Factors That Affect Disease Progression After First Attack of Acute Pancreatitis.
Clin Gastroenterol Hepatol. 2015 Apr 21;
Authors: Bertilsson S, Swärd P, Kalaitzakis E
Abstract
BACKGROUND & AIMS: Little is known about recurrence of pancreatitis following an initial episode, and little is known about how the disease progresses or what factors affect progression. We performed a population-based study of patients with acute pancreatitis (AP) to determine their outcomes and factors associated.
METHODS: We performed a retrospective study of patients with first-time AP from 2003 through 2012 in a well-defined area of Sweden. Data were collected from medical records on disease etiology, severity (according to the Atlanta classification), recurrence of AP, subsequent chronic pancreatitis, and mortality. Patients were followed for a median time of 4.6 y, until death or the end of 2013.
RESULTS: We identified 1457 patients with first-time AP (48% biliary disease, 17% alcohol-associated, 9.9% severe); 23% of patients had ≥1 recurrence. Risk for recurrence was significantly higher among smokers (hazard ratio [HR], 1.42; 95% confidence interval [CI], 1.03-1.95; P=.03), patients with alcohol-associated AP (HR, 1.58; 95% CI, 1.25-2.23; P<.01), after organ failure (HR, 1.46; 95% CI 1.05-2.03; P=.02), and in patients with systemic complications (HR, 1.88; 95% CI, 1.27-2.79; P<.01) or local complications (HR, 1.66; 95% CI, 1.22-2.27; P<.01). AP of all etiologies progressed to chronic pancreatitis, although alcohol-associated AP progressed most frequently (2.8/100 patient-years). Patients with recurrent AP were at highest risk for chronic pancreatitis (HR, 6.74; 95% CI, 4.02-11.3; P<.01), followed by alcohol-associated AP (HR, 3.10; 95% CI, 2.05-5.87; P<.01), smoking (HR, 2.26; 95% CI, 1.12-4.58; P=.02), systemic complications (HR, 1.37; 95% CI, 1.06-4.62; P=.03) and peri-pancreatic necrosis (HR, 2.74; 95% CI, 1.7-4.43; P<.01). In-hospital mortality was 2.8%, independently associated with only organ failure (odds ratio 71.17; 95% CI, 21.14-239.60; P<.01). Fifty-three percent of patients who died during disease recurrence had biliary AP; a higher percentage of these patients died upon first recurrence (5.9%) than upon first attack of AP (2%; P=.01).
CONCLUSIONS: Severity of first-time AP, smoking, and alcohol abuse are related to recurrence and subsequent chronic pancreatitis. Recurrence increases risk for progression to chronic pancreatitis. Most patients who die upon disease recurrence have biliary AP.
PMID: 25911118 [PubMed - as supplied by publisher]