Short- and long-term outcomes of a disruption and disconnection of the pancreatic duct in necrotizing pancreatitis: a multicenter cohort study in 896 patients : Disrupted pancreatic duct in acute pancreatitis

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

*Corresponding author for this work

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OBJECTIVES: 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-OR2.52 [95%-CI 1.62-3.93]), new-onset organ failure (adjusted-OR2.26 [95%-CI 1.45-3.55]), infected necrosis (adjusted-OR4.63 [95%-CI 2.87-7.64]) and pancreatic interventions (adjusted-OR7.55 [95%-CI 4.23-13.96]). During long-term follow-up, DPD increased the risk of pancreatic intervention (adjusted-OR9.71 [95%-CI 5.37-18.30], recurrent pancreatitis (adjusted-OR2.08 [95%-CI 1.32-3.29]), chronic pancreatitis (adjusted-OR2.73 [95%-CI 1.47-5.15]) and endocrine pancreatic insufficiency (adjusted-OR1.63 [95%-CI 1.05-2.53]).Central or subtotal pancreatic necrosis on computed tomography (CT), (OR9.49 [95%-CI 6.31-14.29] and a high levels of serum C-reactive protein (CRP) in the first 48 hours after admission (per 10 points increase, OR1.02 [95%-CI 1.00-1.03] were identified as independent predictors for developing DPD.

CONCLUSIONS: At least one of every four patients with necrotizing pancreatitis suffer from DPD which is associated with detrimental, short and long-term interventions and complications. Central and subtotal pancreatic necrosis and high levels of serum CRP in the first 48 hours are independent predictors for DPD.

Original languageEnglish
Number of pages12
JournalAmerican Journal of Gastroenterology
Publication statusE-pub ahead of print - 23 Dec 2022

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