Pancreatic function, quality of life and costs at long-term follow-up after acute pancreatitis

Abstract

Aim: To evaluate long-term endocrine and exocrine pancreatic function, quality of life and health care costs after mild acute pancreatitis and severe acute pancreatitis (SAP).

Methods: Patients prospectively included in 2001-2005 were followed-up after 42 (36-53) mo. Pancreatic function was evaluated with laboratory tests, the oral glucose tolerance test (OGTT), fecal elastase-1 and a questionnaire. Short Form (SF)-36, was completed.

Results: Fourteen patients with a history of SAP and 26 with mild acute pancreatitis were included. Plasma glucose after OGTT was higher after SAP (9.2 mmol/L vs 7.0 mmol/L, P = 0.044). Diabetes mellitus or impaired glucose tolerance in fasting plasma glucose and/or 120 min plasma glucose were more common in SAP patients (11/14 vs 11/25, P = 0.037). Sick leave, time until the patients could take up recreational activities and time until they had recovered were all longer after SAP (P < 0.001). No significant differences in SF-36 were seen between the groups, or when comparing with age and gender matched reference groups. Total hospital costs, including primary care, follow-up and treatment of complications, were higher after SAP (median €16 572 vs €5000, P < 0.001).

Conclusion: Endocrine pancreatic function was affected, especially after severe disease. SAP requires greater resource use with long recovery, but most patients regained a good quality of life.

Figures

Figure 1

Log-rank test for time to recovery after acute pancreatitis in mild and severe acute pancreatitis patients.

Figure 2

Relationship between mild and severe acute pancreatitis patients in the oral glucose tolerance test evaluating plasma glucose (mmol/L, A) and C-peptide values (nmol/L, B).

Figure 3

The graphs shows quality of life, measured by Short Form-36, in mild and severe acute pancreatitis patients, comparing age- and gender-matched control group. A: Mean values for patients after mild (black squares) acute pancreatitis and severe (black circles) acute pancreatitis in the 8 Short Form-36 domains; B: Mean value for patients after severe (black squares) acute pancreatitis compared with an age- and gender-matched control group (grey bars) in the 8 SF-36 domains. SAP: Severe acute pancreatitis; PF: Physical function; RP: Role physical; BP: Bodily pain; GH: General health; VT: Vitality; SF: Social functioning; RE: Role emotional; MH: Mental health.

Figure 4

Box-plots showing the specified hospital costs in acute pancreatitis patients. A: In-hospital costs during primary care for acute pancreatitis, in mild and severe acute pancreatitis patients; B: Costs at follow-up, including cost for primary care and all subsequent inpatient and outpatient costs, in mild and severe acute pancreatitis patients. ICU: Intensive care unit.