Przewlekłe zapalenie trzustki – Rokowania, prognozy i postęp choroby

Przewlekłe zapalenie trzustki
Rokowania, prognozy i postęp choroby

Przewlekłe zapalenie trzustki (PZT) to postępujący proces zapalno-włóknieniowy prowadzący do nieodwracalnej niewydolności egzo- i endokrynnej trzustki, charakteryzujący się wysoką śmiertelnością (56% w badaniu 50 pacjentów przez 19 lat) oraz dwukrotnie wyższą śmiertelnością niż w populacji ogólnej. Kluczowe powikłania obejmują ropnie, torbiele rzekome, martwicę krwotoczną, wyniszczenie, zakażenia, uzależnienie od narkotyków oraz hipoglikemię związaną z nadmiernym wydzielaniem insuliny. W celu oceny ciężkości choroby i ryzyka hospitalizacji opracowano system punktacji COPPS, który koreluje z liczbą i czasem hospitalizacji (r od 0,13 do 0,16, P ≤ 0,04), choć wymaga dalszej optymalizacji. Czynniki ryzyka rozwoju PZT to nawracające ostre zapalenie trzustki (NOZT), alkoholizm, palenie tytoniu oraz wiek pierwszego epizodu <55 lat. Trzeci i czwarty epizod OZT zwiększają ryzyko PZT do 16-50%, a w grupie z ≥4 epizodami PZT stwierdzono u ~50% pacjentów. Model predykcyjny uwzględniający te czynniki pozwala na wczesną identyfikację pacjentów wysokiego ryzyka (częstość PZT ~31/1000 osobolat).

Przewidywanie rokowania w przewlekłym zapaleniu trzustki – przegląd
System punktacji COPPS (Chronic Pancreatitis Prognosis Score)
Czynniki ryzyka rozwoju przewlekłego zapalenia trzustki

Nawracające ostre zapalenie trzustki
Inne czynniki ryzyka

Modele predykcyjne dla przewlekłego zapalenia trzustki

Model punktacji ryzyka
Metaboliczny profil biomarkerów

Czynniki prognostyczne w ostrym i nawracającym zapaleniu trzustki
Wczesna diagnoza i monitorowanie
Wnioski końcowe

Kolejne rozdziały

Przewidywanie rokowania w przewlekłym zapaleniu trzustki – przegląd

Przewlekłe zapalenie trzustki (PZT) stanowi postępujący proces włóknienia i zapalenia, prowadzący do nieodwracalnego uszkodzenia funkcji egzo- i endokrynnej trzustki. Rokowanie w tej jednostce chorobowej pozostaje niepewne, a jej przebieg kliniczny jest trudny do przewidzenia.¹² Dane historyczne wskazują na wysoką śmiertelność – w jednej z serii przypadków obejmującej 50 pacjentów obserwowanych przez okres do 19 lat, śmiertelność wyniosła 56%, z czego ponad połowa zgonów była bezpośrednio związana z alkoholem.³

Choroba znacząco zwiększa chorobowość i śmiertelność dotkniętych nią pacjentów.⁴ Śmiertelność w PZT jest około dwukrotnie wyższa niż w populacji ogólnej.⁵ Komplikacje PZT obejmują powikłania trzustkowe (ropień, torbiel rzekoma, martwica krwotoczna), a także ogólne wyniszczenie, zakażenia, uzależnienie od narkotyków oraz przedłużoną hipoglikemię związaną z nadmiernym wydzielaniem insuliny.⁶

System punktacji COPPS (Chronic Pancreatitis Prognosis Score)

Ze względu na nieprzewidywalny przebieg kliniczny PZT, opracowano narzędzie do oceny ciężkości choroby i przewidywania ryzyka hospitalizacji – Chronic Pancreatitis Prognosis Score (COPPS). Jest to łatwy w użyciu dynamiczny wieloczynnikowy system punktacji, podobny do skali Child-Pugh dla marskości wątroby.⁷

System COPPS umożliwia obiektywne monitorowanie pacjentów z PZT, określając ryzyko ponownej hospitalizacji oraz potencjalny czas pobytu w szpitalu.⁸ W badaniach wykazano, że punktacja COPPS koreluje z wszystkimi głównymi wynikami: hospitalizacjami z jakiegokolwiek powodu (liczba: r = 0,15, P = 0,01; czas trwania: r = 0,16, P = 0,01) oraz hospitalizacjami związanymi z trzustką (liczba: r = 0,15, P = 0,02; czas trwania: r = 0,13, P = 0,04).⁹¹⁰

Jednakże korelacje te były słabsze niż w poprzednich badaniach, co może być związane z ambulatoryjnym charakterem kohorty PROspective Evaluation of Chronic Pancreatitis for EpidEmiologic and Translational StuDies oraz niższą częstością występowania choroby o dużej ciężkości.¹¹¹² System COPPS wykazał istotną statystycznie korelację z krótkoterminowym rokowaniem (prawdopodobieństwo i czas trwania hospitalizacji w ciągu 12 miesięcy), jednak siła związku była niewielka, co sugeruje potrzebę dalszej optymalizacji narzędzia do predykcji klinicznej przed jego wdrożeniem do opieki nad pacjentem.¹³

Czynniki ryzyka rozwoju przewlekłego zapalenia trzustki

Zidentyfikowanie pacjentów z grupy wysokiego ryzyka rozwoju PZT ma kluczowe znaczenie, ponieważ jest to choroba końcowego stadium, bez specyficznej terapii, a wczesna diagnoza jest niezwykle istotna.¹⁴ Badania wykazały kilka kluczowych czynników ryzyka:

Nawracające ostre zapalenie trzustki

Jednym z najważniejszych odkryć jest to, że częstość nawrotów ostrego zapalenia trzustki (OZT) zwiększa ryzyko rozwoju PZT. Pierwsze dwa ataki mają niewielki wpływ (0-1%) na prawdopodobieństwo rozwoju PZT, podczas gdy trzeci i czwarty epizod (16-50%) mają znacznie większy wpływ.¹⁵ W grupie pacjentów z trzema nawrotami OZT, 16% pacjentów ma już ustalone PZT, podczas gdy w grupie z czterema lub więcej nawrotami odsetek ten wynosi prawie 50%.¹⁶

Analiza porównawcza pokazuje, że wśród pacjentów z nawracającym ostrym zapaleniem trzustki (NOZT), 12,98% rozwinęło PZT, podczas gdy wśród pacjentów z tylko jednym epizodem OZT, jedynie 1,21% rozwinęło PZT.¹⁷

Inne czynniki ryzyka

Analiza wieloczynnikowa wykazała, że obecność nawracającego OZT (NOZT), alkoholizm, palenie tytoniu oraz wiek wystąpienia pierwszego epizodu poniżej 55 lat są czterema istotnymi czynnikami ryzyka rozwoju PZT.¹⁸¹⁹²⁰

