Morbid Obesity Is Associated With Adverse Clinical Outcomes in Acute Pancreatitis: A Propensity-Matched Study

Krishna, Somashekar G.; Hinton, Alice; Oza, Veeral; Hart, Phil A.; Swei, Eric; El-Dika, Samer; Stanich, Peter P.; Hussan, Hisham; Zhang, Cheng; Conwell, Darwin L.

doi:10.1038/ajg.2015.343

Cited by 91 publications

(69 citation statements)

References 44 publications

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“…Other studies have also shown decreasing mortality rates over the last decade, which are further corroborated by our finding of a decrease from 3,749 (1.62%) to 2,130 (0.79%) during the study period. 12,13,18–20 . These outcomes are justifiable since milder cases of AP are becoming easier to detect with better testing and complications can be identified earlier in the disease course.…”

Section: Discussionmentioning

confidence: 99%

The Changing Epidemiology of Acute Pancreatitis Hospitalizations

et al. 2017

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Objectives The epidemiological trends contributing to increasing acute pancreatitis (AP) hospitalizations remain unknown. We sought to analyze etiological factors and outcomes of increasing AP-hospitalizations. Methods Utilizing the Nationwide Inpatient Sample, retrospective analyses of adult (≥18 years) inpatient admissions with a primary diagnosis of AP (total N: 2,016,045) were performed. Patient hospitalizations from 2009–2012 were compared to those from 2002–2005. Results Compared to 2002–2005, there was a 13.2% (p<0.001) increase in AP-admissions in 2009–2012. Multivariate analysis adjusted for “time-period”, patient and hospital demographics, AP-etiologies, and disease associations, demonstrated an increase in the odds of associated-chronic pancreatitis (CP) (2002–2005: odds ratio [OR] 32.04, 95% confidence interval [CI] 30.51–33.64; 2009–2012: OR 35.02, 95% CI 33.94–36.14); while associated odds of gallstones (2002–2005: OR 36.37, 95% CI 35.32–37.46; 2009–2012: OR 29.85, 95% CI 29.09–30.64) decreased. Compared to 2002–2005, the AP-related mortality decreased in 2009–2012 (1.62% to 0.79%, p<0.001) and was lower in AP with associated-CP (0.65% to 0.26%; p<0.001) compared to AP without-CP. Conclusion In the preceding decade, AP-hospitalizations are increasing but associated mortality is declining. Associated-CP has emerged as a leading contributor for AP-related hospitalizations. Further research is needed to identify novel interventions to prevent disease progression of AP.

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Section: Discussionmentioning

confidence: 99%

The Changing Epidemiology of Acute Pancreatitis Hospitalizations

et al. 2017

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“…A subject in which close similarities between human and animal models may exist is related to the worsening effects of obesity, especially intrapancreatic fat necrosis, on disease severity 57 . Both diet-induced obesity and congenital forms of obesity are used to model the human state.…”

Section: Animal Models Of Clinical Acute Pancreatitismentioning

confidence: 99%

Do Animal Models of Acute Pancreatitis Reproduce Human Disease?

Gorelick

Lerch

2017

Cellular and Molecular Gastroenterology and Hepatology

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Acute pancreatitis is currently the most common cause of hospital admission among all nonmalignant gastrointestinal diseases. To understand the pathophysiology of the disease and as a potential step toward developing targeted therapies, attempts to induce the disease experimentally began more than 100 years ago. Recent decades have seen progress in developing new experimental pancreatitis models as well as elucidating many underlying cell biological and pathophysiological disease mechanisms. Some models have been developed to reflect specific causes of acute pancreatitis in human beings. However, the paucity of data relating to the molecular mechanisms of human disease, the likelihood that multiple genetic and environmental factors affect the risk of disease development and its severity, and the limited information regarding the natural history of disease in human beings make it difficult to evaluate the value of disease models. Here, we provide an overview of key models and discuss our views on their strengths for characterizing cell biological disease mechanisms or for identifying potential therapeutic targets. We also acknowledge their limitations.

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“…To investigate the controversial association between obesity and mortality in patients with AP, Krishna et al . used data from the NIS (2007–2011) to perform propensity score-matched analyses to compare outcomes for adult inpatients with AP with and without morbid obesity 22 . Morbid obesity was associated with higher frequencies of acute kidney injury (10.8% versus 8.2%; p <0.001) and respiratory failure (7.9% versus 6.4%; p <0.001) and higher odds of mortality (OR 1.6, 95% CI 1.2–2.1) 22 .…”

Section: Recent Advances In Epidemiology and Evaluation Of Acute Pancmentioning

confidence: 99%

“…used data from the NIS (2007–2011) to perform propensity score-matched analyses to compare outcomes for adult inpatients with AP with and without morbid obesity 22 . Morbid obesity was associated with higher frequencies of acute kidney injury (10.8% versus 8.2%; p <0.001) and respiratory failure (7.9% versus 6.4%; p <0.001) and higher odds of mortality (OR 1.6, 95% CI 1.2–2.1) 22 . Finally, following hospital discharge for a first episode of AP, a recent study reported 1-year mortality associated with three independent predictors: readmission within 30 days, higher Charlson comorbidity index, and longer hospitalizations 23 .…”

Section: Recent Advances In Epidemiology and Evaluation Of Acute Pancmentioning

confidence: 99%

“…Studies from over 10 years ago reported frequencies of 40–50% and about 20% for biliary AP and alcohol AP, respectively 22, 46, 47 . A more recent study reported a lower frequency of biliary AP (22%) and a higher frequency of alcohol AP (29%), likely due to inclusion of patients with CP, representing 15% of the cohort of patients with AP.…”

Section: Recent Advances In Epidemiology and Evaluation Of Acute Pancmentioning

confidence: 99%

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Recent advances in understanding and managing acute pancreatitis

Mandalia¹,

Wamsteker²,

DiMagno³

2018

F1000Res

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This review highlights advances made in recent years in the diagnosis and management of acute pancreatitis (AP). We focus on epidemiological, clinical, and management aspects of AP. Additionally, we discuss the role of using risk stratification tools to guide clinical decision making. The majority of patients suffer from mild AP, and only a subset develop moderately severe AP, defined as a pancreatic local complication, or severe AP, defined as persistent organ failure. In mild AP, management typically involves diagnostic evaluation and supportive care resulting usually in a short hospital length of stay (LOS). In severe AP, a multidisciplinary approach is warranted to minimize morbidity and mortality over the course of a protracted hospital LOS. Based on evidence from guideline recommendations, we discuss five treatment interventions, including intravenous fluid resuscitation, feeding, prophylactic antibiotics, probiotics, and timing of endoscopic retrograde cholangiopancreatography (ERCP) in acute biliary pancreatitis. This review also highlights the importance of preventive interventions to reduce hospital readmission or prevent pancreatitis, including alcohol and smoking cessation, same-admission cholecystectomy for acute biliary pancreatitis, and chemoprevention and fluid administration for post-ERCP pancreatitis. Our review aims to consolidate guideline recommendations and high-quality studies published in recent years to guide the management of AP and highlight areas in need of research.

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Morbid Obesity Is Associated With Adverse Clinical Outcomes in Acute Pancreatitis: A Propensity-Matched Study

Cited by 91 publications

References 44 publications

The Changing Epidemiology of Acute Pancreatitis Hospitalizations

The Changing Epidemiology of Acute Pancreatitis Hospitalizations

Do Animal Models of Acute Pancreatitis Reproduce Human Disease?

Recent advances in understanding and managing acute pancreatitis

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