Mortality and recurrence risk after a first episode of acute pancreatitis in the elderly: population-based study.
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ABSTRACT:
SUBMITTER: Gimberg K
PROVIDER: S-EPMC10361676 | biostudies-literature | 2023 Jul
REPOSITORIES: biostudies-literature
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Mortality and recurrence risk after a first episode of acute pancreatitis in the elderly: population-based study.
Gimberg Karolina K Enochsson Lars L Sandblom Gabriel G
The British journal of surgery 20230701 8
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Project description:Background and objectivesAcute pancreatitis (AP) carries the risk of subsequent nutritional deficiencies. The prevalence of these deficiencies following a single episode of AP in children is unknown. We aimed to determine prevalence of anthropometric and laboratory-based measures of nutritional status in children following their first (index) admission for AP.MethodsProspective observational cohort study of patients ≤21 years of age with first episode of confirmed AP. Anthropometric and laboratory values were obtained at time of AP onset and at follow up time points of 3 and 12 months (m) post AP. AP attack was classified as either: mild, moderately severe or severe (which were combined in one group (SAP)).Results181 patients met criteria and were followed prospectively with 52% male, a median age of 13.7 years (IQR 9.4-16.0) and median Body Mass Index (BMI) Z-score of 0.6 (IQR -0.5, 1.6). Most patients had mild AP (140, 77%), with 23% meeting criteria for moderate or severe (41/181). 6 (3%) had diabetes mellitus (DM) predating AP and were excluded from further analysis. BMI Z-score remained stable during the follow up period. 13% of patients developed pre-DM or DM at 3m or 12m. Nearly one third of patients had low ferritin at 3m (29%) or 12m (29%). At 12m, 8% of patients had Vitamin A deficiency. 6% of patients had low Vitamin E levels at 3m and 5% at 12m. Over half of patients at both 3m and 12m had 25 OH Vitamin D insufficiency or deficiency (56% and 56%). Prolonged International Normalized Ratio (INR) (>1.3) was seen in 9% of patients at 12m. Very low albumin (<3.5 g/dL) was found in 24% of patients at 3m and 18% at 12m (Table 1). Patients with very low albumin at 3m were younger (median 10.7 vs. 14.2 years, p = 0.04), however sex, BMI Z-score and AP severity were not associated with albumin level. Although BMI Z-score did not differ between the groups, those with SAP had a significant decrease in BMI Z-score from first attack compared to mild AP at 3m (-0.4 vs. 0.0, p = 0.0002, Figure 2). At 3m, Vitamin E deficiency in SAP versus mild AP was found in 20% vs 2% (p = 0.04) and SAP had a lower median hematocrit (35.8 vs. 37.6, p = 0.046). There were no other laboratory significant differences at 3m in mild versus SAP groups. At 12m, those with SAP were more likely to have pre-DM or DM compared to mild AP (31% vs. 7%, p = 0.002). No other significant laboratory differences occurred at 12m.ConclusionsAfter the first AP attack patients experience nutritional deficiencies, including ferritin, all fat-soluble vitamins, and low albumin. SAP is associated with a decrease in BMI Z-score, increased prevalence of vitamin E deficiency at 3m, and an increase in pre-diabetes and diabetes at 12m. Serial monitoring of vitamin and mineral values post AP is warranted and further prospective studies are needed.
| S-EPMC11884237 | biostudies-literature
Project description:The aim of this study is to identifying post treatment recurrence rates in pneumothorax patients under 35 and without any comorbidities according to the treatment types, gender, and age categories based on nationwide population data. Clinical information of pneumothorax patients was extracted from the Korean National Health Insurance Service (NHIS) database between January 2002 and December 2020. Enrolled patients were categorized into two groups; (1) Group I, those who underwent conservative management including pain relief, oxygen therapy, and closed thoracostomy, and (2) Group II, surgical intervention. Recurrence rates were compared according to age, gender, and type of treatment. Surgical intervention was performed in 25.6% patients as first treatment. The overall recurrence rate was 20.3%. Male patients showed a higher 5-year recurrence rate than female (20.8% vs. 10.9%, p < 0.001). Those with conservative management showed lower 5-year recurrence rates than those with surgical treatment (7.9% vs. 23.7%, p < 0.001). The 5-year recurrence rates of patients aged 14≤, and < 20 was higher than other age groups (29.2% vs. 4.5 and 11.9%, p < 0.001). Surgical intervention, male gender and aged under 20 showed association with higher recurrence rates.
