Anwar Ahmad, Stalin Dharmayan, Nicolae Bostan, Mrinway Barua, Abraham Abiodun Ayantunde
Introduction Acute idiopathic pancreatitis remains a challenge with no available strong recommendations. Its impact on patient outcome is not clear. This study compared the outcomes between patients with idiopathic pancreatitis and acute non-idiopathic pancreatitis. Methods A retrospective analysis of electronic prospectively maintained database of all episodes of acute pancreatitis over a 4-year study period. Patients’ clinicopathological data for hospital admissions were collected. Primary end points were organ failure, intensive care unit admission, pancreatic necrosis and mortality. Data analysis using SPSS version 19.0 with Chi-square test and unpaired Student t-test comparing the outcomes between idiopathic pancreatitis and non-idiopathic pancreatitis with p-value <0.05 set as statistically significance. Results 569 episodes of acute pancreatitis were recorded in 446 patients during the study period. The median age for all episodes was 62 (13-100) years with 264 males and 305 females. 142/569 (25%) and 427/569 (75%) were idiopathic pancreatitis and non-idiopathic pancreatitis respectively. Both groups were similar in their pre-admission co-morbidities (p=0.77) and demographics except for a preponderance of female patients in the idiopathic pancreatitis (63%) compared to the idiopathic pancreatitis (51%) (p=0.012). 21/142 (15%) patients with IP had overall poor outcomes compared with 30/427 (7%) in the non-idiopathic pancreatitis group (odds ratio 2.29; 95% confidence interval 1.27-4.16; P=0.006). Significantly poor outcomes noted in idiopathic pancreatitis compared with non-idiopathic pancreatitis for pancreatitis specific mortality (odds ratio 3.17; confidence interval 1.408-7.180; P=0.004), intensive care unit admission (odds ratio 2.73; confidence interval 1.36-5.46; P=0.003) and multi-organ failure (odds ratio 2.97; confidence interval 1.36-6.49; P=0.004). Conclusions Outcomes is significantly poor in idiopathic pancreatitis and this reflects our lack of understanding of the mechanisms of pancreatitis in this group of patients. We need rigorous management pathway to optimise their investigations and management.
