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The characteristics and prognostic role of acute abdominal on-admission pain in acute pancreatitis: A prospective cohort-analysis of 1432 cases

Introduction:Pain is the most common symptom in acute pancreatitis(AP) and is part of the diagnostic criteria. Its clinical characteristics in APhave not been detailed.Aims:Therefore, we aimed to characterize acute abdominal pain in AP.Materials and Methods:The Hungarian Pancreatic Study Group hasprospectively collected multicenter clinical data of 1435 adult AP patientsbetween 2012 and 2017. The pain was characterized by its intensity (mild, intense), duration prior to admission (hours), localization (9 regions of theabdomen), and type (sharp, dull, cramping). Associations between paincategory groups and outcome parameters were investigated.Results:97.3% of patients (n¼1394) had pain on admission. Pain wasmostly intense (70%, n¼511), cramping (61%, n¼705), and epigastric (48%, n¼687). More intense pain was associated with disease severity (p¼0.021), and we observed higher proportion of peripancreaticfluid collection(19.5% vs 11.0% ; p¼0.009) and edematous pancreas (8.4% vs 3.1% ; p¼0.016)on on-admission imaging with intense pain. Sharp pain was associatedAbstracts / Pancreatology 21 (2021) S18eS119S36 N. GedeS. KissA. VinczeJ. BajorI. SzaboZ. SzepesF.IzbekiJ. GervainJ. HamvasZ. VitalisE. FeherS.CraiV. SallinenE.Ramirez MoldandoA. MeczkerP.VarjúG. PoropatD. StimacN.FaluhegyiA. MisetaT. NagyA. VereczkeiZ.MartonP.J. HegyiP. HegyiA.ParniczkyA. Szentesi with AP severity (OR¼2.481 95% CI: 1.550-3.969) and increased mortality(OR¼2.263, 95% CI: 1.199e4.059) compared to other pain types. Long- standing pain (>72 h) on admission was not associated with outcomes ; however, it was associated with milder (p<0.001) and rather dull pain(p<0.05).Conclusion:Intense and sharp pain on admission is associated withthe severity of AP and intensive pain was associated with higher propor-tion of pancreas abnormalities on on- admission imaging. The questionarises whether pain relief improves AP outcome.

Acute pancreatitis, pain, prognosis

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