A population-based cohort study on risk factors for acute pancreatitis: A comparison by age group

Background/objectives: Acute pancreatitis (AP) is an acute inflammatory disorder that can occur in all age groups. The risk of AP has been shown to increase with age. However, no study has compared risk factors for AP according to age group yet. Thus, the aim of this study was to perform such comparison. MethodsClinical data from individuals 20 years of age and older who received a health examination arranged by the Korean national health insurance program in 2009 (n = 4,238,822) were used. First-attack AP was identified using claims data from baseline to December 2018. Incidence and risk factors of AP were analyzed for young (20–39 years old), middle-aged (40–64 years old), and old (over 65 years old) groups. ResultsIncidences of AP in young, middle-aged, and old groups were 16.30, 27.85, and 57.19 per 100,000 person-years, respectively. Smoking, alcohol drinking, diabetes, gallstone, and chronic pancreatitis were associated with increased risk of AP in all age groups. Meanwhile, male, older age, and higher waist circumference were associated with increased risk of AP in middle-aged and old groups. In young and middle-aged groups, risk of AP was increased in the presence of hypertension and dyslipidemia. However, high income was associated with decreased risk of AP in these groups. ConclusionsIn this population-based cohort study, incidences and risk factors for AP differed according to age group. Thus, a tailored strategy might be needed to prevent AP according to age group.

Serum pancreatic enzymes and imaging in paediatric acute pancreatitis: Does lipase diagnostic superiority justify eliminating amylase testing?

Background:In acute pancreatitis (AP), serum amylase, lipase and imaging help establish a diagnosis with recognised lipase superiority. Recent literature has debated serum amylase testing and proposed its elimination, but little is known about the diagnostic role of simultaneously measured serum amylase levels in patients with non-diagnostic lipase. This study examined the contribution of pancreatic enzymes and imaging and the role of simultaneously measured serum amylase in children with non-diagnostic serum lipase.Methods:Retrospective medical records review of children aged <18 years with a verified discharge diagnosis of first-attack AP between January 01, 1994, and December 31, 2016.Results:First-attack AP was confirmed in 127 children (median age, 12.5 years). The sensitivity was 90.4%, 54.3%, 42.2% and 36.4% for lipase, amylase, contrast-enhanced computed tomography and ultrasonography (US), respectively. Combination US and lipase identified 96.6% of AP cases. Simultaneous amylase and lipase measurements in 125 children showed that either was ≥3× the upper limit of normal (ULN) in 95.2%, while both were <3× the ULN in 4.8% of cases. Nondiagnostic lipase was seen in 12 (9.6%) children, and diagnosis was based on amylase level ≥3× the ULN in six children and imaging in the other six.Conclusions:Serum amylase, serum lipase and imaging should continue for the conclusive diagnosis of AP in children. Simultaneous serum amylase measurement helped diagnose AP with non-diagnostic lipase.

Comparative analysis of epidemiology, etiology, and outcomes between elderly and young and middle-aged acute pancreatitis patients: a retrospective, single-center study.

The aim of this study was to analyze the etiology and epidemiology of the patients with first-attack acute pancreatitis of two-age groups. This is a retrospective comparative study of 2965 patients aged 18 years and older with first-attack acute pancreatitis between 2013 and 2018 in the Affiliated Hospital of Southwest Medical University. Patients divided into the elderly group (age > or = 60 years) and the young and middle-aged group (age <60 years). The etiology tendency and clinical characteristics were analyzed. In the elderly group, the proportions of women to men was higher compared with the young and middle-aged group (1.48 vs. 0.69, P < 0.001). The primary etiology of acute pancreatitis in two groups were biliary tract diseases. The main etiology of the young and middle-aged group among men was alcohol and among women was biliary disease. Comparing with the young and middle-aged group, the elderly patients had a higher proportion of hypertension, ischemic heart disease, and cerebrovascular disease (P < 0.001). Meanwhile, the proportions of system inflammatory reaction syndrome, multiple organ dysfunction syndrome (MODS), and shock were also higher in the elderly group (P < 0.001). Mortality in the elderly group and the young and middle-aged group was 1.69 and 0.72%, respectively. Biliary tract diseases were the predominant etiological factor in two groups. The two groups had different etiological proportions according to gender, complications, comorbidities, and outcomes. Furthermore, elderly patients are more likely to with complications, comorbidities, and highly mortality rate. We should pay more attention to realize the characteristics of acute pancreatitis at different ages.

