Postpancreatitis diabetes mellitus (PPDM-A) is a significant endocrine complication of acute pancreatitis, often with a severe disease course. Using the Los Angeles General Hospital acute pancreatitis (AP) cohort, we aimed to identify risk factors for PPDM-A and create a model to predict its occurrence. This prospectively ascertained cohort included consecutive adults admitted with AP between 2015 and 2022 with no prior history of diabetes mellitus, chronic pancreatitis, or pancreas resection. The primary outcome was PPDM-A, defined as a hemoglobin A1c value ≥6.5% or documented diagnosis of diabetes following index admission for AP. The cohort was divided into training and validation (80:20) samples. In the training cohort, logistic regression with best subset selection was used to construct a series of models to predict PPDM-A. Among 891 patients with AP, 16.5% of whom had moderately severe or severe disease, PPDM-A developed in 62 (7.0%), with a median of 27.8 months (IQR: 15.0-49.3) after index admission. The optimal model included 4 predictors: history of cirrhosis, serum albumin, history of prediabetes, and history of moderate to severe pancreatitis, summarized by the acronym CAPS. It achieved an AUROC of 0.631 (0.454-0.808) in the validation cohort. A score >6 achieved 50% sensitivity and 74% specificity in the validation cohort. A score using readily available clinical information at index admission predicts diabetes mellitus following acute pancreatitis. This CAPS tool will need to be validated and refined in large cohorts such as the type 1 diabetes in acute pancreatitis consortium (T1DAPC).

Routine feeding tube (FT) placement during pancreaticoduodenectomy (PD) has not reduced complication rates. Nonetheless, FTs are often selectively placed in patients with poor nutritional status such as those with significant weight loss or hypoalbuminemia, based on the assumption that the benefits outweigh the risks. This study examined whether FT placement reduced complications in at-risk nutritional subgroups. This retrospective cohort study used data from the National Surgical Quality Improvement Program (NSQIP) database (2017-2020). Patients undergoing PD were grouped according to nutritional status as follows: (1) weight Loss >10%, (2) albumin <30g/L, (3) weight loss or low albumin, (4) both weight loss and low albumin, and (5) neither. Five propensity score matching (PSM) models were utilized, each adjusted for perioperative variables, and postoperative outcomes between patients with and without FTs across these groups were compared. Each subgroup analysis served as an independent evaluation of the potential benefits of FT placement in the defined populations. Among 16,780 patients with PD, 742 (4.4%) received FTs. PSM analyses showed that FT placement did not reduce complications in any subgroup, but significantly increased delayed gastric emptying rates, especially in patients with low albumin and weight loss (29.4% vs 16.0%, P < 0.0001). FT placement also led to longer hospital stays (11 vs 8d, P < 0.0001) and higher reoperation rates in 2 groups. In nutritionally at-risk patients undergoing pancreaticoduodenectomy, the risks of feeding tube placement appear to outweigh the benefits, as no reduction in complications was observed, and morbidity was increased.

Genetics is a significant contributor to acute recurrent pancreatitis. This study evaluates the prevalence of genetic variants and assesses electrophysiological characteristics in Israeli patients. Patients with ≥2 episodes of acute pancreatitis, no history of drug use, normal IgG4 levels, and normal cholangiopancreatographic findings were included. Genetic analysis targeted the PRSS1, SPINK1, CTRC, CFTR, CPA1 , and TRPV6 genes, as well as the CEL-HYB1 allele. Sweat testing and nasal potential difference measurements were also performed. Seventy-nine patients (median age: 13y; range: 2-61) were referred between 2015 and 2021. Forty-five (57.0%) carried at least one genetic variant; 18 patients carried 2 or more variants. CFTR variants were the most common (35.4%), followed by PRSS1 (11.4%), SPINK1 (10.1%), and CTRC (10.1%). The rare PRSS1 p.Lys23Arg variant was prevalent among Jewish Georgian patients (n=8). Patients with genetic variants were younger than those without ( P <0.0035). Of the 71 patients who underwent nasal potential difference testing, 2 (5.6%) had abnormal results. Sweat test in 66 patients showed a mean value of 36 ± 16mmol/L; 6 had results above 60mmol/L; 2 of these carried CFTR variants TG[11]T[5] and p.Leu997Phe but had normal nasal potential. More than half of acute recurrent pancreatitis cases had a genetic basis, presenting at a younger age. CFTR variants were the most prevalent. The high prevalence of the PRSS1 p.Lys23Arg variant among Jewish Georgian individuals suggests a potential founder effect. These findings highlight the importance of genetic evaluation in the diagnosis and management of acute recurrent pancreatitis.

