Young Age Predicts Acute Pancreatitis Severity in Children

Objectives:

The course and evolution of pediatric acute pancreatitis (AP) is poorly understood. Prognostication models in children perform poorly and lack consensus. We aimed to identify predictors of AP severity, and the risk for AP recurrence.

Methods:

We retrospectively studied all patients hospitalized with AP at a single tertiary center, between January 1995 and June 2016. Patient demographics and admission laboratory data were assessed for severity and recurrence prediction.

Results:

A total of 68 patients accounting for a total of 117 (15 moderate-severe) AP episodes were reviewed. Patients with moderate-severe disease were significantly younger (median [interquartile range (IQR)] of 8.3 [4.0–14.4] vs 13.8 [8.1–16.0] years, P = 0.02). Young age at presentation was associated with odds ratio of 3.8 (confidence interval [CI] 1.2–12.1) for children younger than 12 years and 5.8 (CI 1.6–21.4) for children younger than 6 years for developing moderate-severe disease.

Further subanalysis of the 59 patients with first-time AP episodes, demonstrated younger age (median [IQR] of 5.3 [2.9–10.4] vs 12.0 [6.3–15.8] years, P = 0.03) and elevated white blood cell count (median [IQR] of 22.8 [11.8–31.3] vs 11.0 [8.1–14.6] 10⁹/L, P < 0.01) of patients with moderate-severe disease, conferring a risk for moderate-severe disease with odds ratio of 7.5 (CI 1.5–38.2) for children younger than 6 years and 5.3 (CI 1.1–25.4) for patients with white blood cell count >15 × 10⁹/L, respectively. Fourteen (23.7%) of 59 patients with first-time episodes had recurrent AP. Analysis of the data at the primary episode failed to identify predictors to indicate future recurrence.

Conclusions:

In our cohort, only young age (<12 years) predicted AP severity. No parameters were identified to predict future development of AP recurrence.