Aging and comorbidities in acute pancreatitis II.

A cohort-analysis of 1203 prospectively collected cases

Hungarian Pancreatic Study Group

Research output: Contribution to journalReview article

1 Citation (Scopus)

Abstract

Introduction: Our meta-analysis indicated that aging influences the outcomes of acute pancreatitis (AP), however, a potential role for comorbidities was implicated, as well. Here, we aimed to determine how age and comorbidities modify the outcomes in AP in a cohort-analysis of Hungarian AP cases. Materials and Methods: Data of patients diagnosed with AP by the revised Atlanta criteria were extracted from the Hungarian Registry for Pancreatic Patients. Outcomes of interest were mortality, severity, length of hospitalization, local, and systemic complications of AP. Comorbidities were measured by means of Charlson Comorbidity Index (CCI) covering pre-existing chronic conditions. Non-parametric univariate and multivariate statistics were used in statistical analysis. Odds ratios (ORs) with 95% confidence intervals (CIs) were calculated. Results: A total of 1203 patients from 18 centers were included. Median age at admission was 58 years (range: 18.95 years), median CCI was 2 (range: 0.10). Only severe comorbidities (CCI ≥ 3) predicted mortality (OR = 4.48; CI: 1.57.12.80). Although severe comorbidities predicted AP severity (OR = 2.10, CI: 1.08.4.09), middle (35.64 years) and old age (≥65 years) were strong predictors with borderline significance, as well (OR = 7.40, CI: 0.99.55.31 and OR = 6.92, CI: 0.91.52.70, respectively). Similarly, middle and old age predicted a length of hospitalization ≥9 days. Interestingly, the middle-aged patients (35.64 years) were three times more likely to develop pancreatic necrosis than young adults (OR = 3.21, CI: 1.26.8.19), whereas the old-aged (≥65 years) were almost nine times more likely to develop systemic complications than young adults (OR = 8.93, CI: 1.20.66.80), though having severe comorbidities (CCI ≥3) was a predisposing factor, as well. Conclusion: Our results proved that both aging and comorbidities modify the outcomes of AP. Comorbidities determine mortality whereas both comorbidities and aging predict severity of AP. Regarding complications, middle-aged patients are the most likely to develop local complications; in contrast, those having severe comorbidities are prone to develop systemic complications. Studies validating the implementation of CCI-based predictive scores are awaited.

Original languageEnglish
Article number1776
JournalFrontiers in Physiology
Volume10
Issue numberAPR
DOIs
Publication statusPublished - Jan 1 2019

Fingerprint

Pancreatitis
Comorbidity
Cohort Studies
Odds Ratio
Confidence Intervals
Mortality
Young Adult
Hospitalization
Preexisting Condition Coverage
Causality
Registries
Meta-Analysis
Necrosis

Keywords

  • Acute pancreatitis
  • Charlson comorbidity index
  • Comorbidities
  • Complications
  • Length of hospitalization
  • Mortality
  • Prediction
  • Severity

ASJC Scopus subject areas

  • Physiology
  • Physiology (medical)

Cite this

Aging and comorbidities in acute pancreatitis II. A cohort-analysis of 1203 prospectively collected cases. / Hungarian Pancreatic Study Group.

In: Frontiers in Physiology, Vol. 10, No. APR, 1776, 01.01.2019.

