Epidemiological aspects and prognosis

Acute pancreatitis (AP) is an increasingly common gastroenterological disease. Most cases are mild and self-limiting, although 10-20% of patients suffer a more severe disease course, associated with organ failure and complications. It is not fully elucidated, why and in which patients, severe AP develops, or what factors impact the natural history of AP. The aims of the papers included in this thesis were to evaluate the natural history of AP, to study the potential relation of the incidence of AP with the use and sales of certain AP-associated drugs as well as alcohol sales and consumption. In addition, we aimed to investigate the value of microproteinuria in prediction of organ failure in AP patients. In a retrospective part, 1457 patients with first-time AP, between 2003 and 2012, were included. The main AP etiology was gallstone disease, followed by alcohol. In all, 23% experienced one or more recurrent AP (RAP) episode, and 5% developed chronic pancreatitis. Severity of first-time AP, alcoholic etiology and smoking predicted RAP as well as chronic pancreatitis (p<0.05), and RAP was the strongest predictor for development of chronic pancreatitis (HR 6.7; 95% CI, 4-11.3, p<0.01). The incidence of AP (in particular biliary AP) showed increasing time-trends, while the incidence of alcoholic AP remained stable. Users of AP-associated drugs increased from 32% in 2003 to 51% in 2012 (p<0.05), reflective of increasing user rates in the general population, but was not related to AP incidence nor severity (p>0.05). Alcohol sales and consumption decreased, in the general population, and did not correlate to the incidence of (alcoholic or non-alcoholic) AP (p>0.05). The prospective part comprised 92 AP patients. The urine 1-microglobulin-, albumin-, and IgG/creatinine ratios were significantly higher in patients with vs. without organ failure (p<0.05, for all). In particular, the 1-microglobulin/creatinine upon admission predicted organ failure (OR 1.29; 95% CI, 1.02-1.61) with an AUROC of 0.81 (95% CI, 0.69-0.94), making it a promising marker for early prediction of AP severity.