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Digestive Diseases and Sciences

, Volume 59, Issue 5, pp 1055–1062 | Cite as

Incidence, Risk Factors and Clinical Course of Pancreatic Fluid Collections in Acute Pancreatitis

  • Mei Lan Cui
  • Kook Hyun Kim
  • Ho Gak Kim
  • Jimin Han
  • Hyunsoo Kim
  • Kwang Bum Cho
  • Min Kyu Jung
  • Chang Min Cho
  • Tae Nyeun Kim
Original Paper

Abstract

Background

Acute pancreatitis is an acute inflammatory process of the pancreas with variable involvement of other regional tissues or remote organ systems. Acute fluid collections and pseudocyst formation are the most frequent complications of acute pancreatitis.

Aims

The aims of this study were to evaluate the incidence, risk factors, and clinical course of pancreatic fluid collections and pseudocyst formation following acute pancreatitis.

Methods

A prospective multicenter study was conducted in five participating centers with 302 patients diagnosed with acute pancreatitis from January 2011 to July 2012.

Results

The incidence of pancreatic fluid collections and pseudocyst was 42.7 and 6.3 %, respectively. Patients with fluid collections were significantly younger, compared to those without fluid collections (51.5 ± 15.9 vs. 60.4 ± 16.5 years, P = 0.000). The proportion of alcoholic etiology (54.3 %) in patients with fluid collections was significantly higher compared to other etiologies (P = 0.000). C-reactive protein (CRP) (48 h) was significantly higher in patients with fluid collections, compared to patients without fluid collections (39.2 ± 77.4 vs. 15.1 ± 36.2 mg/dL, P = 0.016). LDH (48 h) was significantly higher in patients with pseudocyst formation, compared to patients with complete resolution (1,317.6 ± 706.4 vs. 478.7 ± 190.5 IU/L, P = 0.000). Pancreatic fluid collections showed spontaneous resolution in 69.8 % (90/129) and 84.2 % of the pseudocysts disappeared or decreased in size during follow up.

Conclusions

Age, CRP (48 h), and alcohol etiology are risk factors for pancreatic fluid collections. LDH (48 h) appears to be a risk factor for pseudocyst formation. Most pseudocysts showed a decrease in size or spontaneous resolution with conservative management.

Keywords

Acute pancreatitis Fluid collections Pseudocyst Incidence 

Notes

Acknowledgments

This work was supported by the 2011 Yeungnam University Research Grant, and the grant of Research Institute of Medical Science, Catholic University of Daegu (2011).

Conflict of interest

None.

