Chronic alcohol consumption is a major risk factor for pancreatic necrosis in acute pancreatitis

BACKGROUND: Much of the late morbidity and mortality of acute pancreatitis (AP) is attributed to complications of pancreatic necrosis (PNEC). Early diagnosis of PNEC in high-risk patients is critical to management. Hemoconcentration is one risk factor for PNEC, but additional risk factors are likely implicated. AIMS: (1) To evaluate a series of preselected clinical factors in a prospectively collected cohort with AP to identify risk factors for PNEC and (2) to verify the relative risk of any newly identified factor(s) by retrospective analysis of a large patient cohort. METHODS: Phase I: 102 AP patients were prospectively ascertained, of which 77 (mean age 49 yr; 35 women, 42 men) underwent contrast-enhanced computerized tomography (CECT) and were studied. Eleven subjects developed PNEC (14%). Binary logistic regression was performed to identify any clinical factors associated with PNEC. Phase II: 1,474 anonymized patients admitted to the hospital with a diagnosis of AP were electronically reviewed to identify 359 subjects (mean age 54 yr; 157 women, 202 men) with AP and CECT. Seventy-six of these patients (21%) exhibited CECT evidence of PNEC. The associations found in the Phase I group were compared with Phase II by logistic regression analysis. RESULTS: In Phase I, only chronic alcohol consumption was identified as a significant new risk factor for the development of PNEC (6/19 vs 5/58, p = 0.02, OR 4.8, CI 1.27-18.2). In Phase II, it was verified that excessive alcohol consumption was a significant risk factor for PNEC (18/52 vs 58/307, p = 0.012, OR 2.27, CI 1.19-4.30). CONCLUSION: Chronic alcohol consumption seems to constitute a strong risk factor for PNEC.