A 5-Year Retrospective Cohort Study: Epidemiology, Etiology, Severity, and Outcomes of Acute Pancreatitis.

The aim of this study was to evaluate the epidemiology, etiology, severity, and outcomes of acute pancreatitis (AP) in the southern Sichuan region of China. All patients with first-attack AP between 2013 and 2018 in the Affiliated Hospital of Southwest Medical University were retrospectively identified. The etiology tendency was analyzed, and the relationship was defined with sex, aging, severity, length of stay, and mortality. Three thousand twenty-eight patients were enrolled for analysis. Acute biliary pancreatitis had the highest incidence rate; the second and third most common causes were hypertriglyceridemic (14.4%) and alcoholic (14.2%), followed by idiopathic (13.6%), mixed etiology (12.9%), and miscellaneous (2.31%). Patients with alcoholic AP were more likely to be middle-aged males, whereas patients with acute biliary pancreatitis were more likely to be elderly females (P < 0.05). The overall mortality in the hospital was 1%, and there was no difference in each etiological groups (P > 0.05). Biliary disease was the predominant etiology of AP in southern Sichuan of China, and hypertriglyceridemia ranked second. The proportion of hypertriglyceridemic AP and mixed etiology AP gradually increased, whereas idiopathic AP decreased. There were different etiology proportion of AP according age, sex, and severity.

Radiomics model of contrast-enhanced computed tomography for predicting the recurrence of acute pancreatitis.

To predict the recurrence of acute pancreatitis (AP) by constructing a radiomics model of contrast-enhanced computed tomography (CECT) at AP first attack. We retrospectively enrolled 389 first-attack AP patients (271 in the primary cohort and 118 in the validation cohort) from three tertiary referral centers; 126 and 55 patients endured recurrent attacks in each cohort. Four hundred twelve radiomics features were extracted from arterial and venous phase CECT images, and clinical characteristics were gathered to develop a clinical model. An optimal radiomics signature was chosen using a multivariable logistic regression or support vector machine. The radiomics model was developed and validated by incorporating the optimal radiomics signature and clinical characteristics. The performance of the radiomics model was assessed based on its calibration and classification metrics. The optimal radiomics signature was developed based on a multivariable logistic regression with 10 radiomics features. The classification accuracy of the radiomics model well predicted the recurrence of AP for both the primary and validation cohorts (87.1% and 89.0%, respectively). The area under the receiver operating characteristic curve (AUC) of the radiomics model was significantly better than that of the clinical model for both the primary (0.941 vs. 0.712, p = 0.000) and validation (0.929 vs. 0.671, p = 0.000) cohorts. Good calibration was observed for all the models (p > 0.05). The radiomics model based on CECT performed well in predicting AP recurrence. As a quantitative method, radiomics exhibits promising performance in terms of alerting recurrent patients to potential precautions. • The incidence of recurrence after an initial episode of acute pancreatitis is high, and quantitative methods for predicting recurrence are lacking. • The radiomics model based on contrast-enhanced computed tomography performed well in predicting the recurrence of acute pancreatitis. • As a quantitative method, radiomics exhibits promising performance in terms of alerting recurrent patients to the potential need to take precautions.

Risk of Diabetes Mellitus after First-Attack Acute Pancreatitis: A National Population-Based Study.

