The following is a summary of “Short-term and Long-term Outcomes of a Disruption and Disconnection of the Pancreatic Duct in Necrotizing Pancreatitis: A Multicenter Cohort Study in 896 Patients,” published in the May 2023 issue of Gastroenterology by Timmerhuis, et al.
Disrupted or disconnected pancreatic duct (DPD) can occur due to necrotizing pancreatitis and has significant implications for a patient’s clinical outcome. However, comprehensive data on the clinical spectrum of DPD are limited, which hinders the development of effective diagnostic and treatment strategies.
For a study, researchers conducted a long-term post hoc analysis of a nationwide cohort comprising 896 patients with necrotizing pancreatitis (collected between 2005 and 2015). The median follow-up duration after hospital admission was 75 months (interquartile range: 41-151). They compared the clinical outcomes of patients with and without DPD using regression analyses, adjusting for potential confounding factors.
Additionally, we explored predictive factors for the development of DPD. DPD was confirmed in 243 (27%) of the 896 patients, and its presence was associated with worse clinical outcomes during the initial hospital admission and long-term follow-up. Specifically, during hospital admission, DPD was linked to a higher rate of new-onset intensive care unit admission (adjusted odds ratio [aOR] 2.52; 95% confidence interval [CI] 1.62-3.93), new-onset organ failure (aOR 2.26; 95% CI 1.45-3.55), infected necrosis (aOR 4.63; 95% CI 2.87-7.64), and pancreatic interventions (aOR 7.55; 95% CI 4.23-13.96). In the long-term follow-up, DPD increased the risk of pancreatic intervention (aOR 9.71; 95% CI 5.37-18.30), recurrent pancreatitis (aOR 2.08; 95% CI 1.32-3.29), chronic pancreatitis (aOR 2.73; 95% CI 1.47-5.15), and endocrine pancreatic insufficiency (aOR 1.63; 95% CI 1.05-2.53). Independent predictors for developing DPD were central or subtotal pancreatic necrosis on computed tomography (odds ratio [OR] 9.49; 95% CI 6.31-14.29) and a high level of serum C-reactive protein within the first 48 hours after admission (per 10-point increase, OR 1.02; 95% CI 1.00-1.03).
Approximately 25% of patients with necrotizing pancreatitis experienced DPD, associated with detrimental short-term and long-term interventions and complications. Central and subtotal pancreatic necrosis, along with elevated serum C-reactive protein levels within the first 48 hours, were identified as independent predictors for the development of DPD.