Short-term and Long-term Outcomes of a Disruption and Disconnection of the Pancreatic Duct in Necrotizing Pancreatitis: A Multicenter Cohort Study in 896 Patients
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) American Journal of Gastroenterology, volume 118, issue 5, pp. 880 - 891
(Article)
Abstract
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
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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.
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Keywords: disconnected pancreatic duct syndrome, pancreatic duct leak, pancreatic necrosis, Hepatology, Gastroenterology
ISSN: 0002-9270
Publisher: Nature Publishing Group
Note: Publisher Copyright: © 2023 Wolters Kluwer Health. All rights reserved.
(Peer reviewed)