To investigate the contributing factors for the development of systemic inflammatory response syndrome (SIRS) in acute pancreatitis (AP) patients and subsequently develop a novel nomogram prediction model. A multivariate logistic regression analysis was conducted to determine independent predictors of SIRS, where the variables were chosen based on statistical significance from univariate analysis. Based on their presence, 238 AP patients were grouped into non-SIRS (n=170) and SIRS (n=68). Logistic regression analysis identified independent predictors of SIRS complications. We then developed a visual nomogram prediction model alongside a logistic regression model. The model's predictive power cut-off was determined by receiver operating characteristic (ROC) curve analysis, providing sensitivity, specificity, and predictive accuracy. The study found that in the cohort of acute pancreatitis (AP) patients, systemic inflammatory response syndrome (SIRS) incidence was 28.6%. From our analysis, we determined that red blood cell distribution width (RDW), fibrinogen (FIB), amylase (AMY), blood glucose (Glu), and lactate dehydrogenase (LDH) were independent risk factors for SIRS. In addition, we calculated the area under the ROC curve (AUC) for our prediction model of SIRS reached 0.816, which exceeded the AUCs of the individual risk indicators (RDW, FIB, AMY, Glu, and LDH) and the bedside index of severity in acute pancreatitis (BISAP) score. In addition, we conducted a correlation analysis to validate the relationships among the predictive factors and to eliminate possible multicollinearity. The calibration curve plot showed that the nomogram agreed well between the predicted SIRS and actual risks. Finally, the clinical decision curve for our model also indicated its clinical utility by guiding decision-making for timely interventions at a threshold probability range of 0.4-1. The model predicted non-SIRS with a critical value ≥0.332, a sensitivity of 71.3% and specificity of 87.1%, and a kappa value of 0.56. These results indicate that this prediction model is based on admission data, with recommended additional validation assessments at multiple time points (eg, 24, 48, and 72h) to fully characterize the progression of SIRS's risk. Overall, this nomogram prediction model provides an efficient and simple means to predict SIRS for patients with AP.

Pancreatic fat infiltration (PFI) is strongly associated with obesity, insulin resistance, and cardiometabolic risk. However, its impact on pancreatic stiffness remains unclear. This study aimed to evaluate the relationship between PFI, pancreatic stiffness measured by transabdominal 2D-SWE elastography, and cardiometabolic risk factors (CMRF). This cross-sectional study included patients with and without PFI, identified by abdominal ultrasound. Exclusion criteria included a history of pancreatic or liver disease and alcohol consumption >20g/day. CMRFs were assessed, and pancreatic stiffness was measured using transabdominal 2D-SWE elastography. In patients with PFI, additional assessments included hepatic 2D-SWE elastography, attenuation imaging for hepatic fat quantification, and evaluation of insulin resistance. A total of 205 patients were included, 103 with PFI and 102 without. Patients with PFI were older and had a higher prevalence of CMRFs, including increased waist circumference (84.5%), overweight/obesity (79.6%), hypertriglyceridemia (62.7%), metabolic syndrome (59.4%), and insulin resistance (53.9%). Hepatic steatosis was present in 61% of patients with PFI but absent in those without. Pancreatic stiffness was significantly higher in patients with PFI compared with those without (7.35 KPa [IQR: 6.30-8.79] vs. 5.3 KPa [IQR: 4.5-6.1]; P<0.001). A stiffness threshold of ≥6 KPa demonstrated 85% sensitivity and an 86% negative predictive value for detecting PFI. Among CMRFs, hyperglycemia was significantly associated with increased pancreatic stiffness, and type 2 diabetes (T2D) emerged as the strongest predictor of elevated stiffness. PFI is a relevant metabolic marker associated with central obesity, insulin resistance, and increased pancreatic stiffness. These findings support the potential of transabdominal 2D-SWE as a non-invasive tool for detecting early pancreatic structural, particularly in patients with T2D. Longitudinal studies are warranted to clarify its role in predicting pancreatic dysfunction and metabolic disease progression.

Background:Acute pancreatitis (AP) is a prevalent gastrointestinal emergency with a substantial risk of severe complications. Evidence indicates that glucocorticoids (GCs) may attenuate organ failure and reduce mortality in AP through their anti-inflammatory and immunomodulatory properties. However, the therapeutic application of GCs in AP remains contentious due to potential adverse effects, such as heightened infection risk and exacerbation of pancreatic injury.Objective:This review evaluates recent developments in GC therapy for AP, with an emphasis on their mechanisms of action, therapeutic efficacy, and associated risks.Methods:A review investigates the role of GCs in AP pathophysiology, their impact on inflammatory markers, organ function, survival outcomes, and the ongoing controversies regarding their clinical efficacy and safety.Results:Current evidence suggests that GCs may attenuate inflammation and enhance survival in animal models and select clinical studies on AP. Yet, findings regarding their impact on disease progression and patient outcomes remain inconclusive. In addition, combination therapies incorporating GCs may be most effective within a multimodal therapeutic approach.Conclusion:GCs exhibit potential in the management of AP by modulating inflammatory pathways and immune responses. Their use necessitates thorough risk assessment. Large-scale clinical trials are essential to establish standardized protocols, optimal dosing regimens, and patient selection criteria for GCs therapy in AP.

