Pancreas

Am J Gastroenterol. 2023;118(5):880−91

Timmerhuis HC, van Dijk SM, Hollemans RA, Sperna Weiland CJ, Umans DS, Boxhoorn L, Hallensleben NH, van der Sluijs R, Brouwer L, van Duijvendijk P, Kager L, Kuiken S, Poley JW, de Ridder R, Römkens TEH, Quispel R, Schwartz MP, Tan ACITL, Venneman NG, Vleggaar FP, van Wan-rooij RLJ, Witteman BJ, van Geenen EJ, Molenaar IQ, Bruno MJ, van Hooft JE, Besselink MG, Voermans RP, Bollen TL, Verdonk RC, van Santvoort HC; Dutch Pancreatitis Study Group

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.

DOI: 10.14309/ajg.0000000000002157