In The American journal of gastroenterology
INTRODUCTION : 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.
Timmerhuis Hester C, van Dijk Sven M, Hollemans Robbert A, Sperna Weiland Christina J, Umans Devica S, Boxhoorn Lotte, Hallensleben Nora H, van der Sluijs Rogier, Brouwer Lieke, van Duijvendijk Peter, Kager Liesbeth, Kuiken Sjoerd, Poley Jan-Werner, de Ridder Rogier, Römkens Tessa E H, Quispel Rutger, Schwartz Matthijs P, Tan Adriaan C I T L, Venneman Niels G, Vleggaar Frank P, van Wanrooij Roy L J, Witteman Ben J, van Geenen Erwin J, Molenaar I Quintus, Bruno Marco J, van Hooft Jeanin E, Besselink Marc G, Voermans Rogier P, Bollen Thomas L, Verdonk Robert C, van Santvoort Hjalmar C
2023-Jan-30
