In:
American Journal of Gastroenterology, Ovid Technologies (Wolters Kluwer Health), Vol. 118, No. 5 ( 2023-05), p. 880-891
Abstract:
Necrotizing pancreatitis may result in a disrupted or disconnected pancreatic duct (DPD) with the potential for long-lasting negative impact on a patient's clinical outcome. There is a lack of detailed data on the full clinical spectrum of DPD, which is critical for the development of better diagnostic and treatment strategies. METHODS: We performed a long-term post hoc analysis of a prospectively collected nationwide cohort of 896 patients with necrotizing pancreatitis (2005–2015). The median follow-up after hospital admission was 75 months (P25–P75: 41–151). Clinical outcomes of patients with and without DPD were compared using regression analyses, adjusted for potential confounders. Predictive features for DPD were explored. RESULTS: DPD was confirmed in 243 (27%) of the 896 patients and resulted in worse clinical outcomes during both the patient's initial admission and follow-up. During hospital admission, DPD was associated with an increased rate of new-onset intensive care unit admission (adjusted odds ratio [aOR] 2.52; 95% confidence interval [CI] 1.62–3.93), new-onset organ failure (aOR 2.26; 95% CI 1.45–3.55), infected necrosis (aOR 4.63; 95% CI 2.87–7.64), and pancreatic interventions (aOR 7.55; 95% CI 4.23–13.96). During long-term follow-up, DPD increased the risk of pancreatic intervention (aOR 9.71; 95% CI 5.37–18.30), recurrent pancreatitis (aOR 2.08; 95% CI 1.32–3.29), chronic pancreatitis (aOR 2.73; 95% CI 1.47–5.15), and endocrine pancreatic insufficiency (aOR 1.63; 95% CI 1.05–2.53). Central or subtotal pancreatic necrosis on computed tomography (OR 9.49; 95% CI 6.31–14.29) and a high level of serum C-reactive protein in the first 48 hours after admission (per 10-point increase, OR 1.02; 95% CI 1.00–1.03) were identified as independent predictors for developing DPD. DISCUSSION: At least 1 of every 4 patients with necrotizing pancreatitis experience DPD, which is associated with detrimental, short-term and long-term interventions, and complications. Central and subtotal pancreatic necrosis and high levels of serum C-reactive protein in the first 48 hours are independent predictors for DPD.
Type of Medium:
Online Resource
ISSN:
0002-9270
,
1572-0241
DOI:
10.14309/ajg.0000000000002157
Language:
English
Publisher:
Ovid Technologies (Wolters Kluwer Health)
Publication Date:
2023
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