Current Diagnosis and Treatment of Acute Pancreatitis in Korea: A Nationwide Survey
1
조회
0
다운로드
0
인용
0
참고문헌
키워드
초록
Background/Aims: Acute pancreatitis (AP) is a leading cause of emergency hospitalization. We present the current diagnostic and therapeutic status of AP as revealed by analysis of a large multicenter dataset. Methods: The medical records of patients diagnosed with AP between 2018 and 2019 in 12 tertiary medical centers in Korea were retrospectively reviewed. Results: In total, 676 patients were included, of whom 388 (57.4%) were male, and the mean age of all patients was 58.6 years. There were 355 (52.5%), 301 (44.5%), and 20 (3.0%) patients with mild, moderate, and severe AP, respectively, as assessed by the revised Atlanta classification. The most common etiologies of AP were biliary issues (41.6%) and alcohol consumption (24.6%), followed by hypertriglyceridemia (6.8%). The etiology was not identified in 111 (16.4%) patients at the time of initial admission. The overall mortality rate was 3.3%, increasing up to 45.0% among patients with severe AP. Notably, 70.0% (14/20) of patients with severe AP and 81.5% (154/189) of patients with systemic inflammatory response syndrome had received <4 L per day during the initial 24 hours of admission. Only 23.8% (67/281) of acute biliary pancreatitis patients underwent cholecystectomy during their initial admission. In total, 17.8% of patients experienced recurrent attacks during follow-up. However, none of the patients with acute biliary pancreatitis experienced recurrent attacks if they had undergone cholecystectomy during their initial admission. Conclusions: This study provides insights into the current status of AP in Korea, including its etiology, severity, and management. Results reveal disparities between clinical guidelines and their practical implementation for AP treatment.
Abstract
Background/Aims: Acute pancreatitis (AP) is a leading cause of emergency hospitalization. We present the current diagnostic and therapeutic status of AP as revealed by analysis of a large multicenter dataset. Methods: The medical records of patients diagnosed with AP between 2018 and 2019 in 12 tertiary medical centers in Korea were retrospectively reviewed. Results: In total, 676 patients were included, of whom 388 (57.4%) were male, and the mean age of all patients was 58.6 years. There were 355 (52.5%), 301 (44.5%), and 20 (3.0%) patients with mild, moderate, and severe AP, respectively, as assessed by the revised Atlanta classification. The most common etiologies of AP were biliary issues (41.6%) and alcohol consumption (24.6%), followed by hypertriglyceridemia (6.8%). The etiology was not identified in 111 (16.4%) patients at the time of initial admission. The overall mortality rate was 3.3%, increasing up to 45.0% among patients with severe AP. Notably, 70.0% (14/20) of patients with severe AP and 81.5% (154/189) of patients with systemic inflammatory response syndrome had received <4 L per day during the initial 24 hours of admission. Only 23.8% (67/281) of acute biliary pancreatitis patients underwent cholecystectomy during their initial admission. In total, 17.8% of patients experienced recurrent attacks during follow-up. However, none of the patients with acute biliary pancreatitis experienced recurrent attacks if they had undergone cholecystectomy during their initial admission. Conclusions: This study provides insights into the current status of AP in Korea, including its etiology, severity, and management. Results reveal disparities between clinical guidelines and their practical implementation for AP treatment.
참고문헌 (35)
- Peery AF, "Burden and cost of gastrointestinal, liver, and pancreatic diseases in the United States : update 2021", Gastroenterology, 162, pp.621~644 (2022)
- Iannuzzi JP, "Global incidence of acute pancreatitis is increasing over time : a systematic review and meta-analysis", Gastroenterology, 162, pp.122~134 (2022)
- Kim CD, "Current status of acute pancreatitis in Korea", Korean J Gastroenterol, 42, pp.1~11 (2003)
- Forsmark CE, "Acute pancreatitis", N Engl J Med, 375, pp.1972~1981 (2016)
- Das SL, "Newly diagnosed diabetes mellitus after acute pancreatitis : a systematic review and meta-analysis", Gut, 63, pp.818~831 (2014)
- Hollemans RA, "Pancreatic exocrine insufficiency following acute pancreatitis : systematic review and study level meta-analysis", Pancreatology, 18, pp.253~262 (2018)
