Exocrine pancreas insufficiency in chronic pancreatitis – Risk factors and associations with complications. A multicentre study of 1869 patients

Erchinger, Friedemann; Engjom, Trond; Drewes, Asbjørn Mohr; Olesen, Søren Schou; Vujasinović, Miroslav; Löhr, Matthias; Nøjgaard, Camilla; Novovic, Srdan; Laukkarinen, Johanna; Parhiala, Mikael; Lindkvist, Björn; Waage, Anne; Hauge, Truls; Puķītis, Aldis; Ozola-Zālīte, Imanta; Kalaitzakis, Evangelos; Okhlobystin, Alexey; Barauskas, Giederius; Efsen, Dahl Eva; Tjora, Erling

doi:10.1016/j.pan.2022.02.003

Cited by 10 publications

(6 citation statements)

References 45 publications

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“…Recent cohort studies have demonstrated that patients with CP have an increased risk of cerebrovascular diseases, acute coronary syndrome, deep vein thrombosis and pulmonary embolism [11,28,36]. The results of our study may indicate the role of EPI in an increased cardiovascular risk in CP combined with AH.…”

Section: Discussionsupporting

confidence: 61%

The level of pancreatic fecal elastase-1 and the risk of cardiovascular complications in patients with chronic pancreatitis combined with arterial hypertension

Filippova,

Kryvoshei

2023

GASTRO

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Background. Chronic pancreatitis and malnutrition are associated with cardiovascular diseases and cardiovascular events, while the role of exocrine pancreatic insufficiency as a risk factor for cardiovascular events is unknown. The purpose of the study was to evaluate the level of pancreatic fecal elastase-1 in patients with chronic pancreatitis combined with hypertension and to determine the relationship with cardiovascular risk. Materials and methods. One hundred and ten patients (46 men, 64 women) aged 45–65 years with chronic pancreatitis were included in the study. The first group consisted of people with a combined course of chronic pancreatitis and hypertension; the second — with chronic pancreatitis alone. The levels of total cholesterol, triglycerides (TG), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), and very low-density cholesterol, pancreatic fecal elastase-1, total protein, serum content of albumin, iron, vitamin D, zinc and magnesium were evaluated in all patients. Results. In the group 1, there were significantly more cases of severe exocrine pancreatic insufficiency and a significantly lower number of patients with a normal level of pancreatic fecal elastase-1 (p < 0.05). In addition, a very high cardiovascular risk was detected significantly more often in this group — 11.5 % (p < 0.05). The main cardiovascular risk factors among patients with chronic pancreatitis, in addition to hypertension, included obesity and increased body weight — 70.9 % of cases. Elevated levels of TG, LDL, and total cholesterol were observed in 86.4, 94.5, and 91.8 % of patients with chronic pancreatitis combined with hypertension, respectively, and a reduced content of HDL-C was found in 34.5 % (p < 0.05). Significantly higher levels of TG, LDL-C, total cholesterol, and a lower level of HDL were revealed in the group 1 compared to the group 2 (p < 0.05). In patients of the group 1, a reliable inverse correlation was found between the pancreatic fecal elastase-1 and TG, atherogenic index, the SCORE2 scale (r = –0.43, p < 0.05; r = –0.52, p < 0.05; r = –0.48, p < 0.05, respectively), as well as a reliable direct correlation with HDL level (r = 0.50; p < 0.05). Conclusions. The combined course of chronic pancreatitis with exocrine pancreatic insufficiency and hypertension is associated with an increased cardiovascular risk. A decrease in the level of pancreatic fecal elastase-1 and malnutrition may be associated with an increase in the frequency of dyslipidemia and in the risk of cardiovascular events among these patients.

