Recurrence Rates and Risk Factors for Recurrence after First Episode of Acute Pancreatitis: A Systematic Review and Meta-analysis
Background and Purpose:
- Acute pancreatitis (AP) patients may suffer from multiple episodes and develop recurrent acute pancreatitis (RAP).
- To better understand the recurrence rates and associated risk factors for RAP, Li et al (Eur J Int Med (2023) identified and assessed studies reporting AP recurrence.
Methods:
- PubMed, Web of Science, Scopus, and EMBASE databases were searched to identify all publications reporting AP recurrence until October 20th, 2022.
- Meta-analysis and meta-regression were performed to calculate the pooled estimates via the random-effects model in adherence with PRISMA and MOOSE reporting guidelines.
- Criteria for Included Studies and Publications
- Adult patients (aged ≥ 18 years) with a diagnosis of AP
- Studies which investigated the recurrence of AP and evaluated risk factors influencing the recurrence
- Studies wherein the length of follow-up was greater than 12 months
- Criteria for Excluded Studies and Publications
- Non-primary research articles and studies using animal or in vitro models
- Studies that did not report the first episode of AP or which lacked sufficient data to evaluate risk factors with RAP
- Studies that enrolled only chronic, hereditary, gestational, and auto-immune pancreatitis patients
- Study Outcomes
- Primary outcome – the natural recurrence rate of AP after the initial episode
- Secondary outcome – the recurrence after the control of underlying causes, and the number and proportion of patients who were diagnosed with RAP following the first episode within each specific etiology
Results:
- 36 studies met the inclusion criteria and were used in pooled analyses.
- Overall rate of recurrence after first-time AP – 21%
- Pooled recurrence rates – biliary (12%), alcoholic (30%), idiopathic (25%), and hypertriglyceridemia (30%)
- Recurrence rate decreased after managing underlying causes post-discharge
- Increased risk of recurrence was observed in patients with a smoking history, alcoholic etiology, male sex, and local complications
- Biliary etiology associated with lower recurrence rates
Conclusion:
- >1/5 of patients experienced recurrence after discharge
- Highest recurrence rate observed in alcoholic and hypertriglyceridemia etiologies
- Smoking history, alcoholic etiology, male gender, and presence of local complications were independent risks for the recurrence.
- Further high-quality and large-scale studies are warranted to investigate the effects of control of underlying causes after discharge on AP recurrence.
- The authors state
- Smoking history, alcoholic etiology, male gender, and presence of local complications were independent risks for the recurrence.
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