Introduction

The transition from acute pancreatitis (AP) to recurrent (RAP) and chronic (CP) pancreatitis poses significant clinical challenges.

Aims & Methods

This systematic review and meta-analysis aimed to identify risk factors associated with this progression. Following the protocol registration on PROSPERO (CRD42022368931), we searched Medline, Embase, and Cochrane databases up to December 19th, 2023, for studies examining risk factors for the evolution of AP into RAP or CP. 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 124 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: male gender, smoking, alcoholic etiology, hypertriglyceridemia, diabetes mellitus, pseudocyst, etc. The pooled OR for the male gender was 1.49 (95% CI: 1.31-1.62, I²=25%), for smoking was 1.47 (95% CI: 1.22-1.71, I²=57%), for alcoholic etiology was 1.78 (95% CI: 1.45-2.14, I²=78%), for hypertriglyceridemia was 2.48 (95% CI: 2.16-2.83, I²=9%), for diabetes mellitus was 1.51 (95% CI: 1.21-1.75, I²=0%), for pseudocyst was 2.23 (95% CI: 1.61-3.12, 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

These findings suggest that addressing modifiable risk factors might be key in preventing the progression of pancreatitis

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

Chronic pancreatitis (CP) is a progressive inflammatory disorder that predisposes patients to various complications, including vascular events. Among these, splenic vein thrombosis (SVT) represents a siginficant, but often underdiagnosed complication, with reported prevalence rates varying widely. SVT may lead to sinistral portal hypertension, resulting in gastric varices and, in severe cases, life-threatening gastrointestinal hemorrhage. This systematic review and meta-analysis aims to determine the true pooled prevalence of SVT in CP patients and to evaluate the bleeding rate among those with splenic thrombosis by synthesizing data from studies in which all participants underwent appropriate imaging for SVT detection.

Aims & Methods

An exploratory search was conducted to identify key articles reporting on the prevalence of SVT among CP patients. Four studies were selected based on their provision of relevant, poolable data on prevalence with the use of proper imaging techniques for detecting SVT, encompassing a total of 1,973 patients. A random effects meta‐analysis was performed using SPSS, and a forest plot was genrated to visually represent both individual and overall prevalence estimates. An ongoing PRISMA compliant systematic literature search continues to capture all pertinent studies on this topic.

Results

Analysis of data from the four selected studies (n = 1,973) revealed a pooled SVT prevalence of 12.7% in CP patients. Although individual study estimates varied, likely reflecting differences in study design, CP etiology, and follow-up duration, the overall result indicates that approximately one in eight patients with CP develops SVT.

Conclusion

Our preliminary findings demonstrate that, when appropriate imaging is employed, SVT occurs in approximately 12.7% of chronic pancreatitis cases. These results underscore the clinical importance of SVT, particularly given its association with an increased risk of gastrointestinal hemorrhage. Routine evaluation for SVT in CP patients should be considered, and further research is warranted to elucidate underlying risk factors and to refine management strategies for this potentially life-threatening vascular complication.

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.

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

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) is a systemic inflammatory disease with a rising incidence and high mortality, particularly in severe cases. Cardiac abnormalities, including heart failure and arrhythmias, are frequently observed during and after AP-related hospitalizations. Despite the known association between AP and cardiac complications, the bidirectional relationship between cardiac changes and AP outcomes remains poorly understood.

Aims & Methods

This study aims to systematically review and meta-analyze the bidirectional associations between cardiac abnormalities and AP outcomes, focusing on mortality, severity, and post-discharge complications. A systematic search was conducted on November 5, 2023, across MEDLINE, Embase, and Cochrane CENTRAL, with additional backward and forward citation searches completed on February 19, 2024. The study protocol was registered on PROSPERO (CRD42023479679, CRD42023479674). Observational studies and randomized controlled trials (RCTs) assessing cardiac abnormalities in AP patients, including atrial fibrillation (AF), repolarization changes, and QTc prolongation, were included. Data on mortality and AP severity were analyzed using odds ratios (OR) and mean differences (MD) with 95% confidence intervals (CI) in a random-effects model. The PRISMA 2020 guideline and Cochrane Handbook were followed for study selection and data extraction. The risk of bias was assessed using the Quality In Prognosis Studies (QUIPS) tool.

Results

Thirty-two studies involving 5.3 million patients were included, with 1.3 million AP patients analyzed for specific cardiac abnormalities. Patients with AF had nearly threefold higher odds of in-hospital mortality compared to those without AF (OR: 2.69; CI: 1.34–5.38). Severe and moderately severe AP [(M)SAP] tripled the odds of ECG repolarization changes compared to mild AP (OR: 2.75; CI: 1.19–6.36). No significant association was found between (M)SAP and QTc prolongation (OR: 2.25; CI: 0.63–8.03). Pre-existing chronic heart failure (CHF) was associated with a threefold increased odds of mortality (OR: 3.43; CI: 1.96–5.98). According to the systematic review, although data were limited, echocardiographic parameters, such as pericardial effusion and cardiac dysfunction, were associated with worse AP outcomes. Elevated cardiac laboratory markers, including creatine kinase-MB (CK-MB), were associated with higher mortality and longer hospital stays.

Conclusion

This study highlights the significant bidirectional relationship between cardiac abnormalities and AP outcomes. Patients with AF face a 2.7-fold increased odds of in-hospital mortality, while those with pre-existing CHF have a 3.4-fold higher odds of mortality in AP. Additionally, (M)SAP is associated with three times higher odds of ECG repolarization changes compared to mild AP. These findings underscore the importance of routine cardiology screening in AP patients during hospitalization. Future research should focus on longitudinal studies to better understand the long-term cardiovascular complications following AP and to develop targeted interventions to reduce mortality and improve outcomes. Implementing early cardiac assessment and monitoring in AP patients, particularly those with pre-existing cardiac conditions, could significantly improve clinical management and reduce mortality rates.