title: Decreased Severity in Recurrent Versus Initial Episodes of Acute Pancreatitis.
abstract: OBJECTIVE
  The comparative outcomes of initial versus recurrent acute pancreatitis (AP) have not been clearly established.
  
  
  OBJECTIVE
  The aim was to compare the clinical outcomes of those with an initial episode of AP to those with recurrent AP stratified by the number of prior episodes.
  
  
  METHODS
  This retrospective cohort study included consecutive patients with AP admitted to the Cleveland Clinic between 2008 and 2011. The odds of severe AP, multisystem organ failure, ICU admission, new local complications, elevated blood urea nitrogen and bedside index for severity in acute pancreatitis score, systemic inflammatory response syndrome, and mortality were compared using univariable and multivariable logistic regression.
  
  
  RESULTS
  Two hundred and ninety two patients were included, of which 213 (72%) were admitted on their initial AP episode. Mortality in patients experiencing first episode was 4.7%, compared to 0% in patients with recurrent attack of pancreatitis (P = 0.047). Prior episodes of AP were found to be protective against multisystem organ failure (odds ratio, 0.14 for each prior episode; confidence interval, 0.01-0.76) and intensive care unit admission (0.24, confidence interval, 0.06-0.91), adjusting for potential confounding factors such as transfer status and obesity.
  
  
  CONCLUSIONS
  Patients presenting with recurrent AP may be at decreased risk of a clinically severe course and incur decreased mortality.
authors.affiliation: From the *Digestive Disease Institute, and †Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, OH.
authors.forename: Peter J W
authors.initials: PJ
authors.lastname: Lee
authors.forename: Amit
authors.initials: A
authors.lastname: Bhatt
authors.forename: Jordan
authors.initials: J
authors.lastname: Holmes
authors.forename: Amareshwar
authors.initials: A
authors.lastname: Podugu
authors.forename: Rocio
authors.initials: R
authors.lastname: Lopez
authors.forename: Matthew
authors.initials: M
authors.lastname: Walsh
authors.forename: Tyler
authors.initials: T
authors.lastname: Stevens
mesh_terms: D000208:Acute Disease; D000328:Adult; D000368:Aged; D015415:Biomarkers / Q000097:blood; D001806:Blood Urea Nitrogen; D005260:Female; D006760:Hospitalization; D006801:Humans; D053208:Kaplan-Meier Estimate; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009102:Multiple Organ Failure / Q000175:diagnosis / Q000453:epidemiology; D015999:Multivariate Analysis; D016017:Odds Ratio; D009820:Ohio / Q000453:epidemiology; D010195:Pancreatitis / Q000097:blood / Q000175:diagnosis* / Q000453:epidemiology* / Q000401:mortality / Q000628:therapy; D012008:Recurrence; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D015415:Biomarkers