| S-EPMC10439191 | biostudies-literature
Project description:ImportanceThere is an absence of mortality risk assessment tools in first-episode psychosis (FEP) that could enable personalized interventions.ObjectiveTo examine the feasibility of machine learning (ML) in discerning mortality risk in FEP and to assess whether such risk predictions can inform pharmacotherapy choices.Design, setting, and participantsIn this prognostic study, Swedish nationwide cohort data (from July 1, 2006, to December 31, 2021) were harnessed for model development and validation. Finnish cohort data (from January 1, 1998, to December 31, 2017) were used for external validation. Data analyses were completed between December 2022 and December 2023.Main outcomes and measuresFifty-one nationwide register variables, encompassing demographics and clinical and work-related histories, were subjected to ML to predict future mortality risk. The ML model's performance was evaluated by calculating the area under the receiver operating characteristic curve (AUROC). The comparative effectiveness of pharmacotherapies in patients was assessed and was stratified by the ML model to those with predicted high mortality risk (vs low risk), using the between-individual hazard ratio (HR). The 5 most important variables were then identified and a model was retrained using these variables in the discovery sample.ResultsThis study included 24 052 Swedish participants (20 000 in the discovery sample and 4052 in the validation sample) and 1490 Finnish participants (in the validation sample). Swedish participants had a mean (SD) age of 29.1 (8.1) years, 62.1% were men, and 418 died with 2 years. Finnish participants had a mean (SD) age of 29.7 (8.0) years, 61.7% were men, and 31 died within 2 years. The discovery sample achieved an AUROC of 0.71 (95% CI, 0.68-0.74) for 2-year mortality prediction. Using the 5 most important variables (ie, the top 10% [substance use comorbidities, first hospitalization duration due to FEP, male sex, prior somatic hospitalizations, and age]), the final model resulted in an AUROC of 0.70 (95% CI, 0.63-0.76) in the Swedish sample and 0.67 (95% CI, 0.56-0.78) in the Finnish sample. Individuals with predicted high mortality risk had an elevated 15-year risk in the Swedish sample (HR, 3.77 [95% CI, 2.92-4.88]) and an elevated 20-year risk in the Finnish sample (HR, 3.72 [95% CI, 2.67-5.18]). For those with predicted high mortality risk, long-acting injectable antipsychotics (HR, 0.45 [95% CI, 0.23-0.88]) and mood stabilizers (HR, 0.64 [95% CI, 0.46-0.90]) were associated with decreased mortality risk. Conversely, for those predicted to survive, only oral aripiprazole (HR, 0.38 [95% CI, 0.20-0.69]) and risperidone (HR, 0.38 [95% CI, 0.18-0.82]) were associated with decreased mortality risk.Conclusions and relevanceIn this prognostic study, an ML-based model was developed and validated to predict mortality risk in FEP. These findings may help to develop personalized interventions to mitigate mortality risk in FEP.
