Predictive Risk Factors of Pancreatic Exocrine Insufficiency Developed After Acute Pancreatitis: A Retrospective Cohort Study

Yulin Guo; Xiaohui Wang; Shuo Wang; Ang Li; Feng Cao; Fei Li

doi:10.2147/JIR.S392932

Predictive Risk Factors of Pancreatic Exocrine Insufficiency Developed After Acute Pancreatitis: A Retrospective Cohort Study

J Inflamm Res. 2023 Mar 15:16:1157-1167. doi: 10.2147/JIR.S392932. eCollection 2023.

Authors

Yulin Guo^#^{1

2}, Xiaohui Wang^#^{1

2}, Shuo Wang^#^{1

2}, Ang Li^{1

2}, Feng Cao^{1

2}, Fei Li^{1

2}

Affiliations

¹ Department of General Surgery, Xuanwu Hospital of Capital Medical University, Beijing, People's Republic of China.
² Acute Pancreatitis Clinical Center of Capital Medical University, Beijing, People's Republic of China.

^# Contributed equally.

Abstract

Purpose: The aim of this study was to compare the clinical characteristics of acute pancreatitis (AP) patients between those who developed pancreatic exocrine insufficiency (PEI) and those who did not, and to investigate the predictive factors of PEI.

Patients and methods: From October 1st 2019 to July 30th 2021, AP patients admitted at our center were included. The fecal elastase-1 assay was adopted for PEI diagnosis. The clinical characteristics, treatments, and outcomes between the patients with and without PEI were analyzed.

Results: In total, 63 males and 42 females were included. There were 27 patients with mild AP, 54 with moderately severe AP, and 24 with severe AP. The median modified computed tomography severity index (MCTSI) was 6.000(4.000, 8.000). During the follow-up, 38 patients developed PEI after AP. The univariate analysis showed that higher ASA grade (P = 0.006), more severe AP (P = 0.000), the presence of multiple organ dysfunction syndrome (P = 0.030), higher MCTSI (P = 0.000), the development of infected pancreatic necrosis (P = 0.002) and local complications (P = 0.000), higher levels of triacylglycerol (P = 0.022), video-assisted retroperitoneal debridement intervention (P = 0.015), and longer intensive care unit stay (P = 0.044) were correlated with PEI development. Furthermore, the logistic regression analyses showed that MCTSI during hospitalization is an independent risk factor for PEI development during the AP recovery period.

Conclusion: ASA grade, severity of AP, multiple organ dysfunction syndrome, MCTSI, infected pancreatic necrosis, local complications, higher levels of triacylglycerol, video-assisted retroperitoneal debridement intervention, and longer intensive care unit stay were potentially associated with PEI development during the AP recovery period. High MCTSI was independently associated with the development of PEI during the AP recovery period, which may help alert to the possibility of PEI to help with its early detection and treatment.

Keywords: acute pancreatitis; fecal elastase-1; modified computed tomography severity index; pancreatic exocrine insufficiency.

Grants and funding

This study was supported by the Construction Project of Clinical Advanced subjects of Capital Medical University [No. 1192070312 to F.L.]; and the Beijing Municipal Science & Technology Commission [No. Z171100001017077 to F.L., No. Z191100006619038 to F.C.]; and the Capital Health Research and Development of Special [No.2020-1-2012 to F.L.]; and the Beijing Postdoctoral Funding for Scientific Research [No. ZZ2019-18 to Y.G.].