Pancreas最新文献

Background: Social determinants of health (SDH) encompass socioeconomic and environmental factors that influence individual health outcomes. While SDH has been studied in relation to cardiovascular and metabolic diseases, its potential relationship with acute pancreatitis (AP) remains insufficiently explored.

Methods: We conducted a prospective cohort study using data from the UK Biobank, including over 340,000 participants without a history of AP at baseline. A composite SDH score was constructed from multiple indicators and the association between SDH and incident AP was examined using Cox proportional hazards models. Restricted cubic spline (RCS) regression was used to assess dose-response relationships. Stratified analyses were performed by demographic and clinical subgroups. Associations between SDH and AP-related diseases were also investigated.

Results: Elevated SDH scores were significantly associated with increased AP risk (P<0.001), with a linear dose-response relationship confirmed by RCS analysis. After full adjustment, the risk of AP was found to be higher in participants with unfavorable SDH (HR 1.52, 95%CI 1.37-1.70) compared to those with favorable SDH. In post-AP individuals, participants in the higher SDH group had increased risks of chronic pancreatitis (CP) and type 2 diabetes mellitus (T2DM). However, no significant association was found between SDH and post-AP pancreatic cancer (PC) (P=0.632).

Conclusions: Social disadvantage, as reflected by higher SDH scores, is associated with high risk of AP and AP-related diseases. These findings underscore the importance of considering social context in clinical and public health efforts to reduce the burden of pancreatic diseases.

Objectives: The diagnosis of spontaneous bacterial peritonitis relies on polymorphonuclear (PMN) cell counts (>250/mm3) in cirrhotic ascites. However, ascites in pancreatic ductal adenocarcinoma (PDAC) develop through mixed mechanisms, presenting different profiles compared to those of cirrhotic ascites. This study aimed to investigate the characteristics of PDAC-associated ascites and propose redefined criteria for bacterial peritonitis diagnosis in patients with PDAC.

Methods: This retrospective study was conducted at three tertiary medical centers in Korea. The etiology (peritoneal carcinomatosis, portal hypertension, or mixed etiology) and characteristics of PDAC-associated ascites of the exploration cohort (n=493) were analyzed. Diagnostic criteria for bacterial peritonitis were then derived from patients with elevated PMN cell counts (>250/mm3, n=183) in ascites. Subsequently, these criteria were validated in an external cohort (n=614).

Results: Peritoneal carcinomatosis and portal hypertension showed similar proportions as ascites etiologies. Median PMN cell counts and proportions were higher in peritoneal carcinomatosis (106/mm3, 13%) than in portal hypertension (15/mm3, 7%; P<0.001) and mixed etiology (38/mm3, 9%; P<0.05). In the derivation analysis, PMN cell proportion was the sole statistically significant variable for bacterial peritonitis diagnosis, with an optimal cut-off value of >35.5%. The redefined diagnostic criteria for bacterial peritonitis (PMN cell proportion >35% with counts >250/mm3) increased the specificity from 85% to 92% (RR: 1.08, 95% CI 1.04-1.13, P<0.001) in external validation, with minimal compromise in the sensitivity.

Conclusions: PDAC-associated ascites exhibited distinct characteristics according to their etiology. Redefined diagnostic criteria could aid in a more specific diagnosis of bacterial peritonitis in patients with PDAC.

Aim: This study aimed to investigate the relationship between non-alcoholic fatty pancreas disease (NAFPD) and metabolic dysfunction-associated steatotic liver disease (MASLD), and to evaluate the effects of pancreatic steatosis on clinical and laboratory parameters in patients aged 40-49 years. The secondary aim was to identify independent predictors of pancreatic steatosis and discuss their clinical relevance for early detection and prevention.

Methods: This retrospective single-center study included 132 patients aged 40-49 years who underwent abdominal magnetic resonance imaging (MRI). Pancreatic and hepatic fat fractions were measured using a chemical shift-based MRI technique. Demographic data, comorbidities, and laboratory parameters were analyzed. Patients with a history of alcohol intake, pancreatitis, or incomplete data were excluded.

