Pancreas
Am J Gastroenterol. 2023;118(5):880−91
Short-term and long-term outcomes of a disruption and disconnection of the pancreatic duct in necrotizing pan-creatitis: A multicenter cohort study in 896 patients
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: The authors 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 of the 896 patients (27%) 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 a disrupted or disconnected pancreatic duct (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.