EC Gastroenterology and Digestive System

Background: Necrotizing pancreatitis is associated with high rate of morbidity and mortality that could be a leading cause of serious complications such as cholangitis, ileus, bowel ischemia, formation of pseudoaneurysm, hemorrhage and venous thrombosis. Therefore, identification of different possible risk factors is essential as it help in early diagnosis and management. This study aimed to identify possible risk factors to develop necrotizing pancreatitis including both biliary or non biliary risk factors after presenting as case of acute pancreatitis.

Methods: This study is a retrospective cohort study which will include all patients admitted to King Saud Medical City, Riyadh Saudi Arabia, with diagnosis of acute and necrotizing pancreatitis, male and female, aged more than or equal to 18 years old A customized data collection sheet will be used to collect relevant data. A p value of less than or equal to 0.025 will considered significant.

Results: The prevalence of gallbladder disease and stones in this study was found to be 19.3% and 39.4% respectively. Around 13.1% of the subjects had a history of pancreatitis and 2.7% had developed an infection. In the overall sample, 12.01% of the patients (n = 34) had developed Necrotizing Pancreatitis (NP), (82.4%) were males (P-value: 0.005), alcoholics (32.5%) (p-value: 0.02), and (41.2%) were diabetics (23.3%; p-value: 0.025). Surprisingly, a lower proportion of the patients with NP had gallbladder disease (14.8%) or gallbladder stones (20.6%) (P-value: 0.04). In addition, the distribution of continuous variables such as WBC (P-value: 0.027), serum glucose (P-value: 0.02), blood urea nitrogen (P-value: 0.001), serum calcium (P-value: 0.001), serum lactase (P-value: 0.001), LDH (P-value: 0.0001), and serum lipase (P-value: 0.032) was significantly different for patients with and without NP. Findings of binary regression analysis showed that males (OR = 4.89; [95% CI: 2.18 - 10.96]), alcoholics (RR = 2.49; [95% CI: 1.13 - 5.53]), and diabetic patients (RR = 2.30 [95% CI: 1.09 - 4.84) were more likely to develop NP. Patients with gallbladder stones and gallbladder disease were 49% and 85% less likely to develop NP, respectively (RR = 0.41; 95% CI: 0.17 - 0.98). The significant risk factors of NP after making adjustments were found to be gender (male) (aRR = 2.89; 95% CI: 1.11 - 7.50), diabetes history (aRR = 2.17; 95% CI: 0.99 - 4.76), and history of pancreatitis (aRR = 2.59; 95% CI: 1.01 - 6.60).

Conclusion: Risk factors that were correlated positively with development of Necrotizing pancreatitis (NP) after an acute pancreatitis (AP) episode were being male (RR = 3.46), alcoholic (RR = 2.49), and have diabetes mellitus (RR = 2.3), initial presentation with septic picture (RR = 3.83). on the other hand, patients with gallbladder disease or stone were less likely to develop NP as a sequel of AP.

Keywords: Necrotizing Pancreatitis; Risk Factors; Biliary; Non Biliary

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