The relationship between pre-existing diabetes mellitus and the severity of acute pancreatitis: Report from a large international registry.

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Citation: Pancreatology. 22(1):85-91, 2022 Jan.PMID: 34656431Institution: MedStar Washington Hospital CenterDepartment: Internal Medicine ResidencyForm of publication: Journal ArticleMedline article type(s): Journal ArticleSubject headings: *Diabetes Mellitus, Type 2/ep [Epidemiology] | *Pancreatitis/ep [Epidemiology] | Acute Disease | Adult | Aged | Diabetes Mellitus, Type 2/co [Complications] | Female | Hospitalization | Humans | Male | Middle Aged | Pancreatitis/co [Complications] | Prevalence | Registries | Retrospective Studies | Severity of Illness Index | Systemic Inflammatory Response Syndrome/ep [Epidemiology]Year: 2022Name of journal: Pancreatology : official journal of the International Association of Pancreatology (IAP) ... [et al.]Abstract: BACKGROUND/OBJECTIVES: The relationship between pre-existing diabetes mellitus (DM) and acute pancreatitis (AP) severity has not been established. We assessed the impact of pre-existing DM on AP severity in an international, prospectively ascertained registry.CONCLUSION: About one in 5 patients with AP have pre-existing DM. Once confounding risk factors are considered, pre-existing DM per se is not a risk factor for severe AP. Copyright (c) 2021. Published by Elsevier B.V.METHODS: APPRENTICE registry prospectively enrolled 1543 AP patients from 22 centers across 4 continents (8 US, 6 Europe, 5 Latin America, 3 India) between 2015 and 2018, and collected detailed clinical information. Pre-existing DM was defined a diagnosis of DM prior to AP admission. The primary outcome was AP severity defined by the Revised Atlanta Classification (RAC). Secondary outcomes were development of systemic inflammatory response syndrome (SIRS) or intensive care unit (ICU) admission.RESULTS: Pre-existing DM was present in 270 (17.5%) AP patients, of whom 252 (93.3%) had type 2 DM. Patients with pre-existing DM were significantly (p < 0.05) older (55.8 +/- 16 vs. 48.3 +/- 18.7 years), more likely to be overweight (BMI 29.5 +/- 7 vs. 27.2 +/- 6.2), have hypertriglyceridemia as the etiology (15% vs. 2%) and prior AP (33 vs. 24%). Mild, moderate, and severe AP were noted in 66%, 23%, and 11% of patients, respectively. On multivariable analysis, pre-existing DM did not significantly impact AP severity assessed by the RAC (moderate-severe vs. mild AP, OR = 0.86, 95% CI 0.63-1.18; severe vs. mild-moderate AP, OR = 1.05, 95% CI, 0.67-1.63), development of SIRS, or the need for ICU admission. No interaction was noted between DM status and continent.All authors: Archibugi L, Barbu ST, Conwell DL, Cote GA, de-Madaria E, Easler JJ, Ferreira Bogado M, Goenka MK, Gonzalez JA, Gulla A, Gutierrez SC, Hart PA, Hinton A, Jeong K, Kochhar R, Lee PJ, Nawaz H, Ocampo C, Papachristou GI, Paragomi P, Pelaez-Luna M, Pothoulakis I, Singh VK, Stevens T, Talukdar R, Thakkar S, Toledo FGS, Triantafyllou K, Wu BU, Yadav D, Zarnescu NOriginally published: Pancreatology. 22(1):85-91, 2022 Jan.Fiscal year: FY2022Digital Object Identifier: Date added to catalog: 2022-02-21
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Journal Article MedStar Authors Catalog Article 34656431 Available 34656431

BACKGROUND/OBJECTIVES: The relationship between pre-existing diabetes mellitus (DM) and acute pancreatitis (AP) severity has not been established. We assessed the impact of pre-existing DM on AP severity in an international, prospectively ascertained registry.

CONCLUSION: About one in 5 patients with AP have pre-existing DM. Once confounding risk factors are considered, pre-existing DM per se is not a risk factor for severe AP. Copyright (c) 2021. Published by Elsevier B.V.

METHODS: APPRENTICE registry prospectively enrolled 1543 AP patients from 22 centers across 4 continents (8 US, 6 Europe, 5 Latin America, 3 India) between 2015 and 2018, and collected detailed clinical information. Pre-existing DM was defined a diagnosis of DM prior to AP admission. The primary outcome was AP severity defined by the Revised Atlanta Classification (RAC). Secondary outcomes were development of systemic inflammatory response syndrome (SIRS) or intensive care unit (ICU) admission.

RESULTS: Pre-existing DM was present in 270 (17.5%) AP patients, of whom 252 (93.3%) had type 2 DM. Patients with pre-existing DM were significantly (p < 0.05) older (55.8 +/- 16 vs. 48.3 +/- 18.7 years), more likely to be overweight (BMI 29.5 +/- 7 vs. 27.2 +/- 6.2), have hypertriglyceridemia as the etiology (15% vs. 2%) and prior AP (33 vs. 24%). Mild, moderate, and severe AP were noted in 66%, 23%, and 11% of patients, respectively. On multivariable analysis, pre-existing DM did not significantly impact AP severity assessed by the RAC (moderate-severe vs. mild AP, OR = 0.86, 95% CI 0.63-1.18; severe vs. mild-moderate AP, OR = 1.05, 95% CI, 0.67-1.63), development of SIRS, or the need for ICU admission. No interaction was noted between DM status and continent.

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