Research output: Contribution to journalReview article

@article{d36a0ee7682d4a5abdbdfef4d04ce5c8,
title = "Aging and comorbidities in acute pancreatitis II.: A cohort-analysis of 1203 prospectively collected cases",
abstract = "Introduction: Our meta-analysis indicated that aging influences the outcomes of acute pancreatitis (AP), however, a potential role for comorbidities was implicated, as well. Here, we aimed to determine how age and comorbidities modify the outcomes in AP in a cohort-analysis of Hungarian AP cases. Materials and Methods: Data of patients diagnosed with AP by the revised Atlanta criteria were extracted from the Hungarian Registry for Pancreatic Patients. Outcomes of interest were mortality, severity, length of hospitalization, local, and systemic complications of AP. Comorbidities were measured by means of Charlson Comorbidity Index (CCI) covering pre-existing chronic conditions. Non-parametric univariate and multivariate statistics were used in statistical analysis. Odds ratios (ORs) with 95{\%} confidence intervals (CIs) were calculated. Results: A total of 1203 patients from 18 centers were included. Median age at admission was 58 years (range: 18.95 years), median CCI was 2 (range: 0.10). Only severe comorbidities (CCI ≥ 3) predicted mortality (OR = 4.48; CI: 1.57.12.80). Although severe comorbidities predicted AP severity (OR = 2.10, CI: 1.08.4.09), middle (35.64 years) and old age (≥65 years) were strong predictors with borderline significance, as well (OR = 7.40, CI: 0.99.55.31 and OR = 6.92, CI: 0.91.52.70, respectively). Similarly, middle and old age predicted a length of hospitalization ≥9 days. Interestingly, the middle-aged patients (35.64 years) were three times more likely to develop pancreatic necrosis than young adults (OR = 3.21, CI: 1.26.8.19), whereas the old-aged (≥65 years) were almost nine times more likely to develop systemic complications than young adults (OR = 8.93, CI: 1.20.66.80), though having severe comorbidities (CCI ≥3) was a predisposing factor, as well. Conclusion: Our results proved that both aging and comorbidities modify the outcomes of AP. Comorbidities determine mortality whereas both comorbidities and aging predict severity of AP. Regarding complications, middle-aged patients are the most likely to develop local complications; in contrast, those having severe comorbidities are prone to develop systemic complications. Studies validating the implementation of CCI-based predictive scores are awaited.",
keywords = "Acute pancreatitis, Charlson comorbidity index, Comorbidities, Complications, Length of hospitalization, Mortality, Prediction, Severity",
author = "{Hungarian Pancreatic Study Group} and Zsolt Szak{\'a}cs and No{\'e}mi Gede and D{\'a}niel P{\'e}csi and F. Izb{\'e}ki and M. Papp and Gy{\"o}rgy Kov{\'a}cs and Eszter Feh{\'e}r and Dalma Dobszai and Bal{\'a}zs Kui and Katalin M{\'a}rta and Kl{\'a}ra K{\'o}nya and Imre Szab{\'o} and Imola T{\"o}r{\"o}k and L{\'a}szl{\'o} Gajd{\'a}n and T. Tak{\'a}cs and Patr{\'i}cia Sarl{\'o}s and Szil{\'a}rd G{\'o}di and M{\'a}rta Varga and J{\'o}zsef Hamvas and A. Vincze and Andrea Szentesi and Andrea P{\'a}rniczky and P. Hegyi",
year = "2019",
month = "1",
day = "1",
doi = "10.3389/fphys.2018.01776",
language = "English",
volume = "10",
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TY - JOUR

T1 - Aging and comorbidities in acute pancreatitis II.

T2 - A cohort-analysis of 1203 prospectively collected cases

AU - Hungarian Pancreatic Study Group

AU - Szakács, Zsolt

AU - Gede, Noémi

AU - Pécsi, Dániel

AU - Izbéki, F.

AU - Papp, M.

AU - Kovács, György

AU - Fehér, Eszter

AU - Dobszai, Dalma

AU - Kui, Balázs

AU - Márta, Katalin

AU - Kónya, Klára

AU - Szabó, Imre

AU - Török, Imola

AU - Gajdán, László

AU - Takács, T.

AU - Sarlós, Patrícia

AU - Gódi, Szilárd

AU - Varga, Márta

AU - Hamvas, József

AU - Vincze, A.

AU - Szentesi, Andrea

AU - Párniczky, Andrea

AU - Hegyi, P.

