■急性胰腺炎(AP)后发生外分泌功能不全(EPI),报告的发生率不同,恢复时间表不明确。这项研究的目的是在前瞻性队列中确定AP后12个月EPI的患病率和预测因子。
■在这个前景中,多中心,纵向队列研究,因AP发作(由修订的亚特兰大分类定义)入院的成年参与者(≥18岁)被纳入美国多中心纵向队列(站点:俄亥俄州立大学,匹兹堡大学,和约翰·霍普金斯大学)。如果患者患有胰腺癌,将被排除在外,慢性胰腺炎,或吸收不良疾病(包括先前诊断的EPI)。参与者数据是通过访谈和电子病历审查获得的。通过基线时收集的粪便弹性蛋白酶(FE-1)水平评估EPI,3个月,和12个月(主要终点)。EPI定义为FE-1<200μg/g;重度FE-1水平≤100μg/g;轻度FE-1101-200μg/g。在12个月时使用多变量逻辑回归来确定EPI的预测因子。这项研究在ClinicalTrials.gov注册,NCT03063398。
■在85名参与者中的29名(34.1%)[44名(51.8%)男性,平均年龄54.7±14.1岁]在12个月时提供粪便样本。对于整个研究,参与者是在2017年6月22日至2021年10月18日期间招募的.共筛选5794人,其中311人符合研究条件。112名参与者在基线时提供了粪便样本,在3个月时完成了79份粪便样本,在12个月时完成了85个样本。64名参与者包括所有3个时间点的样品。在单变量分析中,12个月时与EPI显著相关的因素包括复发性(与指数相比)AP,预先存在的糖尿病,酒精,和特发性病因,并增加AP的严重程度。在多变量分析中,特发性AP病因学在12个月时发生EPI的几率增加了4倍(几率4.095,95%置信区间[CI]1.418,11.826),中度或重度AP的3倍(赔率3.166,95%CI1.156,8.670),和基线糖尿病(赔率比3.217,95%CI1.113,9.298)。即使有轻度AP发作指数的个体(n=39)在12个月时也出现了严重的EPI(患病率12.8%)。
■FE-1诊断的EPI在AP后12个月出现在超过三分之一的前瞻性评估患者中。由于EPI在轻度AP患者中发展,需要进行调查以了解损伤机制并确定量身定制的筛查方法.
■这项研究得到了来自AbbVie的研究者发起的研究资助,Inc.
UNASSIGNED: Exocrine Pancreatic insufficiency (EPI) occurs following acute pancreatitis (AP) at variably reported rates and with unclear recovery timeline. The aim of this study was to establish the prevalence and predictors of EPI at 12 months after AP in a prospective cohort.
UNASSIGNED: In this prospective, multicentre, longitudinal cohort study, adult participants (≥18 years) admitted to the hospital with an AP attack (defined by Revised Atlanta Classification) were enrolled in a United States multi-centre longitudinal cohort (Sites: The Ohio State University, University of Pittsburgh, and Johns Hopkins University). Patients were excluded if they had pancreatic cancer, chronic pancreatitis, or malabsorptive disease (including previously diagnosed EPI). Participant data was obtained by interview and by review of the electronic medical record. EPI was assessed by stool fecal elastase (FE-1) levels collected at baseline, 3 months, and 12 months (primary endpoint). EPI was defined by FE-1 <200 μg/g; severe FE-1 level ≤100 μg/g; mild FE-1 101-200 μg/g. Multivariable logistic regression was used to identify predictors of EPI at 12 months. This study is registered with ClinicalTrials.gov, NCT03063398.
UNASSIGNED: EPI was observed in 29 (34.1%) of the 85 participants [44 (51.8%) male, mean age 54.7 ± 14.1 years] who provided stool samples at 12 months. For the study overall, participants were recruited between June 22, 2017 and October 18, 2021. A total of 5794 individuals were screened, 311 of whom were eligible for the study. 112 participants provided stool samples at baseline, 79 completed stool samples at 3 months, and 85 completed samples at 12 months. 64 participants included samples at all 3 timepoints. In univariable analysis, factors significantly associated with EPI at 12 months included recurrent (versus index) AP, pre-existing diabetes, alcohol, and idiopathic etiologies, and increasing severity of AP. In multivariable analysis, the odds of having EPI at 12 months increased 4-fold with idiopathic AP etiology (Odds Ratio 4.095, 95% Confidence Interval [CI] 1.418, 11.826), and 3-fold with moderately severe or severe AP (Odds Ratio 3.166, 95% CI 1.156, 8.670), and baseline diabetes mellitus (Odds Ratio 3.217, 95% CI 1.113, 9.298). Even individuals with an index mild attack of AP (n = 39) developed severe EPI at 12 months (prevalence 12.8%).
UNASSIGNED: EPI as diagnosed by FE-1 is present in over one third of prospectively assessed patients at 12 months post-AP. Since EPI develops in patients with mild AP, investigations are needed to understand the mechanisms of injury and identify methods for tailored screening.
UNASSIGNED: This study was supported by an Investigator Initiated Research Grant from AbbVie, Inc.