Risk Factors for Rapid Progression From Acute Recurrent to Chronic Pancreatitis in Children: Report From INSPPIRE

Area of Science:

• Pediatric Gastroenterology
• Pancreatology
• Clinical Research

Background:

• Acute recurrent pancreatitis (ARP) is a significant concern in pediatric patients.
• Understanding the progression of ARP to chronic pancreatitis (CP) is crucial for early intervention.
• Identifying risk factors for accelerated progression is essential for improving patient outcomes.

Purpose of the Study:

• To determine the rate of progression from acute recurrent pancreatitis (ARP) to chronic pancreatitis (CP) in children.
• To identify and assess risk factors associated with this progression.

Main Methods:

• Utilized data from the INternational Study group of Pediatric Pancreatitis: In search for a cuRE (INSPPIRE) cohort.
• Employed Kaplan-Meier curves to calculate progression duration from initial acute pancreatitis (AP) to CP.
• Applied Cox proportional hazard regression models to identify hazard ratios for progression.

Main Results:

• The median time from initial AP to CP was 3.79 years.
• Progression to CP was significantly faster in children aged 6 years or older at the first AP episode (2.91 years) compared to younger children (4.92 years).
• Children with pathogenic PRSS1 variants showed more rapid progression to CP (2.52 years) than those without (4.48 years).
• Within 6 years, 18.0% developed exocrine pancreatic insufficiency and 7.7% developed diabetes mellitus.

Conclusions:

• Pediatric patients with ARP demonstrate rapid progression to CP, exocrine pancreatic insufficiency, and diabetes.
• Age at first AP episode (≥6 years) and presence of pathogenic PRSS1 variants are key factors accelerating CP progression.
• Further research is needed to elucidate factors contributing to aggressive disease courses in childhood pancreatitis.