Bouça-Machado Tiago, Araújo Teixeira João Paulo, Rebelo Paula, Barbosa Elisabete, Pedersen Jan Bech, Drewes Asbjørn Mohr, Olesen Søren Schou
Department of Surgery, São João University Hospital, Porto, Portugal.
Faculty of Medicine of the University of Porto.
Eur J Gastroenterol Hepatol. 2025 Apr 1;37(4):433-438. doi: 10.1097/MEG.0000000000002928. Epub 2025 Jan 22.
Acute on chronic pancreatitis (ACP) shares a similar clinical presentation with acute pancreatitis (AP) and is often diagnosed and treated in the same way. However, these two conditions may have distinct clinical risk profiles and prognoses. There is currently limited evidence available regarding the specific characteristics of ACP.
This retrospective cohort study included all adult patients admitted with a diagnosis of AP or ACP between 2017 and 2019 at two tertiary referral centers. The primary outcome was disease severity as defined by the Atlanta classification. Secondary outcomes included the presence of local and systemic complications, organ failure, ICU admission, and mortality. Differences in outcomes between ACP and AP were compared using multivariate logistic regression models, with results presented as odds ratios (ORs).
We included 1163 patients, 90% of whom had AP and 10% had ACP. ACP patients were predominantly male (81 vs. 46%; P < 0.001), whereas AP patients were older (mean age 62.6 vs. 56.5 years, P < 0.001). ACP patients had lower amylase and lipase levels ( P < 0.001). Multivariate analysis showed no difference in the risk of moderate or severe pancreatitis (OR, 1.15; 95% CI, 0.66-1.98; P = 0.615). ACP patients had a higher risk of local complications (predominantly pseudocysts) (OR, 1.71; 95% CI, 1.00-2.92; P = 0.049) and a lower risk of organ failure ( P = 0.019) and ICU admission ( P = 0.005).
Our study confirms previous observations that ACP has a more favorable in-hospital prognosis than AP and extends these findings to a modern European setting.
慢性胰腺炎急性发作（ACP）与急性胰腺炎（AP）具有相似的临床表现，且通常以相同方式进行诊断和治疗。然而，这两种病症可能具有不同的临床风险特征和预后。目前关于ACP具体特征的证据有限。
这项回顾性队列研究纳入了2017年至2019年间在两家三级转诊中心因诊断为AP或ACP而入院的所有成年患者。主要结局是由亚特兰大分类定义的疾病严重程度。次要结局包括局部和全身并发症的存在、器官衰竭、入住重症监护病房（ICU）以及死亡率。使用多变量逻辑回归模型比较ACP和AP之间结局的差异，结果以比值比（OR）表示。
我们纳入了1163例患者，其中90%为AP患者，10%为ACP患者。ACP患者以男性为主（81%对46%；P<0.001），而AP患者年龄更大（平均年龄62.6岁对56.5岁，P<0.001）。ACP患者的淀粉酶和脂肪酶水平较低（P<0.001）。多变量分析显示，中度或重度胰腺炎的风险无差异（OR，1.15；95%置信区间，0.66 - 1.98；P = 0.615）。ACP患者发生局部并发症（主要是假性囊肿）的风险较高（OR，1.71；95%置信区间，1.00 - 2.92；P = 0.049），而发生器官衰竭（P = 0.019）和入住ICU（P = 0.005）的风险较低。
我们的研究证实了先前的观察结果，即ACP的院内预后比AP更有利，并将这些发现扩展到现代欧洲背景。
