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On admission severe and sharp pain is associated with local and systemic complications of acute pancreatitis: a prospective cohort-analysis of 1435 cases

Purpose: Pain is the most common symptom in acute pancreatitis (AP), and is part of the diagnostic criteria. Since its clinical characteristics in AP have not been detailed in the literature, we aimed to characterize acute abdominal pain in AP. Materials and methods: The Hungarian Pancreatic Study Group (HPSG) has prospectively collected multicenter clinical data of 1435 adult AP patients between 2012 and 2017. The pain was characterized by (i) its intensity (Visual Analog Scale ; 0–10), (ii) duration prior to admission (hours), (iii) localization (9 regions of the abdomen), and (iv) type (sharp, dull, cramping). Associations between the pain categories and outcome parameters were investigated Results: 97.3% of patients (n=1394) had pain on admission. It was mostly severe (VAS 7–10: 70%, n=511), cramping (61%, n=705), and epigastric (48%, n=687). Severe pain was associated with a more severe disease course (p<0.05) ; however, it was not associated with a higher rate of mortality (p=0.826). Sharp pain was associated with AP severity (OR=2.481 95% CI: 1.550- 3.969), mortality (OR=2.263, 95% CI: 1.199–4.059), systemic complications (OR=2.263, 95% CI: 1.550–3.970) and new-onset diabetes (2.7% vs. 9.3% ; p<0.001). Longstanding pain (>72 h) on admission was not associated with worse outcomes. If pain lasted more than 72 hours, amylase was only increased in 62% of cases on admission. Furthermore, longstanding (>3 days) pain was associated with milder (p<0.001) and rather dull pain (p<0.05), localized in the right abdomen (p<0.005). Conclusions: The severity and sharpness of pain as patients reported data on admission are strongly associated with the severity of AP, therefore, these patients should receive more attention by healthcare professionals.

Acute pancreatitis ; Pain ; Complications

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