Original ArticleMetabolic syndrome and acute pancreatitis
Introduction
Acute pancreatitis is an inflammatory disorder of the pancreas. Due to the risk of developing local and systemic complications, these patients are admitted to internal medicine or surgical wards for further monitoring and treatment. The most common etiologies of acute pancreatitis are biliary and alcoholic [1]. The course of acute pancreatitis depends on the level of severity and can be, according to the revised Atlanta classification from 2012, divided into mild, moderate, or severe, with severe acute pancreatitis carrying a significant mortality risk of up to 40% seen in patients suffering from infected pancreatic necrosis [2]. Mild acute pancreatitis, the most common form, has no organ failure, local or systemic complications and usually resolves in the first week. Moderately severe acute pancreatitis is defined by the presence of transient organ failure, local complications or exacerbation of co-morbid disease(s). Severe acute pancreatitis is defined by persistent organ failure, lasting longer than 48 h. Local complications of acute pancreatitis are peripancreatic fluid collections, pancreatic and peripancreatic necrosis (sterile or infected), pseudocysts and walled-off necrosis (sterile or infected) [3]. Due to high mortality and limited treatment options in the management of acute pancreatitis, potential modifiable risk factors, as well as new scoring systems for early identification of high-risk patients are still being investigated.
Metabolic syndrome is a combination of factors that increases the risk of cardiovascular diseases and includes diabetes mellitus type 2 (T2DM), dyslipidemia, arterial hypertension and abdominal obesity. It has been shown that metabolic syndrome is associated with a variety of other diseases and that obesity, as a vital component of the metabolic syndrome, correlates with the increased occurrence and severity of acute pancreatitis [4]. However, there is a lack of data regarding the association between severity of acute pancreatitis and the presence of metabolic syndrome. A small number of studies have shown conflicting data regarding the presence of metabolic syndrome and the course of acute pancreatitis [4]. Most of the studies have investigated the association between obesity and course of acute pancreatitis and majority of these studies have shown that the presence of obesity has a negative impact on the course of AP [4], [5], [6], [7], [8], [9], [10].
Therefore, the aim of our study was to investigate the influence of metabolic syndome on the severity of acute pancreatitis, on the presence of local and systemic complications, as well as on the survival rate.
Section snippets
Patients and methods
In this retrospective study we analyzed 700 patients diagnosed with acute pancreatitis and admitted to our hospital in the period from January 1, 2008 to June 31, 2015. Acute pancreatitis was defined as the onset of typical upper abdominal pain (nausea and/or vomiting) within 48 h prior to admission and the elevation of serum amylase and/or lipase activity at least 3 times above the upper limit of normal. Only the patients having the first attack of acute pancreatitis were included in the study.
Results
Of the 609 patients with acute pancreatitis, 110 fulfilled the criteria for metabolic syndrome. Table 1 shows demographic and clinical characteristics of our patients. The mean age of the analyzed patients was 63.2 ± 16.1 years, 55.5% of the patients were male. The most common etiologies of acute pancreatitis were biliary (66.2%) and alcoholic (13.8%). There was no statistically significant difference between the groups of patients with metabolic syndrome compared to those without metabolic
Discussion
Acute pancreatitis is an inflammatory process of the pancreas and in most patients the course of the disease is mild. However, 10–20% of patients develop the severe form of the disease, necrotizing pancreatitis, with a high mortality rate that ranges from 14 to 25%. About half of these deaths occur within the first 1–2 weeks and are mainly attributable to the development of multiple organ dysfunction syndrome [12], [13], [14], [15]. The incidence of severe pancreatitis in our study was 14.6%,
Conclusion
The presence of metabolic syndrome at admission portends a higher risk of moderately severe and severe acute pancreatitis, as well as higher mortality and longer duration of stay in intensive care unit. Given the rising incidence of metabolic syndrome, we can expect even higher incidence of severe acute pancreatitis in the near future. Regarding the fact that most of metabolic syndrome components can be either prevented or improved through lifestyle changes and/or pharmacological agents, a
Conflict of interests
The authors state that they have no conflicts of interest and that no sources of financial support were used.
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