Moderately severe and severe acute pancreatitis : a systematic review of the outcomes in the USA and European Union-5

Abstract

Background and objectives: The global incidence of hospitalisation due to acute pancreatitis (AP) has been rising in the recent decades. In the USA alone, there was a 13.2% increase between 2009 and 2012 compared with 2002-2005. There remains a lack of approved treatments to prevent disease progression, leaving many liable to developing complications that include multisystem organ failure (OF) and death. This therapeutic deficit raises questions about the scale of the current burden of illness (BOI) associated with severe forms of AP. The aim of the systematic literature review (SLR) was to assess clinical, humanistic, and economic outcomes associated with moderately severe AP (MSAP) and severe AP (SAP) in the USA and the European Union-5 (EU-5).

Methods: Systematic searches were conducted in MEDLINE and Embase to identify studies published in English (between 2007 and 2017) that reported on the BOI of MSAP and/or SAP. Manual searches of 'grey' literature sources were also conducted.

Results: The SLR identified 19 studies which indicated that 15%-20% of patients with AP progress to more severe forms of the disease, up to 10.5% of those with SAP require surgery for complications, and up to 40% die during hospitalisation. By contrast, there appears to be a lack of data on the extent to which SAP affects patients' quality of life.

Conclusion: The available evidence clearly demonstrates that the current management for MSAP and SAP in the USA and EU-5 does not adequately meet patients' needs. Early identification and intervention for AP is crucial, given the evidence of high rates of morbidity and an associated economic burden that is considerable. Since many patients with the condition present to hospitals at a point when multisystem OF or death is highly likely, there is a particularly urgent need for effective treatment options to prevent disease progression.

Keywords: burden of illness; moderate severe acute pancreatitis; severe acute pancreatitis.

Figure 1

Preferred Reporting Items for Systematic Review and Meta-Analysis diagram of studies evaluating patients with SAP and with AP before reclassification. AP, acute pancreatitis; HRQoL, health-related quality of life; SAP, severe acute pancreatitis; SLR, systematic literature review.

Figure 2

Diagram of included studies evaluating patients with MSAP and SAP after reclassification. *Only studies reporting data of MSAP or SAP according to RAC 2012 are included in this manuscript. †Findings relating to AP or mixed AP/SAP studies are not summarised in this manuscript. AP, acute pancreatitis; MSAP, moderately severe acute pancreatitis; RAC, revised Atlanta classification; SAP, severe acute pancreatitis.