Pediatric Gastroenterology, Hepatology and Nutrition Clinic, Dana-Dwek Children's Hospital, The Tel-Aviv Medical Center and Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel.
J Pediatr Gastroenterol Nutr. 2019 May;68(5):720-726. doi: 10.1097/MPG.0000000000002294.
The course and evolution of pediatric acute pancreatitis (AP) is poorly understood. Prognostication models in children perform poorly and lack consensus. We aimed to identify predictors of AP severity, and the risk for AP recurrence.
We retrospectively studied all patients hospitalized with AP at a single tertiary center, between January 1995 and June 2016. Patient demographics and admission laboratory data were assessed for severity and recurrence prediction.
A total of 68 patients accounting for a total of 117 (15 moderate-severe) AP episodes were reviewed. Patients with moderate-severe disease were significantly younger (median [interquartile range (IQR)] of 8.3 [4.0-14.4] vs 13.8 [8.1-16.0] years, P = 0.02). Young age at presentation was associated with odds ratio of 3.8 (confidence interval [CI] 1.2-12.1) for children younger than 12 years and 5.8 (CI 1.6-21.4) for children younger than 6 years for developing moderate-severe disease.Further subanalysis of the 59 patients with first-time AP episodes, demonstrated younger age (median [IQR] of 5.3 [2.9-10.4] vs 12.0 [6.3-15.8] years, P = 0.03) and elevated white blood cell count (median [IQR] of 22.8 [11.8-31.3] vs 11.0 [8.1-14.6] 10/L, P < 0.01) of patients with moderate-severe disease, conferring a risk for moderate-severe disease with odds ratio of 7.5 (CI 1.5-38.2) for children younger than 6 years and 5.3 (CI 1.1-25.4) for patients with white blood cell count >15 × 10/L, respectively. Fourteen (23.7%) of 59 patients with first-time episodes had recurrent AP. Analysis of the data at the primary episode failed to identify predictors to indicate future recurrence.
In our cohort, only young age (<12 years) predicted AP severity. No parameters were identified to predict future development of AP recurrence.
小儿急性胰腺炎（AP）的病程和演变尚不清楚。儿童的预后模型表现不佳且缺乏共识。本研究旨在确定 AP 严重程度和 AP 复发的预测因素。
我们回顾性研究了 1995 年 1 月至 2016 年 6 月期间在一家三级中心住院的所有 AP 患者。评估患者的人口统计学和入院实验室数据以预测严重程度和复发。
共回顾了 68 例患者，共计 117 例（15 例为中度-重度）AP 发作。患有中度-重度疾病的患者明显更年轻（中位数[四分位距（IQR）]为 8.3 [4.0-14.4] vs 13.8 [8.1-16.0]岁，P=0.02）。发病时年龄较小与 12 岁以下儿童发生中度-重度疾病的比值比 3.8（95%置信区间[CI] 1.2-12.1）和 6 岁以下儿童 5.8（95%CI 1.6-21.4）相关。对 59 例首次发作的 AP 患者的进一步亚分析显示，年龄较小（中位数[IQR]为 5.3 [2.9-10.4] vs 12.0 [6.3-15.8]岁，P=0.03）和白细胞计数升高（中位数[IQR]为 22.8 [11.8-31.3] vs 11.0 [8.1-14.6]×10/L，P＜0.01）的患者更易发生中度-重度疾病，与 6 岁以下儿童比值比 7.5（95%CI 1.5-38.2）和白细胞计数＞15×10/L 的患者比值比 5.3（95%CI 1.1-25.4）分别具有发生中度-重度疾病的风险。59 例首次发作的患者中有 14 例（23.7%）发生了复发性 AP。对首发发作的数据进行分析，未能确定预示未来复发的预测因素。
在我们的队列中，只有年龄较小（＜12 岁）可预测 AP 的严重程度。没有参数可以预测未来 AP 复发的发生。
