Glucose levels show independent and dose-dependent association with worsening acute pancreatitis outcomes: Post-hoc analysis of a prospective, international cohort of 2250 acute pancreatitis cases.

Abstract

BackgroundMetabolic risk factors, such as obesity, hypertension, andhyperlipidemiaare independent risk factors for the development of various complications in acute pancreatitis (AP).Hypertriglyceridemiadose-dependently elicits pancreatotoxicity and worsens the outcomes of AP. The role ofhyperglycemia, as a toxic metabolic factor in the clinical course of AP, has not been examined yet.MethodsWe analyzed a prospective, international cohort of 2250 AP patients, examining associations between (1)glycosylated hemoglobin(HbA1c), (2) on-admission glucose, (3) peak in-hospital glucose and clinically important outcomes (mortality, severity, complications, length of hospitalization (LOH), maximal C-reactive protein (CRP)). We conducted a binarylogistic regressionaccounting for age, gender, etiology, diabetes, and our examined variables. Receiver Operating Characteristic Curve (ROC) was applied to detect the diagnostic accuracy of the three variables.ResultsBoth on-admission and peak serum glucose are independently associated with AP severity and mortality, accounting for age, gender, known diabetes and AP etiology. They show a dose-dependent association with severity (p<0.001 in both), mortality (p<0.001), LOH (p<0.001), maximal CRP (p<0.001), systemic (p<0.001) and local complications (p<0.001). Patients with peak glucose >7mmol/l had a 15 times higher odds for severe AP and a five times higher odds for mortality. We found a trend of increasingHbA1cwith increasing LOH (p<0.001), severity and local complications.ConclusionsOn-admission and peak in-hospital glucose are independently and dose-dependently associated with increasing AP severity and mortality. In-hospital laboratory control of glucose and adequate treatment of hyperglycemia are crucial in themanagement of AP.KeywordsGlucoseHemoglobin A1cDose-dependencyPancreatotoxicityAcute pancreatitis