Retrospective Cohort Study
Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Jun 21, 2020; 26(23): 3260-3270
Published online Jun 21, 2020. doi: 10.3748/wjg.v26.i23.3260
Pancreatic necrosis and severity are independent risk factors for pancreatic endocrine insufficiency after acute pancreatitis: A long-term follow-up study
Bing-Jun Yu, Nian-Shuang Li, Wen-Hua He, Cong He, Jian-Hua Wan, Yin Zhu, Nong-Hua Lu
Bing-Jun Yu, Nian-Shuang Li, Wen-Hua He, Cong He, Jian-Hua Wan, Yin Zhu, Nong-Hua Lu, Department of Gastroenterology, The First Affiliated Hospital of Nanchang University, Nanchang 330006, Jiangxi Province, China
Author contributions: Yu BJ conceptualized and designed the study and wrote the manuscript; Yu BJ and Li NS collected the data; He WH made critical revisions to the manuscript; Wan JH and He C helped in interpreting and analyzing the data; Zhu Y and Lu NH made substantial contributions to the conception, design, and coordination of the study and gave final approval of the version to be published; all authors read and approved the final manuscript.
Supported by National Natural Science Foundation of China, No. 81860122.
Institutional review board statement: This study was approved by the Ethics Committee of the First Affiliated Hospital of Nanchang University.
Informed consent statement: All involved subjects gave their informed consent (written or verbal) prior to study inclusion.
Conflict-of-interest statement: The authors declare that they have no conflict of interest.
STROBE statement: The authors have read the STROBE Statement—checklist of items, and the manuscript was prepared and revised according to the STROBE Statement—checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Nong-Hua Lu, MD, Professor, Department of Gastroenterology, The First Affiliated Hospital of Nanchang University, 17 Yongwaizheng Street, Nanchang 330006, Jiangxi Province, China. lunonghua@ncu.edu.cn
Received: January 22, 2020
Peer-review started: January 22, 2020
First decision: February 27, 2020
Revised: March 29, 2020
Accepted: May 15, 2020
Article in press: May 15, 2020
Published online: June 21, 2020
Processing time: 150 Days and 23.7 Hours
Abstract
BACKGROUND

Pancreatic endocrine insufficiency after acute pancreatitis (AP) has drawn increasing attention in recent years.

AIM

To assess the impact of risk factors on the development of pancreatic endocrine insufficiency after AP.

METHODS

This retrospective observational long-term follow-up study was conducted in a tertiary hospital. Endocrine function was evaluated by the oral glucose tolerance test. The data, including age, sex, body mass index, APACHE II score, history of smoking and drinking, organ failure, pancreatic necrosis, debridement of necrosis (minimally invasive and/or open surgery), and time interval, were collected from the record database.

RESULTS

A total of 361 patients were included in the study from January 1, 2012 to December 30, 2018. A total of 150 (41.6%) patients were diagnosed with dysglycemia (including diabetes mellitus and impaired glucose tolerance), while 211 (58.4%) patients had normal endocrine function. The time intervals (mo) of the above two groups were 18.73 ± 19.10 mo and 31.53 ± 27.27 mo, respectively (P = 0.001). The morbidity rates of pancreatic endocrine insufficiency were 46.7%, 28.0%, and 25.3%, respectively, in the groups with different follow-up times. The risk factors for pancreatic endocrine insufficiency after AP were severity (odds ratio [OR] = 3.489; 95% confidence interval [CI]: 1.501-8.111; P = 0.004) and pancreatic necrosis (OR = 4.152; 95%CI: 2.580-6.684; P = 0.001).

CONCLUSION

Pancreatic necrosis and severity are independent risk factors for pancreatic endocrine insufficiency after AP. The area of pancreatic necrosis can affect pancreatic endocrine function.

Keywords: Acute pancreatitis; Pancreatic necrosis; Diabetes; Pancreatic necrosis; Pancreatic necrosis debridement; Endocrine function

Core tip: This is the first research to explore the association between acute pancreatitis and pancreatic endocrine insufficiency in a longer time than before and we included patients who were followed for a long time from 3 mo to 7 years. Furthermore, we found that pancreatic necrosis and severity were independent risk factors for pancreatic endocrine insufficiency after AP. Debridement of necrosis (percutaneous catheter drainage and/or operative necrosectomy) was a protective factor on pancreatic endocrine insufficiency after AP. Our results will provide some guidance on the clinical practice in the future.