Bassem Matta1, Amir Gougol1, Xiaotian Gao2, Nageshwar Reddy3, Rupjyoti Talukdar3, Rakesh Kochhar4, Mahesh Kumar Goenka5, Aiste Gulla6, Jose A Gonzalez7, Vikesh K Singh8, Miguel Ferreira9, Tyler Stevens10, Sorin T Barbu11, Haq Nawaz12, Silvia C Gutierrez13, Narcis O Zarnescu14, Gabriele Capurso15, Jeffrey Easler16, Konstantinos Triantafyllou17, Mario Pelaez-Luna18, Shyam Thakkar19, Carlos Ocampo20, Enrique de-Madaria21, Gregory A Cote22, Bechien U Wu23, Pedram Paragomi1, Ioannis Pothoulakis1, Gong Tang2, Georgios I Papachristou24. 1. University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania. 2. Department of Biostatistics, School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania. 3. Asian Gastroenterology Institute, Hyderabad, India. 4. Postgraduate Institute of Medical Education and Research, Chandigarh, India. 5. Apollo Gleneagles Hospitals Kolkata, Kolkata, India. 6. Lithuanian University of Health Sciences, Kaunas, Lithuania. 7. Universidad Autónoma de Nueva León, Monterrey, Mexico. 8. Johns Hopkins Medical Institutions, Baltimore, Maryland. 9. Hospital Nacional de Itauguá, Itaugua, Paraguay. 10. Cleveland Clinic Foundation, Cleveland, Ohio. 11. University of Medicine and Pharmacy "Iuliu Hatieganu", Cluj-Napoca, Romania. 12. Eastern Maine Medical Center, Bangor, Maine. 13. Hospital Nacional "Professor Alejandro Posadas", Buenos Aires, Argentina. 14. "Carol Davila" University of Medicine and Pharmacy, University Emergency Hospital Bucharest, Romania. 15. San Raffaele Scientific Institute, Vita Salute San Raffaele University, Milan, Italy. 16. Indiana University School of Medicine, Indianapolis, Indiana. 17. Attikon University General Hospital, Athens, Greece. 18. Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán-Universidad Autónoma de Mexico, Mexico City, Mexico. 19. Allegheny Health Network, Pittsburgh, Pennsylvania. 20. Hospital General de Argudos "Dr. Cosme Argerich," Buenos Aires, Argentina. 21. Investigación Sanitaria y Biomédica de Alicante (ISABIAL - Fundación FISABIO), Alicante, Spain. 22. Medical University of South Carolina, Charleston, South Carolina. 23. Kaiser Permanente, Pasadena, California. 24. University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania; Ohio State University Wexner Medical Center, Columbus, Ohio. Electronic address: georgios.papachristou@osumc.edu.
Abstract
BACKGROUND & AIMS: Few studies have compared regional differences in acute pancreatitis. We analyzed data from an international registry of patients with acute pancreatitis to evaluate geographic variations in patient characteristics, management, and outcomes. METHODS: We collected data from the APPRENTICE registry of patients with acute pancreatitis, which obtains information from patients in Europe (6 centers), India (3 centers), Latin America (5 centers), and North America (8 centers) using standardized questionnaires. Our final analysis included 1612 patients with acute pancreatitis (median age, 49 years; 53% male, 62% white) enrolled from August 2015 through January 2018. RESULTS: Biliary (45%) and alcoholic acute pancreatitis (21%) were the most common etiologies. Based on the revised Atlanta classification, 65% of patients developed mild disease, 23% moderate, and 12% severe. The mean age of patients in Europe (58 years) was older than mean age for all 4 regions (46 years) and a higher proportion of patients in Europe had comorbid conditions (73% vs 50% overall). The predominant etiology of acute pancreatitis in Latin America was biliary (78%), whereas alcohol-associated pancreatitis accounted for the highest proportion of acute pancreatitis cases in India (45%). Pain was managed with opioid analgesics in 93% of patients in North America versus 27% of patients in the other 3 regions. Cholecystectomies were performed at the time of hospital admission for most patients in Latin America (60% vs 15% overall). A higher proportion of European patients with severe acute pancreatitis died during the original hospital stay (44%) compared with the other 3 regions (15%). CONCLUSIONS: We found significant variation in demographics, etiologies, management practices, and outcomes of acute pancreatitis worldwide. ClinicalTrials.gov number: NCT03075618.
BACKGROUND & AIMS: Few studies have compared regional differences in acute pancreatitis. We analyzed data from an international registry of patients with acute pancreatitis to evaluate geographic variations in patient characteristics, management, and outcomes. METHODS: We collected data from the APPRENTICE registry of patients with acute pancreatitis, which obtains information from patients in Europe (6 centers), India (3 centers), Latin America (5 centers), and North America (8 centers) using standardized questionnaires. Our final analysis included 1612 patients with acute pancreatitis (median age, 49 years; 53% male, 62% white) enrolled from August 2015 through January 2018. RESULTS: Biliary (45%) and alcoholic acute pancreatitis (21%) were the most common etiologies. Based on the revised Atlanta classification, 65% of patients developed mild disease, 23% moderate, and 12% severe. The mean age of patients in Europe (58 years) was older than mean age for all 4 regions (46 years) and a higher proportion of patients in Europe had comorbid conditions (73% vs 50% overall). The predominant etiology of acute pancreatitis in Latin America was biliary (78%), whereas alcohol-associated pancreatitis accounted for the highest proportion of acute pancreatitis cases in India (45%). Pain was managed with opioid analgesics in 93% of patients in North America versus 27% of patients in the other 3 regions. Cholecystectomies were performed at the time of hospital admission for most patients in Latin America (60% vs 15% overall). A higher proportion of European patients with severe acute pancreatitis died during the original hospital stay (44%) compared with the other 3 regions (15%). CONCLUSIONS: We found significant variation in demographics, etiologies, management practices, and outcomes of acute pancreatitis worldwide. ClinicalTrials.gov number: NCT03075618.
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