First Attack Of Acute Pancreatitis Research Articles

Increased incidence and reduced mortality after first attack of acute pancreatitis over an 18-year period

Aims To determine time trends in the incidence and etiology of acute pancreatitis and identify predictors for in-hospital mortality. Patients and methods Retrospective study of 1722 patients with acute pancreatitis admitted to Akershus University Hospital between January 2000 and December 2017. Data were obtained from electronic patient files and computed tomography scans. We estimated a logistic regression model to assess differences in associations between patient characteristics and in-hospital mortality in two time periods, 2000–2009 (first period) and 2010–2018 (second period). Results First attack of acute pancreatitis (FAAP) was identified in 1579 patients (91.7%). The incidence of FAAP increased from 20.1/100,000 during the first period to 27.7/100,000 in the second period (p = .011). Etiology showed no differences between the two time periods. Gallstone was the most frequent etiology (47.2%). In total, 187 patients (11.8%) had necrotizing pancreatitis; more in the second period compared to the first (14.2 vs. 7.7%; p < .001). The overall mortality rate was 3.9%. Mortality rates decreased for both inflammatory and necrotizing pancreatitis during the study period. Age and comorbidity according to Charlson Comorbidity Index (CCI) were predictors of in-hospital mortality (OR 1.07, 95% CI 0.07; 0.40 and 13.58, 95% CI 3.88; 47.52), as were alcohol and organ failure (OR 7.20, 95% CI 2.02; 25.67 and OR 34.15, 95% CI 8.94; 130.53, respectively). Conclusions The incidence of FAAP is increasing in southeast Norway. The etiology has remained unchanged over an 18-year period, with gallstones being the most frequent cause. The outcomes for both inflammatory and necrotic pancreatitis are improving.

High Triglyceride Variability Increases the Risk of First Attack of Acute Pancreatitis.

Hypertriglyceridemia is the third most common etiology of acute pancreatitis. Whether triglyceride variability, independent of absolute triglyceride levels, is a predictor of acute pancreatitis is unknown. We identified 98,819 patients who were diagnosed with hyperlipidemia between January 1, 2007, and December 31, 2013, and had at least 1 triglyceride measurement annually for 4 consecutive years from the Chang Gung Research Database in Taiwan. Triglyceride variability, defined as variability independent of the mean, was calculated in the 4-year run-in period. The patients were stratified according to the quartiles of triglyceride variability and were followed until December 31, 2019, for first attack of acute pancreatitis. During a mean follow-up of 5.9 years, 825 (0.83%) patients were newly diagnosed with acute pancreatitis (14.1 events per 10,000 person-years; 95% confidence interval 13.2-15.1). Triglyceride variability was significantly associated with an increased risk of acute pancreatitis, independent of baseline triglyceride and mean triglyceride levels (hazard ratio, 1.28 [95% confidence interval 1.05-1.57] for the highest vs the lowest quartiles of triglyceride variability; P for trend = 0.006 over the quartiles of triglyceride variability). Subgroup analysis showed that this association was more pronounced among the patients with a higher neutrophil-to-lymphocyte ratio ( P for trend = 0.022). In this multi-institutional cohort study, high triglyceride variability was associated with an increased risk of first attack of acute pancreatitis, independent of baseline and mean triglyceride levels. The association between triglyceride variability and acute pancreatitis may be partly mediated by subclinical inflammation.

Computed tomography characteristics of acute pancreatitis based on different etiologies at different onset times: a retrospective cross-sectional study.

