Division of Gastroenterology and Hepatology, Medical College of Wisconsin, Milwaukee, WI, USA.
Division of Gastroenterology and Hepatology, Medical College of Wisconsin, Milwaukee, WI, USA.
Pancreatology. 2023 Mar;23(2):163-170. doi: 10.1016/j.pan.2023.01.008. Epub 2023 Jan 18.
The prevalence of acute pancreatitis (AP) and mental health disorders (MHDs) are rising. While the association between chronic pancreatitis (CP) and MHDs is established, it is unknown whether there is a risk of MHDs after an index episode of AP. The aim of this study was to evaluate the incidence of MHDs and pharmacotherapy use after an episode of AP.
This was a large observational study using the TriNetX research network, an electronic health record dataset containing inpatient and outpatient data from more than 50 healthcare organizations. Patients with AP from 2015-2020 were identified. Four cohorts were created: acute necrotizing pancreatitis (ANP), acute pancreatitis without necrosis (AP-WON), acute appendicitis, and healthy controls without pancreatitis. The cohorts were matched by age, sex, race, ethnicity, and nicotine and alcohol use. The primary outcome was new composite MHDs at one-year. Secondary outcomes included stratified MHDs, psychiatric medication use, opioid analgesic use, and all-cause mortality.
The ANP, AP-WON, appendicitis, and healthy control cohorts contained 11,806, 177,266, 27,187, and 561,833 patients, respectively. Patients with AP-WON had significantly higher rates of composite MHDs compared with those hospitalized for appendicitis (9.7% vs 4.7%, HR 1.9, 95% CI 1.7-1.9). This association was augmented when comparing ANP to appendicitis (12.8% vs 5.2%, HR 2.4, 95% CI 2.1-2.7). All secondary outcomes were observed at significantly higher rates in the AP-WON cohort when compared to appendicitis. Again, these associations were augmented comparing ANP to appendicitis.
Compared with controls, patients with AP had significantly higher rates of new MHDs and their associated pharmacotherapies at one-year, suggesting that a single episode of AP may independently place patients at risk for developing MHDs irrespective of whether they go on to develop CP.
急性胰腺炎（AP）和精神健康障碍（MHDs）的患病率正在上升。虽然慢性胰腺炎（CP）与 MHDs 之间存在关联，但尚不清楚 AP 发作后是否存在 MHDs 的风险。本研究旨在评估 AP 发作后 MHDs 的发病率和药物治疗的使用情况。
这是一项使用 TriNetX 研究网络的大型观察性研究，该网络是一个包含 50 多个医疗保健组织的住院和门诊数据的电子健康记录数据集。2015-2020 年间确定了患有 AP 的患者。创建了四个队列：急性坏死性胰腺炎（ANP）、无坏死性胰腺炎（AP-WON）、急性阑尾炎和无胰腺炎的健康对照组。通过年龄、性别、种族、民族、尼古丁和酒精使用情况对队列进行匹配。主要结局是一年时新发复合 MHDs。次要结局包括分层 MHDs、精神科药物使用、阿片类镇痛药使用和全因死亡率。
ANP、AP-WON、阑尾炎和健康对照组分别包含 11806、177266、27187 和 561833 名患者。与因阑尾炎住院的患者相比，AP-WON 患者的复合 MHDs 发生率显著更高（9.7% vs. 4.7%，HR 1.9，95%CI 1.7-1.9）。与阑尾炎相比，比较 ANP 时这种关联更为明显（12.8% vs. 5.2%，HR 2.4，95%CI 2.1-2.7）。在 AP-WON 队列中，所有次要结局的发生率均显著高于阑尾炎队列。再次比较 ANP 与阑尾炎，这些关联更为明显。
与对照组相比，AP 患者在一年时出现新的 MHDs 及其相关药物治疗的比率明显更高，这表明单次 AP 发作可能会独立增加患者发生 MHDs 的风险，无论他们是否会发展为 CP。
