Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

Etiology, case fatality, recurrence, and severity in pediatric acute pancreatitis: a meta-analysis of 48 studies

Abstract

For children, there are very few published reviews focusing on severe acute pancreatitis (AP). PubMed, EMBASE, Web of Science, Scopus, Chinese National Knowledge Infrastructure (CNKI), Wanfang data, EBSCO, and Cochrane Library were searched from inception until March 2020. Meta-regression analyses were used to estimate the etiology, case fatality, recurrence, and severity of pediatric AP in different regions (North America, Asia, South America, Europe, and Oceania). Pooled data from 47 papers (48 studies) found that main causes of pediatric AP were gallstones in Asia; trauma in Oceania; and idiopathic in Europe, North America, and South America. The case-fatality rate (CFR) of pediatric AP is 4.7% (North America), 6.2% (Europe), 2.4% (Asia), 3.1% (South America), and 7.4% (Oceania). The incidence rates of recurrent acute pancreatitis (RAP) in children who have had an episode of acute pancreatitis in North American, Asia, and Europe were 15.3, 13.1, and 13.8%, respectively. The incidence of severe acute pancreatitis (SAP) in different regions was 30.3% (Oceania), 29.2% (South America), 20.8% (Europe), 15.8% (Asia), and 13.7% (North America). It suggests that physicians should notice the etiology of pediatric AP for the initial assessment, diagnosis, prediction of relapse, and appropriate treatment at a later stage.

Impact

  • It indicates the etiology of pediatric acute pancreatitis for the initial assessment, diagnosis, and prediction of relapse.

  • Main causes of pediatric AP were gallstones in Asia; trauma in Oceania; and idiopathic in Europe, North America, and South America. The case-fatality rate of pediatric AP is diverse worldwide.

  • It suggests that physicians noticed the etiology of pediatric AP for the initial assessment, diagnosis, prediction of relapse, and appropriate treatment at a later stage.

Access options

Rent or Buy article

Get time limited or full article access on ReadCube.

from$8.99

All prices are NET prices.

Fig. 1: Flowchart depicting the selection process of included studies for the meta-analysis.
Fig. 2: The epidemiology of etiology of pediatric AP in different regions.
Fig. 3: Forest plot of case-fatality rates of pediatric AP in different regions.
Fig. 4: Forest plot of acute recurrent pancreatitis rates of pediatric AP in different regions.
Fig. 5: Forest plot of severe acute pancreatitis rates of pediatric AP in different regions.

References

  1. 1.

    Yadav, D. & Lowenfels, A. B. The epidemiology of pancreatitis and pancreatic cancer. Gastroenterology 144, 1252–1261 (2013).

    PubMed  PubMed Central  Article  Google Scholar 

  2. 2.

    Bai, H. X., Lowe, M. E. & Husain, S. Z. What have we learned about acute pancreatitis in children? J. Pediatr. Gastroenterol. Nutr. 52, 262–270 (2011).

    PubMed  PubMed Central  Article  Google Scholar 

  3. 3.

    Morinville, V. D., Barmada, M. M. & Lowe, M. E. Increasing incidence of acute pancreatitis at an American pediatric tertiary care center: is greater awareness among physicians responsible? Pancreas 39, 5–8 (2010).

    PubMed  Article  Google Scholar 

  4. 4.

    Marta, K. et al. Aging and comorbidities in acute pancreatitis I: a meta-analysis and systematic review based on 194,702 patients. Front. Physiol. 10, 328 (2019).

    PubMed  PubMed Central  Article  Google Scholar 

  5. 5.

    Knobloch, K., Yoon, U. & Vogt, P. M. Preferred reporting items for systematic reviews and meta-analyses (PRISMA) statement and publication bias. J. Craniomaxillofac. Surg. 39, 91–92 (2011).

    PubMed  Article  Google Scholar 

  6. 6.

    Balthazar, E. J., Robinson, D. L., Megibow, A. J. & Ranson, J. H. Acute pancreatitis: value of CT in establishing prognosis. Radiology 174, 331–336 (1990).

