A prospective, multicenter study found that over one-third of patients had exocrine pancreatic insufficiency 12 months after an episode of acute pancreatitis.
In the Post-Acute Pancreatitis Pancreatic Exocrine Insufficiency (PAPPEI) study, published in eClinicalMedicine, researchers from the University of Pittsburgh, The Ohio State University, and Johns Hopkins University examined the prevalence and predictors of exocrine pancreatic insufficiency (EPI) following acute pancreatitis (AP). They enrolled 311 eligible adult patients admitted with AP between June 2017 and October 2021. Stool samples were provided by 85 patients at the 12-month follow-up. The researchers sought to identify idiopathic AP etiology, moderately severe or severe AP, and preexisting diabetes as independent predictors of EPI at 12 months.
Study population characteristics included:
- Mean age: 54.7 ± 14.1 years
- 51.8% male
- 92.9% White
- 54.1% obese (BMI ≥ 30 kg/m²)
- 64.7% first episode of AP
- 61.2% mild AP, 29.4% moderately severe, 9.4% severe.
The study found:
- 34.1% (n = 29/85) of patients had EPI at 12 months post-AP
- 22.4% (n = 19/85) had severe EPI (fecal elastase-1 [FE-1] ≤ 100 μg/g)
- 11.8% (n = 10/85) had mild EPI (FE-1 101 to 200 μg/g)
- 12.8% of patients with an index mild AP attack developed severe EPI.
Multivariable logistic regression analysis revealed:
- Idiopathic AP etiology: oods ratio [OR] = 4.095 (95% confidence interval [CI] = 1.418–11.826)
- Moderately severe or severe AP: OR = 3.166 (95% CI = 1.156–8.670)
- Preexisting diabetes: OR = 3.217 (95% CI = 1.113–9.298)
- The researchers used FE-1 levels to diagnose EPI, with EPI defined as FE-1 ≤ 200 μg/g. Stool samples were collected at baseline, 3 months, and 12 months post-AP. Among the 184 consented patients, 112 of them provided baseline samples, 79 at 3 months, and 85 at 12 months.
AP etiologies were:
- 38.8% gallstones
- 29.4% idiopathic
- 10.6% alcoholic
- 8.2% hypertriglyceridemia
- 7.1% post-ERCP
- 5.9% other.
The natural course of EPI showed:
- 43% prevalence at baseline (n= 112)
- 34% prevalence at 12 months (n = 85)
- Severe EPI decreased from 29% at baseline to 22% at 12 months
- Mild EPI remained stable (14% vs 12%).
Among 64 patients with samples at all timepoints:
- 25% with baseline EPI recovered by 12 months
- 7 recovered by 3 months, but 1 redeveloped EPI by 12 months
- 4 additional patients recovered by 12 months
- 5 new EPI cases developed (4 by 3 months, 1 by 12 months).
Additional data from the study included:
- Mean Charlson Comorbidity Index: 3.0 ± 1.7
- 29.4% of patients had preexisting diabetes
- 27.4% of patients had pancreatic necrosis
- 9.9% of patients experienced Systemic Inflammatory Response Syndrome (SIRS) during admission
- Just 7% (n = 6/85) of patients with EPI at 12 months were initiated on pancreatic enzyme replacement therapy (PERT).
The study also reported on smoking and alcohol use:
- 54.8% never smoked, 13.1% were active smokers, and 32.1% were former smokers
- 28.2% never consumed alcohol, 43.5% were active drinkers, and 28.2% were former drinkers
- Univariable analysis showed that factors significantly associated with EPI at 12 months included recurrent (versus index) AP, preexisting diabetes, alcohol and idiopathic etiologies, and increasing severity of AP. However, these factors were not included in the final multivariable regression model.
The study had limitations, including potential selection bias caused by recruitment at tertiary care centers and a 24% dropout rate between enrollment and 12-month follow-up. The use of FE-1 for EPI diagnosis also has limitations, with moderate sensitivity (54% to 75%) in mild to moderate EPI.
A full conflict of interest disclosure statement can be found in the study.