From the *Division of Gastroenterology, Johns Hopkins Hospital, Baltimore, MD; †Division of Gastroenterology and Hepatology, University of Pittsburgh Medical Center, Pittsburgh, PA; and ‡Pancreatitis Center and §Department of Surgery, Johns Hopkins Hospital, Baltimore, MD.
Pancreas. 2013 Nov;42(8):1245-50. doi: 10.1097/MPA.0b013e3182a85af3.
The objectives of this study were to evaluate the severity of patients with acute pancreatitis (AP) on chronic pancreatitis (CP) and compare this to patients with AP without CP.
The Maryland Health Services database was queried for all adult inpatient discharges with a primary diagnosis of AP from 1994 to 2010. Acute pancreatitis on CP and AP without CP were defined by the presence of the associated diagnosis code for CP. Severity was defined as organ failure, intensive care unit stay, or mortality.
Acute pancreatitis on CP accounted for 13.7% of all AP discharges (9747/70,944). The proportion of AP-on-CP discharges doubled during the study period (8.8% to 17.6%; P < 0.0001). When compared with patients with AP without CP, AP-on-CP patients were younger, were more likely to be male and black, had higher rates of alcohol and drug abuse, and had less severe disease with lower rates of mortality, organ failure, need for mechanical ventilation, and intensive care unit stay. Among AP-on-CP patients, significant predictors of severity included advanced age, weight loss, and 2 or more comorbidities.
Patients with AP on CP have less severe disease than do those with AP without CP. Weight loss, advanced age, and comorbidity increase the risk of severity in patients with AP on CP.
本研究旨在评估伴有慢性胰腺炎（CP）的急性胰腺炎（AP）患者的严重程度，并与不伴有 CP 的 AP 患者进行比较。
通过检索 1994 年至 2010 年期间马里兰州卫生服务数据库中所有伴有 AP 主要诊断的成年住院患者的资料。AP 伴 CP 和不伴 CP 是通过 CP 相关诊断代码来定义的。严重程度定义为器官衰竭、入住重症监护病房或死亡。
AP 伴 CP 占所有 AP 出院患者的 13.7%（9747/70944）。在研究期间，AP 伴 CP 出院患者的比例增加了一倍（8.8%至 17.6%；P<0.0001）。与不伴有 CP 的 AP 患者相比，AP 伴 CP 患者更年轻，更可能为男性和黑人，滥用酒精和药物的比例更高，疾病严重程度较轻，死亡率、器官衰竭、需要机械通气和入住重症监护病房的比例较低。在 AP 伴 CP 患者中，严重程度的显著预测因素包括年龄较大、体重减轻和 2 种或更多合并症。
伴有 CP 的 AP 患者的疾病严重程度低于不伴有 CP 的 AP 患者。体重减轻、年龄较大和合并症增加了伴有 CP 的 AP 患者发生严重程度的风险。