    CAS  PubMed  Article  Google Scholar 

  7. 7.

    Stang, A. Critical evaluation of the Newcastle-Ottawa scale for the assessment of the quality of nonrandomized studies in meta-analyses. Eur. J. Epidemiol. 25, 603–605 (2010).

    Article  PubMed  Google Scholar 

  8. 8.

    Higgins, J. P., Thompson, S. G., Deeks, J. J. & Altman, D. G. Measuring inconsistency in meta-analyses. BMJ 327, 557–560 (2003).

    PubMed  PubMed Central  Article  Google Scholar 

  9. 9.

    Egger, M., Davey Smith, G., Schneider, M. & Minder, C. Bias in meta-analysis detected by a simple, graphical test. BMJ 315, 629–634 (1997).

    CAS  PubMed  PubMed Central  Article  Google Scholar 

  10. 10.

    Balshem, H. et al. GRADE guidelines: 3. Rating the quality of evidence. J. Clin. Epidemiol. 64, 401–406 (2011).

    PubMed  Article  Google Scholar 

  11. 11.

    Vitale, D. S. et al. Blood urea nitrogen elevation is a marker for pediatric severe acute pancreatitis. Pancreas 48, 363–366 (2019).

    CAS  PubMed  Article  Google Scholar 

  12. 12.

    Vidal, E., Alberici, I. & Verrina, E. Acute pancreatitis in children on chronic maintenance dialysis. Pediatr. Nephrol. 34, 1501–1512 (2019).

    PubMed  Article  Google Scholar 

  13. 13.

    Nauka, P. C. et al. Validation of lipase and systemic inflammatory response syndrome as prognostic indicators in pediatric acute pancreatitis: a retrospective analysis. J. Pediatr. Gastroenterol. Nutr. 68, 389–393 (2019).

    PubMed  Article  Google Scholar 

  14. 14.

    Galai, T. et al. Young age predicts acute pancreatitis severity in children. J. Pediatr. Gastroenterol. Nutr. 68, 720–726 (2019).

    PubMed  Article  Google Scholar 

  15. 15.

    Cheng, Y. J. et al. Epidemiology of pediatric acute pancreatitis in taiwan: a nationwide population-based study. J. Pediatr. Gastroenterol. Nutr. 68, e7–e12 (2019).

    PubMed  Article  Google Scholar 

  16. 16.

    Sweeny, K. F. et al. Rapid progression of acute pancreatitis to acute recurrent pancreatitis in children. J. Pediatr. Gastroenterol. Nutr. 68, 104–109 (2019).

    PubMed  PubMed Central  Article  Google Scholar 

  17. 17.

    Zheng, W. et al. Amalgamation of systemic inflammatory response syndrome score with C-reactive protein level in evaluating acute pancreatitis severity in children. Scand. J. Gastroenterol. 53, 755–759 (2018).

    CAS  PubMed  Article  Google Scholar 

  18. 18.

    Sag, E. et al. Acute pancreatitis in children: a single center experience over ten years. Turk. J. Pediatr. 60, 153–158 (2018).

    PubMed  Article  Google Scholar 

  19. 19.

    Izquierdo, Y. E. et al. Multivariate model for the prediction of severity of acute pancreatitis in children. J. Pediatr. Gastroenterol. Nutr. 66, 949–952 (2018).

    PubMed  Article  Google Scholar 

  20. 20.

    Grzybowska-Chlebowczyk, U. et al. Acute pancreatitis in children. Prz. Gastroenterol. 13, 69–75 (2018).

    PubMed  Google Scholar 

  21. 21.

    Alabdulkareem, A. et al. Etiology and clinical characteristics of pediatric acute pancreatitis in Saudi Arabia: a 20-year experience from a single tertiary center. Int. J. Pediatr. Adolesc. Med. 5, 13–17 (2018).

    PubMed  PubMed Central  Article  Google Scholar 

  22. 22.

    Suzuki, M. et al. Validation of severity assessment for acute pancreatitis in children. Pediatr. Int. 59, 1127–1128 (2017).

    PubMed  Article  Google Scholar 

  23. 23.