Acute pancreatitis (AP) is a leading cause of gastrointestinal hospitalizations worldwide, with rising incidence, significant morbidity, and high healthcare costs. Pain, a hallmark symptom of AP, remains inadequately assessed, often relying on unidimensional scales such as visual analogue score, which fail to capture its multidimensional nature. Poorly managed acute pain negatively impacts clinical outcomes, prolongs recovery, and increases the risk of chronic pain syndromes. Comprehensive pain assessment tools specific to AP are lacking, highlighting the need for improved evaluation methods. The proposed study aims to develop and validate the Comprehensive Acute Pancreatitis Pain Outcome Set (CAPPOS) to address this evidence gap. The CAPPOS initiative follows COMET and COSMIN guidelines. Three systematic reviews will identify pain domains and assessment methods in AP, acute abdominal pain, and postpancreatectomy pain. A consensus process, using a modified Delphi approach, will involve multidisciplinary experts and patients to confirm and define key domains. Measurement tools will be selected for each domain and refined through iterative feedback. Pilot testing with 50 patients will evaluate the feasibility, clarity, and responsiveness to change of the preliminary tool. Validation studies with 200 AP patients will assess structural, content, and criterion validity, reliability, and sensitivity to change, ensuring content validity and clinical utility. CAPPOS will provide a validated, multidimensional core outcome set to optimize pain assessment in AP. It will also facilitate standardized reporting in clinical trials, advancing research and care for AP-related pain.

We aimed to determine the association between frailty status and outcomes in patients with post-ERCP pancreatitis (PEP). Appended data were obtained from the 2016-2017 National Inpatient Sample (NIS) database. We performed a nationwide cohort study utilizing International Classification of Diseases (ICD) diagnostic codes to identify adult patients with PEP. The Hospital Frailty Risk Score (HFRS) was used to classify patients as frail or non-frail. The primary outcome was composite complications related to PEP including all-cause mortality. Secondary outcomes were length of stay and total hospitalization costs. There were 41,615 patients represented in the data, with 34.6% (14,382) characterized as frail and 65.4% (27,233) as non-frail. Of frail patients, 60.7% suffered composite complications related to PEP compared with 29.3% of non-frail patients ( P < 0.001). Frail patients had more cardiovascular, pulmonary, gastrointestinal, renal and endocrine, neurological, and infectious complications compared with non-frail patients. Frail patients also had higher all-cause mortality rates during inpatient admission (4.6% vs under 0.1%, P < 0.001) and increased length of stay (11.6 vs 0.8 d, P < 0.001) as well as total hospitalization charges ($140,855 vs $73,539, P < 0.001). On multivariable analysis, positive frailty status was associated with 2.94 times increased odds of having composite complications. Frailty assessments can be utilized as a predictor of outcomes and serve to guide clinical decision-making when determining prophylactic measures in patients undergoing ERCP who may be at risk for PEP.

Splanchnic venous thrombosis (SVT) involving veins in the vicinity of the pancreas is a significant complication of acute pancreatitis (AP). The natural history of SVT, especially the rates of recanalization, is poorly understood. This study aimed to evaluate the natural history of SVT in AP, with a focus on recanalization rates and identifying predictors of nonrecanalization. This was an observational study in which patients with SVT in the setting of AP were included. Patients were followed for at least 6 months. Recanalization was assessed using Doppler ultrasound or CT imaging, and outcomes were classified as complete recanalization, partial recanalization, or nonrecanalization. Statistical analysis was done to identify predictors of nonrecanalization. Among 814 patients with AP, 92 (11.3%) developed SVT. Of these, 70 met the inclusion criteria. The mean age was 38.1 years, with 92.8% male predominance. Alcohol was the most common etiology (62.8%). The retropancreatic splenic vein was the most commonly affected vessel. At follow-up, complete recanalization was observed in 54.3% of cases, partial recanalization in 2.9%, while 42.8% showed no evidence of recanalization. Therapeutic anticoagulation was administered to 20% of patients without significantly influencing recanalization rates. A BISAP score ≥2 was a significant predictor of nonrecanalization ( P =0.007). Most patients with SVT following AP demonstrate spontaneous recanalization. A key predictor for nonrecanalization is the severity of pancreatitis.