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
ARTICLE HIGHLIGHTS
Research background

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

Research motivation

In recent years, we discovered another complication with an increasing frequency after AP onset, namely, pancreatic endocrine insufficiency. DM is associated with a heavy burden on the society due to related disabilities and high costs. Therefore, it is important to determine the incidence rate, risk factors, treatment, and outcome of pancreatic endocrine insufficiency after AP onset, which remain unclear. Hence, in this study, we conducted a long-term follow-up investigation to assess the potential risk factors for and incidence of pancreatic endocrine insufficiency after AP onset.

Research objectives

The aim of the present study was to assess the impact of risk factors on the development of pancreatic endocrine insufficiency after AP.

Research methods

This was a long-term follow-up retrospective observational study with patient data collected from the AP database of the First Affiliated Hospital of Nanchang University; it was conducted from January 1, 2012 to December 30, 2018. A total of 361 AP patients agreed to be followed after discharge. Pancreatic endocrine function was assessed by the fasting blood glucose level and an oral glucose tolerance test. All tests were performed at the First Affiliated Hospital of Nanchang University. One-way analysis of variance, Kolmogorov-Smirnov test, Cox regression, and univariate Cox regression analysis were used in this study.

Research results

The morbidity of DM and IGT in patients with pancreatic necrosis was significantly higher than that in the non-pancreatic necrosis patients (χ2 = 4.152, P = 0.001). According to the CT images, the area of pancreatic necrosis was divided into three subgroups on the basis of the extent of pancreatic necrosis: Necrotic area < 30%, necrotic area 30%-50%, and necrotic area > 50%. The morbidity of DM and IGT showed a significant difference between patients with different extents of pancreatic necrosis (P = 0.001).

The results of multivariate Cox regression analysis showed that the severity of AP and pancreatic necrosis were independent risk factors for pancreatic endocrine insufficiency in AP patients and that the area of pancreatic necrosis was related to pancreatic endocrine function.

Research conclusions

This study is the first to explore the association between AP and endocrine insufficiency in such a long follow-up time from 3 mo to 7 years. We confirmed that pancreatic necrosis and the severity of AP are independent risk factors for pancreatic endocrine insufficiency after AP. Meanwhile, we proposed that the area of pancreatic necrosis can affect pancreatic endocrine function after AP and high blood glucose recovers to normal levels as the disease of AP improves in this study. Our result will provide some guidance on the clinical practice in the future.

Research perspectives

In the future, pancreatic endocrine function should be further evaluated with HbA1c and C-peptide. This study found that pancreatic endocrine insufficiency recovers over time, but we did not determine which time point is associated with the highest incidence of pancreatic endocrine insufficiency. An RCT will be needed to evaluate the time point, and we should not only pay attention to the pancreatic endocrine insufficiency, but also the exocrine pancreatic insufficiency.