BackgroundThe clinical characteristics and imaging findings of acute pancreatitis (AP) are different across the various etiologies, the results are conflicting, and their time from symptom onset to imaging varies. The imaging findings of different etiologies at different onset times are unclear. This study aimed to investigate the computed tomography (CT) characteristics of AP based on different etiologies at different onset times.MethodsPatients who underwent plain and contrast-enhanced computed tomography (CECT) for the first attack of AP in 3 hospitals (Affiliated Hospital of North Sichuan Medical College, Chinese People’s Liberation Army Western Theater General Hospital, and Suining Central Hospital) from 2015 to 2019 were recruited. According to the different etiologies of AP, the patients were divided into 5 subgroups: biliary AP (n=591), alcoholic AP (n=267), hypertriglyceridemic AP (n=258), mixed causes subgroups (n=199), and “other/idiopathic” AP (n=545). According to the time from onset to CT examination (e.g., 1–3, 4–7, 8–14, 15–28, and >28 days), the onset time was divided into 5 respective phases (I-V). The CT characteristics and clinical and laboratory features were retrospectively reviewed and compared among the different etiology subgroups and onset time.ResultsThe positive rate of CT findings in AP diagnosis based on CECT was 96.7% (1,860/1,924). Necrotizing pancreatitis (NP) occurred in 33.2% (617/1,860) of AP patients with positive CECT findings. Among patients with NP, local complications and severe AP of the modified CT severity index (MCTSI) increased over time in those with biliary AP from 17.1%, 25.2%, and 20.0% in Phase I to 42.9%, 44.0%, and 39.7% in Phase IV [all P<0.05, 95% confidence interval (CI): 0.15 to 0.52, 0.28 to 0.63, and 0.18 to 0.82, respectively]. In contrast, NP, local complications and severe AP of MCTSI in those with hypertriglyceridemic AP decreased over time from 24.3%, 22.5%, and 22.7% in Phase I to 1.3%, 1.2%, and 1.9% in Phase V (all P<0.05, 95% CI: 3.20 to 181.74, 3.31 to 175.74, and 2.00 to 120.78, respectively).ConclusionsThe proportion of NP was 33.2% of positive CECT findings. There may be differences in the CT and clinical manifestations of the different etiologies, and those differences may be related to the onset time.

Intrapancreatic, Liver, and Skeletal Muscle Fat Depositions in First Attack of Acute Pancreatitis Versus Health.

Increased intrapancreatic fat deposition (IPFD) has emerged as a harbinger of pancreatic cancer and chronic pancreatitis. Although it is well recognized that diseases of the exocrine pancreas often lie on a continuum (with acute pancreatitis preceding the development of chronic pancreatitis and/or pancreatic cancer), whether increased IPFD predisposes to acute pancreatitis is unknown. This study aimed to compare fat depositions in the pancreas (as well as the liver and skeletal muscle) between individuals who developed first attack of acute pancreatitis and healthy individuals. This was a matched case-control study nested into population-based cohort. MRI on a single 3 T scanner was used to quantify intrapancreatic, liver, and skeletal muscle fat depositions using the same protocols in all study participants. Binary logistic regression with adjustment for body mass index and other possible confounders was performed. Fifty individuals with first attack of nonnecrotizing acute pancreatitis comprised the case group and 100 healthy individuals comprised the control group. A 1% increase in IPFD (but not the other fat depositions) was significantly associated with a more than 30% higher chance of developing first attack of acute pancreatitis, consistently in both the unadjusted ( P = 0.004) and all adjusted models. Furthermore, a 1% increase in IPFD (but not the other fat depositions) was significantly associated with up to a 27% higher chance of developing first attack of acute pancreatitis in individuals with normotriglyceridemia, consistently in both the unadjusted ( P = 0.030) and all adjusted models. Increased IPFD may predispose to the development of acute pancreatitis. This opens up opportunities for reducing the burden of acute pancreatitis by means of primary prevention.

Diabetes is an independent predictor of severe acute pancreatitis

Objectives We aimed to determine the effect of diabetes mellitus (DM) on the severity of acute pancreatitis (AP) and whether diabetes is a predictor of severe acute pancreatitis (SAP). Methods A total of 181 patients diagnosed with a first attack of AP in our hospital were retrospectively evaluated. AP severity was evaluated and compared between diabetic and non-diabetic patients. Independent factors predicting SAP were identified with a binary logistic regression model. Results Of the 164 patients [108 (65.9%) women, 56 (34.1%) men] enrolled in the study, 35 patients (21.3%) had been diagnosed with DM, while 129 (78.7%) did not have DM. SAP, necrotizing pancreatitis, and local complications were observed to be more common among diabetic patients compared to non-diabetic patients (all P<0.001), while the incidences of systemic complications and transient or persistent organ failure were similar between the groups. The incidences of DM and cancer were higher in the SAP group (P<0.001 and P=0.033, respectively). The presence of DM (OR: 3.246, 95% CI: 1.278-8.244, P=0.013), high (≥3) Ranson score (OR: 3.529, 95% CI: 1.342-9.280, P=0.011), and high maximum C-reactive protein level (OR: 1.005, 95% CI: 1.001-1.010, P=0.046) were independent risk factors predicting SAP. Conclusion DM is both a risk factor for SAP and an independent predictor of SAP. Evaluation of the presence of DM at the time of diagnosis can help predict SAP in a considerably early phase.

