The Effect of Non-Steroidal Anti-Inflammatory Drugs on Acute Pancreatitis: A Retrospective Study at a London District General Hospital

Abstract

Context Acute pancreatitis (AP) is a common emergency condition. Despite a complication rate of up to 20%, current management only includes supportive treatment and surgery in specific circumstances. Non-steroidal anti-inflammatory drugs (NSAIDs) are shown to reduce post-endoscopic retrograde cholangiopancreatography pancreatitis. Objective To assess the effect of NSAIDs on disease progress and patient outcomes in acute pancreatitis in a large district general hospital. Methods A retrospective analysis was performed on 361 consecutive, adult patients with AP from April 2018 to September 2020. Demographic data, biochemical information, pancreatitis severity scores and clinical outcomes were recorded. Patients were divided into two groups based on NSAID usage prior to hospital admission. Results Patients on NSAIDs prior to admission were older (69.4 vs 54.4, p-value<0.0001) and less likely to have ASA grade I (16.1% vs 34.6%, p-value=0.0446). They had a significantly lower Day 5 C-reactive protein (CRP) (89.0 mg/L vs 155.4 mg/L, p-value=0.0226). No patient using NSAIDs prior to admission developed pancreatic necrosis, however, this was not statistically significant (0.0% vs 6.4%, p-value=0.1478). There were no statistically significant differences in other clinical and biochemical outcomes. Discussions Routine NSAIDs use appears to reduce CRP level five days after admission and may protect from pancreatic necrosis after AP. Despite being older and in a poorer fitness level, patients on NSAIDs had similar outcomes to those without NSAIDs, suggesting potential benefits on AP. Conclusion NSAIDs may have some therapeutic value in AP. More studies are recommended to evaluate this further.