    Grover, A. S. et al. The utility of the systemic inflammatory respsonse syndrome score on admission in children with acute pancreatitis. Pancreas 46, 106–109 (2017).

    CAS  PubMed  Article  Google Scholar 

  24. 24.

    Majbar, A. A. et al. Incidence and clinical associations of childhood acute pancreatitis. Pediatrics. 138, e20161198 (2016).

  25. 25.

    Hashimoto, N. et al. Efficacy of pediatric acute pancreatitis scores at a Japanese tertiary center. Pediatr. Int. 58, 224–228 (2016).

    PubMed  Article  Google Scholar 

  26. 26.

    Hao, F., Guo, H., Luo, Q. & Guo, C. Disease progression of acute pancreatitis in pediatric patients. J. Surg. Res. 202, 422–427 (2016).

    PubMed  Article  Google Scholar 

  27. 27.

    Bierma, M. J. et al. Predicting severe acute pancreatitis in children based on serum lipase and calcium: a multicentre retrospective cohort study. Pancreatology 16, 529–534 (2016).

    CAS  PubMed  Article  Google Scholar 

  28. 28.

    Abu-El-Haija, M. et al. Early enteral nutrition in children with acute pancreatitis. J. Pediatr. Gastroenterol. Nutr. 62, 453–456 (2016).

    CAS  PubMed  Article  Google Scholar 

  29. 29.

    Suzuki, M. et al. Scoring system for the prediction of severe acute pancreatitis in children. Pediatr. Int. 57, 113–118 (2015).

    PubMed  Article  Google Scholar 

  30. 30.

    Goday, P. S. et al. Acute pancreatitis in the pediatric intensive care unit. J. Pediatr. Gastroenterol. Nutr. 61, 108–112 (2015).

    CAS  PubMed  Article  Google Scholar 

  31. 31.

    Bolia, R. et al. Prevalence, natural history, and outcome of acute fluid collection and pseudocyst in children with acute pancreatitis. J. Pediatr. Gastroenterol. Nutr. 61, 451–455 (2015).

    PubMed  Article  Google Scholar 

  32. 32.

    Terlizzi, V. et al. Prediction of acute pancreatitis risk based on PIP score in children with cystic fibrosis. J. Cyst. Fibros. 13, 579–584 (2014).

    CAS  PubMed  Article  Google Scholar 

  33. 33.

    Guo, Q. et al. Predictors for mortality following acute pancreatitis in children. Pediatr. Surg. Int. 30, 1111–1115 (2014).

    PubMed  Article  Google Scholar 

  34. 34.

    Boskovic, A. et al. The role of D-dimer in prediction of the course and outcome in pediatric acute pancreatitis. Pancreatology 14, 330–334 (2014).

    CAS  PubMed  Article  Google Scholar 

  35. 35.

    Antunes, H., Nascimento, J., Mesquita, A. & Correia-Pinto, J. Acute pancreatitis in children: a tertiary hospital report. Scand. J. Gastroenterol. 49, 642–647 (2014).

    PubMed  Article  Google Scholar 

  36. 36.

    Kim, S. C. & Yang, H. R. Clinical efficacy of gabexate mesilate for acute pancreatitis in children. Eur. J. Pediatr. 172, 1483–1490 (2013).

    CAS  PubMed  Article  Google Scholar 

  37. 37.

    Lautz, T. B. et al. Utility of the computed tomography severity index (Balthazar score) in children with acute pancreatitis. J. Pediatr. Surg. 47, 1185–1191 (2012).

    PubMed  Article  Google Scholar 

  38. 38.

    Fabre, A. et al. Severity scores in children with acute pancreatitis. J. Pediatr. Gastroenterol. Nutr. 55, 266–267 (2012).

    PubMed  Article  Google Scholar 

  39. 39.

    Zhu, Y. M. et al. [Clinical characteristics of children with acute pancreatitis]. Zhonghua Er Ke Za Zhi 49, 10–16 (2011).

    PubMed  Google Scholar 

  40. 40.