References

  1. 1.
    Sarr MG. 2012 Revision of the Atlanta classification of acute pancreatitis. Pol Arch Med Wewn. 2013;123:118–124.PubMedGoogle Scholar
  2. 2.
    Kim CD. Current status of acute pancreatitis in Korea. Korean J Gastroenterol. 2003;42:1–11.PubMedGoogle Scholar
  3. 3.
    Bradley EL 3rd. A clinically based classification system for acute pancreatitis. Summary of the international symposium on acute pancreatitis, Atlanta, GA, 11–13 September 1992. Arch Surg. 1993;128:586–590.PubMedCrossRefGoogle Scholar
  4. 4.
    Diculescu M, Ciocirlan M, Ciocirlan M, Stanescu D, Ciprut T, Marinescu T. Predictive factors for pseudocysts and peripancreatic collections in acute pancreatitis. Rom J Gastroenterol. 2005;14:129–134.PubMedGoogle Scholar
  5. 5.
    Kourtesis G, Wilson SE, Williams RA. The clinical significance of fluid collections in acute pancreatitis. Am Surg. 1990;56:796–799.PubMedGoogle Scholar
  6. 6.
    London NJ, Neoptolemos JP, Lavelle J, Bailey I, James D. Serial computed tomography scanning in acute pancreatitis: a prospective study. Gut. 1989;30:397–403.PubMedCentralPubMedCrossRefGoogle Scholar
  7. 7.
    Lankisch PG, Weber-Dany B, Maisonneuve P, Lowenfels AB. Pancreatic pseudocysts: prognostic factors for their development and their spontaneous resolution in the setting of acute pancreatitis. Pancreatology. 2012;12:85–90.PubMedCrossRefGoogle Scholar
  8. 8.
    Maringhini A, Uomo G, Patti R, et al. Pseudocysts in acute nonalcoholic pancreatitis: incidence and natural history. Dig Dis Sci. 1999;44:1669–1673.PubMedCrossRefGoogle Scholar
  9. 9.
    Bradley EL, Gonzalez AC, Clements JL Jr. Acute pancreatic pseudocysts: incidence and implications. Ann Surg. 1976;184:734–737.PubMedCentralPubMedCrossRefGoogle Scholar
  10. 10.
    Kim KO, Kim TN. Acute pancreatic pseudocyst: incidence, risk factors, and clinical outcomes. Pancreas. 2012;41:577–581.PubMedCrossRefGoogle Scholar
  11. 11.
    Lankisch PG, Burchard-Reckert S, Petersen M, et al. Etiology and age have only a limited influence on the course of acute pancreatitis. Pancreas. 1996;13:344–349.PubMedCrossRefGoogle Scholar
  12. 12.
    Nguyen BL, Thompson JS, Edney JA, Bragg LE, Rikkers LF. Influence of the etiology of pancreatitis on the natural history of pancreatic pseudocysts. Am J Surg. 1991;162:527–530.PubMedCrossRefGoogle Scholar
  13. 13.
    Schulze S, Baden H, Brandenhoff P, Larsen T, Burcharth F. Pancreatic pseudocysts during first attack of acute pancreatitis. Scand J Gastroenterol. 1986;21:1221–1223.PubMedCrossRefGoogle Scholar
  14. 14.
    Harvey MH, Cates MC, Reber HA. Possible mechanisms of acute pancreatitis induced by ethanol. Am J Surg. 1988;155:49–56.PubMedCrossRefGoogle Scholar
  15. 15.
    Chen CC, Wang SS, Chao Y, et al. C-reactive protein and lactate dehydrogenase isoenzymes in the assessment of the prognosis of acute pancreatitis. J Gastroenterol Hepatol. 1992;7:363–366.PubMedCrossRefGoogle Scholar
  16. 16.
    Zrnic IK, Milic S, Fisic E, Radic M, Stimac D. [C-reactive protein and lactate dehydrogenase as single prognostic factors of severity in acute pancreatitis]. Lijec Vjesn. 2007;129:1–4.PubMedGoogle Scholar
  17. 17.
    Neoptolemos JP, Kemppainen EA, Mayer JM, et al. Early prediction of severity in acute pancreatitis by urinary trypsinogen activation peptide: a multicentre study. Lancet. 2000;355:1955–1960.PubMedCrossRefGoogle Scholar
  18. 18.
    Mayer AD, McMahon MJ, Bowen M, Cooper EH. C reactive protein: an aid to assessment and monitoring of acute pancreatitis. J Clin Pathol. 1984;37:207–211.PubMedCentralPubMedCrossRefGoogle Scholar
  19. 19.
    Vitas GJ, Sarr MG. Selected management of pancreatic pseudocysts: operative versus expectant management. Surgery. 1992;111:123–130.PubMedGoogle Scholar
  20. 20.
    Yeo CJ, Bastidas JA, Lynch-Nyhan A, Fishman EK, Zinner MJ, Cameron JL. The natural history of pancreatic pseudocysts documented by computed tomography. Surg Gynecol Obstet. 1990;170:411–417.PubMedGoogle Scholar
  21. 21.
    Mehta R, Suvarna D, Sadasivan S, et al. Natural course of asymptomatic pancreatic pseudocyst: a prospective study. Indian J Gastroenterol. 2004;23:140–142.PubMedGoogle Scholar
  22. 22.
    Soliani P, Ziegler S, Franzini C, et al. The size of pancreatic pseudocyst does not influence the outcome of invasive treatments. Dig Liver Dis. 2004;36:135–140.PubMedCrossRefGoogle Scholar
  23. 23.
    Bradley EL, Clements JL Jr, Gonzalez AC. The natural history of pancreatic pseudocysts: a unified concept of management. Am J Surg. 1979;137:135–141.PubMedCrossRefGoogle Scholar
  24. 24.
    Floyd A, Pedersen L, Nielsen GL, Thorladcius-Ussing O, Sorensen HT. Secular trends in incidence and 30-day case fatality of acute pancreatitis in North Jutland County, Denmark: a register-based study from 1981–2000. Scand J Gastroenterol. 2002;37:1461–1465.PubMedCrossRefGoogle Scholar
  25. 25.
    Gullo L, Migliori M, Olah A, et al. Acute pancreatitis in five European countries: etiology and mortality. Pancreas. 2002;24:223–227.PubMedCrossRefGoogle Scholar
  26. 26.
    Mutinga M, Rosenbluth A, Tenner SM, Odze RR, Sica GT, Banks PA. Does mortality occur early or late in acute pancreatitis? Int J Pancreatol. 2000;28:91–95.PubMedCrossRefGoogle Scholar
  27. 27.
    Sekimoto M, Takada T, Kawarada Y, 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.PubMedCentralPubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2013

Authors and Affiliations

  • Mei Lan Cui
    • 1
  • Kook Hyun Kim
    • 1
  • Ho Gak Kim
    • 2
  • Jimin Han
    • 2
  • Hyunsoo Kim
    • 3
  • Kwang Bum Cho
    • 4
  • Min Kyu Jung
    • 5
  • Chang Min Cho
    • 5
  • Tae Nyeun Kim
    • 1
  1. 1.Division of Gastroenterology and Hepatology, Department of Internal MedicineYeungnam University College of MedicineTaeguKorea
  2. 2.Department of Internal MedicineCatholic University of Daegu School of MedicineTaeguKorea
  3. 3.Department of Internal MedicineDaegu Fatima HospitalTaeguKorea
  4. 4.Department of Internal MedicineKeimyung University School of MedicineTaeguKorea
  5. 5.Department of Internal MedicineKyungpook National University School of MedicineTaeguKorea

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