Dataset Information

Retrospective Matched-Cohort Analysis of Acute Pancreatitis Induced by 5-Aminosalicylic Acid-Derived Drugs.

ABSTRACT: OBJECTIVES:This study aimed to compare the clinical course of 5-aminosalicylic acid-derived, drug-induced acute pancreatitis (5-ASA-DIAP) to acute pancreatitis (AP) caused by other etiologies. METHODS:A cohort of patients with 5-ASA-DIAP was established through literature search. As a control AP (CAP) group, a cohort was generated from a registry. Data on the diagnostic procedure, symptoms, enzyme elevation, imaging, severity, and recovery parameters were collected. Causality was assessed using the Naranjo algorithm. RESULTS:Twenty-nine articles were included, which describe 36 patients with fifty-one 5-ASA-DIAP episodes (60.78% female, 39.22% male). There were 88.2% mild, 3.92% moderate, and 7.84% severe cases of AP in the 5-ASA-DIAP group, and 70.6%, 25.5%, and 3.92% such cases in the CAP population, respectively. Symptoms improved significantly faster (mean ± SE, 2.5 ± 0.34 vs 3.74 ± 0.42 days; P = 0.018); however, pancreatic enzyme levels normalized significantly more slowly (6.27 ± 1.53 vs 3.63 ± 0.61 days, P = 0.008) in the 5-ASA-DIAP cohort compared with the CAP group. This study confirms that there are no diagnostic differences between 5-ASA-DIAP and AP of other etiologies. CONCLUSIONS:Fewer moderate but more severe cases were found in the 5-ASA-DIAP group; therefore, 5-ASA-DIAP must be taken as seriously as AP of other etiologies.

SUBMITTER: Meczker A

PROVIDER: S-EPMC6493669 | biostudies-other | 2019 Apr

REPOSITORIES: biostudies-other

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Retrospective Matched-Cohort Analysis of Acute Pancreatitis Induced by 5-Aminosalicylic Acid-Derived Drugs.

Meczker Ágnes Á Mikó Alexandra A Gede Noémi N Szentesi Andrea A Párniczky Andrea A Gódi Szilárd S Hegyi Péter P

Pancreas 20190401 4

<h4>Objectives</h4>This study aimed to compare the clinical course of 5-aminosalicylic acid-derived, drug-induced acute pancreatitis (5-ASA-DIAP) to acute pancreatitis (AP) caused by other etiologies.<h4>Methods</h4>A cohort of patients with 5-ASA-DIAP was established through literature search. As a control AP (CAP) group, a cohort was generated from a registry. Data on the diagnostic procedure, symptoms, enzyme elevation, imaging, severity, and recovery parameters were collected. Causality was ...[more]

PMID: 30946233

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Project description:BackgroundCurrently, the concept of "a single cause results in acute pancreatitis (AP)" has been deeply incorporated into clinical practice, whereas the concept of "compound-etiology" has not attract considerable attention. This study aimed to explore the impact of the category of etiology on AP clinical outcomes.MethodsPatients with AP hospitalized within 72 h of symptom onset were retrospectively enrolled in this study from January 2014 to October 2019. AP etiology was classified into two main categories: single-etiology and compound-etiology category. The single-etiology category mainly includes biliary, hypertriglyceridemia (HTG), and alcohol. The compound-etiology category refers to AP with two or more causes, which mainly include dual-etiology and triple-etiology category, that is the biliary-HTG type, HTG-alcoholic type, and biliary-HTG-alcoholic type. The general information and clinical outcomes were reviewed and compared in AP patients with different etiologies.ResultsTwo hundred sixty-eight out of a total of 904 AP patients belonged to the compound-etiology category. Compared with the single-etiology category, the patients in the compound-etiology category were younger, more predominantly male, more likely to be obese (body mass index ≥30 kg/m2) and more likely to have pre-existing diabetes. The clinical outcomes were worse for patients with increasing complexity of etiology type, as shown by comparison of the incidence of any organ failure (P<0.001); persistent organ failure (POF) (P<0.001); intensive care unit need (P<0.001); local complications (P<0.001). AP with HTG had a higher rate of POF (P=0.032) and acute necrotic collection (P=0.013) than AP with biliary or alcohol involvement. When other etiologies simultaneously accompanied HTG-AP, the clinical outcomes were significantly worse than those in HTG-AP without other etiologies, particularly the biliary-HTG-alcoholic type. The compound-etiology category was independently associated with POF [odds ratio (OR): 2.47, 95% confidence interval (CI): 1.65-3.72, P<0.001].ConclusionsThese results highlight the importance of determining AP etiology and the prevalence of the "compound-type" etiology. The compound-etiology category should be recognized as a separate concept in AP etiology and deserve higher priority.

Project description:Although enteral nutrition has become one of the standard therapies for patients with acute pancreatitis, the optimal formulae for enteral nutrition have been under debate. Elemental formula is assumed to be suitable in the treatment of patients with acute pancreatitis because it has less stimulating effects for exocrine secretions of the pancreas, simultaneously maintaining gut immunity; however, clinical studies corroborating this assumption have been scarce.We conducted a retrospective cohort study using a Japanese national administrative database between 2010 and 2015. Patients with acute pancreatitis who received enteral feeding within 3 days of admission were identified and divided into two groups according to whether elemental formula was administered. We assessed the impact of elemental formula for the outcomes (primary, in-hospital mortality; secondary, development of sepsis, hospital-free days at 90 days, and total health-care costs) using a multivariate mixed-effect regression analysis and propensity score matching analysis adjusted by a well-validated case-mix adjustment model. Analysis for the subpopulation of patients with severe acute pancreatitis was also performed.Of 243,312 patients with acute pancreatitis, 948 patients were identified and classified into the elemental formula group (N?=?382) and the control group (N?=?566). No significant differences were observed for in-hospital mortality [10.2% in the elemental formula group vs. 11.0% in the control group; adjusted adds ratio (95% confidence interval; CI)?=?0.94 (0.53-1.67)], sepsis development [5.0 vs. 7.1%; adjusted adds ratio (95% CI)?=?0.66 (0.34-1.28)], mean hospital-free days [54 days vs. 51 days; adjusted difference (95% CI)?=?2 days (-?2 to 5)], and mean total health-care costs [$29,360 vs. $34,214; adjusted difference (95% CI)?=?-?$4250 (-?8643 to 141)]. Similar results were also observed in patients with severe acute pancreatitis.The results of our retrospective cohort study using a large-scale national database did not demonstrate the benefit of elemental formula compared to semi-elemental and polymeric formulae in patients with acute pancreatitis. Further assessment of alternative nutritional strategy is expected.

Dataset Information

Retrospective Matched-Cohort Analysis of Acute Pancreatitis Induced by 5-Aminosalicylic Acid-Derived Drugs.

Publications

Retrospective Matched-Cohort Analysis of Acute Pancreatitis Induced by 5-Aminosalicylic Acid-Derived Drugs.

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