    Chang, Y. J. et al. Acute pancreatitis in children. Acta Paediatr. 100, 740–744 (2011).

    PubMed  Article  Google Scholar 

  41. 41.

    Park, A. et al. Changing referral trends of acute pancreatitis in children: a 12-year single-center analysis. J. Pediatr. Gastroenterol. Nutr. 49, 316–322 (2009).

    PubMed  PubMed Central  Article  Google Scholar 

  42. 42.

    Li, N. & Wang, X. Y. [Relationship between acute pancreatitis and systemic inflammation response syndrome in children]. Zhongguo Dang Dai Er Ke Za Zhi 10, 715–718 (2008).

    CAS  PubMed  Google Scholar 

  43. 43.

    Kandula, L. & Lowe, M. E. Etiology and outcome of acute pancreatitis in infants and toddlers. J. Pediatr. 152, 106.e1–110.e1 (2008).

    Article  Google Scholar 

  44. 44.

    Nydegger, A. et al. Changing incidence of acute pancreatitis: 10-year experience at the Royal Children’s Hospital, Melbourne. J. Gastroenterol. Hepatol. 22, 1313–1316 (2007).

    PubMed  Article  Google Scholar 

  45. 45.

    Chen, C. F., Kong, M. S., Lai, M. W. & Wang, C. J. Acute pancreatitis in children: 10-year experience in a medical center. Acta Paediatr. Taiwan 47, 192–196 (2006).

    PubMed  Google Scholar 

  46. 46.

    Stringer, M. D. et al. Multidisciplinary management of surgical disorders of the pancreas in childhood. J. Pediatr. Gastroenterol. Nutr. 40, 363–367 (2005).

    PubMed  Article  Google Scholar 

  47. 47.

    Laugel, V. et al. [Severe acute pancreatitis in children receiving asparaginase: multicenter retrospective study]. Arch. Pediatr. 12, 34–41 (2005).

    CAS  PubMed  Article  Google Scholar 

  48. 48.

    Werlin, S. L., Kugathasan, S. & Frautschy, B. C. Pancreatitis in children. J. Pediatr. Gastroenterol. Nutr. 37, 591–595 (2003).

    PubMed  Article  Google Scholar 

  49. 49.

    Choi, B. H. et al. Acute pancreatitis associated with biliary disease in children. J. Gastroenterol. Hepatol. 18, 915–921 (2003).

    PubMed  Article  Google Scholar 

  50. 50.

    Alvarez Calatayud, G. et al. Acute pancreatitis in childhood. Rev. Esp. Enferm. Dig. 95, 40–44, 45-48 (2003).

    CAS  PubMed  Google Scholar 

  51. 51.

    Tiao, M. M. et al. Pancreatitis in children: clinical analysis of 61 cases in southern Taiwan. Chang Gung Med. J. 25, 162–168 (2002).

    PubMed  Google Scholar 

  52. 52.

    Pezzilli, R. et al. Acute pancreatitis in children. An Italian multicentre study. Dig. Liver Dis. 34, 343–348 (2002).

    CAS  PubMed  Article  Google Scholar 

  53. 53.

    DeBanto, J. R. et al. Acute pancreatitis in children. Am. J. Gastroenterol. 97, 1726–1731 (2002).

    PubMed  Article  Google Scholar 

  54. 54.

    Javid, G. et al. Etiology and outcome of acute pancreatitis in children in Kashmir (India). An endemic area of hepatobiliary ascariasis. World J. Surg. 37, 1133–1140 (2013).

    PubMed  Article  Google Scholar 

  55. 55.

    Yeung, C. Y. et al. Pancreatitis in children–experience with 43 cases. Eur. J. Pediatr. 155, 458–463 (1996).

    CAS  PubMed  Article  Google Scholar 

  56. 56.

    Berney, T. et al. Influence of severe underlying pathology and hypovolemic shock on the development of acute pancreatitis in children. J. Pediatr. Surg. 31, 1256–1261 (1996).

    CAS  PubMed  Article  Google Scholar 

  57. 57.