PY - 2019/1/1

Y1 - 2019/1/1

N2 - Introduction: Our meta-analysis indicated that aging influences the outcomes of acute pancreatitis (AP), however, a potential role for comorbidities was implicated, as well. Here, we aimed to determine how age and comorbidities modify the outcomes in AP in a cohort-analysis of Hungarian AP cases. Materials and Methods: Data of patients diagnosed with AP by the revised Atlanta criteria were extracted from the Hungarian Registry for Pancreatic Patients. Outcomes of interest were mortality, severity, length of hospitalization, local, and systemic complications of AP. Comorbidities were measured by means of Charlson Comorbidity Index (CCI) covering pre-existing chronic conditions. Non-parametric univariate and multivariate statistics were used in statistical analysis. Odds ratios (ORs) with 95% confidence intervals (CIs) were calculated. Results: A total of 1203 patients from 18 centers were included. Median age at admission was 58 years (range: 18.95 years), median CCI was 2 (range: 0.10). Only severe comorbidities (CCI ≥ 3) predicted mortality (OR = 4.48; CI: 1.57.12.80). Although severe comorbidities predicted AP severity (OR = 2.10, CI: 1.08.4.09), middle (35.64 years) and old age (≥65 years) were strong predictors with borderline significance, as well (OR = 7.40, CI: 0.99.55.31 and OR = 6.92, CI: 0.91.52.70, respectively). Similarly, middle and old age predicted a length of hospitalization ≥9 days. Interestingly, the middle-aged patients (35.64 years) were three times more likely to develop pancreatic necrosis than young adults (OR = 3.21, CI: 1.26.8.19), whereas the old-aged (≥65 years) were almost nine times more likely to develop systemic complications than young adults (OR = 8.93, CI: 1.20.66.80), though having severe comorbidities (CCI ≥3) was a predisposing factor, as well. Conclusion: Our results proved that both aging and comorbidities modify the outcomes of AP. Comorbidities determine mortality whereas both comorbidities and aging predict severity of AP. Regarding complications, middle-aged patients are the most likely to develop local complications; in contrast, those having severe comorbidities are prone to develop systemic complications. Studies validating the implementation of CCI-based predictive scores are awaited.

AB - Introduction: Our meta-analysis indicated that aging influences the outcomes of acute pancreatitis (AP), however, a potential role for comorbidities was implicated, as well. Here, we aimed to determine how age and comorbidities modify the outcomes in AP in a cohort-analysis of Hungarian AP cases. Materials and Methods: Data of patients diagnosed with AP by the revised Atlanta criteria were extracted from the Hungarian Registry for Pancreatic Patients. Outcomes of interest were mortality, severity, length of hospitalization, local, and systemic complications of AP. Comorbidities were measured by means of Charlson Comorbidity Index (CCI) covering pre-existing chronic conditions. Non-parametric univariate and multivariate statistics were used in statistical analysis. Odds ratios (ORs) with 95% confidence intervals (CIs) were calculated. Results: A total of 1203 patients from 18 centers were included. Median age at admission was 58 years (range: 18.95 years), median CCI was 2 (range: 0.10). Only severe comorbidities (CCI ≥ 3) predicted mortality (OR = 4.48; CI: 1.57.12.80). Although severe comorbidities predicted AP severity (OR = 2.10, CI: 1.08.4.09), middle (35.64 years) and old age (≥65 years) were strong predictors with borderline significance, as well (OR = 7.40, CI: 0.99.55.31 and OR = 6.92, CI: 0.91.52.70, respectively). Similarly, middle and old age predicted a length of hospitalization ≥9 days. Interestingly, the middle-aged patients (35.64 years) were three times more likely to develop pancreatic necrosis than young adults (OR = 3.21, CI: 1.26.8.19), whereas the old-aged (≥65 years) were almost nine times more likely to develop systemic complications than young adults (OR = 8.93, CI: 1.20.66.80), though having severe comorbidities (CCI ≥3) was a predisposing factor, as well. Conclusion: Our results proved that both aging and comorbidities modify the outcomes of AP. Comorbidities determine mortality whereas both comorbidities and aging predict severity of AP. Regarding complications, middle-aged patients are the most likely to develop local complications; in contrast, those having severe comorbidities are prone to develop systemic complications. Studies validating the implementation of CCI-based predictive scores are awaited.

KW - Acute pancreatitis

KW - Charlson comorbidity index

KW - Comorbidities

KW - Complications

KW - Length of hospitalization

KW - Mortality

KW - Prediction

KW - Severity

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U2 - 10.3389/fphys.2018.01776

DO - 10.3389/fphys.2018.01776

M3 - Review article

VL - 10

JO - Frontiers in Physiology

JF - Frontiers in Physiology

SN - 1664-042X

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