Obserwacje te znajdują potwierdzenie zarówno w badaniach klinicznych, jak i eksperymentalnych, sugerujących, że trzy lub więcej epizodów NOZT można uznać za wczesne przewlekłe zapalenie trzustki (WPZT).²¹

Modele predykcyjne dla przewlekłego zapalenia trzustki

Model punktacji ryzyka

Opracowano model punktacji predykcyjnej dla PZT, który uwzględnia cztery główne czynniki ryzyka: obecność nawracającego OZT, spożywanie alkoholu, wiek wystąpienia pierwszego epizodu oraz nawyk palenia.²²²³ Model ten wykazał doskonałą zdolność dyskryminacyjną i został pomyślnie zweryfikowany w badaniach.²⁴

Korzystając z tego systemu punktacji, lekarz może łatwo przewidzieć wynik pacjenta z epizodem OZT i zaplanować dalsze badania, takie jak test funkcji trzustki lub endoskopowa ultrasonografia po ostrej fazie dla kategorii wysokiego ryzyka, aby jak najwcześniej zdiagnozować PZT (częstość występowania PZT około 31 na 1000 osobolat w grupie wysokiego ryzyka, na podstawie badań).²⁵ Jest to szczególnie istotne, ponieważ PZT jest ważnym czynnikiem ryzyka raka trzustki, zwiększając jego ryzyko nawet 26-krotnie.²⁶

Metaboliczny profil biomarkerów

W innowacyjnym dwuetapowym badaniu identyfikacyjnym i walidacyjnym zidentyfikowano sygnaturę biomarkerów dla PZT za pomocą spektrometrii masowej (chromatografia gazowa-spektrometria masowa i chromatografia cieczowa-tandemowa spektrometria masowa).²⁷ Jest to pierwsze badanie, które identyfikuje i niezależnie waliduje metabolomiczną sygnaturę w osoczu i surowicy dla diagnostyki PZT w dużych, prospektywnych kohortach.²⁸²⁹

Algorytm Naive Bayes zidentyfikował osiem metabolitów z sześciu klas ontologicznych. Po treningu algorytmu i obliczeniu optymalnych wartości granicznych, klasyfikacja zgodnie z sygnaturą metaboliczną wykrywała PZT z polem pod krzywą (AUC) wynoszącym 0,85 ((95% CI 0,79 do 0,91).³⁰ W badaniu proof-of-concept dotyczącym biomarkerów, przeprowadzonym zgodnie z wytycznymi TRIPOD, po raz pierwszy wykazano, że sygnatura składająca się z 8 metabolitów sześciu różnych klas ontologicznych może skutecznie różnicować między PZT a grupą kontrolną z akceptowalną dokładnością (AUC 0,8) w próbkach surowicy i osocza EDTA.³¹

Odkryto, że sygnatura metaboliczna opracowana w celu odróżnienia PZT od grupy kontrolnej jest mniej dyskryminująca, gdy jest stosowana do próbek marskości wątroby. Podobieństwo to interpretowano jako prawdopodobnie wynikające z aktywacji włóknienia i nadużywania alkoholu, cech wspólnych dla obu zaburzeń.³²

Wyniki tego badania mogą stanowić podstawę do opracowania pierwszego rutynowego testu laboratoryjnego dla PZT.³³³⁴

Czynniki prognostyczne w ostrym i nawracającym zapaleniu trzustki

Hipoteza martwicy-włóknienia opisuje kontinuum między pojedynczymi atakami ostrego zapalenia trzustki (POZT), nawracającym ostrym zapaleniem trzustki (NOZT) a przewlekłym zapaleniem trzustki (PZT) z niewydolnością endokrynną i egzokrynną trzustki.³⁵

Chociaż wszystkie parametry wynikowe były porównywalne między POZT a NOZT, tylko ciśnienie skurczowe krwi i objętość trzustki były prognostyczne w NOZT. W POZT jedynie zmodyfikowana ocena Marshalla i mCTSI (modyfikowana skala tomografii komputerowej ciężkości) wykazały wartość prognostyczną dla krótkoterminowej śmiertelności, podczas gdy CTSI (skala ciężkości w tomografii komputerowej) była predyktorem potrzeby interwencji.³⁶

U pacjentów z POZT zmodyfikowana ocena Marshalla była najlepszym predyktorem krótkoterminowej śmiertelności związanej z zapaleniem trzustki, a następnie mCTSI, co koreluje z wcześniejszymi ustaleniami.³⁷ Natomiast u pacjentów z NOZT tylko ciśnienie skurczowe krwi wykazało słabą ujemną wartość predykcyjną dla śmiertelności z powodu zapalenia trzustki.³⁸

Jedyną istotną korelację między procentowym zasięgiem martwicy trzustki a całkowitym czasem hospitalizacji stwierdzono u pacjentów z martwiczym NOZT, co wskazuje na jej wartość prognostyczną, ale ograniczoną z powodu możliwych czynników zakłócających, takich jak wiek i inne choroby współistniejące.³⁹

Wczesna diagnoza i monitorowanie

Wczesna diagnoza PZT ma kluczowe znaczenie, biorąc pod uwagę brak specyficznej terapii dla zaawansowanej choroby.⁴⁰ Nowe kryteria diagnostyczne dla wczesnego PZT (WPZT) pozwalają na wcześniejsze zdiagnozowanie większości pacjentów z PZT.⁴¹

Zależne od epizodu zmniejszenie podwyższonej aktywności amylazy podkreśla utratę komórek zrazikowych w trzustce i funkcjonalne zmniejszenie wydzielania enzymów trzustkowych/wycieku z komórek zrazikowych.⁴² Ten biomarker, wraz z innymi, wykazał dwukierunkowe zmiany w etiologiach alkoholowych i żółciowych u pacjentów z OZT, NOZT i PZT.⁴³

Potrzebne są badania w innych prospektywnych kohortach, aby zrozumieć pełną użyteczność COPPS jako potencjalnego narzędzia do oceny ryzyka klinicznego i interwencji.⁴⁴

Wnioski końcowe

Przewlekłe zapalenie trzustki pozostaje poważnym schorzeniem z nieprzewidywalnym przebiegiem klinicznym i istotnym wpływem na śmiertelność. Rozwój narzędzi prognostycznych, takich jak COPPS i modele predykcyjne oparte na czynnikach ryzyka, stanowi znaczący postęp w zarządzaniu tą chorobą. Trwają prace nad biomarkerami metabolicznymi, które mogą w przyszłości umożliwić wcześniejszą i dokładniejszą diagnozę.

Szczególnie istotne jest rozpoznanie pacjentów z trzema lub więcej epizodami ostrego zapalenia trzustki jako grupy wysokiego ryzyka rozwoju PZT. To wczesne rozpoznanie pozwala na odpowiednie monitorowanie i potencjalnie wcześniejszą interwencję, zwłaszcza biorąc pod uwagę zwiększone ryzyko raka trzustki u tych pacjentów.