Non-Alcoholic Fatty Liver Disease (NAFLD) Is an Independent Risk Factor for Developing New-Onset Diabetes After Acute Pancreatitis: A Multicenter Retrospective Cohort Study in Chinese Population.

BackgroundNumerous studies validated frequent glucose dysfunction in patients with acute pancreatitis (AP). However, the prevalence of new-onset diabetes in individuals after a first episode of AP varies widely among previous studies. This study aims to determine the incidence of post-acute pancreatitis diabetes mellitus (PPDM-A) in Chinese people and further identify potential risk factors that influence diabetes development in patients with AP.MethodsThis was a multi-center retrospective cohort study including 6009 inpatients with a first attack of AP. A total of 1804 patients with AP without known endocrine pancreatic disorders or other pancreatic exocrine diseases were eligible for analysis. Data was collected from medical records by hospital information system and telephone follow-ups after discharge. The multiple logistic regression analysis was established to evaluate the potential influencing factors of PPDM-A.ResultsThe prevalence of newly diagnosed diabetes after a first episode of AP in China was 6.2%. Data showed that patients who developed PPDM-A were more likely to be younger (X2 = 6.329, P = 0.012), experienced longer hospital stays (X2 = 6.949, P = 0.008) and had a higher frequency of overweight or obesity (X2 = 11.559, P = 0.003) compared to those with normal glycemia. The frequency of stress hyperglycemia on admission (X2 = 53.815, P < 0.001), hyperlipidemia (X2 = 33.594, P < 0.001) and non-alcoholic fatty liver disease (NAFLD) (X2 = 36.335, P < 0.001) were significantly higher among individuals with PPDM-A compared with control group. Also, patients with PPDM-A were more likely to be hyperlipidemic AP (X2 = 16.304, P = 0.001) and show a higher degree of severity (X2 = 7.834, P = 0.020) and recurrence rate (X2 = 26.908, P < 0.001) of AP compared to those without diabetes. In addition, multiple logistic regression analysis indicated that stress hyperglycemia, hyperlipidemia, NAFLD and repeated attacks of AP were the independent influence factors for developing PPDM-A.ConclusionOur study first demonstrated the prevalence of secondary diabetes in Chinese patients after AP. The disorder of glucose metabolism in individuals with AP should be regularly evaluated in clinical practice. Further studies are needed to verify the relationship between liver and pancreas in keeping glucose homeostasis under AP condition.

Natural history and risk factors for recurrent and chronic pancreatitis after first attack of acute pancreatitis

Natural history and risk factors for recurrent and chronic pancreatitis after first attack of acute pancreatitis

Harmless Acute Pancreatitis Negative among Cases of Acute Pancreatitis in a Tertiary Care Centre: A Descriptive Cross-sectional Study.

Acute Pancreatitis is a common disease, diagnosed in about 3% of cases presenting with abdominal pain. Severe disease with multiple systemic complications develops in 10-20% of the cases which require intensive care in specialized centres. Harmless acute pancreatitis score is a simple and economical score predicting the non-severe course of disease within 30 minutes of admission. The aim of our study was to find the prevalence of harmless (harmless acute pancreatitis) among cases of acute pancreatitis in a tertiary care centre. A descriptive cross-sectional study was conducted after obtaining the ethical approval (Reference no. 344/2076/77). The study was carried out from September 2019 to February 2020 taking 50 patients with the first attack of acute pancreatitis. Convenient sampling was done. Harmless acute pancreatitis score prediction of severe disease and final outcome as severe or non-severe was noted with predefined severity criteria. Data were entered in Microsoft Excel and Statistical Package for the Social Sciences and results represented in tables and charts. Point estimate at 95% was done and frequency and percentage were calculated. Out of 50 patients with first attack of acute pancreatitis, using the harmless acute pancreatitis score, the prevalence of harmless acute pancreatitis was 22 (56%) (44.45-67.5 at 90% Confidence Interval). The harmless acute pancreatitis score is an easy, less expensive, quick and promising early scoring system for prediction of non-severe courses of acute pancreatitis. The prevalence of harmless (harmless acute pancreatitis) among cases of acute pancreatitis was found to be similar toother studies.

