Cannabis Users With Acute Pancreatitis Less Likely to Have Necrosis, Fluid Collections

Roberto Simons-Linares, MD

Cannabis could reduce the prevalence of several negative outcomes for acute pancreatitis patients, while increasing the odds of other negative outcomes.

In research presented as a poster at the American College of Gastroenterology’s Annual Scientific Meeting (ACG 2019), a team of investigators, led by C. Roberto Simons-Linares, MD, the Cleveland Clinic, from a pioneer study investigating the clinical impact of cannabis use in acute pancreatitis, including outcomes and severity of patients with pancreatic necrosis and/or pancreatic/peripancreatic fluid collections.

The investigators also sought to ascertain the clinical effects of cannabis use has on the severity and outcome on this patient population.

In the retrospective cohort study, the team examined all consecutive patients admitted with a first episode of acute pancreatitis at a large tertiary referral center in Chicago between 2012-2018.

They identified acute pancreatitis diagnosis and severity using the Revised Atlanta Classification. The presence of pancreatic or pancreatic/peripancreatic fluid was established by radiologic imaging or histopathologic evaluation.

The use of cannabis was identified through recorded history and/or urine toxicology. A multivariate logistic regression model was constructed using STATA software version 13.

The 519-patient study included 107 (20.6%) cannabis users. Of the 69 patients who developed acute necrotizing pancreatic, 58 (84%) were non-cannabis users. A total of 109 patients with moderate-to-severe acute pancreatitis developed pancreatic/peripancreatic fluid collections.

The overwhelming majority of these patients—92 (84.4%)—were non-cannabis users.

The mean age of the non-cannabis users in the study was 46.3 and 48.4 for the cannabis users.

The investigators found a number of outcomes regarding acute necrotizing pancreatitis.

“Acute necrotizing pancreatitis outcomes: CU were more likely to have persistent SIRS (18.2% vs. 12.1%) and to require ICU (63.6% vs. 43.1%), they were also less likely to have Infected necrosis (9.1% vs. 51.7%), bacteremia (18.2% vs. 31%), to require debridement of necrosis (9.1% vs. 32.8%),” the authors wrote. “CU with any pancreatic/peripancreatic fluid collection were more likely to have AKI (47.1% vs. 26.1%).”

Acute pancreatitis is often complicated by pancreatic necrosis and/or pancreatic/peripancreatic fluid collections. However, it is unknown how the effects of cannabis and the incidence of necrosis and/or pancreatic/peripancreatic fluid collections.

“Cannabis users (CU) with acute necrotizing pancreatitis or fluid collection are more likely to have persistent SIRS [systemic inflammatory response syndrome], AKI [acute kidney injury] and require ICU [intensive care unit],” the authors wrote. “However, they’re less likely to have infected necrosis/fluid collections, bacteremia and to require pancreatic/peripancreatic fluid debridement.”

The poster, “Outcomes of Acute Necrotizing Pancreatitis and Associated Fluid Collections in Cannabis Users,” was presented Sunday, October 27, 2019, at the American College of Gastroenterology Annual Scientific Meeting (ACG 2019) in San Antonio, Texas.