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Section: Discussionsupporting

confidence: 61%

The level of pancreatic fecal elastase-1 and the risk of cardiovascular complications in patients with chronic pancreatitis combined with arterial hypertension

Filippova,

Kryvoshei

2023

GASTRO

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“…In a recent multivariate analysis examining the risk factors for EPI in a Nordic cohort of 1869 CP patients, smoking, bile duct stricture, and prior stenting and resection were all associated with EPI. 20 The presence of EPI was also related to poor nutrition and diabetes, emphasizing the need for intensive nutritional monitoring in patients with CP. Those findings were consistent with the factors extracted by our machine learning algorithm being nutritional factors, that is, low BMI and TP level.…”

Section: Discussionmentioning

confidence: 99%

Predictive Insights Into Exocrine Pancreatic Insufficiency in Chronic Pancreatitis and Autoimmune Pancreatitis

Tanaka,

Kimura,

Wakabayashi

et al. 2024

Pancreas

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Objective Exocrine pancreatic insufficiency (EPI) is a common manifestation of chronic pancreatitis (CP) and autoimmune pancreatitis (AIP). This study aimed to estimate the presence of EPI in patients with CP or AIP using alternative clinical markers. Materials and Methods A machine learning analysis employing a decision tree model was conducted on a retrospective training cohort comprising 57 patients with CP or AIP to identify EPI, defined as fecal elastase-1 levels less than 200 μg/g. The outcomes were then confirmed in a validation cohort of 26 patients. Results Thirty-nine patients (68%) exhibited EPI in the training cohort. The decision tree algorithm revealed body mass index (≤21.378 kg/m2) and total protein level (≤7.15 g/dL) as key variables for identifying EPI. The algorithm's performance was assessed using 5-fold cross-validation, yielding area under the receiver operating characteristic curve values of 0.890, 0.875, 0.750, 0.625, and 0.771, respectively. The results from the validation cohort closely replicated those in the training cohort. Conclusions Decision tree analysis revealed that EPI in patients with CP or AIP can be identified based on body mass index and total protein. These findings may help guide the implementation of appropriate treatments for EPI.

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“…Проявления ЭНПЖ включают стеаторею, дефицит микроэлементов и витаминов, боли в животе, метеоризм, что в итоге может привести к уменьшению массы тела и значительному снижению качества жизни [32,33]. При раннем ХП неожиданная потеря массы тела может быть связана с экзокринной недостаточностью ПЖ [2,[34][35][36]. При ЭНПЖ легкой степени происходит снижение секреции одного или нескольких ферментов на фоне нормальной концентрации бикарбоната в соке двенадцатиперстной кишки и нормальной экскреции жира с калом.…”

Section: методы диагностики раннего хронического панкреатитаunclassified

Early diagnosis of chronic pancreatitis

Khatkov

Tyulyaeva²,

Lesko

et al. 2023

Almanac of Clinical Medicine

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Chronic pancreatitis is one of the most challenging disorders from the perspective of its early diagnosis and effective treatment. Within the last decade, the diagnosis of early chronic pancreatitis has been firmly introduced into the practice of gastroenterology. The delineation of this form as an initial stage of chronic pancreatitis is based on the need in early and effective treatment that could cease the progression of the disease and reduce the possibility of its complications. The diagnostic criteria of chronic pancreatitis have been described in details in the literature; however, specifics of the diagnosis in its early stage have been scarcely highlighted. Chronic pancreatitis is commonly diagnosed with a number of imaging techniques (they can show abnormalities in morphology of the pancreas), as well as laboratory tests (showing functional organ deficit). However, morphological and imaging techniques are insufficient for the diagnosis of the early chronic pancreatitis. A new integral strategy towards early diagnosis seems necessary, that would consider not only the morphology, but also potential etiology, risk factors of the disease and its complications in patients with suspected chronic pancreatitis. The review of the literature presents the definition of the early pancreatitis and discusses the potential of imaging techniques and functional tests in its diagnosis. An adequate strategy for the diagnosis of the early pancreatitis is formulated, based on an individual patient characteristic with suspected early chronic pancreatitis, namely, risk factors, clinical manifestations, imaging results and serological biomarkers.

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Exocrine pancreas insufficiency in chronic pancreatitis – Risk factors and associations with complications. A multicentre study of 1869 patients

Cited by 10 publications

References 45 publications

The level of pancreatic fecal elastase-1 and the risk of cardiovascular complications in patients with chronic pancreatitis combined with arterial hypertension

The level of pancreatic fecal elastase-1 and the risk of cardiovascular complications in patients with chronic pancreatitis combined with arterial hypertension

Predictive Insights Into Exocrine Pancreatic Insufficiency in Chronic Pancreatitis and Autoimmune Pancreatitis

Early diagnosis of chronic pancreatitis

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