Nomogram for the Prediction of 30-Day Readmission in Acute Pancreatitis.

A prediction model for 30-day readmission in patients with acute pancreatitis (AP) was needed. To develop a nomogram to predict 30-day readmission in patients with AP and validate the usefulness of serum indicators after discharge for the prediction of 30-day readmission. This was a retrospective cohort study enrolling patients with the first attack of AP. Baseline characteristics, clinical profiles, and serum indicators after discharge were compared. Multivariate logistic regression analysis and a nomogram were employed to determine the independent risk factors for 30-day readmission. A total of 7.32% (121/1653) of the patients were readmitted within 30days after discharge. Different etiologies (biliary pancreatitis (adjusted odds ratio (AdjOR), 9.63; 95% confidence interval (CI), 1.28-72.52; P = 0.028), other causes (AdjOR, 9.37; 95% CI, 1.15-76.12, P = 0.026), mixed causes (AdjOR, 10.76; 95% CI, 1.27-91.35; P = 0.03) compared with alcoholic pancreatitis)), infected pancreatitis necrosis (IPN) (AdjOR, 2.3; 95% CI, 1.2-4.42; P = 0.013), total bilirubin level ≥ 20.5µmol/L (AdjOR, 2.42; 95% CI, 1.23-4.77; P = 0.01), glucose level ≥ 6.1mmol/L (AdjOR, 1.93; 95% CI, 1.16-3.19; P = 0.011), and albumin level < 40g/L (AdjOR, 4.25; 95% CI, 2.44-7.41; P < 0.001) were independently associated with 30-day readmission. A nomogram incorporating these factors demonstrated good discrimination, calibration, and clinical utility. Serum indicators after discharge added predictive value compared with clinical variables alone (AUC, 0.78 vs. 0.685; P = 0.0001). The nomogram combining etiology, IPN, and serum indicators after discharge has favorable predictive performance for 30-Day readmission. The close monitoring and reexamination of serum indicators are essential for AP patients at high risk.

Pancreatic-Portal Vein Fistula: a Rare Diagnosis with Wide-Ranging Complications—13-Year Experience of a Pancreas Center of Excellence

PurposeTo determine factors affecting mortality, and long-term patency of portal vein, in patients with pancreatic-portal vein fistula (PPVF). MethodsConsecutive cases of PPVF at the University of Pittsburgh Medical Center from 2008 to 2020 were retrospectively identified. Clinical history, imaging studies, management strategies, complications, and long-term outcomes were analyzed. ResultsFourteen patients, representing the largest PPVF cohort reported to date (mean age 58.6 years, 64.3% women, median follow-up 10 months [1–98 months]) were identified. Underlying chronic pancreatitis was seen in 9 (64.3%) patients, while 5 (35.7%) developed PPVF with first attack of acute pancreatitis. PPVF involved proximal main portal vein (MPV) in 10 (78.6%) patients. Of the 5 patients (35.7%) who died, all had occlusive (n=4) or near-occlusive (n=1) PPVF-associated filling defect (FD) in the MPV. Conversely, 7 of 9 survivors (87.5%) had subocclusive FD and patent MPV. In patients with sepsis (n=5), 1 underwent surgical necrosectomy and survived, while 3 of 4 (75%) patients without debridement died. ConclusionOcclusive/near-occlusive PPVF-associated MPV FD, and sepsis, are associated with high mortality rates, while subocclusive MPV FD is associated with survival and long-term MPV patency. PPVF is a potentially life-threatening, and possibly under-diagnosed, entity that warrants early clinical suspicion for timely diagnosis, to facilitate optimal management.

