The relationship between pre-existing diabetes mellitus and the severity of acute pancreatitis: Report from a large international registry

Pedram Paragomi, University of Pittsburgh Medical Center, Pittsburgh, PA, USA; University of Pittsburgh Medical Center Hillman Cancer Center, Pittsburgh, PA, USA.
Georgios I. Papachristou, Division of Gastroenterology, Hepatology, and Nutrition, The Ohio State University, Wexner Medical Center, Columbus, OH, USA.
Kwonho Jeong, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.
Alice Hinton, Division of Gastroenterology, Hepatology, and Nutrition, The Ohio State University, Wexner Medical Center, Columbus, OH, USA; Division of Biostatistics, College of Public Health, The Ohio State University, Columbus, Ohio, USA.
Ioannis Pothoulakis, University of Pittsburgh Medical Center, Pittsburgh, PA, USA; MedStar Washington Hospital Center, Washington, DC, USA.
Rupjyoti Talukdar, Asian Gastroenterology Institute, Hyderabad, India.
Rakesh Kochhar, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
Mahesh K. Goenka, Apollo Gleneagles Hospitals Kolkata, Kolkata, India.
Aiste Gulla, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius, Lithuania; Georgetown University Hospital, Washington, DC, USA.
Jose A. Gonzalez, Universidad Autónoma de Nueva León, Monterrey, Mexico.
Vikesh K. Singh, Division of Gastroenterology, John Hopkins Medical Institution, Baltimore, MD, USA.
Miguel Ferreira Bogado, Hospital Nacional de Itauguá, Itaugua, Paraguay.
Tyler Stevens, Cleveland Clinic, Cleveland, OH, USA.
Sorin T. Barbu, University of Medicine and Pharmacy "Iuliu Hatieganu", Cluj-Napoca, Romania.
Haq Nawaz, Eastern Maine Medical Center, Bangor, ME, USA.
Silvia C. Gutierrez, Hospital Nacional "Professor Alejandro Posadas", Buenos Aires, Argentina.
Narcis Zarnescu, Department of Gastroenterology, "Carol Davila" University of Medicine and Pharmacy, University Emergency Hospital Bucharest, Bucharest, Romania.
Livia Archibugi, Department of Pancreato-Biliary Endoscopy and Endosonography, San Raffaele Scientific Institute, Vita Salute San Raffaele University, Milan, Italy.
Jeffrey J. Easler, Department of Gastroenterology, Division of Gastroenterology, Indiana University School of Medicine, Indianapolis, IN, USA.
Konstantinos Triantafyllou, Department of Medicine, Attikon University General Hospital, Athens, Greece.
Mario Peláez-Luna, Department of Gastroenterology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán-Universidad∖Autónoma de Mexico, Mexico City, Mexico.
Shyam Thakkar, Division of Gastroenterology, West Virginia University, Morgantown, WV, USA.
Carlos Ocampo, Hospital General de Argudos "Dr. Cosme Argerich", Buenos Aires, Argentina.
Enrique de-Madaria, Hospital General Universitario de Alicante, Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL - Fundación FISABIO), Alicante, Spain.
Gregory A. Cote, Medical University of South Carolina, Charleston, SC, USA.
Bechien U. Wu, Kaiser Permanente, Los Angeles, CA, USA.
Peter J. Lee, Division of Gastroenterology, Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA, USA.
Phil A. Hart, Division of Gastroenterology, Hepatology, and Nutrition, The Ohio State University, Wexner Medical Center, Columbus, OH, USA.
Darwin L. Conwell, Division of Gastroenterology, Hepatology, and Nutrition, The Ohio State University, Wexner Medical Center, Columbus, OH, USA.
Frederico G. Toledo, Division of Endocrinology and Metabolism, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
Dhiraj Yadav, University of Pittsburgh Medical Center, Pittsburgh, PA, USA. Electronic address: yadavd@upmc.edu.

Abstract

BACKGROUND/OBJECTIVES: The relationship between pre-existing diabetes mellitus (DM) and acute pancreatitis (AP) severity has not been established. We assessed the impact of pre-existing DM on AP severity in an international, prospectively ascertained registry. METHODS: APPRENTICE registry prospectively enrolled 1543 AP patients from 22 centers across 4 continents (8 US, 6 Europe, 5 Latin America, 3 India) between 2015 and 2018, and collected detailed clinical information. Pre-existing DM was defined a diagnosis of DM prior to AP admission. The primary outcome was AP severity defined by the Revised Atlanta Classification (RAC). Secondary outcomes were development of systemic inflammatory response syndrome (SIRS) or intensive care unit (ICU) admission. RESULTS: Pre-existing DM was present in 270 (17.5%) AP patients, of whom 252 (93.3%) had type 2 DM. Patients with pre-existing DM were significantly (p < 0.05) older (55.8 ± 16 vs. 48.3 ± 18.7 years), more likely to be overweight (BMI 29.5 ± 7 vs. 27.2 ± 6.2), have hypertriglyceridemia as the etiology (15% vs. 2%) and prior AP (33 vs. 24%). Mild, moderate, and severe AP were noted in 66%, 23%, and 11% of patients, respectively. On multivariable analysis, pre-existing DM did not significantly impact AP severity assessed by the RAC (moderate-severe vs. mild AP, OR = 0.86, 95% CI 0.63-1.18; severe vs. mild-moderate AP, OR = 1.05, 95% CI, 0.67-1.63), development of SIRS, or the need for ICU admission. No interaction was noted between DM status and continent. CONCLUSION: About one in 5 patients with AP have pre-existing DM. Once confounding risk factors are considered, pre-existing DM per se is not a risk factor for severe AP.