Worldwide Variations in Demographics, Management, and Outcomes of Acute Pancreatitis
Bassem Matta, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.
Amir Gougol, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.
Xiaotian Gao, Department of Biostatistics, School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania.
Nageshwar Reddy, Asian Gastroenterology Institute, Hyderabad, India.
Rupjyoti Talukdar, Asian Gastroenterology Institute, Hyderabad, India.
Rakesh Kochhar, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
Mahesh Kumar Goenka, Apollo Gleneagles Hospitals Kolkata, Kolkata, India.
Aiste Gulla, Lithuanian University of Health Sciences, Kaunas, Lithuania.
Jose A. Gonzalez, Universidad Autónoma de Nueva León, Monterrey, Mexico.
Vikesh K. Singh, Johns Hopkins Medical Institutions, Baltimore, Maryland.
Miguel Ferreira, Hospital Nacional de Itauguá, Itaugua, Paraguay.
Tyler Stevens, Cleveland Clinic Foundation, Cleveland, Ohio.
Sorin T. Barbu, University of Medicine and Pharmacy "Iuliu Hatieganu", Cluj-Napoca, Romania.
Haq Nawaz, Eastern Maine Medical Center, Bangor, Maine.
Silvia C. Gutierrez, Hospital Nacional "Professor Alejandro Posadas", Buenos Aires, Argentina.
Narcis O. Zarnescu, "Carol Davila" University of Medicine and Pharmacy, University Emergency Hospital Bucharest, Romania.
Gabriele Capurso, San Raffaele Scientific Institute, Vita Salute San Raffaele University, Milan, Italy.
Jeffrey Easler, Indiana University School of Medicine, Indianapolis, Indiana.
Konstantinos Triantafyllou, Attikon University General Hospital, Athens, Greece.
Mario Pelaez-Luna, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán-Universidad Autónoma de Mexico, Mexico City, Mexico.
Shyam Thakkar, Allegheny Health Network, Pittsburgh, Pennsylvania.
Carlos Ocampo, Hospital General de Argudos "Dr. Cosme Argerich," Buenos Aires, Argentina.
Enrique de-Madaria, Investigación Sanitaria y Biomédica de Alicante (ISABIAL - Fundación FISABIO), Alicante, Spain.
Gregory A. Cote, Medical University of South Carolina, Charleston, South Carolina.
Bechien U. Wu, Kaiser Permanente, Pasadena, California.
Pedram Paragomi, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.
Ioannis Pothoulakis, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.
Gong Tang, Department of Biostatistics, School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania.
Georgios I. Papachristou, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania; Ohio State University Wexner Medical Center, Columbus, Ohio. Electronic address: georgios.papachristou@osumc.edu.
Abstract
BACKGROUND & AIMS: Few studies have compared regional differences in acute pancreatitis. We analyzed data from an international registry of patients with acute pancreatitis to evaluate geographic variations in patient characteristics, management, and outcomes. METHODS: We collected data from the APPRENTICE registry of patients with acute pancreatitis, which obtains information from patients in Europe (6 centers), India (3 centers), Latin America (5 centers), and North America (8 centers) using standardized questionnaires. Our final analysis included 1612 patients with acute pancreatitis (median age, 49 years; 53% male, 62% white) enrolled from August 2015 through January 2018. RESULTS: Biliary (45%) and alcoholic acute pancreatitis (21%) were the most common etiologies. Based on the revised Atlanta classification, 65% of patients developed mild disease, 23% moderate, and 12% severe. The mean age of patients in Europe (58 years) was older than mean age for all 4 regions (46 years) and a higher proportion of patients in Europe had comorbid conditions (73% vs 50% overall). The predominant etiology of acute pancreatitis in Latin America was biliary (78%), whereas alcohol-associated pancreatitis accounted for the highest proportion of acute pancreatitis cases in India (45%). Pain was managed with opioid analgesics in 93% of patients in North America versus 27% of patients in the other 3 regions. Cholecystectomies were performed at the time of hospital admission for most patients in Latin America (60% vs 15% overall). A higher proportion of European patients with severe acute pancreatitis died during the original hospital stay (44%) compared with the other 3 regions (15%). CONCLUSIONS: We found significant variation in demographics, etiologies, management practices, and outcomes of acute pancreatitis worldwide. ClinicalTrials.gov number: NCT03075618.
