PhD Scientific Days 2025

Theoretical and Translational Medicine III.

Investigating the effect of metabolic syndrome on the exocrine pancreas after acute pancreatitis

Name of the presenter

Lipp Mónika Bernadett

Institute/workplace of the presenter

Semmelweis University

Authors

Mónika Lipp¹, Andrea Szentesi², Zsolt Abonyi-Tóth², Vivien Vass³, Katalin Márta¹, Ferenc Izbéki⁴, László Gajdán⁴, Bálint Erőss¹, Péter Hegyi¹, Alexandra Mikó²

1: Institute of Pancreatic Diseases, Semmelweis University, Budapest, Hungary
2: Centre for Translational Medicine, Semmelweis University, Budapest, Hungary
3: Institute for Translational Medicine, Medical School, University of Pécs, Pécs, Hungary
4: Szent György Teaching Hospital of Fejér County, Székesfehérvár, Hungary

Text of the abstract

Aims
Recent data highlight a significant risk of mortality following acute pancreatitis (AP), with a one-year mortality rate of 5.5%, emphasizing the need for long-term follow-up. Multiple metabolic syndrome factors are associated with worse outcomes. The GOULASH PLUS study (ISRCTN63396106), a longitudinal, observational multicentre trial, aims to evaluate the role of metabolic syndrome in pancreatic disease progression. The study has reached 50% of its planned enrolment. This interim analysis examines the impact of metabolic factors on disease progression.

Method
Data from 357 patients were analyzed for metabolic syndrome factors: obesity, hypertension, hypertriglyceridemia, hypercholesterolemia, and diabetes. Patients were categorized into four groups based on exocrine pancreatic morphology: (1) single AP episode, (2) recurrent AP (RAP, ≥2 episodes), (3) early chronic pancreatitis (ECP, ≥3 episodes or imaging signs), and (4) chronic pancreatitis (CP). Imaging included abdominal ultrasound in years 1 and 3; EUS or MRCP in years 2 and 4.

Results
Among 194 obese AP patients, 27 (13.9%) progressed to RAP, ECP, or CP by year 4. In contrast, 20 of 43 non-obese AP patients (46.5%) showed progression. Of 160 hypertensive AP patients, 29 (18.1%) progressed versus 9 of 84 non-hypertensives (10.7%). Among 48 with abnormal triglycerides, 11 (22.9%) progressed, versus 27 of 194 with normal levels (13.9%). Of 68 with hypercholesterolemia, 12 (17.6%) progressed, compared to 26 of 170 with normal cholesterol (15.3%). Regarding glucose metabolism, 35 of 144 with prediabetes/diabetes (24.3%) progressed versus 54 of 208 with normal glucose (25.9%). Not all patients completed year-four follow-up.

Conclusion
By year four, metabolic factors affected progression to RAP, ECP, or CP. Surprisingly, non-obese AP patients had higher progression rates, potentially due to early cholecystectomy in obese patients. Hypertension, elevated triglycerides, and cholesterol modestly increased progression risk. Glucose abnormalities had no significant impact.