| S-EPMC10949098 | biostudies-literature
Project description:BackgroundAccurate mortality risk prediction could enhance treatment planning in bipolar disorder, where mortality rates rival those of many cancers. Such prognostic tools are lacking in psychiatry, where assessments typically emphasize immediate suicidality while neglecting long-term mortality risks, and their clinical use is debated. We evaluated the recently developed machine learning model MIRACLE-FEP, initially developed for first-episode psychosis, in predicting all-cause mortality in patients with first-episode bipolar disorder (FEBD), hypothesizing that it would provide accurate risk prediction and guide pharmacotherapy decisions.MethodsWe utilized national register-based cohorts of FEBD patients from Sweden (N = 31,013, followed 2006-2021) and Finland (N = 13,956, followed 1996-2018). We assessed the MIRACLE-FEP model's performance in predicting all-cause mortality using the area under the receiver operating characteristic curve (AUROC), calibration, and decision curve analysis. Additionally, we conducted a pharmacoepidemiologic analysis to examine the relationship between predicted mortality risk and pharmacotherapy effectiveness.FindingsMIRACLE-FEP achieved an AUROC = 0.77 (95%CI = 0.73-0.80) for 2-year mortality prediction in Sweden and 0.71 (95%CI = 0.67-0.75) in Finland. For 10-year all-cause mortality prediction, the model demonstrated an AUROC of 0.71 in both cohorts. The model demonstrated relatively good calibration and indicated potential clinical utility in decision curve analysis. Among patients with predicted risk exceeding the observed two-year mortality rate in FEBD, the lowest mortality risk was observed with polytherapy regimens (compared to non-use of antipsychotics or mood stabilizers), including quetiapine and lamotrigine (HR = 0.42, 95%CI = 0.23-0.80) or mood stabilizer polytherapy (HR = 0.47, 95%CI = 0.27-0.82). Conversely, in patients with predicted risk below this threshold, complex pharmacotherapy was not associated with a significant reduction in mortality risk.InterpretationMIRACLE-FEP offers a promising approach to predicting long-term mortality risk and could guide proactive treatment decisions, such as targeting combination pharmacotherapy, in FEBD.FundingThe Swedish Research Council for Health, Working Life and Welfare, FORTE (2021-01079).
| S-EPMC11874523 | biostudies-literature
Project description:BackgroundThe aim of this study was to explore whether there is a relationship between pyogenic liver abscess (PLA) and subsequent risk of acute pancreatitis in Taiwan.MethodsUsing inpatients claims data from the Taiwan National Health Insurance Program, we identified 30 866 subjects aged 20-84 years with the first-attack of PLA from 2000 to 2010 as the PLA group and randomly selected 123 464 subjects without PLA as the non-PLA group. The incidence of the first attack of acute pancreatitis at the end of 2010 and the risk associated with PLA and other comorbidities were measured.ResultsThe overall incidence of acute pancreatitis was 3.84-fold greater in the PLA group than in the non-PLA group (4.61 vs 1.19 events per 1000 person-years; 95% CI, 3.43-4.29). After controlling for potential confounding factors, the adjusted hazard ratio of acute pancreatitis was 3.00 (95% CI, 2.62-3.43) for the PLA group, as compared to the non-PLA group. Further analysis showed that compared to subjects with neither PLA nor comorbidities, patients with PLA and hypertriglyceridemia, biliary stones, alcoholism, or hepatitis C had greater risk of acute pancreatitis than those with PLA alone.ConclusionsPLA correlates with increased risk of subsequent acute pancreatitis. Comorbidities, including hypertriglyceridemia, biliary stones, alcoholism, and hepatitis C, may enhance the risk of developing acute pancreatitis.
