Huh Ji Hye, Jeon Hosung, Park Sun Min, Choi EunHee, Lee Geun Sook, Kim Jae Woo, Lee Kyong Joo
Division of Endocrinology and Metabolism.
Division of Gastroenterology and Hepatology, Department of Internal Medicine.
J Clin Gastroenterol. 2018 Feb;52(2):178-183. doi: 10.1097/MCG.0000000000000783.
Predicting severe pancreatitis is important for early aggressive management of patients with acute pancreatitis (AP). Despite the established role of diabetes mellitus (DM) in the risk of AP, the impact of DM on the clinical outcome in AP has not been fully elucidated. The objective of this study was to assess the risk of mortality and severity in AP among patients with type-2 DM.
Patients diagnosed with first attacks of AP were enrolled from January 2013 to June 2015.
A total of 201 patients (63.2% male, mean age, 59.4 y) with AP were included. Etiologies included gallstones (51.2%), alcohol (37.3%), hypertriglyceridemia (2%), and idiopathic causes (9.5%). There were 54 AP patients (26.9%) with type-2 DM. Severity indices in AP, such as Atlanta Classification (severe), Ranson score, and Bedside Index of Severity in Acute Pancreatitis, were higher in subjects with DM than those without DM. Prevalence of intensive care unit admission and mortality were higher in AP patients with DM compared with those without DM. The association between DM and increased risk of mortality in AP remained statistically significant even after adjustments for confounding factors and Atlanta Classification (odds ratio, 7.76, 95% confidence interval, 1.26-47.63, P=0.027).
Type-2 DM was associated with severity and increased mortality in patients with AP. Our findings provide evidence of the potential role of DM in the pathogenesis and management of severe AP.
预测重症胰腺炎对于急性胰腺炎(AP)患者的早期积极治疗至关重要。尽管糖尿病(DM)在AP发病风险中的作用已明确,但DM对AP临床结局的影响尚未完全阐明。本研究的目的是评估2型糖尿病患者发生AP时的死亡风险和严重程度。
选取2013年1月至2015年6月诊断为首次发作AP的患者。
共纳入201例AP患者(男性占63.2%,平均年龄59.4岁)。病因包括胆结石(51.2%)、酒精(37.3%)、高甘油三酯血症(2%)和特发性病因(9.5%)。有54例(26.9%)AP患者患有2型糖尿病。糖尿病患者的AP严重程度指标,如亚特兰大分类(重症)、兰森评分和急性胰腺炎床边严重程度指数,均高于非糖尿病患者。与非糖尿病AP患者相比,糖尿病AP患者入住重症监护病房的比例和死亡率更高。即使在对混杂因素和亚特兰大分类进行调整后,DM与AP患者死亡风险增加之间的关联仍具有统计学意义(优势比,7.76;95%置信区间,1.26 - 47.63;P = 0.027)。
2型糖尿病与AP患者的病情严重程度和死亡率增加相关。我们的研究结果为DM在重症AP发病机制和治疗中的潜在作用提供了证据。