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 E.H.
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 J.
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.
N1 - 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
UR - http://www.scopus.com/inward/record.url?scp=85158843845&partnerID=8YFLogxK
U2 - 10.14309/ajg.0000000000002157
DO - 10.14309/ajg.0000000000002157
M3 - Article
C2 - 36707931
AN - SCOPUS:85158843845
SN - 0002-9270
VL - 118
SP - 880
EP - 891
JO - American Journal of Gastroenterology
JF - American Journal of Gastroenterology
IS - 5
ER -