| S-EPMC4341002 | biostudies-literature
Project description:IntroductionSeveral gastrointestinal diseases have been linked to acute pancreatitis, but the risk of acute pancreatitis in microscopic colitis (MC) has not been studied.MethodsWe conducted a nationwide, population-based, matched cohort study in Sweden of 12,140 patients with biopsy-verified MC (diagnosed in 2003-2017), 57,806 matched reference individuals, and 12,781 siblings without MC with a follow-up until 2021. Data on MC were obtained from all of Sweden's regional pathology registers (n = 28) through the ESPRESSO cohort. Data on acute pancreatitis were collected from the National Patient Register. Adjusted hazard ratios (aHR) and 95% confidence intervals (CI) were calculated using Cox regression.ResultsDuring a mean follow-up of 9.9 years (SD = 4.3), 146 patients with MC and 437 reference individuals were diagnosed with acute pancreatitis (127.8 vs 80.1 per 100,000 person-years), corresponding to an aHR of 1.57 (95% CI = 1.30-1.90). Moreover, we found a positive association between MC and acute nongallstone-related pancreatitis (aHR 1.99 [95% CI = 1.57-2.51]), but not with acute gallstone-related pancreatitis (aHR 1.08 [95% CI = 0.78-1.49]). Comparing patients with MC with their unaffected siblings yielded an aHR of 1.28 (95% CI = 0.92-1.78). The risk of acute pancreatitis remained elevated also for patients with MC with a follow-up exceeding 10 years (aHR 1.75 [95% CI = 1.14-2.67]).DiscussionThis nationwide study of more than 12,000 patients with MC demonstrated an increased risk of acute pancreatitis after MC. Hence, clinicians should have a low threshold for the evaluation of acute pancreatitis in patients with MC. In addition, these patients should receive advice and care aimed at reducing the risk of acute pancreatitis.
| S-EPMC10692309 | biostudies-literature
Project description:BackgroundAlthough diabetes is reportedly associated with the occurrence of acute pancreatitis (AP), the risk of AP according to the duration and severity of diabetes is not yet clear. We aimed to investigate the risk of AP based on glycemic status and the presence of comorbidities using a nationwide population-based study.MethodsWe enrolled 3,912,496 adults who underwent health examinations under the National Health Insurance Service in 2009. All participants were categorized by glycemic status as normoglycemic, impaired fasting glucose (IFG), or diabetes. Baseline characteristics and the presence of comorbidities at the time of health check-up were investigated, and the occurrence of AP was followed up until 31 December 2018. We estimated the adjusted hazard ratios (aHRs) for AP occurrence according to the glycemic status, duration of diabetes (new-onset, duration < 5 years, or ≥ 5 years), type and number of anti-diabetic medications, and presence of comorbidities.ResultsDuring the observation period of 32,116,716.93 person-years, 8,933 cases of AP occurred. Compared with normoglycemia, the aHRs (95% confidence interval) were 1.153 (1.097-1.212) in IFG, 1.389 (1.260-1.531) in new-onset diabetes, 1.634 (1.496-1.785) in known diabetes < 5 years, and 1.656 (1.513-1.813) in patients with known diabetes aged ≥ 5 years. The presence of comorbidities associated with diabetes severity had a synergistic effect on the relationship between diabetes and AP occurrence.ConclusionAs glycemic status worsens, the risk of AP increases, and there is a synergistic effect when comorbidities coexist. To reduce the risk of AP, active control of factors that can cause AP should be considered in patients with long-standing diabetes and comorbidities.
| S-EPMC10197233 | biostudies-literature
Project description:To evaluate the suggested association between antidopaminergic drugs and acute pancreatitis.A large population-based nested case-control study.Swedish nationwide study from 2006 to 2008.The Patient Register was used to identify 6161 cases of acute pancreatitis. The 61?637 control subjects were randomly selected from the Register of the Total Population by frequency-based density sampling, matched for age, sex and calendar year.Exposure data were extracted from the Prescribed Drug Register. Antidopaminergic drugs were grouped into antiemetic/anxiolytic and other antipsychotics. Current use of antidopaminergic drugs was defined as filling a prescription 1-114 days before index date, while previous use was 115 days to 3.5 years before index date.Cases were defined as being diagnosed as having acute pancreatitis. ORs and 95% CIs were calculated using unconditional logistic regression.The unadjusted OR indicated an increased risk of acute pancreatitis among current users of antiemetic/anxiolytics (OR 1.9, 95% CI 1.4 to 2.6), but not in the multivariable model adjusting for alcohol-related comorbidity, chronic obstructive lung disease, ischaemic heart disease, obesity, diabetes, opioid use, gallstone disease, educational level, marital status and number of concomitant medications (OR 0.9, 95% CI 0.6 to 1.2). Similarly, among current users of other antipsychotics, the unadjusted OR was 1.4 (95% CI 1.1 to 1.6), while the adjusted OR was 0.8 (95% CI 0.6 to 0.9). Results regarding previous use of antidopaminergic drugs followed a similar risk pattern as for current use.The lack of association between antidopaminergic drugs and acute pancreatitis after adjustment for confounding factors in this study suggests that the previously reported positive associations might be explained by confounding.
