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Long-term outcome of severe acute pancreatitis

  • Takeo Yasuda
  • Takashi Ueda
  • Yoshifumi Takeyama
  • Makoto Shinzeki
  • Hidehiro Sawa
  • Takahiro Nakajima
  • Yoshikazu Kuroda
Original Article

Abstract

Background/Purpose

This study was undertaken to evaluate the post-discharge outcome of severe acute pancreatitis (SAP) and to clarify the prognostic factors for poor outcome.

Methods

In 45 patients, recurrence of acute pancreatitis (AP), transition to chronic pancreatitis (CP), and development of diabetes mellitus (DM) were evaluated. Relationships of the outcome with the findings on admission and the presence/absence of alcohol intake were analyzed.

Results

The mean follow-up period was 56 ± 6 months. Recurrence of AP was noted in 19% of the patients. The recurrence rate was higher in patients with necrotizing pancreatitis than in those without this feature. C-reactive protein and white blood cell (WBC) count were higher in patients with recurrence of AP. Transition to CP was noted in 22% of patients. The transition rate was higher in those with alcoholic SAP than in those with biliary SAP. In patients with transition to CP, the WBC count, hematocrit, Ranson score, and Japanese severity score were higher, and base excess (BE) was lower, compared with these features in patients without this transition. Development of DM was noted in 39% of patients. Blood glucose and BE were higher in patients who developed DM than in those who did not.

Conclusions

The degree of inflammation and pancreatic necrosis found on admission for SAP may be related to the recurrence of AP. Alcoholic SAP in which the disease is very severe may contribute to the transition to CP. Patients with impaired glucose tolerance readily develop DM after SAP.

Key words

Severe acute pancreatitis Long-term outcome Recurrence Chronic pancreatitis Diabetes mellitus 