    Weizman, Z. & Durie, P. R. Acute pancreatitis in childhood. J. Pediatr. 113, 24–29 (1988).

    CAS  PubMed  Article  Google Scholar 

  58. 58.

    Uc, A. & Husain, S. Z. Pancreatitis in children. Gastroenterology 156, 1969–1978 (2019).

    PubMed  PubMed Central  Article  Google Scholar 

  59. 59.

    Husain, S. Z. & Srinath, A. I. What’s unique about acute pancreatitis in children: risk factors, diagnosis and management. Nat. Rev. Gastroenterol. Hepatol. 14, 366–372 (2017).

    PubMed  Article  Google Scholar 

  60. 60.

    Steer, M. L., Waxman, I. & Freedman, S. Chronic pancreatitis. N. Engl. J. Med. 332, 1482–1490 (1995).

    CAS  PubMed  Article  Google Scholar 

  61. 61.

    Zhu, Y. et al. A study on the etiology, severity, and mortality of 3260 patients with acute pancreatitis according to the Revised Atlanta Classification in Jiangxi, China over an 8-year period. Pancreas 46, 504–509 (2017).

    PubMed  Article  Google Scholar 

  62. 62.

    Shukla-Udawatta, M., Madani, S. & Kamat, D. An update on pediatric pancreatitis. Pediatr. Ann. 46, e207–e211 (2017).

    PubMed  Article  Google Scholar 

  63. 63.

    Restrepo, R. et al. Acute pancreatitis in pediatric patients: demographics, etiology, and diagnostic imaging. AJR Am. J. Roentgenol. 206, 632–644 (2016).

    PubMed  Article  Google Scholar 

  64. 64.

    Zheng, J., Yang, Q. J., Dang, F. T. & Yang, J. Drug-induced pancreatitis: an update. Arab J. Gastroenterol. 20, 183–188 (2019).

    PubMed  Article  Google Scholar 

  65. 65.

    Pant, C. et al. Acute recurrent pancreatitis in children: a study from the pediatric health information system. J. Pediatr. Gastroenterol. Nutr. 62, 450–452 (2016).

    PubMed  Article  Google Scholar 

  66. 66.

    Abu-El-Haija, M. et al. Genetic variants in acute, acute recurrent and chronic pancreatitis affect the progression of disease in children. Pancreatology 19, 535–540 (2019).

    PubMed  PubMed Central  Article  Google Scholar 

  67. 67.

    Heidari, S. et al. Sex and Gender Equity in Research: rationale for the SAGER guidelines and recommended use. Res Integr. Peer Rev. 1, 2 (2016).

    PubMed  PubMed Central  Article  Google Scholar 

Download references

Acknowledgements

This study was supported by the National Key R&D Program of China (2018YFC0114900), the Development Project of National Major Scientific Research Instrument (82027803), the Development Project of National Major Scientific Research Instrument of China (8202780008), the National Natural Science Foundation of China (81971623), the Major Research plan of the National Natural Science Foundation of China (91630311), the National S&T Major Project of China (2018ZX10301201), the Natural Science Foundation of Zhejiang Province (LZ20H180001), and Zhejiang Provincial Association Project for Mathematical Medicine (LSY19H180015).

Author information

Affiliations

Authors

Contributions

Conceptualization: T.J. Acquisition of data: all authors. Analysis and interpretation of data: G.T., L.Z. Writing—original draft: G.T. Critical revision of the manuscript for important intellectual content: T.J. Formal analysis: G.T., Q.Z. Funding acquisition: Q.Z., T.J. Methodology: Q.Z. Supervision: T.J.

Corresponding author

Correspondence to Tian’an Jiang.

Ethics declarations

Competing interests

The authors declare no competing interests.

Patient consent

Because this is a meta-analysis, patient consent was not required.

Additional information

Publisher’s note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Supplementary information

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Tian, G., Zhu, L., Chen, S. et al. Etiology, case fatality, recurrence, and severity in pediatric acute pancreatitis: a meta-analysis of 48 studies. Pediatr Res (2021). https://doi.org/10.1038/s41390-021-01454-1

Download citation

Search

Quick links