Introduction

Approximately 40% of patients develop diabetes mellitus (DM) after acute pancreatitis (AP). Even a single episode of mild AP confers a two-fold increase in DM risk compared to the general population. Nonetheless, information on risk factors is limited.

Aims & Methods

We aimed to identify risk factors for developing PD or DM following AP.
We conducted a systematic search of three databases Up until September 4, 2023, to get direct, within-study comparisons of risk factors on the incidence of PD and DM in patients with AP. If it was not possible to distinguish the PD and DM incidence rates, we presented it as a composite outcome: PD/DM. The random-effects model was used in the meta-analysis to compute pooled odds ratios (OR) with 95% confidence intervals (CI).

Results

The 61 eligible studies reported on 79 risk factors. The meta-analysis included 50 studies, 76,797 participants and 34 risk factor and outcome pairs. We found that the odds of developing DM was significantly higher if the AP was severe or moderately severe (OR: 2.11; CI: 1.30-3.41), the etiology was alcoholic (OR: 1.82; CI: 1.09–3.04), organ failure occurred (OR: 3.19; CI: 0.55–18.64), the patient had recurrent AP (OR: 1.89; CI: 0.95–3.77), liver cirrhosis (OR: 2.48; CI: 0.18–34.25), chronic kidney disease (OR: 2.10; CI: 1.85–2.38), dyslipidemia (OR: 1.82; CI: 0.68–4.84) or was obese (OR: 1.85; CI: 1.43–2.38). A higher probability of developing PD/DM was linked to severe and moderately severe AP (OR: 4.32; CI: 1.76–10.60), pancreatic necrosis (OR: 5.53; CI: 1.59–19.21) and hypertriglyceridemic AP etiology (OR: 3.27; CI: 0.17–63.91).

Conclusion

A number of factors increase the risk of developing PD or DM following AP, including severe and moderately severe AP, alcoholic and hypertriglyceridemic etiologies, pancreatic necrosis, organ failure, recurrent acute pancreatitis and comorbidities of obesity, chronic kidney disease, liver disease, and dyslipidemia.

Introduction

Within five years of having acute pancreatitis (AP), three in five people develop prediabetes (PD) or diabetes mellitus (DM). However, information on risk factors is limited.

Aims & Methods

We aimed to identify risk factors for developing PD or DM following AP. We systematically searched three databases up to 2021.11.18 extracting direct, within-study comparisons of risk factors on the rate of new-onset PD, DM or PD/DM in AP patients. Meta-analysis was performed using the random-effects model to calculate pooled odds ratios (OR) with 95% confidence intervals (CI).

Results

Of the 45 studies identified, 36 were included in the meta-analysis, covering 71,367 participants. The odds of developing DM was significantly higher after severe AP (OR: 2.65; CI: 1.23-5.71) than non-severe, alcoholic AP (OR: 1.95; CI: 1.03-3.67) compared to other aetiologies and if pseudocysts developed (OR: 2.50; CI: 1.00-6.28) versus their absence. The odds of developing PD/DM was significantly higher after severe AP (OR: 3.16; CI: 1.13-8.83) than non-severe, severe and moderate AP (OR: 4.66; CI: 2.24-9.68) versus mild and presence of necrosis (OR: 5.53; CI: 1.59-19.21) versus its absence. Compared to other aetiologies there was a tendency for PD/DM development in hypertriglyceridaemic AP (OR: 3.27; CI: 0.84-12.67) and significantly lower odds of developing DM (OR: 0.61; CI: 0.44-0.85) and PD/DM (OR: 0.72; CI: 0.55-0.94) with idiopathic and biliary aetiology, respectively.

Conclusion

Severe and moderately severe AP, local complications, alcoholic and hypertriglyceridaemic aetiologies may be linked to a higher odds of developing PD or DM.

Disclosure

No conflict of interest.

Introduction

Pancreatic calcification is the most frequent structural change in chronic pancreatitis (CP), but the factors associated with its development are not well understood.

Aims & Methods

We aimed to investigate the risk factors of calcification development in patients with chronic pancreatitis. The study protocol was registered on PROSPERO (CRD42024591837). On September 18, 2024, we conducted a systematic search across three databases (PubMed, EMBASE, and CENTRAL) for studies reporting factors associated with calcification in chronic pancreatitis (CP). Pooled proportions and odds ratios (OR) with 95% confidence intervals (CI) were calculated using a random effects model.