- Párniczky A, "Prospective, multicentre, nationwide clinical data from 600 cases of acute pancreatitis", PLoS One, 11, pp.e0165309~ (2016)
- Fonseca Sepúlveda EV, "Acute pancreatitis and recurrent acute pancreatitis : an exploration of clinical and etiologic factors and outcomes", J Pediatr(Rio J), 95, pp.713~719 (2019)
- Wan J, "Comparison of EUS with MRCP in idiopathic acute pancreatitis : a systematic review and meta-analysis", Gastrointest Endosc, 87, pp.1180~1188 (2018)
- Pereira R, "Endoscopic ultrasound for routine assessment in idiopathic acute pancreatitis", J Gastrointest Surg, 23, pp.1694~1700 (2019)
- Choe JW, "Revised Clinical Practice Guideline of Korean Pancreatobiliary Association for Acute Pancreatitis : purpose and process of guidelines", Korean J Pancreas Biliary Tract, 27, pp.1~5 (2022)
- Banks PA, "Classification of acute pancreatitis--2012 : revision of the Atlanta classification and definitions by international consensus", Gut, 62, pp.102~111 (2013)
- Lee HC, "Revised Atlanta classification of acute pancreatitis can predict clinical outcome better : a retrospective, multicenter study", Korean J Pancreas Biliary Tract, 20, pp.64~70 (2015)
- O’Farrell A, "Hospital admission for acute pancreatitis in the Irish population, 1997 2004 : could the increase be due to an increase in alcohol-related pancreatitis?", J Public Health(Oxf), 29, pp.398~404 (2007)
- Gullo L, "Acute pancreatitis in five European countries : etiology and mortality", Pancreas, 24, pp.223~227 (2002)
- Baig SJ, "A prospective study of the aetiology, severity and outcome of acute pancreatitis in Eastern India", Trop Gastroenterol, 29, pp.20~22 (2008)
- Wang X, "An evidence-based proposal for predicting organ failure in severe acute pancreatitis", Pancreas, 42, pp.1255~1261 (2013)
- Alkareemy EA, "Etiology, clinical characteristics, and outcomes of acute pancreatitis in patients at Assiut University Hospital", Egypt J Intern Med, 32, pp.24~ (2020)
- Scherer J, "Issues in hypertriglyceridemic pancreatitis : an update", J Clin Gastroenterol, 48, pp.195~203 (2014)
- Baranyai T, "Acute pancreatitis caused by hypertriglyceridemia", Orv Hetil, 151, pp.1869~1874 (2010)
- Kim TI, "Differences in clinical features between hypertriglyceridemia-induced acute pancreatitis and other etiologies of acute pancreatitis", Korean J Pancreas Biliary Tract, 27, pp.97~105 (2022)
- Premkumar R, "The clinical relevance of obesity in acute pancreatitis : targeted systematic reviews", Pancreatology, 15, pp.25~33 (2015)
- Martínez J, "Is obesity a risk factor in acute pancreatitis? A meta-analysis", Pancreatology, 4, pp.42~48 (2004)
- Porter KA, "Obesity as a predictor of severity in acute pancreatitis", Int J Pancreatol, 10, pp.247~252 (1991)
- Khatua B, "Obesity and pancreatitis", Curr Opin Gastroenterol, 33, pp.374~382 (2017)
- Yang YS, "Obesity fact sheet in Korea, 2021 : trends in obesity prevalence and obesity-related comorbidity incidence stratified by age from 2009 to 2019", J Obes Metab Syndr, 31, pp.169~177 (2022)
- Hallensleben ND, "The diagnostic work-up and outcomes of ‘presumed’ idiopathic acute pancreatitis : a post-hoc analysis of a multicentre observational cohort", United European Gastroenterol J, 8, pp.340~350 (2020)
- Del Vecchio Blanco G, "Idiopathic acute pancreatitis : a review on etiology and diagnostic work-up", Clin J Gastroenterol, 12, pp.511~524 (2019)
- Machicado JD, "Epidemiology of recurrent acute and chronic pancreatitis : similarities and differences", Dig Dis Sci, 62, pp.1683~1691 (2017)
- de-Madaria E, "Influence of fluid therapy on the prognosis of acute pancreatitis : a prospective cohort study", Am J Gastroenterol, 106, pp.1843~1850 (2011)
- Mao EQ, "Rapid hemodilution is associated with increased sepsis and mortality among patients with severe acute pancreatitis", Chin Med J(Engl), 123, pp.1639~1644 (2010)
- de-Madaria E, "Aggressive or moderate fluid resuscitation in acute pancreatitis", N Engl J Med, 387, pp.989~1000 (2022)
- Lee SH, "Revised Clinical Practice Guidelines of the Korean Pancreatobiliary Association for Acute Pancreatitis", Gut Liver, 17, pp.34~48 (2023)
- Párniczky A, "Antibiotic therapy in acute pancreatitis : from global overuse to evidence based recommendations", Pancreatology, 19, pp.488~499 (2019)
- da Costa DW, "Sameadmission versus interval cholecystectomy for mild gallstone pancreatitis(PONCHO) : a multicentre randomised controlled trial", Lancet, 386, pp.1261~1268 (2015)
