Patients With Sentinel Acute Pancreatitis of Alcoholic Etiology Are at Risk for Organ Failure and Pancreatic Necrosis: A Dual-Center Experience.
To assess the relationship between alcoholic etiology, tobacco use, and severe acute pancreatitis (AP).



Smoking and alcohol exposure were recorded upon admission in a cohort of patients with AP within the United States. Patients with first, "sentinel" attack of AP were identified for analysis.Associations between alcohol, smoking, and severe AP were validated in an independent cohort of patients from Spain.



US cohort (n = 222): Thirty-five percent developed organ failure (OF), 35% pancreatic necrosis (PNec), and 7% died. OF (54% vs 33%, P = 0.03), PNec (62% vs 31%, P = 0.006), intensive care unit admission (58% vs 36%, P = 0.03), and length of stay (LOS) (20 vs 8 days, P = 0.007) were greater in alcoholic when compared to other etiologies.Spanish cohort (n = 366): Similar differences in outcomes were also found with between alcoholic and nonalcoholic etiologies: OF (24% vs 8%, P = 0.001), PNec (38% vs 14%, P < 0.001), intensive care unit admission (20% vs 3%, P < 0.001), and LOS (17 vs 11 days, P = 0.04).Multivariable analysis confirmed alcoholic etiology to be independently associated with OF and PNec in both cohorts.



Alcoholic etiology is independently associated with OF and PNec in patients with sentinel AP and is important when evaluating risk for severe disease in AP.
From the *Division of Gastroenterology, Hepatology and Nutrition, University of Pittsburgh Medical Center, Pittsburgh, PA; †Department of Gastroenterology, Hospital General Universitario de Alicante, Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL - Fundación FISABIO), Alicante, Spain; and ‡Department of Gastroenterology and Hepatology, Mayo Clinic, Scottsdale, AZ.
Jeffrey J
JJ
Easler
Enrique
E
de-Madaria
Haq
H
Nawaz
Neftalí
N
Moya-Hoyo
Efstratios
E
Koutroumpakis
Mónica
M
Rey-Riveiro
Vijay P
VP
Singh
Nelly G
NG
Acevedo-Piedra
David C
DC
Whitcomb
Dhiraj
D
Yadav
Georgios I
GI
Papachristou
D000208:Acute Disease; D000328:Adult; D000368:Aged; D000428:Alcohol Drinking / Q000009:adverse effects; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D007902:Length of Stay / Q000706:statistics & numerical data; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009102:Multiple Organ Failure / Q000175:diagnosis* / Q000209:etiology; D015999:Multivariate Analysis; D009336:Necrosis / Q000175:diagnosis / Q000209:etiology; D010179:Pancreas / Q000473:pathology*; D010195:Pancreatitis / Q000150:complications* / Q000209:etiology; D010343:Patient Admission / Q000706:statistics & numerical data; D011446:Prospective Studies; D013030:Spain; D014481:United States