Results

The systematic search resulted in 10,893 articles, from which 85 eligible studies were identified, covering a total of 34568 participants. The odds of calcification were 45% higher in alcoholic compared to idiopathic CP (OR=1.45, CI: 1.00–2.11). Alcohol consumption (OR=2.31, CI: 1.8–2.98) and smoking (OR=2.22, CI: 1.61–3.06) were associated with a two times higher risk of calcification in CP, when compared to non-smokers and non-drinkers. In contrast, the presence of CFTR mutations did not increase the risk of calcification in CP (OR=0.43, CI: 0.11–1.66) compared to patients without CFTR mutations.

Conclusion

Alcohol consumption and smoking were significantly associated with the presence of calcification in CP, making it essential to identify these risk factors and incorporate smoking cessation and alcohol reduction programs into standard care.

Introduction

Acute pancreatitis (AP) can progress to recurrent acute pancreatitis (RAP) or chronic pancreatitis (CP).

Aims & Methods

This systematic review and meta-analysis aimed to identify risk factors associated with this progression. The protocol was registered on PROSPERO (CRD42022368931). A comprehensive search was conducted in three (Medline, Embase, Cochrane) databases on October 25th, 2022. Articles reporting and risk factors associated with AP progression into RAP or CP were included. Pooled odds ratios (OR) with 95% confidence intervals (CI) were calculated using the random effects model. Heterogeneity was evaluated using the I² statistic. The risk of bias assessment was performed using the Quality in Prognostic Studies (QUIPS) tool.

Results

A total of 71 articles were included in the meta–analysis, and several risk factors were identified for the progression of AP into RAP and CP. We found the following risk factors of AP recurrence: younger age, male gender, smoking, alcoholic etiology, hypertriglyceridemia, diabetes mellitus, pseudocyst, etc. The pooled OR for the male gender was 1.45 (95% CI: 1.29-1.64, I²=24%), for smoking was 1.45 (95% CI: 1.16-1.81, I²=62%), for alcoholic etiology was 1.76 (95% CI: 1.38-2.25, I²=81%), for hypertriglyceridemia was 2.45 (95% CI: 2.07-2.90, I²=9%), for diabetes mellitus was 1.49 (95% CI: 1.24-1.80, I²=0%), for pseudocyst was 2.19 (95% CI: 1.52-3.15, I²=0%). We also found risk factors of RAP progression into CP. The risk of bias was moderate in the majority of the included studies.

Conclusion

Our study identified multiple modifiable risk factors which can be treated to prevent the progression of pancreatitis.

Introduction

96-98% of patients survive acute pancreatitis (AP), but in the post-AP phase, patients are at high risk of morbidity and mortality. It has been shown that pancreatic exocrine insufficiency can occur after AP.

Aims & Methods

We aimed to investigate the rate, risk factors, and the effect of pancreatic enzyme replacement therapy (PERT) for PEI in patients with AP. The study protocol was registered on PROSPERO (CRD42024516403). We conducted a systematic search on 5 February 2024 in three databases (PubMed, EMBASE, and CENTRAL). We included in the analysis studies reporting on risk factors and PERT efficacy in PEI associated with AP. Pooled proportion and odds ratios (OR) with a 95% confidence interval (CI) were calculated using a random effect model.

Results

Fifty-six articles were included in our meta-analysis. Among 17896 patients with AP, the pooled proportion of PEI was 20 % ([CI]: 15–26). The odds of PEI development were two-fold higher in severe acute pancreatitis (OR=2.44, [CI]: 0.98–6.11) compared with mild or moderate AP and three times higher after necrosectomy compared to patients without necrosectomy (OR=3.26, [CI]: 1.6–6.64). There was no significant difference between the odds of PEI among AP patients with necrosis (OR=1.43, [CI]: 0.32–6.45) and those without necrosis. However, the odds of PEI were twice as high in patients with infected necrosis (OR=2.13, [CI]: 0.93–4.87) than in patients with sterile necrosis. Pancreatic enzyme replacement therapy was prescribed for 22% ([CI]: 16–30) of patients after AP.

Conclusion

One in five patients with AP develops PEI. The rate is higher in patients with severe AP, infected necrosis, or who need necrosectomy. Patients with AP should be screened for PEI to allow timely PERT administration.

Introduction

Splanchnic vein thrombosis (SVT) is a local complication of acute pancreatitis (AP) that may lead to subsequent complications such as portal hypertension, gastrointestinal bleeding, and mesenteric ischemia.^1,2 Despite its clinical significance, there is limited data in the literature concerning the temporal development and associated risk factors of SVT.