Dalsze badania są niezbędne do udoskonalenia istniejących narzędzi prognostycznych i opracowania nowych biomarkerów, które mogłyby umożliwić personalizację zarządzania tą złożoną chorobą.

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Materiały źródłowe

#1 Prognosis of Chronic Pancreatitis | SpringerLink
https://link.springer.com/chapter/10.1007/978-1-4613-2907-7_17
Prognosis in chronic pancreatitis must be viewed as guarded. In one series of 50 patients who were followed closely for periods up to 19 years, mortality was 56%. More than half of the deaths were caused directly by alcohol. These included cirrhosis of the liver and a variety of pancreatic complications (including abscess, pseudocyst, and hemorrhagic necrosis). Other causes of death in chronic pancreatitis include general debilitation, varieties of infections including pneumonia and tuberculosis, narcotic addiction, and prolonged hypoglycemia caused by inappropriately large amounts of insulin.
#2 Risk factors and prediction score for chronic pancreatitis: A nationwide population-based cohort study
https://www.wjgnet.com/1007-9327/full/v24/i44/5034.htm
Chronic pancreatitis (CP) involves a persistent destructive, inflammatory process that eventually leads to an irreversible damage to the endocrine and exocrine functions of the pancreas. CP has complications and poor prognosis, with the mortality rate being approximately two-fold higher than that in the general population. Incidence rate of pancreatic cancer is as high as 26-fold in patients with CP, suggesting that the risk of pancreatic cancer is significantly higher in subjects with CP. Therefore, it is critical to predict CP in patients with acute pancreatitis (AP). […] The multivariate analysis revealed that the presence of RAP, alcoholism, smoking habit, and age of onset of 55 years were the four important risk factors for CP. […] Using our prediction score model for CP, we were able to stratify our patients into different categories and arrange further examinations such as pancreatic functional test or endoscopic ultrasound after acute stage for the high-risk category (incidence rate of about 31 per 1000 person-years, based on our study) to detect CP as early as possible and determine the optimal follow-up interval for the patients with AP with a nonbiliary, nonobstructive etiology.
#3 Prognosis of Chronic Pancreatitis | SpringerLink
https://link.springer.com/chapter/10.1007/978-1-4613-2907-7_17
Prognosis in chronic pancreatitis must be viewed as guarded. In one series of 50 patients who were followed closely for periods up to 19 years, mortality was 56%. More than half of the deaths were caused directly by alcohol. These included cirrhosis of the liver and a variety of pancreatic complications (including abscess, pseudocyst, and hemorrhagic necrosis). Other causes of death in chronic pancreatitis include general debilitation, varieties of infections including pneumonia and tuberculosis, narcotic addiction, and prolonged hypoglycemia caused by inappropriately large amounts of insulin.
#4 Identification and validation of a multivariable prediction model based on blood plasma and serum metabolomics for the distinction of chronic pancreatitis subjects from non-pancreas disease control subjects | Gut
https://gut.bmj.com/content/70/11/2150
Chronic pancreatitis (CP) is a fibroinflammatory syndrome leading to organ dysfunction, chronic pain, an increased risk for pancreatic cancer and considerable morbidity. […] A Naive Bayes algorithm identified eight metabolites of six ontology classes. After algorithm training and computation of optimal cut-offs, classification according to the metabolic signature detected CP with an area under the curve (AUC) of 0.85 ((95%CI 0.79 to 0.91). […] This is the first study that identifies and independently validates a metabolomic signature in plasma and serum for the diagnosis of CP in large, prospective cohorts. The results could provide the basis for the development of the first routine laboratory test for CP. […] Chronic pancreatitis greatly increases the morbidity and mortality of affected patients.
#5 Risk factors and prediction score for chronic pancreatitis: A nationwide population-based cohort study
https://www.wjgnet.com/1007-9327/full/v24/i44/5034.htm
Chronic pancreatitis (CP) involves a persistent destructive, inflammatory process that eventually leads to an irreversible damage to the endocrine and exocrine functions of the pancreas. CP has complications and poor prognosis, with the mortality rate being approximately two-fold higher than that in the general population. Incidence rate of pancreatic cancer is as high as 26-fold in patients with CP, suggesting that the risk of pancreatic cancer is significantly higher in subjects with CP. Therefore, it is critical to predict CP in patients with acute pancreatitis (AP). […] The multivariate analysis revealed that the presence of RAP, alcoholism, smoking habit, and age of onset of 55 years were the four important risk factors for CP. […] Using our prediction score model for CP, we were able to stratify our patients into different categories and arrange further examinations such as pancreatic functional test or endoscopic ultrasound after acute stage for the high-risk category (incidence rate of about 31 per 1000 person-years, based on our study) to detect CP as early as possible and determine the optimal follow-up interval for the patients with AP with a nonbiliary, nonobstructive etiology.
#6 Prognosis of Chronic Pancreatitis | SpringerLink
https://link.springer.com/chapter/10.1007/978-1-4613-2907-7_17
Prognosis in chronic pancreatitis must be viewed as guarded. In one series of 50 patients who were followed closely for periods up to 19 years, mortality was 56%. More than half of the deaths were caused directly by alcohol. These included cirrhosis of the liver and a variety of pancreatic complications (including abscess, pseudocyst, and hemorrhagic necrosis). Other causes of death in chronic pancreatitis include general debilitation, varieties of infections including pneumonia and tuberculosis, narcotic addiction, and prolonged hypoglycemia caused by inappropriately large amounts of insulin.
#7 Development and Validation of a Chronic Pancreatitis Prognosis Score in 2 Independent Cohorts – PubMed
https://pubmed.ncbi.nlm.nih.gov/28918191/
The clinical course of chronic pancreatitis is unpredictable. There is no model to assess disease severity or progression or predict patient outcomes. […] We developed and validated an easy to use dynamic multivariate scoring system, similar to the Child-Pugh-Score for liver cirrhosis. The COPPS allows objective monitoring of patients with chronic pancreatitis, determining risk for readmission to hospital and potential length of hospital stay.
#8 Development and Validation of a Chronic Pancreatitis Prognosis Score in 2 Independent Cohorts – PubMed
https://pubmed.ncbi.nlm.nih.gov/28918191/
The clinical course of chronic pancreatitis is unpredictable. There is no model to assess disease severity or progression or predict patient outcomes. […] We developed and validated an easy to use dynamic multivariate scoring system, similar to the Child-Pugh-Score for liver cirrhosis. The COPPS allows objective monitoring of patients with chronic pancreatitis, determining risk for readmission to hospital and potential length of hospital stay.
#9 Evaluation of Chronic Pancreatitis Prognosis Score in an American Cohort – PubMed
https://pubmed.ncbi.nlm.nih.gov/39137098/
