Department of Internal Medicine, I. Medical Clinic and Polyclinic, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
Department for Interdisciplinary Endoscopy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
Eur J Intern Med. 2022 Aug;102:54-62. doi: 10.1016/j.ejim.2022.05.034. Epub 2022 Jun 4.
BACKGROUND & AIMS: Acute pancreatitis (AP) is a frequent indication for hospitalization and may present with varying degrees of severity. AP often coincides with hepatic disease, yet the impact of liver cirrhosis (LC) on the course of AP is uncertain, and early identification of patients at risk for complications remains challenging. We aimed to assess the impact of LC on the development of pancreatic and extra-pancreatic complications of AP, and to identify predictors of adverse outcomes in cirrhotic patients.
All adult patients with LC and AP (LC-AP, n = 52) admitted to our institution between 01/2011-03/2020 were subjected to a 1:2 matched-pair analysis with patients with AP but without LC (NLC-AP, n = 104).
At hospital admission, Glasgow-Imrie and Ranson scores as well as markers of systemic inflammation were comparable in LC-AP and NLC-AP patients, and both groups had similar rates of necrotizing AP. Infectious complications were more prevalent, and medical interventions were performed more often and with higher complication rates in LC-AP patients. While only 12.5% of NLC-AP patients developed organ failures, 48% of LC-AP patients developed single (7.7%) or multiple organ failure (40.4%), resulting in 44% of LC-AP patients with acute-on-chronic liver failure (ACLF). Patients with overt portal hypertension were particularly prone for decompensation. Mortality was higher among LC-AP compared to NLC-AP patients (6-month mortality 25% vs. 1.9%, p < 0.001), and SOFA and MELD scores at admission most accurately predicted outcomes in LC-AP.
Among AP patients, concomitant cirrhosis substantially increases the risk for infections, periprocedural complications, multiorgan failure and death.
急性胰腺炎（AP）是住院的常见指征，其严重程度可能不同。AP 常与肝脏疾病同时发生，但肝硬化（LC）对 AP 病程的影响尚不确定，早期识别发生并发症的高危患者仍然具有挑战性。我们旨在评估 LC 对 AP 胰腺和胰外并发症发展的影响，并确定肝硬化患者不良结局的预测因素。
对我院于 2011 年 1 月至 2020 年 3 月期间收治的所有伴有 LC 和 AP（LC-AP，n=52）的成年患者进行了 1:2 配对分析，并与不伴有 LC 的 AP 患者（NLC-AP，n=104）进行了比较。
入院时，LC-AP 和 NLC-AP 患者的格拉斯哥-伊姆赖（Glasgow-Imrie）和朗森（Ranson）评分以及全身炎症标志物无差异，两组患者的坏死性 AP 发生率相似。LC-AP 患者的感染性并发症更为常见，且更常进行医疗干预，并发症发生率更高。虽然仅有 12.5%的 NLC-AP 患者发生器官衰竭，但 48%的 LC-AP 患者发生单一器官（7.7%）或多器官衰竭（40.4%），导致 44%的 LC-AP 患者发生慢加急性肝衰竭（ACLF）。存在显性门静脉高压的患者尤其容易发生失代偿。LC-AP 患者的死亡率高于 NLC-AP 患者（6 个月死亡率 25%比 1.9%，p<0.001），入院时 SOFA 和 MELD 评分最能准确预测 LC-AP 的预后。
在 AP 患者中，同时伴有肝硬化会显著增加感染、围手术期并发症、多器官衰竭和死亡的风险。
