TY - JOUR
T1 - Short-term and Long-term Outcomes of a Disruption and Disconnection of the Pancreatic Duct in Necrotizing Pancreatitis
T2 - A Multicenter Cohort Study in 896 Patients
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 - Funding Information:
Financial support: This study is investigator initiated (St. Antonius Hospital) and is supported by the Antonius Research Fund. The funder has no role in any part of the study design, conduct, and analysis.
Publisher Copyright:
© 2023 Wolters Kluwer Health. All rights reserved.
PY - 2023/5/1
Y1 - 2023/5/1
N2 - 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.
AB - 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.
KW - Disconnected pancreatic duct syndrome
KW - Pancreatic duct leak
KW - Pancreatic necrosis
U2 - 10.14309/ajg.0000000000002157
DO - 10.14309/ajg.0000000000002157
M3 - Article
C2 - 36707931
SN - 0002-9270
VL - 118
SP - 880
EP - 891
JO - American Journal of Gastroenterology
JF - American Journal of Gastroenterology
IS - 5
ER -