Glucocorticoids in acute pancreatitis: a propensity score matching analysis

Abstract

Background There are few reports about the effect of glucocorticoids in the treatment of acute pancreatitis in humans. This study aims to evaluate the effect of glucocorticoids in the treatment of acute pancreatitis by propensity score matching analysis. Results Acute pancreatitis patients admitted between 2014 and 2019 were collected from the database and analyzed. Included patients were divided into the glucocorticoids-used group (GC group) and the non-glucocorticoids-used group (NGC group) according to whether glucocorticoids were used. A total of 818 eligible patients were included in the final analysis. Seventy-six patients were treated with glucocorticoids, and 742 patients were treated without glucocorticoids. Before propensity score matching, the triglyceride levels (38.2 ± 18.5 vs. 20.2 ± 16.8, P < 0.05) and Acute Physiology and Chronic Health Evaluation II (APACHE II) scores (7.1 ± 2.5 vs. 4.5 ± 2.1, P < 0.05) at admission were significantly higher in the GC group than in the NGC group. The incidence of multi-organ failure (33.3% vs. 11.9%, P < 0.05) was significantly higher in the GC group than in the NGC group. Patients in the GC group showed a positive balance of fluid intake and output over 72 h. After 1:1 propensity score matching, 59 patients from each group (GC and NGC) were included in the analysis. There were no significant differences in age, sex, body mass index, triglycerides, or APACHE II scores between the two groups (P > 0.05), and the patients’ clinical outcomes were reversed. The proportion of patients with organ failure (40.7% vs. 52.5%, p < 0.05) and multi-organ failure (35.0% vs. 67.7%, P < 0.05) was significantly lower in the GC group than in the NGC group. Furthermore, patients in the GC group had significantly shorter lengths of hospital stay (12.9 ± 5.5 vs. 16.3 ± 7.7, P < 0.05) and costs (25,348.4 ± 2512.6vs. 32,421.7 ± 2813.3, P < 0.05) than those in the NGC group. Conclusions This study presents preliminary confirmation of the beneficial effect of glucocorticoids in the treatment of acute pancreatitis. More high-quality prospective studies are needed in the future.

Circulating Blood B and T Lymphocytes and Severity of Acute Pancreatitis: A Systematic Review Protocol

“…However, because of patient heterogeneity, the lack of immunological outcomes and the fact that definitions of the severity of acute pancreatitis and treatment protocols are still variable, the findings from these studies are largely exploratory. 30 Therefore, a better understanding of the role of the cells of the adaptative immune system in this disease might have a huge impact on the outcomes and future treatments of patients with acute pancreatitis not only by trying to increase their number in peripheral blood but also by improving the function of some of the subpopulations of B cells and T cells that are recruited to the inflamed pancreas which most likely are responsible for the production of cytokines and interferons and consequently for the perpetuation of local and systemic inflammation.…”

Fire in the belly: A scoping review of the immunopathological mechanisms of acute pancreatitis

“…Given the profound inflammatory response associated with SAP, glucocorticoids have been trialled albeit with no high quality RCTs testing their efficacy in this disease. We identified three studies that trialled glucocorticoids; one retrospective propensity-matched cohort study, one case control study and one case series (233)(234)(235). In the propensity matched cohort study, it is unclear what the indication for glucocorticoid therapy was, and patients were treated with varying formulations at differing doses and durations.…”