Pedram Paragomi1, Georgios I Papachristou2, Kwonho Jeong3, Alice Hinton4, Ioannis Pothoulakis5, Rupjyoti Talukdar6, Rakesh Kochhar7, Mahesh K Goenka8, Aiste Gulla9, Jose A Gonzalez10, Vikesh K Singh11, Miguel Ferreira Bogado12, Tyler Stevens13, Sorin T Barbu14, Haq Nawaz15, Silvia C Gutierrez16, Narcis Zarnescu17, Livia Archibugi18, Jeffrey J Easler19, Konstantinos Triantafyllou20, Mario Peláez-Luna21, Shyam Thakkar22, Carlos Ocampo23, Enrique de-Madaria24, Gregory A Cote25, Bechien U Wu26, Peter J Lee27, Phil A Hart2, Darwin L Conwell2, Frederico G S Toledo28, Dhiraj Yadav29. 1. University of Pittsburgh Medical Center, Pittsburgh, PA, USA; University of Pittsburgh Medical Center Hillman Cancer Center, Pittsburgh, PA, USA. 2. Division of Gastroenterology, Hepatology, and Nutrition, The Ohio State University, Wexner Medical Center, Columbus, OH, USA. 3. University of Pittsburgh Medical Center, Pittsburgh, PA, USA. 4. Division of Gastroenterology, Hepatology, and Nutrition, The Ohio State University, Wexner Medical Center, Columbus, OH, USA; Division of Biostatistics, College of Public Health, The Ohio State University, Columbus, Ohio, USA. 5. University of Pittsburgh Medical Center, Pittsburgh, PA, USA; MedStar Washington Hospital Center, Washington, DC, USA. 6. Asian Gastroenterology Institute, Hyderabad, India. 7. Postgraduate Institute of Medical Education and Research, Chandigarh, India. 8. Apollo Gleneagles Hospitals Kolkata, Kolkata, India. 9. Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius, Lithuania; Georgetown University Hospital, Washington, DC, USA. 10. Universidad Autónoma de Nueva León, Monterrey, Mexico. 11. Division of Gastroenterology, John Hopkins Medical Institution, Baltimore, MD, USA. 12. Hospital Nacional de Itauguá, Itaugua, Paraguay. 13. Cleveland Clinic, Cleveland, OH, USA. 14. University of Medicine and Pharmacy "Iuliu Hatieganu", Cluj-Napoca, Romania. 15. Eastern Maine Medical Center, Bangor, ME, USA. 16. Hospital Nacional "Professor Alejandro Posadas", Buenos Aires, Argentina. 17. Department of Gastroenterology, "Carol Davila" University of Medicine and Pharmacy, University Emergency Hospital Bucharest, Bucharest, Romania. 18. Department of Pancreato-Biliary Endoscopy and Endosonography, San Raffaele Scientific Institute, Vita Salute San Raffaele University, Milan, Italy. 19. Department of Gastroenterology, Division of Gastroenterology, Indiana University School of Medicine, Indianapolis, IN, USA. 20. Department of Medicine, Attikon University General Hospital, Athens, Greece. 21. Department of Gastroenterology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán-Universidad∖Autónoma de Mexico, Mexico City, Mexico. 22. Division of Gastroenterology, West Virginia University, Morgantown, WV, USA. 23. Hospital General de Argudos "Dr. Cosme Argerich", Buenos Aires, Argentina. 24. Hospital General Universitario de Alicante, Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL - Fundación FISABIO), Alicante, Spain. 25. Medical University of South Carolina, Charleston, SC, USA. 26. Kaiser Permanente, Los Angeles, CA, USA. 27. Division of Gastroenterology, Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA, USA. 28. Division of Endocrinology and Metabolism, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA. 29. University of Pittsburgh Medical Center, Pittsburgh, PA, USA. Electronic address: yadavd@upmc.edu.
