Previously unknown mortality risks have been revealed in a follow-up study of patients with acute pancreatitis, the results of which were published on the cover of the journal ‘Gastroenterology’. The study, conducted in collaboration with the Institute of Pancreatic Disorders at Semmelweis University, found that after recovery, it is invaluable for physicians to continuously and closely monitor the patients’ cardiovascular system and glucose metabolism.

In Hungary, an average of 5,000 people are hospitalized annually with acute pancreatitis, and an estimated 100,000 people are living with this recurrent disease. Around 80 percent of hospital patients are being treated for the first time, and 15-20 percent have a relapsing condition. This carries serious risks, not only for the health care system, but also for the life expectancy of individual patients after discharge from hospital. A recent study conducted by the Institute of Pancreatic Disorders at Semmelweis University found that the first 90-day mortality after discharge (3 percent, compared to the 5.4 percent first-year mortality) was approximately equal to the in-hospital mortality (3.5 percent). “This is why, hopefully, the new results will lead to a change in treatment practice worldwide, and these patients will be recalled for regular check-ups at least for 3 months following hospital discharge, but preferably for 12 months with certain risks, as this would prevent their condition from deteriorating or developing new diseases,” Dr. Péter Hegyi, Director of the institute and founding member of the Hungarian Pancreatic Study Group, told Semmelweis News. The research findings were published on the cover of Gastroenterology, one of the most prestigious international journals on the subject.

“So far, besides research on therapeutic options and prevention, little has been said about how to keep patients with acute pancreatitis healthy later on, and in the future we would focus on identifying patients at risk as soon as possible to prevent deterioration,” pointed out Dr. Péter Hegyi. He added that Semmelweis University joined the research in the last two years, mainly performing data analysis, but nevertheless played a significant role for several reasons. Firstly, since its establishment, the Institute of Pancreatic Disorders has become the leading care center for pancreatic diseases in the Central Hungary region, treating 917 cases of acute pancreatitis, thus increasing the body of patient data available for research. Secondly, experts at the Városmajor Heart and Vascular Center, Director Dr. Béla Merkely and Dr. Dávid Becker, Deputy Director and Cardiology Profile Manager, provided patient care data to evaluate the study, demonstrating that it was not the quality of care or the lifestyle of patients in Hungary in general that had led to the high number of deaths from heart failure following inflammation. Thanks to the comprehensive care provided by the Institute of Pancreatic Disorders, patients hospitalized with mild acute pancreatitis are discharged home in 4 to 5 days, and the hospital mortality rate has been successfully reduced to 2.7 percent, compared to the average of 3.5 percdent. It was already standard practice to recall patients for a month’s follow-up after discharge. This, and the recent announcement, proves that there is a justification for establishing organ-specific care centers,” Dr. Hegyi emphasized.

Analysis of data collected by the Hungarian Pancreatic Study Group between 2011 and 2021 on the treatment and, where available, post-mortem examination records of 2,613 patients who had suffered from acute pancreatitis showed that those who were discharged from hospital are far from being out of critical condition, especially if they are over 65 and have other chronic illnesses, as these factors exponentially increase the risk of mortality. In the first 3 months following recovery from acute pancreatitis, the most common causes of death are end-stage cancer (cachexia) at a rate of 40 percent, heart failure-related problems at more than 20 percent, sepsis related to inflammation at a similar rate, and sepsis not related to pancreatic disease but rather to respiratory, pulmonary or biliary infections at a further rate of 15 percent. Over a one-year time span, cancer remains the most common cause of death, followed by sepsis linked to acute pancreatitis. Heart failure was also recorded in 15 percent of patients. Over an eight-year period following recovery, non-inflammation-related sepsis is the leading cause of death, followed by end-stage pancreatic cancer and heart failure. 

In addition to the high risk of mortality, inflammation can also damage other organs and contribute to the onset of additional illnesses, including cardiovascular disease, diabetes or even pancreatic cancer. For patients with other tumorous diseases, an involuntary, abnormal weight loss, called cachexia, also appears among the causes of death. The exact causes or markers indicating the change in condition are not yet identified regarding the correlation between pancreatitis and the development of the above-mentioned conditions or the higher risk of mortality, but research, both in the coming years and ongoing, is aimed at uncovering these. It has already been shown that people with underlying cardiological disease had a higher risk of cardiac death after inflammation, just as people with diabetes had a higher risk of death following the disease.

There are ten clinical trials currently running at the institute, a significant number of which are examining the post-pancreatitis period, and two more in preparation, which, in collaboration with the Városmajor Center, would look at the possibility of predicting cardiovascular risks, said Dr. Péter Hegyi, hoping that both could be launched within six months.

Among the ongoing studies, some aim to uncover the post-inflammatory changes in sugar metabolism and the underlying causes, some aim to clarify the questions related to the shrinkage of the pancreatic exocrine reserve, and others seek to explore the link with pancreatic cancer, with the aim of early diagnosis, which may also help to identify therapeutic options later on. In addition, a lifestyle study is being conducted to explore the ideal way of living for recovered patients, an awareness campaign is run for patients with pancreatitis induced by alcohol and smoking, furthermore, a dietary study by dieticians as well as a genetic study to aid patient follow-up are also underway. Artificial intelligence models are also being developed, particularly for predictive research, to intervene at an earlier stage. The ultimate goal is to predict the mortality risk of each patient depending on the disease after hospitalization, so that the physician can recommend preventive measures and lifestyle changes,” concluded Dr. Péter Hegyi.

Melinda Katalin Kiss
Translation: Judit Szabados-Dőtsch
Photo: Attila Kovács – Semmelweis University