Population-based data on the risk of diabetes mellitus onset after acute pancreatitis (AP) are lacking. We assessed the incidence of diabetes in AP survivors compared with matched controls. The study cohort, drawn from Taiwan National Health Insurance claims data, included 2,966 first-attack AP patients and 11,864 non-AP general controls individually matched on age and sex, with an AP/non-AP ratio of 1:4. Incidence rate was estimated under Poisson assumption. Relative risks of diabetes were indicated by hazard ratios (HRs) estimated from Cox proportional hazard regression models with a partitioning of time at 3 months to account for proportionality. In the first partition of time (<3 months), the incidences of diabetes were 60.8 and 8.0 per 1,000 person-years in AP and control groups, respectively; representing a covariate-adjusted HR of 5.90 (95% confidence interval (CI) 3.37-10.34). In the second partition (≥3 months), the incidences of diabetes were 22.5 and 6.7 per 1,000 person-years in AP and control groups, respectively (adjusted HR 2.54, 95% CI 2.13-3.04). In the second partition, the risk of diabetes was greater in men than in women (HR 3.21 vs. 1.58, P=0.0004). When the analyses were stratified by severity of AP, the results for mild AP were similar to those for all AP. The risk of diabetes increases by twofold after AP; therefore, a long-term screening is necessary to evaluate diabetes after an attack regardless of severity. Further research should be conducted to develop cost-effective follow-up strategies, and to elucidate the underlying mechanisms of the relationship between diabetes and AP.

Prior statin use and the outcomes in patients with first-attack acute pancreatitis: A retrospective cohort study

BackgroundWe investigated whether prior stain use before admission for a first-attack AP would reduce the severity and mortality rate of a first-attack of AP with a dose–response relationship. MethodsWe conducted a retrospective cohort study from a tertiary medical center's database in Taiwan. We evaluated the dose–response relationship between statin use and the first-attack of AP by defining the daily dose (DDD). The cumulative DDD (cDDD) was calculated as the sum of the dispensed DDD of any specific statin. The outcome measures in our study included the hospital mortality rate, duration of hospitalization, Ranson's score, computed tomography severity index (CTSI), and C-reactive protein (CRP) level. ResultsIn our study, we enrolled 31 patients in statin group and 63 matched patients in control group. In the univariate analysis there was no significant difference between them with regard to the outcomes except the CTSI and serum calcium concentration. According to multivariate analysis the serum calcium concentration was significantly higher in the statin group, and the CTSI was lower in the statin group. In subgroup analysis we divided the statin group into two groups according to the cDDDs (<365days and >365days) and the results showed no significance in the demographic data, overall mortality rate, hospitalization days, CRP level, Ranson's score, or CTSI. ConclusionOur study rejected the hypothesis that statins have beneficial effects on the clinical outcomes of patients with a first-attack of AP. However we demonstrated that statins have a positive effect on the CTSI.

Risk of diabetes mellitus after first-attack acute pancreatitis: a national population-based study

Risk of Diabetes Mellitus after First-Attack Acute Pancreatitis: A National Population-Based Study

Epidemiology of First-Attack Acute Pancreatitis in Taiwan From 2000 Through 2009

This study aimed to describe a 10-year epidemiological trend of patients with first-attack acute pancreatitis (AP) in Taiwan. We analyzed 107,349 patients with first-attack AP from the Taiwan National Health Insurance Research Database between 2000 and 2009. Severe cases were defined according to a modified Atlanta classification. Incidence rates were standardized by direct method. During the study period, the median age of the patients increased from 49 to 55 years and the proportion of men decreased from 66.8% to 62.3%. The averaged annual incidence of first-attack AP was estimated at 36.9 per 100,000 persons and changed only slightly. Stratified analyses showed that the incidence increased in children (<15 years), elderly people (≥ 65 years), and patients with biliary cause, but decreased in young to middle-aged men (15-64 years). The prevalence of severe cases increased from 21.0% to 22.3%, which was mainly caused by an increase of acute organ dysfunction (from 9.7% to 14.1%). Despite that, hospital mortality decreased from 4.3% to 3.3% for all cases and from 18.5% to 13.3% for severe ones. The overall incidence of first-attack AP changed slightly in Taiwan, which differs from the increasing trend observed in most Western countries. Although more patients had severe attacks in recent years, hospital mortality declined.

