Clinical Characteristics of 5375 Cases of Acute Pancreatitis From a Single Chinese Center, 1996-2015

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Clinical Characteristics of 5375 Cases of Acute Pancreatitis From a Single Chinese Center, 1996-2015

Acute pancreatitis (AP)—a sudden inflammation of the pancreas—remains one of the most common and dangerous digestive emergencies worldwide. While causes like gallstones, high cholesterol, and alcohol use are well-known, how AP affects people in China has been under-researched. A 20-year study of over 5,000 patients at Shanghai’s Ruijin Hospital (affiliated with Shanghai Jiao Tong University School of Medicine) offers new insights into who gets AP, why, and how treatment has changed for this population.

The Study Basics

Researchers analyzed data from 5,375 patients discharged between 1996 and 2015. To be included, patients had to be admitted directly to Ruijin Hospital or transferred within 72 hours of AP onset. Severity was classified using the 2012 Atlanta Consensus (mild, moderate, or severe), and causes were grouped as gallstone, hyperlipidemia (high blood fat), alcohol, or “other.”

Who Gets AP?

Most patients were middle-aged: the 51–60 age group was the most affected. Men made up 58% of cases, but women were slightly older on average (55 vs. 51 years). Over the 20-year period, the average age of patients stayed roughly the same—good news for consistency, but a reminder that AP doesn’t just target older adults.

Notably, biliary AP (caused by gallstones) was more common in older patients, while AP from “other” causes (like trauma or medications) was more likely in younger people.

Top Causes: Gallstones Lead, But Trends Shift

Gallstones were the No. 1 cause of AP (63% of cases), followed by hyperlipidemia (8.5%) and alcohol (7.4%). About 21% of cases fell into the “other” category.

Over time, three trends stood out:

  1. Biliary AP increased: More patients had AP from gallstones.
  2. Hyperlipidemic and alcoholic AP rose: Cases linked to high cholesterol or alcohol use grew.
  3. “Other” causes decreased: Less AP from unknown or rare factors.

How Etiology Affects Severity and Outcome

The cause of AP changed everything—from how severe it was to how it was treated:

  • Alcoholic AP: Most likely to be severe (41.5%) and cause pancreatic necrosis (tissue death, 22.6%). But it had the lowest rates of surgery (12.6%) and in-hospital death (1.8%).
  • Biliary AP: Least likely to be severe (21.2%) or cause necrosis (14.2%). But it had the highest rates of surgery (22.7%) and death (5.1%).
  • Adjusted fatality: When researchers accounted for how severe each case was, biliary AP’s death rate dropped to 3.5%—suggesting infections (common in gallstone-related AP) may drive higher actual fatalities.

All causes had similar hospital stays (14–15 days on average), so severity didn’t always mean longer time in the hospital.

Treatment Evolution: Less Surgery, Fewer Complications—But Fatality Stays Steady

For severe AP (SAP)—the deadliest form—treatment shifted dramatically:

  • Less fluid: Patients got fewer IV fluids within 72 hours of onset.
  • Fewer surgeries: Laparotomy (open abdominal surgery) plummeted from 46.7% (1996–2000) to 26.1% (2011–2015). Doctors now prefer less invasive methods like percutaneous drainage.
  • Fewer complications: Pancreatic necrosis dropped from 47.8% to 21.0%, and digestive leaks stayed low.
  • Shorter stays: Hospital stays for SAP got shorter before 2005, thanks to better care.

But here’s the catch: overall fatality didn’t decrease. About 4.5% of all patients died in the hospital, and 12.4% of severe cases. Even though treatment improved, the death rate for AP stayed consistent over 20 years.

Key Takeaways

  • Demographics are stable: AP still hits middle-aged adults hardest, with a slight male bias.
  • Etiology is shifting: Gallstones remain top, but hyperlipidemia and alcohol are growing concerns—likely tied to lifestyle changes.
  • Treatment is more gentle: Surgeons are avoiding open surgery for SAP, which reduces complications and stays. But fatality remains a challenge.
  • Biliary AP needs extra care: It may look milder, but infections make it deadlier—so doctors need to watch for that.

Limitations and Hope

The study is from a single center (Ruijin Hospital), so results may not apply to all of China. But with over 5,000 patients and 20 years of data, it’s one of the largest looks at AP in Chinese populations.

The researchers hope their work helps doctors better understand AP in China—from who to screen (e.g., older adults for gallstones) to how to treat (e.g., less surgery for SAP). But the steady fatality rate is a reminder: more work is needed to save lives.

This study was published in the Chinese Medical Journal in 2019 by Shun-Wei Huang, En-Qiang Mao, and colleagues from Ruijin Hospital’s Emergency and Critical Care departments. Funding came from the Shanghai Science and Technology Commission and the National Natural Science Foundation of China.

doi:10.1097/CM9.0000000000000208

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