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Multicenter Study
. 2021 Oct;21(7):1237-1246.
doi: 10.1016/j.pan.2021.06.003. Epub 2021 Jun 22.

Glucose levels show independent and dose-dependent association with worsening acute pancreatitis outcomes: Post-hoc analysis of a prospective, international cohort of 2250 acute pancreatitis cases

Anikó Nagy  1 , Márk Félix Juhász  2 , Anikó Görbe  2 , Alex Váradi  2 , Ferenc Izbéki  3 , Áron Vincze  4 , Patrícia Sarlós  4 , József Czimmer  4 , Zoltán Szepes  5 , Tamás Takács  5 , Mária Papp  6 , Eszter Fehér  6 , József Hamvas  7 , Klaudia Kárász  8 , Imola Török  9 , Davor Stimac  10 , Goran Poropat  10 , Ali Tüzün Ince  11 , Bálint Erőss  2 , Katalin Márta  2 , Dániel Pécsi  2 , Dóra Illés  5 , Szilárd Váncsa  2 , Mária Földi  12 , Nándor Faluhelyi  13 , Orsolya Farkas  13 , Tamás Nagy  14 , Péter Kanizsai  15 , Zsolt Márton  16 , Andrea Szentesi  12 , Péter Hegyi  17 , Andrea Párniczky  18
Affiliations
Multicenter Study

Glucose levels show independent and dose-dependent association with worsening acute pancreatitis outcomes: Post-hoc analysis of a prospective, international cohort of 2250 acute pancreatitis cases

Anikó Nagy et al. Pancreatology. 2021 Oct.

Abstract

Background: Metabolic risk factors, such as obesity, hypertension, and hyperlipidemia are independent risk factors for the development of various complications in acute pancreatitis (AP). Hypertriglyceridemia dose-dependently elicits pancreatotoxicity and worsens the outcomes of AP. The role of hyperglycemia, as a toxic metabolic factor in the clinical course of AP, has not been examined yet.

Methods: We analyzed a prospective, international cohort of 2250 AP patients, examining associations between (1) glycosylated hemoglobin (HbA1c), (2) on-admission glucose, (3) peak in-hospital glucose and clinically important outcomes (mortality, severity, complications, length of hospitalization (LOH), maximal C-reactive protein (CRP)). We conducted a binary logistic regression accounting for age, gender, etiology, diabetes, and our examined variables. Receiver Operating Characteristic Curve (ROC) was applied to detect the diagnostic accuracy of the three variables.

Results: Both on-admission and peak serum glucose are independently associated with AP severity and mortality, accounting for age, gender, known diabetes and AP etiology. They show a dose-dependent association with severity (p < 0.001 in both), mortality (p < 0.001), LOH (p < 0.001), maximal CRP (p < 0.001), systemic (p < 0.001) and local complications (p < 0.001). Patients with peak glucose >7 mmol/l had a 15 times higher odds for severe AP and a five times higher odds for mortality. We found a trend of increasing HbA1c with increasing LOH (p < 0.001), severity and local complications.

Conclusions: On-admission and peak in-hospital glucose are independently and dose-dependently associated with increasing AP severity and mortality. In-hospital laboratory control of glucose and adequate treatment of hyperglycemia are crucial in the management of AP.

Keywords: Acute pancreatitis; Dose-dependency; Glucose; Hemoglobin A1c; Pancreatotoxicity.

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Conflict of interest statement

Declaration of competing interest Authors declare no conflict of interest.

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