Evidence for diagnosis of early chronic pancreatitis after three episodes of acute pancreatitis: a cross-sectional multicentre international study with experimental animal model

Abstract

Chronic pancreatitis (CP) is an end-stage disease with no specific therapy; therefore, an early diagnosis is of crucial importance. In this study, data from 1315 and 318 patients were analysed from acute pancreatitis (AP) and CP registries, respectively. The population from the AP registry was divided into AP (n = 983), recurrent AP (RAP, n = 270) and CP (n = 62) groups. The prevalence of CP in combination with AP, RAP2, RAP3, RAP4 and RAP5 + was 0%, 1%, 16%, 50% and 47%, respectively, suggesting that three or more episodes of AP is a strong risk factor for CP. Laboratory, imaging and clinical biomarkers highlighted that patients with RAP3 + do not show a significant difference between RAPs and CP. Data from CP registries showed 98% of patients had at least one AP and the average number of episodes was four. We mimicked the human RAPs in a mouse model and found that three or more episodes of AP cause early chronic-like morphological changes in the pancreas. We concluded that three or more attacks of AP with no morphological changes to the pancreas could be considered as early CP (ECP).The new diagnostic criteria for ECP allow the majority of CP patients to be diagnosed earlier. They can be used in hospitals with no additional costs in healthcare.

Hypoalbuminemia affects one third of acute pancreatitis patients and is independently associated with severity and mortality

“…Data collection and validation are detailed by Párniczky et al 24 . The Hungarian Pancreatic Study Group published analyses from the registry, the population of which may overlap with our analysed cohort 24 – 34 .…”

Glucose levels show independent and dose-dependent association with worsening acute pancreatitis outcomes: Post-hoc analysis of a prospective, international cohort of 2250 acute pancreatitis cases

“…DM and thus pathological serum glucose values can be overrepresented in CP cases, 25e80% of CP patients develop DM [57]. Acute exacerbations in people with CP are known to be less severe [58], possibly decreasing severity and mortality in higher HbA1c and glucose groups, but we found a balanced distribution of CP among groups.…”

Metabolic signature might be an option to identify patients with early CP

“…Our study group just published an analysis of a small cohort in which patients with three or more acute pancreatitis episodes have a high probability of developing CP. 12 Therefore, based on Adam et al's study, we decided to retest our observation in a large international cohort of patients with acute pancreatitis (AP). Between 2012 and 2019, from 13 countries and 30 medical centres, 2461 patients were enroled into the Acute Pancreatitis Registry initiated by the Hungarian Pancreatic Study Group.…”