The effect of gastrointestinal bleeding on outcomes of patients with acute pancreatitis: A national population-based study

ObjectivesTo investigate the adverse effect of gastrointestinal bleeding (GIB) in patients with acute pancreatitis (AP), accounting for the status of organ failure (OF). MethodsWe analyzed 107,349 patients with first-attack AP from the Taiwan National Health Insurance Research Database between 2000 and 2009. Patients were categorized into four groups according to the status of GIB and OF, the effect of which was assessed using multivariable analyses with generalized estimating equations models. Primary outcomes were 14-day and hospital mortality. Secondary outcomes were septic complication and prolonged hospital stay (>18 days). ResultsThe covariate-adjusted odds ratio for 14-day mortality, hospital mortality, septic complication, and prolonged stay all significantly increased at 4.63 (95% confidence interval [CI] 3.80–5.63), 4.22 (95% CI 3.66–4.87), 3.52 (95% CI 3.03–4.08), and 1.27 (95% CI 1.20–1.35), respectively for the patients with OF only (n = 88,561). The corresponding figures for the patients with GIB only (n = 5184) were lower but still significant at 1.44 (95% CI 1.09–1.91), 1.42 (95% CI 1.15–1.75), 1.54 (95% CI 1.19–2.00), and 1.38 (95% CI 1.28–1.48). The co-existence of GIB in patients with OF (n = 1663) showed little additional risk of all adverse outcomes. Results of sensitivity analyses (enrolling only patients with principal diagnosis of AP) showed similar findings except that septic complication was not seen for GIB only. ConclusionsOF poses greater adverse effects than GIB on outcomes of AP patients. Nevertheless, GIB still modestly increased the risks of prolonged stay and death in AP patients without OF.

Effect of Diabetes on Severity and Hospital Mortality in Patients With Acute Pancreatitis

OBJECTIVEDiabetes may increase the risk of acute pancreatitis (AP). We aimed to further investigate whether diabetes may also adversely affect outcomes of patients with AP.RESEARCH DESIGN AND METHODSIn this retrospective cohort study, we compared 18,990 first-attack AP with diabetes to 37,980 matched control subjects from Taiwan’s National Health Insurance Research Database between 2000 and 2009. Primary outcomes were development of severe AP, defined by a modified Atlanta classification scheme, and hospital mortality. Analyses were performed using univariable and multivariable logistic regression model with generalized estimating equations accounting for hospital clustering effect.RESULTSAfter baseline characteristics were adjusted, AP patients with diabetes had a higher risk of a severe attack than their nondiabetic counterparts (adjusted odds ratio [OR] 1.21, 95% CI 1.16–1.26). When severity criteria were analyzed individually, diabetic AP patients had a 58% higher risk of intensive care unit admission and a 30% higher risk of local complications, but a 16% lower risk of gastrointestinal bleeding, than AP patients without diabetes. The risk of organ failure at least one system) was similar between the two groups. Conversely, AP patients with diabetes were associated with a lower risk of hospital mortality (adjusted OR 0.77, 95% CI 0.65–0.91).CONCLUSIONSAlthough diabetes may adversely affect the disease process of AP, it seems to protect patients from AP-related mortality.