| S-EPMC3353129 | biostudies-literature
Project description:IntroductionCellulitis recurrences are frequent, difficult to manage, and contribute considerably to overall disease burden. This retrospective cases series reports recurrence rates of first community-acquired lower limb disease episode initially treated with daptomycin.MethodsTreatment consisted of a 21-day two substances sequential scheme: intravenous daptomycin (4 mg/kg/day) during hospitalization and roxithromycin (2 × 150 mg per os) afterwards. Primary study end-point was the rate of recurrences during follow-up; recurrence rates and their binomial 95% confidence intervals (CI) were calculated with SPSS 22.0. Recurrences were identified by (1) review of hospital records and (2) telephone questionnaires.ResultsTwenty-seven patients hospitalized for first lower limb cellulitis episodes were started on daptomycin and 26 patients completed the above three-week sequential treatment scheme. During follow-up (range 37-85 months) one recurrence occurred among the 26 patients who completed the treatment: 96.2% of these patients remained relapse free at the end of follow-up (CI 79.5-99.9%). Considering also treatment failure, the overall effectiveness of this combination treatment was 92.6% recurrence free after more than 3 years follow-up (25/27 patients; CI 75.5-99.0%). This study is limited by retrospective planning and the restricted number of included patients.ConclusionThe choice of the treatment for the initial lower limb cellulitis episode may impact the risk of disease recurrences. Future studies should explore interventions for the first cellulitis episode as a means to modify the risk of the recurring course of this disease.
| S-EPMC4799042 | biostudies-literature
Project description:BackgroundThe impact of pre-existing comorbidities on acute pancreatitis (AP) mortality is not clearly defined. Our study aims to determine the trend in AP hospital mortality and the role of comorbidities as a predictor of hospital mortality.MethodsWe analyzed patients aged ≥ 18 years hospitalized with AP diagnosis between 2016 and 2019. The data have been extracted from the Spanish National Hospital Discharge Database of the Spanish Ministry of Health. We performed a univariate and multivariable analysis of the association of age, sex, and comorbidities with hospital mortality in patients with AP. The role of the Charlson and Elixhauser comorbidity indices as predictors of mortality was evaluated.ResultsA total of 110,021 patients diagnosed with AP were hospitalized during the analyzed period. Hospital mortality was 3.8%, with a progressive decrease observed in the years evaluated. In multivariable analysis, age ≥ 65 years (OR: 4.11, p < 0.001), heart disease (OR: 1.73, p < 0.001), renal disease (OR: 1.99, p < 0.001), moderate-severe liver disease (OR: 2.86, p < 0.001), peripheral vascular disease (OR: 1.43, p < 0.001), and cerebrovascular disease (OR: 1.63, p < 0.001) were independent risk factors for mortality. The Charlson > 1.5 (OR: 2.03, p < 0.001) and Elixhauser > 1.5 (OR: 2.71, p < 0.001) comorbidity indices were also independently associated with mortality, and ROC curve analysis showed that they are useful for predicting hospital mortality.ConclusionsAdvanced age, heart disease, renal disease, moderate-severe liver disease, peripheral vascular disease, and cerebrovascular disease before admission were independently associated with hospital mortality. The Charlson and Elixhauser comorbidity indices are useful for predicting hospital mortality in AP patients.
| S-EPMC10035222 | biostudies-literature