Elsevier

Pancreatology

Volume 15, Issue 3, May–June 2015, Pages 247-252
Pancreatology

Original article
Severity and natural history of acute pancreatitis in diabetic patients

https://doi.org/10.1016/j.pan.2015.03.013Get rights and content

Abstract

Background

There is limited data on the prevalence of coexistent diabetes in acute pancreatitis and subsequent natural history in these patients.

Methods

Using Pennsylvania Health Care Cost Containment Council data set, we identified 7399 unique White and Black Allegheny County, PA residents with first hospitalization for acute pancreatitis from 1996 to 2005. We evaluated the prevalence of coexistent diabetes, demographic and etiologic profile, severity of index hospitalization, and risk of readmission for acute or chronic pancreatitis during follow up (median 39 months) in this cohort.

Results

The prevalence of coexisting diabetes was 18% (1349/7399). When compared with non-diabetics, diabetics were significantly more likely to be older (63 vs. 56 yrs), male (OR 1.4, 95% CI 1.2–1.6), black (OR 2.4, 95% CI 2.1–2.7) and have non-alcoholic etiologies (biliary, OR 1.5, 95% CI 1.2–1.9; idiopathic, OR 2.0, 95% CI 1.7–2.5; metabolic, OR 5.2, 95% CI 4.0–6.7). While diabetic patients had a significantly longer length of stay (median 5 vs. 4 days, p < 0.05), their severity of acute pancreatitis (multivariable OR 1.18, 95% CI 0.94–1.48) or in-hospital mortality (1.9% each, p = 0.98) did not differ than non-diabetics. The overall risk of pancreatitis-related readmissions in diabetics was similar (33% each, p = 0.99), but their risk of subsequent admission for chronic pancreatitis (multivariable HR 0.65, 95% CI 0.44–0.97) was lower than non-diabetics.

Conclusion

About 20% patients with acute pancreatitis have coexistent diabetes. Demographic and etiologic profile of diabetic patients with acute pancreatitis differs from non-diabetics. Diabetic status has limited effect on the severity of and natural history following acute pancreatitis.

Introduction

Acute pancreatitis (AP) is an inflammatory condition resulting from pancreatic injury from various causes [1]. Clinically, patients with AP present with sudden onset of usually severe upper abdominal pain sometimes radiating to the back, elevations in serum pancreatic enzymes and morphologic changes in the pancreas or peripancreatic area [2]. Almost all patients with a clinically significant episode of AP require hospitalization [3]. The clinical course of AP can vary from mild to severe and several host factors may affect its severity [4].

The relationship between AP and diabetes has generated interest in recent years. In population-based studies, diabetes is noted to increase the risk of AP by 1.5–3 folds [5], [6], [7], [8]. This excess risk can be reduced with better blood sugar control [6], [8]. Patients with AP can also develop diabetes. In a recent systematic review of 24 studies, the pooled prevalence of prediabetes and diabetes after a sentinel episode of AP was 16% and 23% respectively, and 15% patients needed insulin treatment [9]. While parenchymal destruction from necrosis may explain the development of diabetes in severe AP, diabetes can also develop in AP patients with mild disease by yet to be defined mechanisms.

There is limited data on the prevalence of coexistent diabetes and the subsequent natural history in these patients. Diabetic patients tend to have a higher number of co-morbidities, some of which may be associated with AP etiology (e.g. hypertriglyceridemia [10]) or severity (e.g. obesity [11]). It is unclear if the etiologic profile of AP in patients with coexisting diabetes is similar to non-diabetic patients. Mortality in patients with AP increases with the number of co-morbidities [12], but published data on the effect of coexistent diabetes on the severity of or mortality from AP is limited. Shen et al. reported an increased risk of severe AP (intensive care unit admission or local complications defined by drainage for pancreatic abscess or cysts), similar risk of organ failure and a lower mortality in patients with coexistent diabetes when compared with non-diabetics [13]. Frey et al. found that presence of diabetes increased the risk of organ failure but did not affect mortality in the first two weeks in AP patients [13]. Other studies not limited to AP have observed that diabetic status does not affect disease course in patients with sepsis [14], [15] and diabetic patients admitted to the ICU have a lower risk of death when compared with non-diabetics [16]. Lastly, whether diabetic status affects the risk of recurrent acute (RAP) or chronic (CP) pancreatitis is unclear.

We have previously reported on the natural history [17], risk and patterns of readmissions after sentinel AP [18] and hospitalizations for CP [19] in Allegheny County, PA population. In this cohort, we were able to evaluate the prevalence of coexistent diabetes and the natural history after sentinel AP based on diabetic status with the specific aims to determine the – prevalence of coexistent diabetes in patients with first attack of AP, demographic and etiologic profile and severity of AP in patients with coexistent diabetes, and natural history after AP in patients with coexistent diabetes.

Section snippets

Methods

This study was approved by the Institutional Review Board of the University of Pittsburgh Medical Center.

Study cohort, demographics, prevalence of coexistent diabetes and AP etiology

The final study population consisted of 7399 White or Black Allegheny County, PA residents. Overall, patients were mostly middle-aged, less than half were male and 80% were White. Among patients with an identifiable etiology, biliary and alcohol etiologies were the most common (Table 1).

The prevalence of coexisting diabetes was 18% (1349/7399). Diabetes prevalence, overall and after stratification by age, sex and race remained constant during the study period (data not shown). Patients with

Discussion

In this population based study, we found about one in five patients with first hospitalization for AP to have coexisting diabetes. When compared with non-diabetics, diabetic patients were more likely to be older, male and Black, were less likely to abuse alcohol or tobacco and were more likely to have non-alcoholic etiologies for AP. Although diabetic patients had a longer length of hospital stay, diabetic status had little effect on disease severity and did not affect the in-hospital

Disclaimer

The Pennsylvania Health Care Cost Containment Council (PHC4) is an independent state agency responsible for addressing the problem of escalating health costs, ensuring the quality of health care, and increasing access to health care for all citizens regardless of ability to pay. PHC4 has provided data to this entity in an effort to further PHC4's mission of educating the public and containing health care costs in Pennsylvania. PHC4, its agents, and staff, have made no representation, guarantee,

Grant support

Department of Medicine, University of Pittsburgh (DY).

Authorship criteria and contributions

Haq Nawaz: Study design, data analysis and interpretation, drafting and revising the article, final approval of the version to be published.

Michael O'Connell: Data analysis and interpretation, revising the article, final approval of the version to be published.

Georgios I. Papachristou: Data interpretation, revising the article, final approval of the version to be published.

Dhiraj Yadav: Study design, obtaining funding, data analysis and interpretation, drafting and revising the article, final

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