The influence of cholecystectomy and recurrent biliary events on the risk of post-pancreatitis diabetes mellitus: a nationwide cohort study in patients with first attack of acute pancreatitis

BackgroundIt is unknown whether cholecystectomy for acute pancreatitis (AP) affects the risk of post-pancreatitis diabetes mellitus (PPDM). We aimed to investigate the associations between cholecystectomy, recurrent biliary events prior to cholecystectomy, and the risk of PPDM in patients with AP. MethodsUsing New Zealand nationwide data from 2007 to 2016, patients with first admission for AP were identified (n = 10,870). Cholecystectomy was considered as a time-dependent exposure. Timing of cholecystectomy was categorized as same-admission, readmission, and delayed cholecystectomy. Recurrent biliary events prior to cholecystectomy were identified. Multivariable Cox regression analyses were conducted. ResultsAmong 2147 patients who underwent cholecystectomy, 141 (6.6%) developed PPDM. Overall, cholecystectomy was not significantly associated with the risk of PPDM (adjusted hazard ratio, 1.14; 95% confidence interval, 0.94–1.38). Delayed cholecystectomy was significantly associated with an increased risk of PPDM (adjusted hazard ratio, 1.36; 95% confidence interval, 1.01–1.83). Patients who had 2 or ≥3 recurrent biliary events prior to cholecystectomy were at a significantly increased risk of PPDM. ConclusionCholecystectomy in general was not associated with the risk of PPDM in patients with AP. Two or more repeated attacks of AP (or other biliary events) were associated with a significantly increased risk of PPDM.

Progression to recurrent acute pancreatitis after a first attack of acute pancreatitis in adults

PurposePatients with a first attack of acute pancreatitis (AP) can develop recurrent acute pancreatitis (RAP). Hence, this study aimed to investigate the clinical features of the disease and the risk factors for RAP. MethodsWe performed a retrospective study of 522 patients from Jan 1 to Dec 31, 2006. All patients with AP were followed for 36 months. The primary end point was the rate of RAP. The secondary end points were the risk factors that were evaluated by Cox regression analysis. The cumulative risk of RAP was assessed using Kaplan-Meier analysis. Results56 of the 522 patients (10.7%) developed RAP. Among those RAP patients, 37 (7.1%) experienced one relapse, 10 (1.9%) experienced two relapses, and 9 (1.7%) experienced three or more relapses. Univariate analysis indicated that age (p = 0.016), male sex, etiology of AP (p = 0.001), local complications (p = 0.001) and Length of stay (LOS) (p = 0.007) were associated with RAP. Multivariate analysis with the Cox proportional hazards model showed that male sex (HR = 2.486, 95% CI, 0.169–0.960, p = 0.04), HTG-associated etiology (HR = 5.690, 95% CI, 2.138–15.146, p = 0.001), alcohol-associated etiology (HR = 5.867, 95% CI, 1.446–23.803, p = 0.013) and current local complications at index admission (HR = 8.917, 95% CI, 3.650–21.789, p = 0.001) were significant independent risk factors for RAP. ConclusionsA first attack of AP led to RAP in 10.7% of patients within 3 years. Male sex was significantly associated with RAP. The etiologies of alcohol and HTG and local complications were the strongest risk factors for recurrent disease. Patients with these characteristics should be given special attention and followed-up closely.

Drug induced pancreatitis is the leading known cause of first attack acute pancreatitis in children

Background/objectivesDrug induced acute pancreatitis (DIAP) as one of the acute pancreatitis (AP) risks factors is a poorly understood entity. The aim of the current study was to compare the characteristics and course of DIAP cases in children presenting with a first attack of AP. MethodsPatients presenting with AP were included in a prospective database. We enrolled 165 AP patients that met criteria for inclusion. DIAP patients were included in that group if they were exposed to a drug known to be associated with AP and the rest were included in the non-drug induced-acute pancreatitis (non-DIAP) group. ResultsDIAP was observed in 40/165 (24%) of cases, 24 cases had drug-induced as the sole risk factor, and 16 had DIAP with another risk factor(s). The two groups were similar in intravenous fluid and feeding managements, but ERCP was more commonly performed in the non- DIAP group, 14 (11%), vs 0% in the DIAP group, p = 0.02. Moderately severe [9 (23%) vs 11 (9%)] and severe AP [7 (18%) vs 6 (5%)] were more commonly associated with DIAP than non- DIAP, p = 0.001. DIAP was more commonly associated with ICU stay, 10 (25%), vs 12 (10%), p = 0.01, hospital stay was longer in DIAP median (IQR) of 6 (3.9–11) days vs 3.3 (2–5.7) days in non- DIAP, p = 0.001. The DIAP group had a significantly higher proportion of comorbidities (p < 0.0001). ConclusionsDIAP is a leading risk factor for a first attack of AP in children and is associated with increased morbidity and severity of the pancreatitis course. DIAP warrants further investigation in future studies.

