Background/Purpose: Long-term outcome of severe acute pancreatitis (SAP) is often complicated, because the etiology, severe inflammation and pancreatic necrosis can affect the endocrine/exocrine function and morphology of pancreas. It is favorable to predict the long-term outcome in the follow-up of patients after the recovery from SAP, but there have been no analyses about the predictable factors for poor outcome after SAP. This study was undertaken to evaluate the post discharge outcome of severe acute pancreatitis (SAP) and clarify the predictable factors for poor outcome.
Methods: Among 103 patients who had recovered from SAP according to the Japanese criteria, we analyzed 45 patients (36 men and 9 women) that we could follow-up more than 12 months after SAP. The mean follow-up period was 56 ± 6 months (range: 12-184). We analyzed the relationships of recurrence of acute pancreatitis (AP), transition to chronic pancreatitis (CP), and development into diabetes mellitus (DM) with the etiology and pancreatic necrosis at SAP, respectively. Moreover, we surveyed the predictable factors for poor outcome in laboratory data on admission of SAP by univariate and multivariate analyses.
Results: The recurrence rate of AP was 19%. The mean interval after SAP was 25 ± 6 months. The recurrence rate of AP in patients with pancreatic necrosis was higher than that in patients without pancreatic necrosis (32% vs. 5%, P <0.05). Univariate analysis showed that the predictable factors for the recurrence of AP were CRP and white blood cell (WBC) count (P <0.05). Multivariate analysis revealed that the independent predictable factor was CRP (P <0.05). The transition rate to CP was 22%. The mean interval after SAP was 52 ± 10 months. The transition rate to CP was higher in alcoholic SAP than that in biliary SAP (32% vs. 0%, P <0.05). Univariate analysis showed that the predictable factors for the transition to CP were WBC count, hematocrit, base excess (BE), Ranson score, and Japanese severity score (JSS) (P <0.05). Multivariate analysis disclosed that the independent predictable factors were WBC count and JSS (P <0.05). The development rate into DM was 39%. The mean interval after SAP was 26 ± 12 months. Univariate analysis showed that the predictable factors for the development into DM were blood glucose and BE (P <0.05). Multivariate analysis revealed that the independent predictable factor was blood glucose (P <0.05).
Conclusions: Degree of inflammation and pancreatic necrosis may be related to the recurrence of AP. Alcoholic SAP with high severity may contribute to transition to CP. Impaired glucose tolerance is easy to develop into DM after SAP.