TY - JOUR
T1 - Short- and long-term outcomes of a disruption and disconnection of the pancreatic duct in necrotizing pancreatitis
T2 - a multicenter cohort study in 896 patients : Disrupted pancreatic duct in acute pancreatitis
AU - Timmerhuis, Hester C
AU - van Dijk, Sven M
AU - Hollemans, Robbert A
AU - Sperna Weiland, Christina J
AU - Umans, Devica S
AU - Boxhoorn, Lotte
AU - Hallensleben, Nora H
AU - van der Sluijs, Rogier
AU - Brouwer, Lieke
AU - van Duijvendijk, Peter
AU - Kager, Liesbeth
AU - Kuiken, Sjoerd
AU - Poley, Jan-Werner
AU - de Ridder, Rogier
AU - Römkens, Tessa
AU - Quispel, Rutger
AU - Schwartz, Matthijs P
AU - Tan, Adriaan C I T L
AU - Venneman, Niels G
AU - Vleggaar, Frank P
AU - van Wanrooij, Roy L J
AU - Witteman, Ben J
AU - van Geenen, Erwin
AU - Molenaar, I Quintus
AU - Bruno, Marco J
AU - van Hooft, Jeanin E
AU - Besselink, Marc G
AU - Voermans, Rogier P
AU - Bollen, Thomas L
AU - Verdonk, Robert C
AU - van Santvoort, Hjalmar C
AU - Dutch Pancreatitis Study Group
N1 - Copyright © 2022 by The American College of Gastroenterology.
PY - 2022/12/23
Y1 - 2022/12/23
N2 - 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.
AB - 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.
U2 - 10.14309/ajg.0000000000002157
DO - 10.14309/ajg.0000000000002157
M3 - Article
C2 - 36707931
SN - 0002-9270
JO - American Journal of Gastroenterology
JF - American Journal of Gastroenterology
ER -