Risk factors for development of secondary diabetes in chronic pancreatitis and impact of ductal decompression

Risk factors for development of secondary diabetes in chronic pancreatitis and impact of ductal decompression

Abstracts / Pancreatology 13 (2013) S1–S80 S27 Table 3 Analysis of BISAP scores and serum PCT. Cut-off value BISAP PCT (ng/mL) 2 3 0.50 1.00 1.77 3...

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Abstracts / Pancreatology 13 (2013) S1–S80

S27

Table 3 Analysis of BISAP scores and serum PCT. Cut-off value BISAP PCT (ng/mL)

2 3 0.50 1.00 1.77 3.29

Sensitivity (%)

Specificity (%)

PPV (%)

NPV (%)

Accuracy (%)

Likelihood ratio

79.17 58.33 87.5 83.33 75 66.67

88.46 96.15 23.08 65.38 76.92 84.62

86.36 93.33 51.22 68.97 75 80

82.14 71.43 66.67 80.95 76.92 73.33

84 78 54 74 76 76

25.433 20.008 11.831 12.861 14.152 14.424

BISAP: bedside index for severity in acute pancreatitis, PCT: procalcitonin, NPV: negative predictive value, PPV: positive predictive value. Table 4 Analysis of various parameters. Parameters

Sensitivity (%)

Specificity (%)

PPV (%)

NPV (%)

Accuracy (%)

Likelihood ratio

BISAP 2 PCT (ng/mL) 3.29 Ranson's score 3 APACHE-II 7 Glasgow score 3 BCTSI 4

79.17 66.67 91.67 75 66.67 62.5

88.46 84.62 96.15 76.92 92.31 65.38

86.36 80 95.65 75 88.89 62.5

82.14 73.33 92.59 76.92 75 65.38

84 76 94 76 80 64

25.433 14.424 46.749 14.152 18.462 3.938

APACHE-II: acute physiology and chronic health examination-II, BCTSI: Balthazar computed tomography severity index, BISAP: bedside index for severity in acute pancreatitis, PCT: procalcitonin, NPV: negative predictive value, PPV: positive predictive value. Table 5 Logistic regression analysis of risk factors for severe acute pancreatitis.

BISAP 2 PCT (ng/mL) 3.29 Ranson score 3 APACHE-II 7 Glasgow score 3 BCTSI 4

B

Odds ratio

p-Value

95% Confidence Interval Upper

Lower

3.372 2.398 5.617 2.303 3.178 1.147

29.13 11.00 275.00 10.00 24.00 3.15

<0.001 0.001 <0.001 0.001 <0.001 0.052

6.153 2.817 23.310 2.730 4.502 0.991

137.947 42.947 3244.305 36.636 127.957 10.000

APACHE-II: acute physiology and chronic health examination-II, BCTSI: Balthazar computed tomography severity index, BISAP: bedside index for severity in acute pancreatitis, PCT: procalcitonin.

[P-033]. Risk factors for development of secondary diabetes in chronic pancreatitis and impact of ductal decompression Rupjyoti Talukdar, G. Venkat Rao, D. Nageshwar Reddy Gastroenterology, Asian Institute of Gastroenterology, Hyderabad, India

Background/aim: Pancreatic calcification has been shown to be a risk factor for diabetes (DM) in patients with chronic pancreatitis (CP). It was unclear whether ductal calculi or parenchymal calcification attributes to the risk. We prospectively re-explored the disease-related risk factors for DM in CP and studied the impact of ductal decompression on DM in a high volume academic center. Methods: 645 patients with chronic pancreatitis were followed for a mean (range) duration of 3.5(1.3–10.1) yrs. Data on clinical/radiological characteristics of CP, diabetic status, and ductal decompression (endotherapy and LPJ) were prospectively recorded. CP related data from evaluation performed elsewhere were also recorded. Univariate analysis was performed to evaluate the association of etiology, clinical characteristics (steatorrhea, acute exacerbation), morphology (ductal diameter, ductal calculi, parenchymal calcification, ductal and biliary stricture) with DM. Variables found to be significant were then put to multivariate analysis. Impact of ductal decompression on diabetes was evaluated using logistic regression. Statistical analysis was performed in the JMP software (SAS Institute). A two tailed ‘p’ value of <0.05 was considered significant. Results: 138 patients did not have complete data and were excluded and 507 analyzed. Table shows patient characteristics of CP with and without DM. 190(38%) patients had DM. Mean (95%CI) duration between onset of CP and DM diagnosis was 2.2(0.9–3.5) yrs. On univariate analysis

following parameters were significantly associated (OR[95%CI]; ‘p’) with DM: alcohol etiology (2.04[1.2–3.5]; 0.02), steatorrhea (2.1[1.03–4.16]; 0.04), ductal calculi (6.4[1.8–22.3]; 0.0001) and biliary stricture (5.7[1.71– 18.71]; 0.0034). On multivariate analysis, ductal calculi (p¼0.005) was the single independent risk-factor for DM. There was no association of ductal decompression on development of DM (OR 0.88; p¼0.54). Conclusions: Presence of ductal calculi is the single important risk factor for the development of DM in patients with CP. Impact of ductal decompression on DM warrants further study. Keywords: Risk factors, Diabetes, Chronic pancreatitis