Tzvika Porges, Tali Shafat, Iftach Sagy, Dan Schwarzfuchs, Ilan Rahmani Tzvi-Ran, Alan Jotkowitz, Leonid Barski
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Primary outcome was defined as composite outcome of 30-day mortality and complications.</p><p><strong>Results: </strong>Among 560 admissions of 437 patients with a primary diagnosis of acute pancreatitis, the main factors identified were gallstones (51.2%) and idiopathic pancreatitis (35.9%), with alcohol ranked third at only 4.8%. Mortality rate within 30 days of hospitalization was 2.9% and within one year was 7.1%. Use of lipid-lowering, anti-hypertensive, and anti-diabetic medications was more frequent among patients with \"idiopathic\" disease (70%, 68%, and 33% versus 59%, 56%, and 27%, respectively). Patients admitted with idiopathic AP, in comparison to patients with known AP etiology, had milder disease with shorter hospital stay (3 days versus 4, respectively), and less re-admission in 30 days (7.5% versus 21.2%). Idiopathic AP patients had better prognosis in terms of 30-day death and complication (HR 0.33, 95% CI 0.08-0.40, P<0.001).</p><p><strong>Conclusion: </strong>Idiopathic disease is common among acute pancreatitis patients; the two study groups differed in severity of disease and prognosis. Common use of medications with doubtful value suggests possible under-diagnosis of drug-induced acute idiopathic pancreatitis.</p>","PeriodicalId":46408,"journal":{"name":"Rambam Maimonides Medical Journal","volume":null,"pages":null},"PeriodicalIF":1.4000,"publicationDate":"2021-07-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8284986/pdf/","citationCount":"4","resultStr":"{\"title\":\"Clinical Characteristics and Prognosis of Idiopathic Acute Pancreatitis.\",\"authors\":\"Tzvika Porges, Tali Shafat, Iftach Sagy, Dan Schwarzfuchs, Ilan Rahmani Tzvi-Ran, Alan Jotkowitz, Leonid Barski\",\"doi\":\"10.5041/RMMJ.10442\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Objective: </strong>Acute pancreatitis is a serious diagnosis with an increasing incidence in the Western world. In this study we sought to investigate the incidence of idiopathic AP and to compare clinical and prognostic characteristics of idiopathic cases with cases of AP with known etiology.</p><p><strong>Methods: </strong>In this retrospective study of adult hospitalized patients diagnosed with acute pancreatitis between 2012 and 2015, a comparison was made between admissions of patients with known etiology and those for whom no cause was found. Primary outcome was defined as composite outcome of 30-day mortality and complications.</p><p><strong>Results: </strong>Among 560 admissions of 437 patients with a primary diagnosis of acute pancreatitis, the main factors identified were gallstones (51.2%) and idiopathic pancreatitis (35.9%), with alcohol ranked third at only 4.8%. Mortality rate within 30 days of hospitalization was 2.9% and within one year was 7.1%. Use of lipid-lowering, anti-hypertensive, and anti-diabetic medications was more frequent among patients with \\\"idiopathic\\\" disease (70%, 68%, and 33% versus 59%, 56%, and 27%, respectively). Patients admitted with idiopathic AP, in comparison to patients with known AP etiology, had milder disease with shorter hospital stay (3 days versus 4, respectively), and less re-admission in 30 days (7.5% versus 21.2%). Idiopathic AP patients had better prognosis in terms of 30-day death and complication (HR 0.33, 95% CI 0.08-0.40, P<0.001).</p><p><strong>Conclusion: </strong>Idiopathic disease is common among acute pancreatitis patients; the two study groups differed in severity of disease and prognosis. 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引用次数: 4
摘要
目的:急性胰腺炎是一种严重的诊断,在西方世界发病率越来越高。在这项研究中,我们试图调查特发性AP的发病率,并比较特发性病例与已知病因的AP的临床和预后特征。方法:回顾性研究2012 - 2015年诊断为急性胰腺炎的成人住院患者,比较已知病因与未发现病因的住院患者。主要转归定义为30天死亡率和并发症的综合转归。结果:在560,437例初诊急性胰腺炎患者中,确定的主要因素是胆结石(51.2%)和特发性胰腺炎(35.9%),酒精排在第三位,仅为4.8%。住院30天内死亡率为2.9%,1年内死亡率为7.1%。在“特发性”疾病患者中,使用降脂、降压和抗糖尿病药物的频率更高(分别为70%、68%和33%,而不是59%、56%和27%)。与已知AP病因的患者相比,特发性AP患者病情较轻,住院时间较短(分别为3天和4天),30天内再入院率较低(7.5%对21.2%)。特发性AP患者在30天死亡和并发症方面预后较好(HR 0.33, 95% CI 0.08-0.40, p)。两个研究组在疾病严重程度和预后方面存在差异。普遍使用的药物价值可疑提示可能对药物性急性特发性胰腺炎诊断不足。
Clinical Characteristics and Prognosis of Idiopathic Acute Pancreatitis.
Objective: Acute pancreatitis is a serious diagnosis with an increasing incidence in the Western world. In this study we sought to investigate the incidence of idiopathic AP and to compare clinical and prognostic characteristics of idiopathic cases with cases of AP with known etiology.
Methods: In this retrospective study of adult hospitalized patients diagnosed with acute pancreatitis between 2012 and 2015, a comparison was made between admissions of patients with known etiology and those for whom no cause was found. Primary outcome was defined as composite outcome of 30-day mortality and complications.
Results: Among 560 admissions of 437 patients with a primary diagnosis of acute pancreatitis, the main factors identified were gallstones (51.2%) and idiopathic pancreatitis (35.9%), with alcohol ranked third at only 4.8%. Mortality rate within 30 days of hospitalization was 2.9% and within one year was 7.1%. Use of lipid-lowering, anti-hypertensive, and anti-diabetic medications was more frequent among patients with "idiopathic" disease (70%, 68%, and 33% versus 59%, 56%, and 27%, respectively). Patients admitted with idiopathic AP, in comparison to patients with known AP etiology, had milder disease with shorter hospital stay (3 days versus 4, respectively), and less re-admission in 30 days (7.5% versus 21.2%). Idiopathic AP patients had better prognosis in terms of 30-day death and complication (HR 0.33, 95% CI 0.08-0.40, P<0.001).
Conclusion: Idiopathic disease is common among acute pancreatitis patients; the two study groups differed in severity of disease and prognosis. Common use of medications with doubtful value suggests possible under-diagnosis of drug-induced acute idiopathic pancreatitis.