title: Factors That Affect Disease Progression After First Attack of Acute Pancreatitis.
abstract: OBJECTIVE
  Little is known about recurrence of pancreatitis after an initial episode, and little is known about how the disease progresses or what factors affect progression. We performed a population-based study of patients with acute pancreatitis (AP) to determine their outcomes and associated factors.
  
  
  METHODS
  We performed a retrospective study of patients with first-time AP from 2003 through 2012 in a well-defined area of Sweden. Data were collected from medical records on disease etiology, severity (according to the Atlanta classification), recurrence of AP, subsequent chronic pancreatitis, and mortality. Patients were followed up for a median time of 4.6 years, until death or the end of 2013.
  
  
  RESULTS
  We identified 1457 patients with first-time AP (48% biliary disease, 17% alcohol-associated, 9.9% severe); 23% of patients had 1 or more recurrences. Risk for recurrence was significantly higher among smokers (hazard ratio [HR], 1.42; 95% confidence interval [CI], 1.03-1.95; P = .03), patients with alcohol-associated AP (HR, 1.58; 95% CI, 1.25-2.23; P < .01), after organ failure (HR, 1.46; 95% CI 1.05-2.03; P = .02), and in patients with systemic complications (HR, 1.88; 95% CI, 1.27-2.79; P < .01) or local complications (HR, 1.66; 95% CI, 1.22-2.27; P < .01). AP of all etiologies progressed to chronic pancreatitis, although alcohol-associated AP progressed most frequently (2.8/100 patient-years). Patients with recurrent AP were at the highest risk for chronic pancreatitis (HR, 6.74; 95% CI, 4.02-11.3; P < .01), followed by alcohol-associated AP (HR, 3.10; 95% CI, 2.05-5.87; P < .01), smoking (HR, 2.26; 95% CI, 1.12-4.58; P = .02), systemic complications (HR, 1.37; 95% CI, 1.06-4.62; P = .03), and peripancreatic necrosis (HR, 2.74; 95% CI, 1.7-4.43; P < .01). In-hospital mortality was 2.8%, and independently associated only with organ failure (odds ratio, 71.17; 95% CI, 21.14-239.60; P < .01). Fifty-three percent of patients who died during disease recurrence had biliary AP; a higher percentage of these patients died upon first recurrence (5.9%) than upon first attack of AP (2%; P = .01).
  
  
  CONCLUSIONS
  The severity of first-time AP, smoking, and alcohol abuse are related to recurrence and subsequent chronic pancreatitis. Recurrence increases the risk for progression to chronic pancreatitis. Most patients who die upon disease recurrence have biliary AP.
authors.affiliation: Department of Gastroenterology, Skåne University Hospital, University of Lund, Lund, Sweden.
authors.forename: Sara
authors.initials: S
authors.lastname: Bertilsson
authors.affiliation: Department of Gastroenterology, Skåne University Hospital, University of Lund, Lund, Sweden.
authors.forename: Per
authors.initials: P
authors.lastname: Swärd
authors.affiliation: Department of Gastroenterology, Skåne University Hospital, University of Lund, Lund, Sweden; Digestive Disease Center, Copenhagen University Hospital/Bispebjerg, University of Copenhagen, Copenhagen, Denmark. Electronic address: evangelos.kalaitzakis@medicine.gu.se.
authors.forename: Evangelos
authors.initials: E
authors.lastname: Kalaitzakis
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000437:Alcoholism / Q000150:complications; D002908:Chronic Disease / Q000453:epidemiology; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D019283:Pancreatitis, Acute Necrotizing / Q000453:epidemiology / Q000473:pathology*; D012008:Recurrence; D012189:Retrospective Studies; D013548:Sweden; D016896:Treatment Outcome; D055815:Young Adult
keywords: Gallstones; Pancreas; Prognosis; Risk Factor