Aims & Methods

Our aim was to understand the time course and risk factors of SVT in the early phase of AP. To identify relevant studies we conducted a systematic search across four major medical databases (Embase, MEDLINE via PubMed, Scopus, and Cochrane Central Register of Controlled Trials) on 27th of October 2022. We included studies that employed appropriate imaging techniques in adult patients with AP, reported SVT data from the early phase of AP, and provided reliable information about the timing of imaging relative to AP symptom onset or hospital admission. We excluded studies that reported data on patients with a recent history of malignant disease or recent surgical procedures. We calculated the proportion of patients affected by SVT with 95% confidence intervals (CI). We conducted subgroup analyses based on diagnostic timing and disease characteristics. To assess the risk of bias we used the Joanna Briggs Institute Critical Appraisal Checklist for Prevalence Studies and the GRADEpro tool to determine the level of evidence. The protocol for this method was registered prospectively in the PROSPERO database, with registration number CRD42022367578.

Results

Data from 14 eligible studies and 1,951 patients was pooled; the proportion of patients with SVT in the early phase of AP (within 11 days after symptom onset or 5 days after hospital admission) was 0.13 (CI 0.07-0.23). The occurrence was lowest 0-3 days after symptom onset at 0.06 (CI 0.03-0.1), it increased to 0.23 (CI 0.16-0.31) between 3-11 days. Disease factors influencing SVT occurrence were severity (mild: 0.14 (CI 0.04-0.39), moderate: 0.23 (CI 0.09-0.47), severe: 0.31 (CI 0.15-0.54), p=0.21), etiology (alcoholic 0.31 (CI 0.13-0.58), biliary 0.12 (CI 0.04-0.3), p=0.03), and pancreatic necrosis (absent 0.10 (CI 0.04-0.25), under 30% 0.25 (CI 0.1-0.5), over 30% 0.55 (CI 0.29-0.78), p= 0.01).

Conclusion

One in eight patients develops SVT in the early phase of AP. Alcoholic etiology and pancreatic necrosis increase the risk of SVT. In addition, this risk seems to increase with the duration of AP; therefore, looking for and diagnosing SVT with imaging is important in the management of AP.

References

1. Nawacki L, Matykiewicz J, Stochmal E, Gluszek S. Splanchnic Vein Thrombosis in Acute Pancreatitis and Its Consequences. Clin Appl Thromb Hemost. 2021;27.
2. Valeriani E, Riva N, Di Nisio M, Ageno W. Splanchnic Vein Thrombosis: Current Perspectives. Vascular Health and Risk Management. 2019;15.

Introduction

Infected necrotizing pancreatitis (INP) is associated with an increased risk of organ failure and mortality. In a previous meta-analysis, procalcitonin (PCT) was found to have the most robust connection to INP. Herein, we aimed to identify early predictors for INP.

Aims & Methods

A systematic search was conducted in Medline (via Pubmed), Embase, and Central databases on 27.10.2022 (PROSPERO no.: CRD42022370672). The selected studies confirmed infection by computed tomography imaging with the presence of gas in the necrotic collection or by examination of the sample acquired by an intervention using Gram staining or culture. Any laboratory biomarkers were included for the index test that were compared between sterile necrotizing pancreatitis and INP. The random effect model was used to gain pooled estimates with 95% CI, and we fitted the SROC curve. Heterogeneity among the studies was evaluated.

Results

We included 14 observational studies involving 1,591 patients, in the analysis 9 studies with 758 patients were included. In the disease’s early phase, within the first 72 hours after admission, the pooled area under the ROC curve (AUC) of C-reactive protein (CRP) was 0.70 (95% confidence interval (CI) = 0.63, 0.77), and for PCT, it was 0.70 (95% CI = 0.57, 0.83), and for white blood cell count (WBC), it was 0.61 (95% CI = 0.47, 0.75). After the first 72 hours, in the late phase, the pooled AUC of CRP showed an elevated level of 0.88 (95% CI = 0.75, 1.00), and for PCT, it was 0.86 (95% CI = 0.60, 1.00). No significant heterogeneity was observed.

Conclusion

The predictive value of CRP and PCT for infection is intermediate in the early phase but very good in the late phase of the disease. Based on these results, in case of persistently high CRP and PCT, infection is likely, and initiation of antibiotics is recommended.

Disclosure

The authors declare no conflict of interest.