Chronic Pancreatitis Prognosis Score (COPPS) was developed to discriminate disease severity and predict risk for future hospitalizations. […] COPPS correlated with all primary outcomes: hospitalizations for any reason (number: r = 0.15, P = 0.01; duration: r = 0.16, P = 0.01) and pancreas-related hospitalizations (number: r = 0.15, P = 0.02; duration: r = 0.13, P = 0.04). […] Statistically, COPPS significantly correlated with hospitalization outcomes, but the correlations were weaker than in previous studies, which may be related to the outpatient nature of the PROspective Evaluation of Chronic Pancreatitis for EpidEmiologic and Translational StuDies cohort and lower prevalence of high severity disease. Studies in other prospective cohorts are needed to understand the full utility of COPPS as a potential tool for clinical risk assessment and intervention.
#10
https://journals.lww.com/ctg/fulltext/2024/11000/evaluation_of_chronic_pancreatitis_prognosis_score.8.aspx
Chronic Pancreatitis Prognosis Score (COPPS) was developed to discriminate disease severity and predict risk for future hospitalizations. In this cohort study, we evaluated if COPPS predicts the likelihood of hospitalization(s) in an American cohort. […] COPPS correlated with all primary outcomes: hospitalizations for any reason (number: r = 0.15, P = 0.01; duration: r = 0.16, P = 0.01) and pancreas-related hospitalizations (number: r = 0.15, P = 0.02; duration: r = 0.13, P = 0.04). […] Statistically, COPPS significantly correlated with hospitalization outcomes, but the correlations were weaker than in previous studies, which may be related to the outpatient nature of the PROspective Evaluation of Chronic Pancreatitis for EpidEmiologic and Translational StuDies cohort and lower prevalence of high severity disease.
#11 Evaluation of Chronic Pancreatitis Prognosis Score in an American Cohort – PubMed
https://pubmed.ncbi.nlm.nih.gov/39137098/
Chronic Pancreatitis Prognosis Score (COPPS) was developed to discriminate disease severity and predict risk for future hospitalizations. […] COPPS correlated with all primary outcomes: hospitalizations for any reason (number: r = 0.15, P = 0.01; duration: r = 0.16, P = 0.01) and pancreas-related hospitalizations (number: r = 0.15, P = 0.02; duration: r = 0.13, P = 0.04). […] Statistically, COPPS significantly correlated with hospitalization outcomes, but the correlations were weaker than in previous studies, which may be related to the outpatient nature of the PROspective Evaluation of Chronic Pancreatitis for EpidEmiologic and Translational StuDies cohort and lower prevalence of high severity disease. Studies in other prospective cohorts are needed to understand the full utility of COPPS as a potential tool for clinical risk assessment and intervention.
#12
https://journals.lww.com/ctg/fulltext/2024/11000/evaluation_of_chronic_pancreatitis_prognosis_score.8.aspx
Chronic Pancreatitis Prognosis Score (COPPS) was developed to discriminate disease severity and predict risk for future hospitalizations. In this cohort study, we evaluated if COPPS predicts the likelihood of hospitalization(s) in an American cohort. […] COPPS correlated with all primary outcomes: hospitalizations for any reason (number: r = 0.15, P = 0.01; duration: r = 0.16, P = 0.01) and pancreas-related hospitalizations (number: r = 0.15, P = 0.02; duration: r = 0.13, P = 0.04). […] Statistically, COPPS significantly correlated with hospitalization outcomes, but the correlations were weaker than in previous studies, which may be related to the outpatient nature of the PROspective Evaluation of Chronic Pancreatitis for EpidEmiologic and Translational StuDies cohort and lower prevalence of high severity disease.
#13
https://journals.lww.com/ctg/fulltext/2024/11000/evaluation_of_chronic_pancreatitis_prognosis_score.8.aspx
The COPPS system provided a score that was significantly correlated with short-term prognosis (likelihood and duration of hospitalization within 12 months) of patients with CP. However, the strength of the association was small, suggesting further optimization of a clinical prediction tool is needed before clinicians can implement this into patient care.
#14 Evidence for diagnosis of early chronic pancreatitis after three episodes of acute pancreatitis: a cross-sectional multicentre international study with experimental animal model | Scientific Reports
https://www.nature.com/articles/s41598-020-80532-6
Chronic pancreatitis (CP) is an end-stage disease with no specific therapy; therefore, an early diagnosis is of crucial importance. […] The prevalence of CP in combination with AP, RAP2, RAP3, RAP4 and RAP5+was 0%, 1%, 16%, 50% and 47%, respectively, suggesting that three or more episodes of AP is a strong risk factor for CP. […] We concluded that three or more attacks of AP with no morphological changes to the pancreas could be considered as early CP (ECP). […] The new diagnostic criteria for ECP allow the majority of CP patients to be diagnosed earlier. […] One of the key findings of this study is that the incidence of recurrent episodes increases the risk of CP development. The first two attacks have small effects (01%) on the odds for developing CP, whereas the third and fourth (1650%) episodes have large ones.
#15 Evidence for diagnosis of early chronic pancreatitis after three episodes of acute pancreatitis: a cross-sectional multicentre international study with experimental animal model | Scientific Reports
https://www.nature.com/articles/s41598-020-80532-6
Chronic pancreatitis (CP) is an end-stage disease with no specific therapy; therefore, an early diagnosis is of crucial importance. […] The prevalence of CP in combination with AP, RAP2, RAP3, RAP4 and RAP5+was 0%, 1%, 16%, 50% and 47%, respectively, suggesting that three or more episodes of AP is a strong risk factor for CP. […] We concluded that three or more attacks of AP with no morphological changes to the pancreas could be considered as early CP (ECP). […] The new diagnostic criteria for ECP allow the majority of CP patients to be diagnosed earlier. […] One of the key findings of this study is that the incidence of recurrent episodes increases the risk of CP development. The first two attacks have small effects (01%) on the odds for developing CP, whereas the third and fourth (1650%) episodes have large ones.
#16 Evidence for diagnosis of early chronic pancreatitis after three episodes of acute pancreatitis: a cross-sectional multicentre international study with experimental animal model | Scientific Reports
https://www.nature.com/articles/s41598-020-80532-6
In the RAP3 group, 16% of patients already have established CP, while the figure is nearly 50% in the RAP4+group. […] These data demonstrate that three or more episodes of AP are to be considered as a significant risk factor for the development of CP. […] Our significant biomarkers clearly showed bidirectional changes in alcoholic and biliary etiologies in AP, RAP and CP patients. […] The episode-dependent decrease in the elevation of amylase activity highlights the loss of acinar cells in the pancreas and the functional decrease of pancreatic enzyme secretion/leakage from acinar cells. […] Taken together, both the clinical and experimental studies suggest that three or more episodes of RAP can be considered as ECP.
#17 Risk factors and prediction score for chronic pancreatitis: A nationwide population-based cohort study
https://www.wjgnet.com/1007-9327/full/v24/i44/5034.htm
AIM To explore the risk factors of developing chronic pancreatitis (CP) in patients with acute pancreatitis (AP) and develop a prediction score for CP. […] RESULTS Among the study subjects, 142 patients (12.98%) developed CP among patients with RAP. On the other hand, only 32 patients (1.21%) developed CP among patients with only one episode of AP. The multivariate analysis revealed that the presence of recurrent AP (RAP), alcoholism, smoking habit, and age of onset of 55 years were the four important risk factors for CP. […] CONCLUSION In the study, we identified the risk factors of CP and developed a prediction score model for CP. […] In this large number, nationwide population-based cohort study, we concluded that the presence of recurrent acute pancreatitis (RAP), along with alcohol consumption, age of onset, and smoking habit are 4 important risk factors of chronic pancreatitis (CP). We developed a novel prediction score model for CP with excellent discrimination and successfully validated this model in our study.
