Increased incidence and reduced mortality after first attack of acute pancreatitis over an 18-year period

Abstract

Aims

To determine time trends in the incidence and etiology of acute pancreatitis and identify predictors for in-hospital mortality.

Patients and methods

Retrospective study of 1722 patients with acute pancreatitis admitted to Akershus University Hospital between January 2000 and December 2017. Data were obtained from electronic patient files and computed tomography scans. We estimated a logistic regression model to assess differences in associations between patient characteristics and in-hospital mortality in two time periods, 2000–2009 (first period) and 2010–2018 (second period).

Results

First attack of acute pancreatitis (FAAP) was identified in 1579 patients (91.7%). The incidence of FAAP increased from 20.1/100,000 during the first period to 27.7/100,000 in the second period (p = .011). Etiology showed no differences between the two time periods. Gallstone was the most frequent etiology (47.2%). In total, 187 patients (11.8%) had necrotizing pancreatitis; more in the second period compared to the first (14.2 vs. 7.7%; p < .001). The overall mortality rate was 3.9%. Mortality rates decreased for both inflammatory and necrotizing pancreatitis during the study period. Age and comorbidity according to Charlson Comorbidity Index (CCI) were predictors of in-hospital mortality (OR 1.07, 95% CI 0.07; 0.40 and 13.58, 95% CI 3.88; 47.52), as were alcohol and organ failure (OR 7.20, 95% CI 2.02; 25.67 and OR 34.15, 95% CI 8.94; 130.53, respectively).

Conclusions

The incidence of FAAP is increasing in southeast Norway. The etiology has remained unchanged over an 18-year period, with gallstones being the most frequent cause. The outcomes for both inflammatory and necrotic pancreatitis are improving.

Keywords:

• Acute pancreatitis
• first attack acute pancreatitis
• FAAP incidence
• etiology
• severity
• predictors
• hospital mortality

Acknowledgements

We thank the department of digestive surgery, Akershus University Hospital for access to patient records, IT-facilities, and time to do this work. I also thank Ask Boe Klakegg and Mohammad Kourosh Piroozmand for their efforts with data collection.

Ethical approval

The study was approved by the hospital’s patient protection board under reference 2017-178 and the Norwegian Ethical Committee under reference 2017/1881/REK.

Disclosure statement

The authors report no conflict of interest. The authors are responsible for the content of the paper. The corresponding author may communicate with the editor on behalf of the other authors.

Additional information

Funding

Support was provided by surgical research funds from the Department of Medicine, Campus Ahus, University of Oslo, Norway.