Analysis Of The Etiology And Clinical Features Of Inpatients With Acute Pancreatitis In A Grade Ⅲ Class A Hospital In Xi’an

Objective: To investigate the etiological composition,changing trend and features of etiology of inpatients with acute pancreatitis(AP)in a Grade Ⅲ Class A hospital in Xi’an,and to analyze the difference of clinical features of AP with different etiologies,so as to provide reference for clinical diagnosis and treatment of AP.Methods:In the first part,the etiology and related clinical data of 1764 AP patients hospitalized in Shaanxi Provincial People’s Hospital from January 2015 to December2019 were collected retrospectively.According to the etiology,it can be divided into biliary acute pancreatitis(BAP),hypertriglyceridemic pancreatitis(HTGP),alcoholic acute pancreatitis(AAP)and AP caused by other causes.To analyze the etiological composition and changing trend of AP inpatients in this hospital in recent 5 years,and Chi-square test was used to analyze the differences of etiology in different gender,age and severity.In the second part,The laboratory indicators and complications of 855 inpatients with AP in our hospital from January 2018 to December 2019 were collected.Kruskal-Wallis H test was used to analyze the difference of laboratory indicators of AP inpatients with different etiology,and Chi-square test or Fisher′s exact test was used to analyze the complications of AP inpatients with different etiologies.Results: Part Ⅰ Analysis of the etiology and features of inpatients with acute pancreatitis1.Among the 1764 AP patients hospitalized in this hospital in recent 5 years,there were 859 cases of BAP(48.70%),297 cases of HTGP(16.84%),221 cases of idiopathic AP(12.53%),219 cases of AP caused by overeating(12.41%),119 cases of AAP(6.74%),and 149 cases of AP caused by other rare causes(2.78%).The proportion of HTGP increased year by year(P=0.002).2.The proportion of BAP in female patients(62.8%)was higher than that in male patients(38.6%),and the proportion of HTGP and AAP in male patients(21.6%,11.1%)was higher than that in female patients(10.2%,0.7%),and the differences were statistically significant(all P < 0.05).3.BAP accounted for the highest proportion(79.3%)in patients aged ≥66 years,and HTGP and AAP accounted for the highest proportion(29.6%,10.6%)in patients aged18～40 years,the differences were statistically significant(all P < 0.008).4.The proportion of smoking and drinking history in patients with AAP was the highest(70.6%,84.0%),while the proportion of diabetes and fatty liver in patients with HTGP was the highest(39.1%,69.4%),and the differences were statistically significant(all P < 0.008).5.The proportion of HTGP in severe patients(35.0%)and moderately severe patients(20.2%)were higher than that in mild acute pancreatitis patients(14.1%),the differences were statistically significant(all P < 0.016).In HTGP,the proportion of patients with Balthazar CT grade D and E and MCTSI score ≥4(24.2%,38.0%)were higher than that of patients with BAP(15.9%,29.0%)and AP caused by other causes(14.9%,27.6%),the differences were statistically significant(all P < 0.008).6.The hospitalization days and the total cost of hospitalization of BAP patients were higher than those of HTGP,AAP and AP caused by other causes,the differences were statistically significant(all P < 0.008).Part Ⅱ Comparative analysis of laboratory indicators and complications of inpatients with acute pancreatitis of different etiologies1.Laboratory indicators: The levels of amylase and lipase in patients with BAP were higher than those in patients with HTGP and AAP,the levels of alanine aminotransferase,aspartate aminotransferase,alkaline phosphatase and γ-glutamyl transpeptidase in patients with BAP were significantly higher than those in HTGP,AAP and AP caused by other causes,albumin and calcium were lower than those of HTGP and AP caused by other causes.The glucose level of HTGP patients was significantly higher than that of BAP,AAP and AP caused by other causes,and the levels of white blood cell,neutrophil and hematocrit were significantly higher than those of BAP and AP caused by other causes.Serum creatinine level of AAP patients was higher than that of BAP,HTGP and AP caused by other causes,and the differences were statistically significant(all P <0.008).2.Complications: The incidence of seroperitoneum and systemic inflammatory response syndrome in HTGP patients(31.1%,25.0%)were higher than those in BAP(20.4%,15.2%),and the incidence of respiratory failure in patients with BAP and HTGP(10.1%,17.1%)were higher than that in patients with AP of other causes(3.9%),and the differences were statistically significant(all P < 0.008).Conclusion:1.BAP,HTGP and idiopathic AP were the top three etiologies of AP in our hospital in recent 5 years,and the proportion of HTGP is increasing year by year.2.The majority of patients with BAP were female,elderly patients,the levels of amylase and lipase were significantly increased,and they were prone to liver damage,and had long hospitalization time and high total cost.3.The majority of patients with HTGP were male,young patients,with diabetes and fatty liver history.The levels of white blood cell,neutrophil,hematocrit and glucose and incidence of seroperitoneum and systemic inflammatory response syndrome in patients with HTGP were higher than those in BAP patients,and most of the clinical manifestations were moderately severe and severe.4.The majority of patients with AAP were male,young patients,and most of them had history of smoking,so health education should be strengthened.