#18
https://vkp.org.ua/index.php/journal/article/view/189
To explore the risk factors of developing chronic pancreatitis (CP) in patients with acute pancreatitis (AP) and develop a prediction score for CP. […] The multivariate analysis revealed that the presence of recurrent AP (RAP), alcoholism, smoking habit, and age of onset of 55 years were the four important risk factors for CP. […] In the study, we identified the risk factors of CP and developed a prediction score model for CP. […] We concluded that the presence of recurrent acute pancreatitis (RAP), along with alcohol consumption, age of onset, and smoking habit are 4 important risk factors of chronic pancreatitis (CP). […] Using this scoring system, a clinician can predict the outcome of a patient with AP episode easily and arrange further examination such as pancreatic functional test or endoscopic ultrasound after the acute stage for the high-risk category to diagnose CP as early as possible (incidence rate of CP about 31 per 1000 person-years in high-risk group, based on our study) since CP is an important risk factor of pancreatic cancer.
#19 Risk factors and prediction score for chronic pancreatitis: A nationwide population-based cohort study
https://www.wjgnet.com/1007-9327/full/v24/i44/5034.htm
AIM To explore the risk factors of developing chronic pancreatitis (CP) in patients with acute pancreatitis (AP) and develop a prediction score for CP. […] RESULTS Among the study subjects, 142 patients (12.98%) developed CP among patients with RAP. On the other hand, only 32 patients (1.21%) developed CP among patients with only one episode of AP. The multivariate analysis revealed that the presence of recurrent AP (RAP), alcoholism, smoking habit, and age of onset of 55 years were the four important risk factors for CP. […] CONCLUSION In the study, we identified the risk factors of CP and developed a prediction score model for CP. […] In this large number, nationwide population-based cohort study, we concluded that the presence of recurrent acute pancreatitis (RAP), along with alcohol consumption, age of onset, and smoking habit are 4 important risk factors of chronic pancreatitis (CP). We developed a novel prediction score model for CP with excellent discrimination and successfully validated this model in our study.
#20 Risk factors and prediction score for chronic pancreatitis: A nationwide population-based cohort study
https://www.wjgnet.com/1007-9327/full/v24/i44/5034.htm
Chronic pancreatitis (CP) involves a persistent destructive, inflammatory process that eventually leads to an irreversible damage to the endocrine and exocrine functions of the pancreas. CP has complications and poor prognosis, with the mortality rate being approximately two-fold higher than that in the general population. Incidence rate of pancreatic cancer is as high as 26-fold in patients with CP, suggesting that the risk of pancreatic cancer is significantly higher in subjects with CP. Therefore, it is critical to predict CP in patients with acute pancreatitis (AP). […] The multivariate analysis revealed that the presence of RAP, alcoholism, smoking habit, and age of onset of 55 years were the four important risk factors for CP. […] Using our prediction score model for CP, we were able to stratify our patients into different categories and arrange further examinations such as pancreatic functional test or endoscopic ultrasound after acute stage for the high-risk category (incidence rate of about 31 per 1000 person-years, based on our study) to detect CP as early as possible and determine the optimal follow-up interval for the patients with AP with a nonbiliary, nonobstructive etiology.
#21 Evidence for diagnosis of early chronic pancreatitis after three episodes of acute pancreatitis: a cross-sectional multicentre international study with experimental animal model | Scientific Reports
https://www.nature.com/articles/s41598-020-80532-6
In the RAP3 group, 16% of patients already have established CP, while the figure is nearly 50% in the RAP4+group. […] These data demonstrate that three or more episodes of AP are to be considered as a significant risk factor for the development of CP. […] Our significant biomarkers clearly showed bidirectional changes in alcoholic and biliary etiologies in AP, RAP and CP patients. […] The episode-dependent decrease in the elevation of amylase activity highlights the loss of acinar cells in the pancreas and the functional decrease of pancreatic enzyme secretion/leakage from acinar cells. […] Taken together, both the clinical and experimental studies suggest that three or more episodes of RAP can be considered as ECP.
#22
https://vkp.org.ua/index.php/journal/article/view/189
To explore the risk factors of developing chronic pancreatitis (CP) in patients with acute pancreatitis (AP) and develop a prediction score for CP. […] The multivariate analysis revealed that the presence of recurrent AP (RAP), alcoholism, smoking habit, and age of onset of 55 years were the four important risk factors for CP. […] In the study, we identified the risk factors of CP and developed a prediction score model for CP. […] We concluded that the presence of recurrent acute pancreatitis (RAP), along with alcohol consumption, age of onset, and smoking habit are 4 important risk factors of chronic pancreatitis (CP). […] Using this scoring system, a clinician can predict the outcome of a patient with AP episode easily and arrange further examination such as pancreatic functional test or endoscopic ultrasound after the acute stage for the high-risk category to diagnose CP as early as possible (incidence rate of CP about 31 per 1000 person-years in high-risk group, based on our study) since CP is an important risk factor of pancreatic cancer.
#23 Risk factors and prediction score for chronic pancreatitis: A nationwide population-based cohort study
https://www.wjgnet.com/1007-9327/full/v24/i44/5034.htm
AIM To explore the risk factors of developing chronic pancreatitis (CP) in patients with acute pancreatitis (AP) and develop a prediction score for CP. […] RESULTS Among the study subjects, 142 patients (12.98%) developed CP among patients with RAP. On the other hand, only 32 patients (1.21%) developed CP among patients with only one episode of AP. The multivariate analysis revealed that the presence of recurrent AP (RAP), alcoholism, smoking habit, and age of onset of 55 years were the four important risk factors for CP. […] CONCLUSION In the study, we identified the risk factors of CP and developed a prediction score model for CP. […] In this large number, nationwide population-based cohort study, we concluded that the presence of recurrent acute pancreatitis (RAP), along with alcohol consumption, age of onset, and smoking habit are 4 important risk factors of chronic pancreatitis (CP). We developed a novel prediction score model for CP with excellent discrimination and successfully validated this model in our study.
#24 Risk factors and prediction score for chronic pancreatitis: A nationwide population-based cohort study
https://www.wjgnet.com/1007-9327/full/v24/i44/5034.htm
