Delayed-Onset Diabetes Mellitus And Cardiorespiratory Morbidity After Acute Pancreatitis Suggests A Need For Individualised Approach To Follow-Up

Introduction: Acute pancreatitis (AP) remains a leading cause of hospitalization and has a deleterious impact on long-term mortality and morbidity. Our aim was to identify key risk factors for long-term mortality and new-onset morbidity after AP. Methods: Healthcare data from 13 eHealth registers including in-patient, critical care, community prescribing and death certificate data for all AP patients in Scotland between 1 April 2009 and 31 March 2012 underwent comprehensive record linkage. Actual minimum follow-up was 5 years. Descriptives and survival analysis used Cox’s methods. Results: 2027 AP patients were included. Median age was 56 years; AP was gallstone-related in 46.8% cases. During the 5-year follow-up, 23.2% of the cohort died. Risk factors for death included increased Charlson co-morbidity index (CCI), non-gallstone aetiology, male gender, and age. New-onset respiratory disease was associated with age (HR1.01, p=0.03), non-gallstone aetiology (HR1.37, p=0.2) and CCI (HR1.97, p<0.01) . New-onset cardiac disease was associated with age (HR1.05, p<0.01) and critical care admission during AP (HR1.61, p<0.01). Predictors of new-onset diabetes included male gender (HR1.43, p<0.01), non-gallstone aetiology (HR1.72, p<0.01) and critical care admission (HR2.68, p<0.01). AP patients needing critical care were at highest risk of new-onset diabetes in the first 2 years after AP (HR4.35, p<0.0001), whereas non-gallstone aetiology was a significant risk factor during later follow-up (HR2.39, p<0.0001). Conclusions: This study identifies discrete predictors of new-onset cardiorespiratory morbidity and a differential risk of new diabetes dependent on critical care admission and AP aetiology. Together, these data support an individualised approach to follow-up after AP.