References

  1. 1.
    Singer MV, Gyr K, Sarles H. Revised classification of pancreatitis. Report of the Second International Symposium on the Classification of Pancreatitis in Marseille, France, March 28–30, 1984. Gastroenterology 1985;89:683–685.PubMedGoogle Scholar
  2. 2.
    Riaz C, Ochi K, Tanaka J, Harada H, Ichimura M, Miki H. Does recurrent acute pancreatitis lead to chronic pancreatitis? Sequential morphological and biochemical studies. Pancreas 1997;14:334–341.PubMedCrossRefGoogle Scholar
  3. 3.
    Pelli H, Sand J, Laippala P, Nordback I. Long-term follow-up after the first episode of acute alcoholic pancreatitis: time course and risk factors for recurrence. Scand J Gastroenterol 2000;35:552–555.PubMedCrossRefGoogle Scholar
  4. 4.
    Sekimoto M, Takada T, Kawarada Y, Hirata K, Mayumi T, Yoshida M, et al. JPN Guidelines for the management of acute pancreatitis: epidemiology, etiology, natural history, and outcome predictors in acute pancreatitis. J Hepatobiliary Pancreat Surg 2006;13:10–24.PubMedCrossRefGoogle Scholar
  5. 5.
    Appelros S, Lindgren S, Borgstrom A. Short and longterm outcome of severe acute pancreatitis. Eur J Surg 2001;167:281–286.PubMedCrossRefGoogle Scholar
  6. 6.
    Halonen KI, Pettila V, Leppaniemi AK, Kemppainen EA, Puolakkainen PA, Haapiainen RK. Long-term health-related quality of life in survivors of severe acute pancreatitis. Intensive Care Med 2003;29:782–786.PubMedGoogle Scholar
  7. 7.
    Doepel M, Eriksson J, Halme L, Kumpulainen T, Hockerstedt K. Good long-term results in patients surviving severe acute pancreatitis Br J Surg 1993;80:1583–1586.PubMedCrossRefGoogle Scholar
  8. 8.
    Eriksson J, Doepel M, Widen E, Halme L, Ekstrand A, Groop L, Hockerstedt K. Pancreatic surgery, not pancreatitis, is the primary cause of diabetes after acute fulminant pancreatitis. Gut 1992;33:843–847.PubMedCrossRefGoogle Scholar
  9. 9.
    Tsiotos GG, Luque-de Leon E, Sarr MG. Long-term outcome of necrotizing pancreatitis treated by necrosectomy. Br J Surg 1998;85:1650–1653.PubMedCrossRefGoogle Scholar
  10. 10.
    Ogawa M, Hirota M, Hayakawa T, Matsuno S, Watanabe S, Atomi Y, et al. Development and use of a new staging system for severe acute pancreatitis based on a nationwide survey in Japan. Pancreas 2002;25:325–330.PubMedCrossRefGoogle Scholar
  11. 11.
    Hirota M, Takada T, Kawarada Y, Hirata K, Mayumi T, Yoshida M, et al. JPN Guidelines for the management of acute pancreatitis: severity assessment of acute pancreatitis. J Hepatobiliary Pancreat Surg 2006;13:33–41.PubMedCrossRefGoogle Scholar
  12. 12.
    Ranson JH, Rifkind KM, Roses DF, Fink SD, Eng K, Spencer FC. Prognostic signs and the role of operative management in acute pancreatitis. Surg Gynecol Obstet 1974;139:69–81.PubMedGoogle Scholar
  13. 13.
    Knaus WA, Draper EA, Wagner DP, Zimmerman JE. APACHE II: a severity of disease classification system. Crit Care Med 1985;13:818–829.PubMedCrossRefGoogle Scholar
  14. 14.
    Mayumi T, Takada T, Kawarada Y, Hirata K, Yoshida M, Sekimoto M, et al. Management strategy for acute pancreatitis in the JPN Guidelines. J Hepatobiliary Pancreat Surg 2006;13:61–67.PubMedCrossRefGoogle Scholar
  15. 15.
    Homma T, Harada H, Koizumi M. Diagnostic criteria for chronic pancreatitis by the Japan Pancreas Society. Pancreas 1997;15:14–15.PubMedCrossRefGoogle Scholar
  16. 16.
    Ueda T, Kuroda Y, Takeyama Y, Yasuda T, Matsumura N, Sawa H, et al. Long-term outcome of acute pancreatitis (in Japanese with English abstract). Suizou (Pancreas) 2005;20:455–464.CrossRefGoogle Scholar
  17. 17.
    Ueda T, Kuroda Y, Takeyama Y, Yasuda T, Matsumura N, Sawa H, et al. Long-term outcome of acute pancreatitis. Pancreas 2006;33:87–88 (JPS selected abstract).Google Scholar
  18. 18.
    Seidensticker F, Otto J, Lankisch PG. Recovery of the pancreas after acute pancreatitis is not necessarily complete. Int J Pancreatol 1995;17:225–229.PubMedGoogle Scholar
  19. 19.
    Kloppel G, Maillet B. The morphological basis for the evolution of acute pancreatitis into chronic pancreatitis. Virchows Arch A Pathol Anat Histopathol 1992;420:1–4.PubMedCrossRefGoogle Scholar
  20. 20.
    Ammann RW, Heitz PU, Kloppel G. Course of alcoholic chronic pancreatitis: a prospective clinicomorphological long-term study. Gastroenterology 1996;111:224–231.PubMedCrossRefGoogle Scholar
  21. 21.
    Angelini G, Pederzoli P, Caliari S, Fratton S, Brocco G, Marzoli G, et al. Long-term outcome of acute necrohemorrhagic pancreatitis. A 4-year follow-up. Digestion 1984;30:131–137.PubMedCrossRefGoogle Scholar
  22. 22.
    Buchler M, Hauke A, Malfertheiner P. Follow-up after acute pancreatitis: morphology and function. In: Beger HG, Buchler M, editors. Acute pancreatitis. Research and clinical management. Berlin Heidelberg New York Tokyo: Springer; 1987. p. 367–374.Google Scholar
  23. 23.
    Kivilaakso E, Lempinen M, Makelainen A, Nikki P, Schroder T. Pancreatic resection versus peritoneal lavation for acute fulminant pancreatitis. A randomized prospective study. Ann Surg 1984;199:426–431.PubMedCrossRefGoogle Scholar
  24. 24.
    Nordback IH, Auvinen OA. Long-term results after pancreas resection for acute necrotizing pancreatitis. Br J Surg 1985;72:687–689.PubMedCrossRefGoogle Scholar
  25. 25.
    Ammori BJ. Applications of minimally invasive surgery in the management of inflammatory and neoplastic diseases of the pancreas. J Hepatobiliary Pancreat Surg 2004;11:107–111.PubMedCrossRefGoogle Scholar
  26. 26.
    Mori T, Abe N, Sugiyama M, Atomi Y. Laparoscopic pancreatic surgery. J Hepatobiliary Pancreat Surg 2005;12:451–455.PubMedCrossRefGoogle Scholar
  27. 27.
    Lowenfels AB, Maisonneuve P, Cavallini G, Ammann RW, Lankisch PG, Andersen JR, et al. Pancreatitis and the risk of pancreatic cancer. International Pancreatitis Study Group. N Engl J Med 1993;328:1433–1437.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Japan 2008

Authors and Affiliations

  • Takeo Yasuda
    • 1
  • Takashi Ueda
    • 1
  • Yoshifumi Takeyama
    • 2
  • Makoto Shinzeki
    • 1
  • Hidehiro Sawa
    • 1
  • Takahiro Nakajima
    • 1
  • Yoshikazu Kuroda
    • 1
  1. 1.Department of Gastroenterological SurgeryKobe University Graduate School of Medical SciencesKobeJapan
  2. 2.Department of SurgeryKinki University School of MedicineOsaka-sayamaJapan

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