Multiple Hits in Acute Pancreatitis: Components of Metabolic Syndrome Synergize Each Other's Deteriorating Effects

Andrea Szentesi, Andrea Párniczky, Áron Vincze, Judit Bajor, Szilárd Gódi, Patricia Sarlós, Noémi Gede, Ferenc Izbéki, Adrienn Halász, Katalin Márta, Dalma Dobszai, Imola Török, Hunor Farkas, Mária Papp, Márta Varga, József Hamvas, János Novák, Artautas Mickevicius, Elena Ramirez Maldonado, Ville Sallinen, Dóra Illés, Balázs Kui, Bálint Erőss, László Czakó, Tamás Takács, Péter Hegyi, Andrea Szentesi, Andrea Párniczky, Áron Vincze, Judit Bajor, Szilárd Gódi, Patricia Sarlós, Noémi Gede, Ferenc Izbéki, Adrienn Halász, Katalin Márta, Dalma Dobszai, Imola Török, Hunor Farkas, Mária Papp, Márta Varga, József Hamvas, János Novák, Artautas Mickevicius, Elena Ramirez Maldonado, Ville Sallinen, Dóra Illés, Balázs Kui, Bálint Erőss, László Czakó, Tamás Takács, Péter Hegyi

Abstract

Introduction: The incidence of acute pancreatitis (AP) and the prevalence of metabolic syndrome (MetS) are growing worldwide. Several studies have confirmed that obesity (OB), hyperlipidemia (HL), or diabetes mellitus (DM) can increase severity, mortality, and complications in AP. However, there is no comprehensive information on the independent or joint effect of MetS components on the outcome of AP. Our aims were (1) to understand whether the components of MetS have an independent effect on the outcome of AP and (2) to examine the joint effect of their combinations.

Methods: From 2012 to 2017, 1435 AP cases from 28 centers were included in the prospective AP Registry. Patient groups were formed retrospectively based on the presence of OB, HL, DM, and hypertension (HT). The primary endpoints were mortality, severity, complications of AP, and length of hospital stay. Odds ratio (OR) with 95% confidence intervals (CIs) were calculated.

Results: 1257 patients (55.7 ± 17.0 years) were included in the analysis. The presence of OB was an independent predictive factor for renal failure [OR: 2.98 (CI: 1.33-6.66)] and obese patients spent a longer time in hospital compared to non-obese patients (12.1 vs. 10.4 days, p = 0.008). HT increased the risk of severe AP [OR: 3.41 (CI: 1.39-8.37)], renal failure [OR: 7.46 (CI: 1.61-34.49)], and the length of hospitalization (11.8 vs. 10.5 days, p = 0.020). HL increased the risk of local complications [OR: 1.51 (CI: 1.10-2.07)], renal failure [OR: 6.4 (CI: 1.93-21.17)], and the incidence of newly diagnosed DM [OR: 2.55 (CI: 1.26-5.19)]. No relation was found between the presence of DM and the outcome of AP. 906 cases (mean age ± SD: 56.9 ± 16.7 years) had data on all four components of MetS available. The presence of two, three, or four MetS factors increased the incidence of an unfavorable outcome compared to patients with no MetS factors.

Conclusion: OB, HT, and HL are independent risk factors for a number of complications. HT is an independent risk factor for severity as well. Components of MetS strongly synergize each other's detrimental effect. It is important to search for and follow up on the components of MetS in AP.

Keywords: acute pancreatitis; diabetes mellitus; hyperlipidemia; hypertension; metabolic syndrome; mortality; obesity; severity.

Copyright © 2019 Szentesi, Párniczky, Vincze, Bajor, Gódi, Sarlós, Gede, Izbéki, Halász, Márta, Dobszai, Török, Farkas, Papp, Varga, Hamvas, Novák, Mickevicius, Maldonado, Sallinen, Illés, Kui, Erőss, Czakó, Takács and Hegyi.

Figures

FIGURE 1
FIGURE 1
Individual effect analysis. OB and the outcome of AP. (A) The share of male patients was lower in the OB group [∗OR: 0.75 (CI: 0.58–0.95)]. (B) There is no difference in the average age between the OB and non-OB groups (p = 0.398). (C) Obese patients have more than double the risk of severe AP [∗OR: 2.15 (CI: 1.31–3.54)]. (D) Obese patients did not have a higher risk of mortality. (E) Obese patients spent more time in the hospital (∗p = 0.008). (F) More local complications were observed in the OB group, although the difference was not significant. (G) Obese patients had a higher risk of systemic complications [∗OR: 1.99 (CI: 1.30–3.05)], respiratory failure [∗OR: 2.15 (CI: 1.26–3.65)], and renal failure [∗OR: 4.56 (CI: 2.23–9.32)].
FIGURE 2
FIGURE 2
Individual effect analysis. HT and the outcome of AP. (A) There are fewer male patients with HT [∗OR: 0.66 (CI: 0.52–0.84)]. (B) Patients with HT are older than patients without it (∗p < 0.001). (C) Hypertensive patients have more than double the risk of the severe form of AP [∗OR: 2.39 (CI: 1.30–4.38)]. (D) The risk of mortality was not higher in the HT group. (E) Patients with HT spent more time in the hospital (∗p = 0.020). (F) There was a higher incidence of fluid collection, pseudocysts, and new onset diabetes, although the difference was not significant. (G) Hypertensive patients have a higher risk of systemic complications [∗OR: 2.83 (CI: 1.64–4.88)], respiratory failure [∗OR: 3.14 (CI: 1.51–6.52)], heart failure [∗OR: 3.82 CI: (1.11–13.11)], and renal failure [∗OR: 6.40 (CI: 1.93–21.17)].
FIGURE 3
FIGURE 3
Individual effect analysis. HL and the outcome of AP. (A) There are more male patients with HL [∗OR: 1.47 (CI: 1.12–1.92)]. (B) Patients with HL are younger than patients without it (∗p < 0.001). (C) Hyperlipidemic patients have a lower chance of having mild AP [∗OR: 0.65 (CI: 0.49–0.85)]. (D) Patients with HL did not have a higher risk of mortality. (E) Patients with HL spent more time in the hospital (∗p = 0.053). (F) HL increases the risk of local complications [∗OR: 1.55 (CI: 1.17–2.05)], acute fluid collection [∗OR 1.48 (CI: 1.11–1.99)], and pseudocysts [∗OR 1.81 (CI: 1.14–2.88)]. (G) Hyperlipidemic patients have a higher risk of renal failure [∗OR 2.17 (CI: 1.51–4.43)].
FIGURE 4
FIGURE 4
Individual effect analysis. DM and the outcome of AP. (A) There is no significant difference in sex between the two groups. (B) Patients with diabetes are older than patients without it (∗p < 0.001). (C,D) Diabetic patients did not have a higher risk of moderately severe or severe AP or mortality in our cohort. (E) There is no difference in LOS between the two groups (p = 0.139). (F,G) As regards local or systemic complications, there are no differences between diabetic and non-diabetic patients in our cohort.
FIGURE 5
FIGURE 5
Joint effect analysis. The effect of MetS factor combinations on the outcome of AP. The more MetS factors are present, the more significantly higher incidence of the different outcome parameters can be observed. Statistical analysis is summarized in Supplementary Appendix S5.

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