Results: Pancreatic steatosis was present in 35.6% of participants. Patients with pancreatic steatosis had significantly higher rates of diabetes mellitus (59.6% vs. 21.2%), obesity (61.7% vs. 14.1%), hypertension (38.3% vs. 17.6%), and hyperlipidemia (44.7% vs. 20%) (all P<0.01). Pancreatic steatosis was strongly associated with hepatic steatosis (80.9% vs. 11.8%, P<0.001). Fasting glucose, HbA1c, HOMA-IR, and triglycerides were higher, whereas HDL and amylase were lower in the steatosis group. In multivariate logistic regression, diabetes mellitus (OR 8.06, 95% CI: 1.15-56.76, P=0.036) and HOMA-IR (OR 1.54, 95% CI: 1.19-1.99, P=0.001) were identified as independent predictors of pancreatic steatosis. Among patients with pancreatic steatosis, 80.9% also had hepatic steatosis, demonstrating a significant association between pancreatic and hepatic fat accumulation.

Conclusion: A significant association was found between pancreatic steatosis and metabolic risk factors such as diabetes, obesity, insulin resistance, and MASLD. MRI-based quantification provided accurate detection, supporting its value as the most reliable imaging modality for assessing pancreatic fat. Lifestyle interventions such as weight loss and physical activity may help mitigate pancreatic steatosis and related metabolic consequences. Further studies are needed to clarify causality and underlying pathways, such as lipotoxicity, inflammation, and β-cell dysfunction.

Background: Mucinous cyst-associated pancreatic cancer (CA-PC) outcomes are varied. This study compares the presentation, management, and outcomes of CA-PC with classic pancreatic ductal adenocarcinoma (PDAC) using a national dataset.

Methods: We queried the National Cancer Database (NCDB) from 2006-2019 for patients with AJCC Stage I-IV CA-PC and PDAC using histologic codes. Clinicopathologic characteristics and outcomes were analyzed, and overall survival (OS) was compared using Kaplan-Meier and Cox proportional hazard models.

Results: Among 239,563 patients, 8,260 (4%) had CA-PC, while 231,303 (97%) had PDAC. CA-PC was diagnosed at earlier stages (Stage II-IV: 66% vs. 76%, P<0.001), with more patients undergoing pancreatectomy (34% vs. 24%, P<0.001). CA-PC patients more frequently had upfront surgery (91.% vs. 76%, P<0.001) but less chemotherapy (55% vs. 75%, P<0.001) and radiation (23% vs. 33%, P<0.001). Median OS after resection was longer for CA-PC (43.2 vs. 22.9 months, P<0.001). CA-PC was associated with improved survival in stages I (HR 0.49) and II (HR 0.73), but not in stage III (HR 1.07).

Discussion: CA-PC has a better prognosis than PDAC in early stages but not in advanced disease, offering important insights for therapeutic strategies.

Objectives: Acute pancreatitis (AP) is associated with significant morbidity and mortality. While most patients fully recover following the acute phase of illness, some develop long-term complications. The objective of this study was to estimate short- and long-term costs among adults hospitalized with AP in US clinical practice, overall and within subgroups defined by AP cause.

Methods: A retrospective cohort design and healthcare claims database were employed. The study population comprised adults hospitalized for AP (first admission = index admission), and was considered overall as well as by AP cause (alcohol-induced, biliary-induced, drug-induced, cause unknown, multiple causes). AP-related healthcare utilization/expenditures were evaluated during the short-term episode (index admission + encounters separated by <30 days) and long-term follow-up period (1 year from end of episode).

Results: Among the 5,051 hospitalized AP patients in the study population, 7% (range by AP cause: 6-8%) had necrosis, 22% (19-26%) had organ failure, 12% (6-16%) had sepsis, and 14% (9-19%) had systemic inflammatory response syndrome. During the long-term follow-up period, rates of recurrent AP and chronic pancreatitis were 14 (8-29) and 15 (10-25), respectively, per 100 person-years. Mean AP-related expenditures were $31,119 ($22,963-$37,733) during the short-term episode, and $12,470 ($9,614-$20,657) during the long-term follow-up period; total expenditures averaged $43,598 ($32,577-$58,390) per patient.

Conclusions: The cost of AP requiring hospitalization is high, for the treatment of both acute disease as well as associated long-term complications, which underscores the potential economic benefits from the prevention of this condition.