Comparison of Acute Physiology and Chronic Health Evaluation II, Modified Computed Tomography Severity Index, and Bedside Index for Severity in Acute Pancreatitis Score in Predicting the Severity of Acute Pancreatitis.

ABSTRACTAims of this studySevere acute pancreatitis has been defined recently based on the persistence of organ failure at 48 hours of admission. The bedside index for severity in acute pancreatitis (BISAP) score, a simplified scoring system to predict severity of acute pancreatitis, is proposed to be useful in early risk stratification of acute pancreatitis. Our aim was to prospectively compare BISAP score with the already established acute physiology and chronic health evaluation II (APACHE II) and modified computed tomography severity index (CTSI) scores in predicting the severity of acute pancreatitis.Materials and methodsA total of 87 consecutive cases presenting with the first attack of acute pancreatitis were included in the study. Acute physiology and chronic health evaluation II and BISAP scores were calculated from the worst parameters in the first 24 hours, and modified CTSI was reported at 48 hours of admission. Receiver-operating characteristic (ROC) curves were plotted, and predictive accuracy of each score was calculated from the area under the curve. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were calculated for each score.ResultsA total of 20 patients (23%) had severe acute pancreatitis with a total of 11 mortalities (12.64%), 10 of them in the severe acute pancreatitis group. Acute physiology and chronic health evaluation II, modified CTSI, and BISAP score all correlated well with each other. Modified CTSI and BISAP score also correlated with duration of hospital stay. Areas under the curve for APACHE II (≥8), modified CTSI (≥8), and BISAP score (≥2) were 0.826, 0.806, and 0.811, respectively, suggesting similar predictive accuracy.ConclusionThe BISAP score was similar to APACHE II and modified CTSI in terms of accuracy, sensitivity, specificity, and NPV. It is much easier to calculate and a useful risk stratification tool. It should be used for early triage and referral to a high dependency unit.How to cite this articleChatterjee R, Parab N, Sajjan B, Nagar VS. Comparison of Acute Physiology and Chronic Health Evaluation II, Modified Computed Tomography Severity Index, and Bedside Index for Severity in Acute Pancreatitis Score in Predicting the Severity of Acute Pancreatitis. Indian J Crit Care Med 2020;24(2):99–103.

New-Onset Diabetes Mellitus After the First Attack of Acute Pancreatitis: A Systematic Review and Meta-Analysis

Context: New-onset diabetes mellitus (DM) after the first attack of acute pancreatitis (AP) has not been fully elucidated. Objectives: The study aimed to explore the incidence and time-course of pancreatic endocrine insufficiency in patients with new-onset prediabetes or DM after the first attack of AP. Data Sources: A comprehensive literature review was conducted by searching four major biomedical journal databases (PubMed, Embase, Cochrane Library, and Web of Science). Study Selection: We included all prospective clinical studies that investigated the change in the metabolization of glucose after hospital discharge following the first attack of AP. Data Extraction: After quality assessment, data were extracted according to a standard protocol. Because of between-study heterogeneity, data were analyzed by the random-effects method. Results: The inclusion criteria were met by 12 clinical studies, including 766 patients with the first attack of AP. Prediabetes and/or DM was observed in 51% (95% CI: 55% to 63%) of the patients after the first attack of AP. The pooled incidence of prediabetes and DM after AP was 23% (95% CI: 16% to 30%) and 18% (95% CI: 11% to 26%), respectively. The risk of new-onset prediabetes and DM significantly increased in 1 - 3 years (relative risk (RR): 4.00 (95% CI: 1.68 - 9.53)) and 3 - 5 years (RR: 2.12 (95% CI: 1.9 - 3.8)), respectively. Conclusions: New-onset prediabetes and/or DM after the first attack of AP developed in 51% of the patients after hospital discharge and the risk of DM increased more than two folds over three years.