Time trends in incidence, etiology, and case fatality rate of the first attack of acute pancreatitis

Purpose. The purpose of this study was to establish estimates of incidence and fatality rates, and to identify likely etiologies of first attack acute pancreatitis (FAAP) in an urban Norwegian population. Material and methods. A total of 874 patients were discharged with a diagnosis of acute pancreatitis from the two hospitals in this region between 1.1.1996 and 31.12.2006. Patient records were reviewed and patients with a verifiable FAAP were identified. Demographic variables, likely etiology, and outcome were registered. Results. FAAP was verified in 567 (65%) of the patients (300 women and 267 men) with a median age of 58 years (range 7–98). The average yearly incidence rate of FAAP was 14.6/100 000 and the gender-specific incidence rates increased yearly by approx. 6% (p = 0.006). There was a decline in diagnoses by s-Amylase from approx. 90% to 62% in 2006 and an increase in diagnoses obtained by CT (p < 0.001). The case fatality rate was low (3.5%), but higher among men (5.8%) than women (2%, p = 0.037). The case fatality rate was lowest among patients with gallstones (0.7%) and higher among patients with alcohol (9%), miscellaneous (10.4%), and non-assessed etiology (6.6%) of FAAP (p < 0.05). Male gender, increasing age, and etiology (alcohol, miscellaneous causes, and non-assessed) were associated with increased case fatality rate in an adjusted regression model (p < 0.001). Conclusions. The incidence rate of FAAP is low and differs from that of official registries. The case fatality rate is low, but related to gender, age, and likely etiology of FAAP.

Trends in the Epidemiology of the First Attack of Acute Pancreatitis

To systematically review trends in the epidemiology of the first attack of acute pancreatitis (AP) based on reported population-based studies. From Medline, we retrieved 18 full-length English language peer-reviewed original articles published from 1966 to June 2005 with population-based information on the epidemiology of first-attack AP. Trends over time were analyzed based on study- and country-specific data and the study site (UK vs non-UK). Eight studies were from the UK and 10 from other European centers. An increase in the annual incidence per 100,000 for first-attack AP was reported in 10 of 12 studies with longitudinal data from 4 countries (UK, Sweden, Denmark, and Netherlands). The overall AP incidence seems to be higher in non-UK studies compared with that of UK, partly explained by a higher incidence of alcoholic pancreatitis in non-UK studies. A linear trend for increase in gallstone pancreatitis incidence over time was observed irrespective of the study site (UK or non-UK). The AP incidence and mortality increased with age. Gallstone pancreatitis was more common in female subjects, and alcoholic pancreatitis was more common in middle-aged male subjects. The AP case fatality (%) has decreased over time, but the overall population mortality rate per 100,000 has remained unchanged. Recurrence after the first attack is milder with a substantially lower mortality. The incidence of AP seems to be increasing. Differences in the incidence and etiology between and within countries reflect differences in the risk factor prevalence. Case-fatality rate, but not the population-based mortality rate, decreased over time.

Obesity: a risk factor for severe acute biliary and alcoholic pancreatitis

Objective: In this study we evaluate the association between obesity and complication development in patients with a first-attack acute pancreatitis (AP), and investigate the influence of comorbid factors on this association. Methods: Medical records of 150 patients with AP were reviewed. General data, AP etiology, admission AP prognostic criteria, and occurrence of complications were recorded. Patients were classified according to body mass index (BMI) as obese (BMI > 25 kg/m 2) and nonobese (BMI ≤ 25 kg/m 2). Results: Prevalence of obesity was 57%. Thirty-eight percent of the obese patients developed complications as compared with 21% of the nonobese (RR = 1.74; 95% CI, 1–2.9). The risk for severe AP increased according to the degree of obesity. Pancreatic and peripancreatic necrosis was more common in obese patients (17.6% vs 6%), as was the incidence of infectious complications. The risk for severe AP was highest in obese patients with either alcoholic (RR = 5.3; 95% CI, 1.2–23) or biliary etiology (RR = 5.2, 95% CI, 1–26). Conclusion: Obesity may predispose to a complicated course of AP, especially if it is secondary to alcohol or gallstones. Further studies are needed to establish the precise prognostic value of obesity in AP, as well as the pathogenic mechanisms involved in the process.