AIM To explore the risk factors of developing chronic pancreatitis (CP) in patients with acute pancreatitis (AP) and develop a prediction score for CP. […] RESULTS Among the study subjects, 142 patients (12.98%) developed CP among patients with RAP. On the other hand, only 32 patients (1.21%) developed CP among patients with only one episode of AP. The multivariate analysis revealed that the presence of recurrent AP (RAP), alcoholism, smoking habit, and age of onset of 55 years were the four important risk factors for CP. […] CONCLUSION In the study, we identified the risk factors of CP and developed a prediction score model for CP. […] In this large number, nationwide population-based cohort study, we concluded that the presence of recurrent acute pancreatitis (RAP), along with alcohol consumption, age of onset, and smoking habit are 4 important risk factors of chronic pancreatitis (CP). We developed a novel prediction score model for CP with excellent discrimination and successfully validated this model in our study.
#25
https://vkp.org.ua/index.php/journal/article/view/189
To explore the risk factors of developing chronic pancreatitis (CP) in patients with acute pancreatitis (AP) and develop a prediction score for CP. […] The multivariate analysis revealed that the presence of recurrent AP (RAP), alcoholism, smoking habit, and age of onset of 55 years were the four important risk factors for CP. […] In the study, we identified the risk factors of CP and developed a prediction score model for CP. […] We concluded that the presence of recurrent acute pancreatitis (RAP), along with alcohol consumption, age of onset, and smoking habit are 4 important risk factors of chronic pancreatitis (CP). […] Using this scoring system, a clinician can predict the outcome of a patient with AP episode easily and arrange further examination such as pancreatic functional test or endoscopic ultrasound after the acute stage for the high-risk category to diagnose CP as early as possible (incidence rate of CP about 31 per 1000 person-years in high-risk group, based on our study) since CP is an important risk factor of pancreatic cancer.
#26 Risk factors and prediction score for chronic pancreatitis: A nationwide population-based cohort study
https://www.wjgnet.com/1007-9327/full/v24/i44/5034.htm
Chronic pancreatitis (CP) involves a persistent destructive, inflammatory process that eventually leads to an irreversible damage to the endocrine and exocrine functions of the pancreas. CP has complications and poor prognosis, with the mortality rate being approximately two-fold higher than that in the general population. Incidence rate of pancreatic cancer is as high as 26-fold in patients with CP, suggesting that the risk of pancreatic cancer is significantly higher in subjects with CP. Therefore, it is critical to predict CP in patients with acute pancreatitis (AP). […] The multivariate analysis revealed that the presence of RAP, alcoholism, smoking habit, and age of onset of 55 years were the four important risk factors for CP. […] Using our prediction score model for CP, we were able to stratify our patients into different categories and arrange further examinations such as pancreatic functional test or endoscopic ultrasound after acute stage for the high-risk category (incidence rate of about 31 per 1000 person-years, based on our study) to detect CP as early as possible and determine the optimal follow-up interval for the patients with AP with a nonbiliary, nonobstructive etiology.
#27 Identification and validation of a multivariable prediction model based on blood plasma and serum metabolomics for the distinction of chronic pancreatitis subjects from non-pancreas disease control subjects | Gut
https://gut.bmj.com/content/70/11/2150
In a two-step identification and validation study a biomarker signature for chronic pancreatitis was identified by mass spectrometry (gas chromatography-mass spectrometry and liquid chromatographytandem mass spectrometry). […] This is the first study that identifies and independently validates a metabolic biomarker signature for the diagnosis of chronic pancreatitis in large, prospective cohorts. […] The results of this study could provide the basis for the development of a first routine laboratory test for chronic pancreatitis. […] In our proof-of-concept biomarker study following the TRIPOD guidelines we show for the first time that a signature comprised of 8 metabolites of six different ontology classes can successfully differentiate between CP and controls with acceptable accuracy (AUC 0.8) in serum and EDTA-plasma samples.
#28 Identification and validation of a multivariable prediction model based on blood plasma and serum metabolomics for the distinction of chronic pancreatitis subjects from non-pancreas disease control subjects | Gut
https://gut.bmj.com/content/70/11/2150
Chronic pancreatitis (CP) is a fibroinflammatory syndrome leading to organ dysfunction, chronic pain, an increased risk for pancreatic cancer and considerable morbidity. […] A Naive Bayes algorithm identified eight metabolites of six ontology classes. After algorithm training and computation of optimal cut-offs, classification according to the metabolic signature detected CP with an area under the curve (AUC) of 0.85 ((95%CI 0.79 to 0.91). […] This is the first study that identifies and independently validates a metabolomic signature in plasma and serum for the diagnosis of CP in large, prospective cohorts. The results could provide the basis for the development of the first routine laboratory test for CP. […] Chronic pancreatitis greatly increases the morbidity and mortality of affected patients.
#29 Identification and validation of a multivariable prediction model based on blood plasma and serum metabolomics for the distinction of chronic pancreatitis subjects from non-pancreas disease control subjects | Gut
https://gut.bmj.com/content/70/11/2150
In a two-step identification and validation study a biomarker signature for chronic pancreatitis was identified by mass spectrometry (gas chromatography-mass spectrometry and liquid chromatographytandem mass spectrometry). […] This is the first study that identifies and independently validates a metabolic biomarker signature for the diagnosis of chronic pancreatitis in large, prospective cohorts. […] The results of this study could provide the basis for the development of a first routine laboratory test for chronic pancreatitis. […] In our proof-of-concept biomarker study following the TRIPOD guidelines we show for the first time that a signature comprised of 8 metabolites of six different ontology classes can successfully differentiate between CP and controls with acceptable accuracy (AUC 0.8) in serum and EDTA-plasma samples.
#30 Identification and validation of a multivariable prediction model based on blood plasma and serum metabolomics for the distinction of chronic pancreatitis subjects from non-pancreas disease control subjects | Gut
https://gut.bmj.com/content/70/11/2150
Chronic pancreatitis (CP) is a fibroinflammatory syndrome leading to organ dysfunction, chronic pain, an increased risk for pancreatic cancer and considerable morbidity. […] A Naive Bayes algorithm identified eight metabolites of six ontology classes. After algorithm training and computation of optimal cut-offs, classification according to the metabolic signature detected CP with an area under the curve (AUC) of 0.85 ((95%CI 0.79 to 0.91). […] This is the first study that identifies and independently validates a metabolomic signature in plasma and serum for the diagnosis of CP in large, prospective cohorts. The results could provide the basis for the development of the first routine laboratory test for CP. […] Chronic pancreatitis greatly increases the morbidity and mortality of affected patients.
#31 Identification and validation of a multivariable prediction model based on blood plasma and serum metabolomics for the distinction of chronic pancreatitis subjects from non-pancreas disease control subjects | Gut
https://gut.bmj.com/content/70/11/2150
