Review of acute pancreatitis etiologies and characteristics at an Australian tertiary health service.

Abstract

Background and Aim: Acute pancreatitis has a growing incidence. We aimed to review acute pancreatitis etiologies and outcomes within our tertiary health service. In particular, we aimed to review hypertriglyceridemia (TG)-related pancreatitis, given the rising prevalence of the metabolic syndrome. Method(s): We performed a retrospective audit of all acute pancreatitis admissions to our health service over a 12-month period from August 2020 to August 2021. Data including patient demographics, pancreatitis characteristics, complications, and interventions were obtained from a review of the electronic medical record. Result(s): A total of 743 patients (356 [48%] female, 391 [52%] male) were admitted with acute pancreatitis. The median age was 46 years, and 295 patients (39%) were aged 60 years or older. The most common cause of pancreatitis was gallstones, accounting for 243 patients (33%), followed by idiopathic pancreatitis (204, (27%), and alcoholic pancreatitis (143, 19%). Less common causes included hypercalcemia (3, < 1%), autoimmune pancreatitis (2, < 1%), pancreatic divisum (5, < 1%), and drug-induced pancreatitis (9, 1%). Five drug-induced pancreatitis cases were due to corticosteroids, with the others due to mesalazine, azathioprine, daratumumab, and dual incretin therapy (one case each). In terms of BISAP scores, 299 patients (40%) had a score of 0; 270 (37%) had a score of 1, 101 (14%) had a score of 2, 54 (7%) had a score of 3, 17 (2%) had a score of 4, and two (< 1%) had a score of 5. Mean length of stay was 4 days for those with BISAP 0, 6 days for BISAP 1, 11 days for BISAP 2, 17 days for BISAP 3, and 14 days for BISAP 4 and 5. There were 75 patients (11%) who required admission to the high dependency/intensive care unit. Fifteen patients with pancreatitis died. Seventy (9%) developed necrotizing pancreatitis. Ninety-six patients (13%) developed peripancreatic collections. Thirteen patients (14%) with peripancreatic collections underwent drainage. Nine patients had endoscopic drainage (five with plastic stents, and four with a lumen-apposing metal stent) and four had percutaneous drainage inserted. Six patients required repeat endoscopic drainage, and one required repeat percutaneous drainage. The median number of days from admission to drainage was 19 (IQR, 12.75-24). Forty-three patients (6%) had TG-related pancreatitis. Nineteen (44%) of these were recurrent TG-related pancreatitis. Mean TG level was 30 mmol/L (upper limit of normal, 1.7 mmol/L). Thirty patients with TG-related pancreatitis (88%) had metabolic syndrome. Twelve patients (29%) had concomitant diabetic ketoacidosis or hyperosmolar hyperglycemic state. Of the patients with TG-related pancreatitis, 74% were treated with an insulin infusion, 74% received statin therapy, 81% received fenofibrate, and 81% received fish oil. Conclusion(s): Gallstones and idiopathic pancreatitis were the leading causes of acute pancreatitis in our cohort. TG-related pancreatitis represented a small but notable number of cases within our cohort. The majority of these patients had the metabolic syndrome, and almost half presented with recurrent pancreatitis. Future studies examining the outpatient management of TG-related pancreatitis are needed, focusing on standardization of pharmacotherapy and patient education, with the aim of reducing health care utilization and optimizing patient outcomes.