Y. Chen, Y. Bo, Z. Han and M. Chen (2025). Risk factors associated with acute pancreatitis in diabetic ketoacidosis patients: a 11-year experience in a single tertiary medical center and comprehensive literature review. Frontiers in medicine, 12, 1571631. https://doi.org/10.3389/fmed.2025.1571631

PubMed 40259984

[Abstract]
OBJECTIVE: To identify independent risk factors and predictive markers for acute pancreatitis (AP) in patients with diabetic ketoacidosis (DKA).

METHODS: Here, we reported a 11-year experience in a single tertiary medical center and conduct a systematic review of acute pancreatitis in diabetic ketoacidosis patients (DKA-AP). 1,941 cases were included. First retrospective cohort study analyzed clinical data from 45 patients with DKA-AP and 45 matched controls with DKA alone (DKA-nonAP) admitted to Yangzhou University Affiliated Hospital (2013-2024). Baseline characteristics included BMI, hyperlipidemia history, and serological profiles. Secondly we retrieved clinical studies of DKA-AP from PubMed database system and analyzed these clinical data in depth.

RESULTS: Significant differences were observed in BMI: median [IQR] = 26.30 [22.15-28.40] vs. 23.20 [20.70-25.35] kg/m2, p = 0.031, hyperlipidemia history (26.7% vs. 4.4%, p = 0.004), abdominal pain duration (3 vs. 0 days, p < 0.001), and lipid profiles TC: median [IQR] = 7.71 [5.60-11.66] vs. 4.86 [4.22-6.52] mmol/L, p < 0.001; TG: median [IQR] = 11.90 [4.71-15.84] vs. 1.60 [0.89-3.64] mmol/L, p < 0.001. Logistic regression identified TC (OR = 1.455, 95% CI: 1.196-1.769), TG (OR = 2.046, 95% CI: 1.202-3.484), and abdominal pain duration (OR = 3.892, 95% CI: 2.173-6.972) as independent risk factors. Receiver operating characteristic curve (ROC) analysis demonstrated strong predictive performance (combined AUC = 0.933, sensitivity = 93.3%, specificity = 73.3%). Moreover, we found 11 clinical studies investigating DKA-AP. Cumulatively, 1,851 patients were studied, including 3 interventional studies, 1 genetic observational study, and 7 cohort studies exploring risk factors.

CONCLUSION: Elevated TC, TG, and prolonged abdominal pain duration are key predictors of DKA-AP. These factors enhance early diagnosis and clinical management in Yangzhou, China.