Individualized prediction of post-acute pancreatitis diabetes mellitus by combining lipid metabolism and anatomical features

Abstract

Objectives: To investigate the lipid metabolism and anatomical risk factors of post-acute pancreatitis diabetes mellitus (PPDM) and their value in individualized prediction.

Materials and methods: A continuous retrospective analysis was conducted on 241 patients with acute pancreatitis (AP) treated in our hospital from January 2017 to December 2021. The type and angle of the pancreaticobiliary junction were measured on magnetic resonance cholangiopancreatography (MRCP) images, and baseline lipid metabolism indicators were collected. We evaluated the risk factors of PPDM using univariate and multivariate Cox proportional hazard analysis, established quantitative prediction models for PPDM, and evaluated the predictive value of lipid metabolism and features of the pancreaticobiliary junction.

Results: Overall, 85 of 241 eligible patients (35.27%) ultimately developed PPDM. Univariate and multivariate analyses showed B-P type in pancreaticobiliary junction (p = 0.017), the angle of junction (p = 0.041), non-high-density lipoprotein (p = 0.029), alcohol index (p < 0.001), body mass index (p = 0.042), inflammatory frequency (p = 0.016), fasting blood glucose (p = 0.002), concomitant hypertension (p < 0.001) were important predictive factors for the occurrence of PPDM. The model that integrated imaging features of the pancreaticobiliary junction has a higher predictive performance than models without imaging features, with an AUC of 0.882 (95% CI, 0.836-0.930). The AUC of the combined model was 0.886 (95% CI, 0.841-0.932), and there was no statistical difference in AUC between the combined model and the pancreaticobiliary junction model (p = 0.340).

Conclusion: The lipid metabolism and morphological characteristics of the pancreaticobiliary junction are additional risk factors for PPDM, and the quantitative prediction model shows moderate predictive performance.

Critical relevance statement: The type and angle of the pancreaticobiliary junction based on MRCP are independent predictors of PPDM, which can quantitatively predict risk in the early stage.

Key points: PPDM has an increasing incidence and poor prognosis, which requires early monitoring. Larger angles and B-P type in the pancreaticobiliary junction are risk factors for PPDM. Quantitative prediction of PPDM risk allows for early personalized prevention and treatment.

Keywords: Acute pancreatitis; Diabetes; Lipid metabolism; Magnetic resonance cholangiopancreatography; Pancreaticobiliary junction.

Fig. 1

Survival curves by Kaplan-Meier analyses. a Comparing the cumulative rate of PPDM among patients with the junction type of B-P, V, and P-B. b Comparing the cumulative rate of PPDM between patients with the junction angle ≥ 42.8° and angle < 42.8°. c Comparing the cumulative rate of PPDM between patients with NHDL ≥ 5 mmol/L and NHDL < 5 mmol/L. NHDL, non high-density lipoprotein

Fig. 2

The quantitative predictive models for PPDM. a The ROC with 95% CI of each model. b The nomogram for the combined model visualization. c The calibration curve of the nomogram. AI, alcohol index; BMI, body mass index; IF, inflammation frequency; FBG, fasting blood glucose; ROC, receiver operator characteristic curve; CI, confidence interval

Fig. 3

One patient with PPDM. The type of junction (a, circle) between the main pancreatic duct (a, short arrow) and the common bile duct (a, long arrow) is B-P type (100 points) and the angle is 56.83° (66.25 points) (b), with AI 1500 (67.5 points), BMI 24.34 (0 points), IF 2 (56.25 points), NHDL 3.41 (0 points), FBG 4.92 (0 points), and no concomitant hypertension (0 points). The total score is about 290 points, and the probability of PPDM occurrence is about 78%

Fig. 4

One patient with PPDM. The type of junction (a, circle) between the main pancreatic duct (a, short arrow) and the common bile duct (a, long arrow) is V-shaped (64 points) and the angle is 22.9° (0 points) (b), with AI 0 (0 points), BMI 26.37 (52.5 points), IF 2 (56.25 points), NHDL 4.33 (0 points), FBG 9.82 (96.25 points), and concomitant hypertension (75 points). The total score is about 344 points, and the probability of PPDM occurrence is about 90%

Fig. 5

One patient without PPDM. The type of junction (a, circle) between the main pancreatic duct (a, short arrow) and the common bile duct (a, long arrow) is P-B type (0 points) and the angle is 32.14° (0 points) (b), with AI 2000 (67.5 points), BMI 21.57 (0 points), IF 1 (0 points), NHDL 2.7 (0 points), FBG 6.50 (0 points), and concomitant hypertension (75 points). The total score is about 142.5 points, and the probability of PPDM occurrence is about 17.5%