Glucose levels show independent and dose-dependent association with worsening acute pancreatitis outcomes: Post-hoc analysis of a prospective, international cohort of 2250 acute pancreatitis cases

Pancreatology. 2021 Oct;21(7):1237-1246. doi: 10.1016/j.pan.2021.06.003. Epub 2021 Jun 22.

Abstract

Background: Metabolic risk factors, such as obesity, hypertension, and hyperlipidemia are independent risk factors for the development of various complications in acute pancreatitis (AP). Hypertriglyceridemia dose-dependently elicits pancreatotoxicity and worsens the outcomes of AP. The role of hyperglycemia, as a toxic metabolic factor in the clinical course of AP, has not been examined yet.

Methods: We analyzed a prospective, international cohort of 2250 AP patients, examining associations between (1) glycosylated hemoglobin (HbA1c), (2) on-admission glucose, (3) peak in-hospital glucose and clinically important outcomes (mortality, severity, complications, length of hospitalization (LOH), maximal C-reactive protein (CRP)). We conducted a binary logistic regression accounting for age, gender, etiology, diabetes, and our examined variables. Receiver Operating Characteristic Curve (ROC) was applied to detect the diagnostic accuracy of the three variables.

Results: Both on-admission and peak serum glucose are independently associated with AP severity and mortality, accounting for age, gender, known diabetes and AP etiology. They show a dose-dependent association with severity (p < 0.001 in both), mortality (p < 0.001), LOH (p < 0.001), maximal CRP (p < 0.001), systemic (p < 0.001) and local complications (p < 0.001). Patients with peak glucose >7 mmol/l had a 15 times higher odds for severe AP and a five times higher odds for mortality. We found a trend of increasing HbA1c with increasing LOH (p < 0.001), severity and local complications.

Conclusions: On-admission and peak in-hospital glucose are independently and dose-dependently associated with increasing AP severity and mortality. In-hospital laboratory control of glucose and adequate treatment of hyperglycemia are crucial in the management of AP.

Keywords: Acute pancreatitis; Dose-dependency; Glucose; Hemoglobin A1c; Pancreatotoxicity.

Publication types

  • Multicenter Study

MeSH terms

  • Adult
  • Aged
  • Blood Glucose / analysis*
  • Disease Progression
  • Female
  • Glycated Hemoglobin / analysis
  • Humans
  • Hyperglycemia* / blood
  • Hyperglycemia* / complications
  • Hyperglycemia* / therapy
  • Male
  • Middle Aged
  • Pancreatitis* / blood
  • Pancreatitis* / complications
  • Pancreatitis* / mortality
  • Pancreatitis* / therapy
  • Prospective Studies
  • Registries
  • Severity of Illness Index

Substances

  • Blood Glucose
  • Glycated Hemoglobin A