In a two-step identification and validation study a biomarker signature for chronic pancreatitis was identified by mass spectrometry (gas chromatography-mass spectrometry and liquid chromatographytandem mass spectrometry). […] This is the first study that identifies and independently validates a metabolic biomarker signature for the diagnosis of chronic pancreatitis in large, prospective cohorts. […] The results of this study could provide the basis for the development of a first routine laboratory test for chronic pancreatitis. […] In our proof-of-concept biomarker study following the TRIPOD guidelines we show for the first time that a signature comprised of 8 metabolites of six different ontology classes can successfully differentiate between CP and controls with acceptable accuracy (AUC 0.8) in serum and EDTA-plasma samples.
#32 Identification and validation of a multivariable prediction model based on blood plasma and serum metabolomics for the distinction of chronic pancreatitis subjects from non-pancreas disease control subjects | Gut
https://gut.bmj.com/content/70/11/2150
We found the metabolic signature developed to distinguish CP from controls to be less discriminative when applied to liver cirrhosis samples. The similarity was interpreted as being likely due to activation of fibrosis and alcohol abuse, a common feature of both disorders. […] In conclusion, we have identified and validated an LC-MS/MS-based human blood-metabolome signature, which successfully discriminates between healthy individuals and patients with CP.
#33 Identification and validation of a multivariable prediction model based on blood plasma and serum metabolomics for the distinction of chronic pancreatitis subjects from non-pancreas disease control subjects | Gut
https://gut.bmj.com/content/70/11/2150
Chronic pancreatitis (CP) is a fibroinflammatory syndrome leading to organ dysfunction, chronic pain, an increased risk for pancreatic cancer and considerable morbidity. […] A Naive Bayes algorithm identified eight metabolites of six ontology classes. After algorithm training and computation of optimal cut-offs, classification according to the metabolic signature detected CP with an area under the curve (AUC) of 0.85 ((95%CI 0.79 to 0.91). […] This is the first study that identifies and independently validates a metabolomic signature in plasma and serum for the diagnosis of CP in large, prospective cohorts. The results could provide the basis for the development of the first routine laboratory test for CP. […] Chronic pancreatitis greatly increases the morbidity and mortality of affected patients.
#34 Identification and validation of a multivariable prediction model based on blood plasma and serum metabolomics for the distinction of chronic pancreatitis subjects from non-pancreas disease control subjects | Gut
https://gut.bmj.com/content/70/11/2150
In a two-step identification and validation study a biomarker signature for chronic pancreatitis was identified by mass spectrometry (gas chromatography-mass spectrometry and liquid chromatographytandem mass spectrometry). […] This is the first study that identifies and independently validates a metabolic biomarker signature for the diagnosis of chronic pancreatitis in large, prospective cohorts. […] The results of this study could provide the basis for the development of a first routine laboratory test for chronic pancreatitis. […] In our proof-of-concept biomarker study following the TRIPOD guidelines we show for the first time that a signature comprised of 8 metabolites of six different ontology classes can successfully differentiate between CP and controls with acceptable accuracy (AUC 0.8) in serum and EDTA-plasma samples.
#35 Clinico-radiological comparison and short-term prognosis of single acute pancreatitis and recurrent acute pancreatitis including pancreatic volumetry | PLOS One
https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0206062
The necrosis-fibrosis hypothesis describes a continuum between single attacks of acute pancreatitis (SAP), recurrent acute pancreatitis (RAP) and chronic pancreatitis (CP) with endocrine and exocrine pancreatic insufficiency. […] Although all outcome parameters were comparable between SAP and RAP, only systolic blood pressure and pancreatic volumetry were prognostic in RAP. In SAP, only the modified Marshall score and mCTSI revealed prognostic value for short-term mortality, whereas CTSI was predictive for the need for intervention. […] In patients with SAP, the modified Marshall score was the best predictor for pancreatitis-related short-term mortality followed by mCTSI, which correlates with previous findings. […] In contrast, in patients with RAP, only systolic blood pressure showed a weak negative predictive value for mortality due to pancreatitis. […] The only significant correlation between the percentage extent of pancreatic necrosis and the total duration of the hospitalization was found in patients with necrotizing RAP, indicating its prognostic, but limited value due to possible confounders like age and other comorbidities.
#36 Clinico-radiological comparison and short-term prognosis of single acute pancreatitis and recurrent acute pancreatitis including pancreatic volumetry | PLOS One
https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0206062
The necrosis-fibrosis hypothesis describes a continuum between single attacks of acute pancreatitis (SAP), recurrent acute pancreatitis (RAP) and chronic pancreatitis (CP) with endocrine and exocrine pancreatic insufficiency. […] Although all outcome parameters were comparable between SAP and RAP, only systolic blood pressure and pancreatic volumetry were prognostic in RAP. In SAP, only the modified Marshall score and mCTSI revealed prognostic value for short-term mortality, whereas CTSI was predictive for the need for intervention. […] In patients with SAP, the modified Marshall score was the best predictor for pancreatitis-related short-term mortality followed by mCTSI, which correlates with previous findings. […] In contrast, in patients with RAP, only systolic blood pressure showed a weak negative predictive value for mortality due to pancreatitis. […] The only significant correlation between the percentage extent of pancreatic necrosis and the total duration of the hospitalization was found in patients with necrotizing RAP, indicating its prognostic, but limited value due to possible confounders like age and other comorbidities.
#37 Clinico-radiological comparison and short-term prognosis of single acute pancreatitis and recurrent acute pancreatitis including pancreatic volumetry | PLOS One
https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0206062
The necrosis-fibrosis hypothesis describes a continuum between single attacks of acute pancreatitis (SAP), recurrent acute pancreatitis (RAP) and chronic pancreatitis (CP) with endocrine and exocrine pancreatic insufficiency. […] Although all outcome parameters were comparable between SAP and RAP, only systolic blood pressure and pancreatic volumetry were prognostic in RAP. In SAP, only the modified Marshall score and mCTSI revealed prognostic value for short-term mortality, whereas CTSI was predictive for the need for intervention. […] In patients with SAP, the modified Marshall score was the best predictor for pancreatitis-related short-term mortality followed by mCTSI, which correlates with previous findings. […] In contrast, in patients with RAP, only systolic blood pressure showed a weak negative predictive value for mortality due to pancreatitis. […] The only significant correlation between the percentage extent of pancreatic necrosis and the total duration of the hospitalization was found in patients with necrotizing RAP, indicating its prognostic, but limited value due to possible confounders like age and other comorbidities.