The role of metabolic syndrome in patients with chronic pancreatitis after the first attack of acute pancreatitis

Background and Objectives: Acute pancreatitis is one of the diseases which carry a potential risk of developing chronic pancreatitis. Metabolic syndrome is another important risk factor in the induction of pancreatic changes. We examined a set of patients after the first attack of acute pancreatitis and in this set we selected a subset of patients with metabolic syndrome. We then evaluated the role of metabolic syndrome in our patients. Materials and Methods: In the set of 231 individuals with chronic pancreatitis a total of 56 patients were initially treated for acute pancreatitis. In 16 patients of this group the diagnosis of metabolic syndrome was found. Results: The mean age of patients with chronic pancreatitis after the first attack of acute pancreatitis was 54 years (42-64), of which there were 28 men (47.5%) and 31 women (52.5%). The most frequent etiological factor was alcohol (52.5%). Biliary etiology was found in 40.7%. In patients with metabolic syndrome, hypertriglyceridaemia was identified in 82.3%, and hyperglycemia in 70.5%. 82.0% of the individuals were obese. Obesity or hypertriglycaeridemia were present in less than 30% and hyperglycemia was positive in 46.4% of a set of 28 patients (group without metabolic syndrome). The mean time interval between the diagnosis of acute pancreatitis and chronic pancreatitis was significantly shorter in the group with metabolic syndrome - 12 (0-14) vs. 20 (16-29) months. Conclusion: 1) Acute pancreatitis is an important factor for the development of chronic pancreatitis. 2) Alcoholic etiology is the most frequent factor, but biliary etiology could also be an important risk factor. 3) Hypertriglycaeridemia and diabetes mellitus type 2 are the most frequent positive components found in patients with chronic pancreatitis and metabolic syndrome. 4) Metabolic syndrome could accelerate the development from acute to chronic pancreatitis.

Serum apolipoprotein B-to-apolipoprotein A1 ratio is independently associated with disease severity in patients with acute pancreatitis

Early identification of severe acute pancreatitis (SAP) is critical for clinical decision-making. The apolipoprotein B-to-apolipoprotein A1 ratio (ApoB/A1 ratio) reflects the balance between pro-inflammation and anti-inflammation in vivo. This study investigated the association between serum ApoB/A1 ratio at admission and acute pancreatitis (AP) severity. A total of 375 patients with first attack of AP were retrospectively recruited from January 2014 to December 2017. The severity of AP was assessed at admission based on the 2012 revised Atlanta Classification. Serum lipids levels were tested on the first 24 h of hospitalization, of which the correlations with clinical features or scoring systems were also measured. The ApoB/A1 ratio markedly increased across disease severity of AP. The ApoB/A1 ratio, expressed as both quartile and continuous variables, was significantly associated with a high risk of SAP, even after adjustment for other conventional SAP risk factors. The ApoB/A1 ratio positively correlated with the revised 2012 Atlanta Classification, Ranson score, Bedside Index for Severity in AP score, Modified Computed Tomography Severity Index score, and Acute Physiology and Chronic Health Evaluation II score for AP severity. The optimal cut-off value of ApoB/A1 ratio for detecting SAP was 0.88, with a sensitivity of 83.08% and a specificity of 69.03%. Serum ApoB/A1 ratio at admission is closely correlated with disease severity in patients with AP and can serve as a reliable indicator for SAP in clinical setting.

Pulmonary dysfunction due to combination of extra-pulmonary causes and alveolar damage is present from first the day of hospital admission in the early phase of acute pancreatitis