Abstract
BACKGROUND/ OBJECTIVES: The relationship between pre-existing diabetes mellitus (DM) and acute pancreatitis (AP) severity has not been established. We assessed the impact of pre-existing DM on AP severity in an international, prospectively ascertained registry. METHODS: APPRENTICE registry prospectively enrolled 1543 AP patients from 22 centers across 4 continents (8 US, 6 Europe, 5 Latin America, 3 India) between 2015 and 2018, and collected detailed clinical information. Pre-existing DM was defined a diagnosis of DM prior to AP admission. The primary outcome was AP severity defined by the Revised Atlanta Classification (RAC). Secondary outcomes were development of systemic inflammatory response syndrome (SIRS) or intensive care unit (ICU) admission. RESULTS: Pre-existing DM was present in 270 (17.5%) AP patients, of whom 252 (93.3%) had type 2 DM. Patients with pre-existing DM were significantly (p < 0.05) older (55.8 ± 16 vs. 48.3 ± 18.7 years), more likely to be overweight (BMI 29.5 ± 7 vs. 27.2 ± 6.2), have hypertriglyceridemia as the etiology (15% vs. 2%) and prior AP (33 vs. 24%). Mild, moderate, and severe AP were noted in 66%, 23%, and 11% of patients, respectively. On multivariable analysis, pre-existing DM did not significantly impact AP severity assessed by the RAC (moderate-severe vs. mild AP, OR = 0.86, 95% CI 0.63-1.18; severe vs. mild-moderate AP, OR = 1.05, 95% CI, 0.67-1.63), development of SIRS, or the need for ICU admission. No interaction was noted between DM status and continent. CONCLUSION: About one in 5 patients with AP have pre-existing DM. Once confounding risk factors are considered, pre-existing DM per se is not a risk factor for severe AP.
BACKGROUND/ OBJECTIVES: The relationship between pre-existing diabetes mellitus (DM) and acute pancreatitis (AP) severity has not been established. We assessed the impact of pre-existing DM on AP severity in an international, prospectively ascertained registry. METHODS: APPRENTICE registry prospectively enrolled 1543 AP patients from 22 centers across 4 continents (8 US, 6 Europe, 5 Latin America, 3 India) between 2015 and 2018, and collected detailed clinical information. Pre-existing DM was defined a diagnosis of DM prior to AP admission. The primary outcome was AP severity defined by the Revised Atlanta Classification (RAC). Secondary outcomes were development of systemic inflammatory response syndrome (SIRS) or intensive care unit (ICU) admission. RESULTS: Pre-existing DM was present in 270 (17.5%) AP patients, of whom 252 (93.3%) had type 2 DM. Patients with pre-existing DM were significantly (p < 0.05) older (55.8 ± 16 vs. 48.3 ± 18.7 years), more likely to be overweight (BMI 29.5 ± 7 vs. 27.2 ± 6.2), have hypertriglyceridemia as the etiology (15% vs. 2%) and prior AP (33 vs. 24%). Mild, moderate, and severe AP were noted in 66%, 23%, and 11% of patients, respectively. On multivariable analysis, pre-existing DM did not significantly impact AP severity assessed by the RAC (moderate-severe vs. mild AP, OR = 0.86, 95% CI 0.63-1.18; severe vs. mild-moderate AP, OR = 1.05, 95% CI, 0.67-1.63), development of SIRS, or the need for ICU admission. No interaction was noted between DM status and continent. CONCLUSION: About one in 5 patients with AP have pre-existing DM. Once confounding risk factors are considered, pre-existing DM per se is not a risk factor for severe AP.
Authors: C J Girman; T D Kou; B Cai; C M Alexander; E A O'Neill; D E Williams-Herman; L Katz Journal: Diabetes Obes Metab Date: 2010-09 Impact factor: 6.577
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Authors: Georgios I Papachristou; Jorge D Machicado; Tyler Stevens; Mahesh Kumar Goenka; Miguel Ferreira; Silvia C Gutierrez; Vikesh K Singh; Ayesha Kamal; Jose A Gonzalez-Gonzalez; Mario Pelaez-Luna; Aiste Gulla; Narcis O Zarnescu; Konstantinos Triantafyllou; Sorin T Barbu; Jeffrey Easler; Carlos Ocampo; Gabriele Capurso; Livia Archibugi; Gregory A Cote; Louis Lambiase; Rakesh Kochhar; Tiffany Chua; Subhash Ch Tiwari; Haq Nawaz; Walter G Park; Enrique de-Madaria; Peter J Lee; Bechien U Wu; Phil J Greer; Mohannad Dugum; Efstratios Koutroumpakis; Venkata Akshintala; Amir Gougol Journal: Ann Gastroenterol Date: 2016-12-01