#38 Clinico-radiological comparison and short-term prognosis of single acute pancreatitis and recurrent acute pancreatitis including pancreatic volumetry | PLOS One
https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0206062
The necrosis-fibrosis hypothesis describes a continuum between single attacks of acute pancreatitis (SAP), recurrent acute pancreatitis (RAP) and chronic pancreatitis (CP) with endocrine and exocrine pancreatic insufficiency. […] Although all outcome parameters were comparable between SAP and RAP, only systolic blood pressure and pancreatic volumetry were prognostic in RAP. In SAP, only the modified Marshall score and mCTSI revealed prognostic value for short-term mortality, whereas CTSI was predictive for the need for intervention. […] In patients with SAP, the modified Marshall score was the best predictor for pancreatitis-related short-term mortality followed by mCTSI, which correlates with previous findings. […] In contrast, in patients with RAP, only systolic blood pressure showed a weak negative predictive value for mortality due to pancreatitis. […] The only significant correlation between the percentage extent of pancreatic necrosis and the total duration of the hospitalization was found in patients with necrotizing RAP, indicating its prognostic, but limited value due to possible confounders like age and other comorbidities.
#39 Clinico-radiological comparison and short-term prognosis of single acute pancreatitis and recurrent acute pancreatitis including pancreatic volumetry | PLOS One
https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0206062
The necrosis-fibrosis hypothesis describes a continuum between single attacks of acute pancreatitis (SAP), recurrent acute pancreatitis (RAP) and chronic pancreatitis (CP) with endocrine and exocrine pancreatic insufficiency. […] Although all outcome parameters were comparable between SAP and RAP, only systolic blood pressure and pancreatic volumetry were prognostic in RAP. In SAP, only the modified Marshall score and mCTSI revealed prognostic value for short-term mortality, whereas CTSI was predictive for the need for intervention. […] In patients with SAP, the modified Marshall score was the best predictor for pancreatitis-related short-term mortality followed by mCTSI, which correlates with previous findings. […] In contrast, in patients with RAP, only systolic blood pressure showed a weak negative predictive value for mortality due to pancreatitis. […] The only significant correlation between the percentage extent of pancreatic necrosis and the total duration of the hospitalization was found in patients with necrotizing RAP, indicating its prognostic, but limited value due to possible confounders like age and other comorbidities.
#40 Evidence for diagnosis of early chronic pancreatitis after three episodes of acute pancreatitis: a cross-sectional multicentre international study with experimental animal model | Scientific Reports
https://www.nature.com/articles/s41598-020-80532-6
Chronic pancreatitis (CP) is an end-stage disease with no specific therapy; therefore, an early diagnosis is of crucial importance. […] The prevalence of CP in combination with AP, RAP2, RAP3, RAP4 and RAP5+was 0%, 1%, 16%, 50% and 47%, respectively, suggesting that three or more episodes of AP is a strong risk factor for CP. […] We concluded that three or more attacks of AP with no morphological changes to the pancreas could be considered as early CP (ECP). […] The new diagnostic criteria for ECP allow the majority of CP patients to be diagnosed earlier. […] One of the key findings of this study is that the incidence of recurrent episodes increases the risk of CP development. The first two attacks have small effects (01%) on the odds for developing CP, whereas the third and fourth (1650%) episodes have large ones.
#41 Evidence for diagnosis of early chronic pancreatitis after three episodes of acute pancreatitis: a cross-sectional multicentre international study with experimental animal model | Scientific Reports
https://www.nature.com/articles/s41598-020-80532-6
Chronic pancreatitis (CP) is an end-stage disease with no specific therapy; therefore, an early diagnosis is of crucial importance. […] The prevalence of CP in combination with AP, RAP2, RAP3, RAP4 and RAP5+was 0%, 1%, 16%, 50% and 47%, respectively, suggesting that three or more episodes of AP is a strong risk factor for CP. […] We concluded that three or more attacks of AP with no morphological changes to the pancreas could be considered as early CP (ECP). […] The new diagnostic criteria for ECP allow the majority of CP patients to be diagnosed earlier. […] One of the key findings of this study is that the incidence of recurrent episodes increases the risk of CP development. The first two attacks have small effects (01%) on the odds for developing CP, whereas the third and fourth (1650%) episodes have large ones.
#42 Evidence for diagnosis of early chronic pancreatitis after three episodes of acute pancreatitis: a cross-sectional multicentre international study with experimental animal model | Scientific Reports
https://www.nature.com/articles/s41598-020-80532-6
In the RAP3 group, 16% of patients already have established CP, while the figure is nearly 50% in the RAP4+group. […] These data demonstrate that three or more episodes of AP are to be considered as a significant risk factor for the development of CP. […] Our significant biomarkers clearly showed bidirectional changes in alcoholic and biliary etiologies in AP, RAP and CP patients. […] The episode-dependent decrease in the elevation of amylase activity highlights the loss of acinar cells in the pancreas and the functional decrease of pancreatic enzyme secretion/leakage from acinar cells. […] Taken together, both the clinical and experimental studies suggest that three or more episodes of RAP can be considered as ECP.
#43 Evidence for diagnosis of early chronic pancreatitis after three episodes of acute pancreatitis: a cross-sectional multicentre international study with experimental animal model | Scientific Reports
https://www.nature.com/articles/s41598-020-80532-6
In the RAP3 group, 16% of patients already have established CP, while the figure is nearly 50% in the RAP4+group. […] These data demonstrate that three or more episodes of AP are to be considered as a significant risk factor for the development of CP. […] Our significant biomarkers clearly showed bidirectional changes in alcoholic and biliary etiologies in AP, RAP and CP patients. […] The episode-dependent decrease in the elevation of amylase activity highlights the loss of acinar cells in the pancreas and the functional decrease of pancreatic enzyme secretion/leakage from acinar cells. […] Taken together, both the clinical and experimental studies suggest that three or more episodes of RAP can be considered as ECP.
#44 Evaluation of Chronic Pancreatitis Prognosis Score in an American Cohort – PubMed
https://pubmed.ncbi.nlm.nih.gov/39137098/
Chronic Pancreatitis Prognosis Score (COPPS) was developed to discriminate disease severity and predict risk for future hospitalizations. […] COPPS correlated with all primary outcomes: hospitalizations for any reason (number: r = 0.15, P = 0.01; duration: r = 0.16, P = 0.01) and pancreas-related hospitalizations (number: r = 0.15, P = 0.02; duration: r = 0.13, P = 0.04). […] Statistically, COPPS significantly correlated with hospitalization outcomes, but the correlations were weaker than in previous studies, which may be related to the outpatient nature of the PROspective Evaluation of Chronic Pancreatitis for EpidEmiologic and Translational StuDies cohort and lower prevalence of high severity disease. Studies in other prospective cohorts are needed to understand the full utility of COPPS as a potential tool for clinical risk assessment and intervention.