Institute for Translational Medicine, Medical School, University of Pécs, Pécs, Hungary; Center for Translational Medicine, Semmelweis University, Budapest, Hungary.
Institute for Translational Medicine, Medical School, University of Pécs, Pécs, Hungary; Department of Metagenomics, University of Debrecen, Debrecen, Hungary; Department of Laboratory Medicine, University of Pécs, Pécs, Hungary.
Gastroenterology. 2023 Sep;165(3):682-695. doi: 10.1053/j.gastro.2023.05.028. Epub 2023 May 27.
BACKGROUND & AIMS: The in-hospital survival of patients suffering from acute pancreatitis (AP) is 95% to 98%. However, there is growing evidence that patients discharged after AP may be at risk of serious morbidity and mortality. Here, we aimed to investigate the risk, causes, and predictors of the most severe consequence of the post-AP period: mortality.
A total of 2613 well-characterized patients from 25 centers were included and followed by the Hungarian Pancreatic Study Group between 2012 and 2021. A general and a hospital-based population was used as the control group.
After an AP episode, patients have an approximately threefold higher incidence rate of mortality than the general population (0.0404 vs 0.0130 person-years). First-year mortality after discharge was almost double than in-hospital mortality (5.5% vs 3.5%), with 3.0% occurring in the first 90-day period. Age, comorbidities, and severity were the most significant independent risk factors for death following AP. Furthermore, multivariate analysis identified creatinine, glucose, and pleural fluid on admission as independent risk factors associated with post-discharge mortality. In the first 90-day period, cardiac failure and AP-related sepsis were among the main causes of death following discharge, and cancer-related cachexia and non-AP-related infection were the key causes in the later phase.
Almost as many patients in our cohort died in the first 90-day period after discharge as during their hospital stay. Evaluation of cardiovascular status, follow-up of local complications, and cachexia-preventing oncological care should be an essential part of post-AP patient care. Future study protocols in AP must include at least a 90-day follow-up period after discharge.
患有急性胰腺炎（AP）的患者住院期间的存活率为 95%至 98%。然而，越来越多的证据表明，AP 出院后的患者可能面临严重发病率和死亡率的风险。在此，我们旨在研究 AP 后最严重后果（即死亡率）的风险、原因和预测因素。
共有 25 个中心的 2613 名特征明确的患者被纳入匈牙利胰腺研究组，从 2012 年到 2021 年进行随访。一般人群和住院人群作为对照组。
AP 发作后，患者的死亡率比一般人群高约三倍（0.0404 比 0.0130 人年）。出院后第一年的死亡率几乎是住院期间的两倍（5.5%比 3.5%），其中 3.0%发生在第 90 天内。年龄、合并症和严重程度是 AP 后死亡的最重要独立危险因素。此外，多变量分析确定入院时的肌酐、葡萄糖和胸腔积液是与出院后死亡率相关的独立危险因素。在第 90 天内，心衰竭和 AP 相关败血症是出院后死亡的主要原因，而癌症相关恶病质和非 AP 相关感染是后期的主要原因。
在我们的队列中，几乎有同样多的患者在出院后的第 90 天内死亡，而在住院期间死亡。评估心血管状态、随访局部并发症和预防恶病质的肿瘤治疗应成为 AP 后患者护理的重要组成部分。未来的 AP 研究方案必须包括出院后至少 90 天的随访期。
