Acute pancreatitis (AP) is a sudden inflammatory condition of the pancreas. Although conservative management results in clinical improvement in most patients, approximately 5% to 10% of cases progress to life-threatening conditions, including multiorgan failure, with significant morbidity and mortality [
Severe AP (SAP) is associated with relatively high morbidity and mortality rates [
In the present study, we determined the factors associated with severity of AP according to etiology and evaluated the relationship between obesity and AP severity in the Korean population.
This study was conducted at St. Vincent Hospital (Suwon, Korea) and St. Paul’s Hospital (Seoul, Korea), The Catholic University of Korea. We retrospectively reviewed the medical records of consecutive patients who were admitted with AP between January 2003 and January 2013. Every patient underwent abdominal computed tomography, ultrasonography, or magnetic resonance imaging of the pancreas. After etiologic evaluation, we included patients who had gallstone- or alcohol-induced AP.
Diagnosis of AP was established by the presence of 2 of the following 3 criteria: (1) abdominal pain compatible with the disease, (2) increased serum amylase and/or lipase (>3 times the upper limit of normal), and/or (3) characteristic features on abdominal imaging studies.
Gallstone-induced AP was diagnosed if the patient had a gallstone, sludge in the gallbladder, and/or lithiasis in the common bile duct with or without a dilated bile duct observed in imaging studies. Alcohol-induced AP was defined as alcohol consumption just before the development of AP without any other cause of pancreatitis. Patients with acute exacerbation of chronic pancreatitis were excluded.
SAP was defined by the Atlanta consensus classification system based on persistent organ failure, including cardiovascular failure, respiratory insufficiency, or renal insufficiency [
As for the evaluation of AP severity related to obesity, all enrolled patients were assessed according to BISAP score.
Continuous data were expressed as mean ± SD and analyzed using the independent samples
This study was reviewed and approved by the Institutional Review Board of The Catholic University of Korea (VC15RISE0185) and was in compliance with the Declaration of Helsinki.
A total of 905 patients with AP were enrolled. The frequency of alcohol-induced AP was 72.9% (660/905), and a male-predominant pattern (528 males, 132 females) was seen in this type of AP. The mean age of patients with alcohol-induced AP was 51.40 ± 14.60 years. The frequency of gallstone-induced AP was 27.1% (245/905), and a male-predominant pattern (154 males, 91 females) was also seen in this type of AP. The mean age of patients with gallstone-induced AP was 59.51 ± 15.57 years. SAP occurred in 72 patients (53 alcohol-induced, 19 gallstone-induced). Pancreatitis-related death occurred in 19 patients (18 alcohol-induced, 1 gallstone-induced) (Table
Baseline characteristics.
Alcohol | Gallstones |
| |
---|---|---|---|
No. of patients (%) | 660 (72.9) | 245 (27.1) | |
Sex, M : F, |
528 : 132 | 154 : 91 | <0.01 |
Age, mean ± SD, y | 51.40 ± 14.60 | 59.51 ± 15.57 | <0.01 |
BMI, mean ± SD, kg/m2 | 22.01 ± 5.29 | 24.04 ± 3.51 | 0.01 |
AP reattack, |
171 | 54 | 0.23 |
SAP, |
53 | 19 | 0.89 |
Pancreatitis-related death, |
18 | 1 | 0.03 |
AP: acute pancreatitis; BMI: body mass index; SAP: severe acute pancreatitis.
In multivariate analysis, current smoking, pancreatic necrosis, and bacteremia were significantly (
Multivariate analysis of factors associated with severe acute pancreatitis induced by alcohol consumption.
OR | 95% CI |
| |
---|---|---|---|
Smoking | 2.59 | 0.99–7.19 | 0.05 |
Pancreatic necrosis | 10.46 | 4.20–26.05 | <0.01 |
Bacteremia | 11.68 | 3.13–43.60 | <0.01 |
Pancreatic fluid collection | 2.85 | 1.00–8.10 | 0.04 |
CI: confidence interval; OR: odds ratio.
Multivariate analysis of factors associated with severe acute pancreatitis induced by gallstones.
OR | 95% CI |
| |
---|---|---|---|
Smoking | 7.22 | 1.05–49.69 | 0.04 |
Pancreatic necrosis | 8.95 | 0.97–82.25 | 0.05 |
Bacteremia | 10.71 | 2.04–56.12 | <0.01 |
Dyslipidemia | 5.21 | 1.36–19.94 | 0.01 |
CI: confidence interval; OR: odds ratio.
When patients were classified according to BMI as obese (BMI ≥ 25 kg/m2) or nonobese (BMI < 25 kg/m2), obesity was not significantly correlated with severity in alcohol- or gallstone-induced AP. However, simple linear regression analysis revealed that BMI was correlated with the BISAP score in both alcohol- and gallstone-induced AP (
Simple regression analysis of body mass index (BMI) and Bedside Index of Severity in Acute Pancreatitis (BISAP) score. In both (a) alcohol-induced pancreatitis (
We performed a retrospective analysis of patients with AP during a recent decade and investigated the factors associated with severity of AP according to etiology. In this study, SAP was defined by the Atlanta consensus classification, which is based on organ failure [
Smoking emerged as an independent factor associated with AP. Several experimental animal studies have suggested that exposure to smoking can induce pathologic and functional changes in the pancreas that can cause inflammatory activity [
In addition, our results showed that pancreatic necrosis and bacteremia aggravated the clinical course of both alcohol- and gallstone-induced AP. A significant correlation has been demonstrated between the extent of pancreatic necrosis and organ failure. Previous reports have suggested that 5% to 10% of patients with AP develop pancreatic necrosis [
Moreover, AP is frequently complicated by infection, such as pneumonia, bacteremia, and infected pancreatic necrosis. Among them, bacteremia has been reported to be a risk factor for infected pancreatic necrosis and a high mortality rate [
Our study also demonstrated that pancreatic fluid collection was associated with SAP in alcohol-induced AP. Previous studies have shown that the incidence of pseudocyst formation or peripancreatic fluid collection was higher in patients with alcohol-induced AP compared with gallstone-induced AP [
This study found that dyslipidemia was a risk factor for SAP in gallstone-induced AP but not alcohol-induced AP. To date, the correlation between dyslipidemia and severity of AP remains ambiguous. Although no significant correlation has been observed between triglyceride levels and AP [
Although the precise mechanisms have not been elucidated, obesity is a possible independent predictor of AP outcome [
This study has several potential limitations. First, its design was retrospective. However, we tried to overcome this drawback by obtaining consecutive data using a standard approach and enrolling a large number of patients. Second, BMI was used as an indicator of the quantity of body fat. In addition to BMI, visceral adipose tissue measured using the waist-to-hip ratio and waist circumference has been proposed as a risk factor associated with worse outcomes. Fat depots close to the pancreas are known to be commonly affected by pancreatitis. In clinical practice, peripancreatic fat necrosis as a part of necrotizing pancreatitis correlates with worse outcomes of AP [
The results of our study revealed that current smoking, pancreatic necrosis, and bacteremia could aggravate the clinical course of AP, while both pancreatic fluid collection and dyslipidemia were associated with AP severity according to different etiologies. Further nationwide studies are needed to validate these findings.
The authors declare that there are no conflicts of interest regarding the publication of this article.