BackgroundOnly few studies have attempted to evaluate the pulmonary function in the early phase of acute pancreatitis (AP), although pulmonary dysfunction is the most frequent complication in the early phase of AP. We aimed to evaluate the changes in pulmonary function tests during the early phase of AP. MethodsProspective cohort study including 44 patients (52% men; median age 54 years) admitted with first attack of AP and 22 healthy controls. Patients underwent assessments on day 1, 2, 3, 6, and 10 as well as one month after discharge. Pulmonary function tests included the % predicted: forced expiratory volume during the first second (FEV1), forced vital capacity (FVC), total lung capacity (TLC), diffusion lung capacity (DLCO) and the ratio between DLCO and alveolar volume (DLCO/VA). ResultsIn total, 9% developed severe acute pancreatitis, 7% died, and 14% required treatment at the intensive or semi-intensive care unit. From admission, patients had impaired FEV1, FVC, DLCO, and TLC compared with controls (p < 0.0001 in all analyses). Patients with CRP >150 mg/L had significantly lower lung function tests. One month after discharge, lung function tests improved but patients had lower FEV1 (p = 0.014), FVC (p = 0.022), TLC (p = 0.020), and DLCO (p < 0.001) compared with controls. ConclusionThis study found that patients with AP had evidence of pulmonary impairment from the first day after hospital admission. The impairment lasted several weeks after hospital discharge.

Pancreas shrinkage following recurrent acute pancreatitis: an MRI study.

Transition from the first attack of acute pancreatitis (AP) to chronic pancreatitis (CP) via recurrent AP is common. Total pancreas volume (TPV) and pancreas diameters are often reduced in advanced CP but have never been studied after AP. The objective of this study was to investigate pancreas size after clinical resolution of AP and its association with the number of AP attacks. Individuals with a history of AP were grouped based on the number of attacks (1, 2, ≥ 3 attacks). Healthy individuals were also recruited. All participants underwent magnetic resonance imaging, from which TPV and pancreas diameters (across the head, body, and tail) were measured independently by two raters in a blinded fashion. Generalised additive models (including age, sex, body mass index, and glycated haemoglobin levels) were used. A total of 123 participants were studied. Total pancreas volume and tail diameter were significantly reduced in both unadjusted (TPV (p = 0.036), tail diameter (p = 0.009)) and adjusted (TPV (p = 0.026), tail diameter (p = 0.034)) models in individuals with ≥ 3 attacks, but not with 1 or 2 attacks, compared with healthy individuals. Head and body diameters did not differ significantly. Reduced TPV and tail diameter characterise individuals after ≥ 3 attacks of AP and may represent one of the earliest irreversible morphological changes in individuals after AP. A high-risk population for transition to CP might include individuals with at least 3 attacks of AP whereas those with less than 3 attacks might be at a low risk. • A significant reduction in total pancreas volume was demonstrated in individuals after 3 or more attacks of acute pancreatitis (without conventional signs of chronic pancreatitis). • Pancreas tail diameter, but not head or body diameter, was reduced in individuals after 3 or more attacks of acute pancreatitis (without conventional signs of chronic pancreatitis). • The above findings were independent of age, sex, body mass index, and glycated haemoglobin levels.

Risk factors for chronic and recurrent pancreatitis after first attack of acute pancreatitis

Objective: To study the outcome of acute pancreatitis and risk factors for recurrent and chronic pancreatitis in a population based cohort of patients with first-time acute pancreatitis.Methods: All patients with first-time acute pancreatitis from 2006–2015 in Iceland were retrospectively evaluated. Medical records were scrutinized and relevant data extracted.Results: 1102 cases of first-time acute pancreatitis were identified: mean age 56yr, 46% female, 41% biliary, 21% alcohol, 26% idiopathic, 13% other causes, mean follow-up 4yr. 21% had ≥1 recurrent acute pancreatitis which was independently related to alcoholic (vs. biliary hazard ratio (HR) 2.29, 95% confidence interval (CI) 1.51–3.46), male gender (HR 1.48, 95%CI 1.08–2.04), and smoking (HR 1.62, 95%CI 1.15–2.28). 3.7% developed chronic pancreatitis. Independent predictors were recurrent acute pancreatitis (HR 8.79, 95%CI 3.94–19.62), alcoholic (vs. biliary HR 9.16, 95%CI 2.71–30.9), local complications (HR 4.77, 95%CI 1.93–11.79), and organ-failure (HR 2.86, 95%CI 1.10–7.42).Conclusions: Recurrent acute pancreatitis occurred in one-fifth of patients. Development of chronic pancreatitis was infrequent. Both recurrent acute pancreatitis and chronic pancreatitis were related to alcoholic acute pancreatitis, while recurrent acute pancreatitis was associated with smoking and male gender, and chronic pancreatitis to recurrent acute pancreatitis, organ-failure, and local complications.