Progression from acute to chronic pancreatitis in children: a systematic review and meta-analysis

Abstract

Background: Most children recover after an initial acute pancreatitis (AP) episode; however, some progress to recurrent AP (RAP) or chronic pancreatitis (CP). Purpose: We aimed to quantify progression rates and identify the risk factors associated with these transitions. Methods: PubMed/MEDLINE, Embase, and Cochrane databases were searched on December 21, 2024, for pediatric studies reporting progression to RAP or CP (PROSPERO number: CRD420251086520). All observational studies were included, while case reports and case series were excluded. To evaluate the differences in RAP rates, we conducted subgroup analyses of etiology and severity. We also assessed clinical, structural, and genetic risk factors for disease progression. A random-effects model was used to pool proportions and odds ratios (OR) with 95% confidence intervals (CI). Heterogeneity was assessed using the I² statistic. Results: A total of 68 studies met the inclusion criteria. After the first AP attack, RAP developed in 18% (95% CI, 16–22%; I2=76%; k=39 studies) and CP developed in 10% (95% CI, 6–16%; I2=67%; k=5 studies) of patients. Among children with RAP, 35% (95% CI, 24–49%; I2=78%; k=7 studies) progressed to CP. The RAP rates varied according to etiology and severity: hypertriglyceridemia, 33%; idiopathic, 28%; biliary, 19%; traumatic, 16%; drug-induced, 14%; virus-induced, 3%; severe, 39%; moderate, 24%; and mild, 21%. Structural abnormalities were associated with a higher risk of RAP (OR, 3.15; 95% CI, 1.51–6.56; I2=0%; k=5 studies). Pancreas divisum (OR, 2.64; 95% CI, 1.51–4.63; I2=17%; k=7 studies) and PRSS1 mutation (OR: 4.56; 95% CI, 3.06–6.80; I2=0%; k=7 studies) were associated with CP. Conclusion: Approximately one in five pediatric AP episodes recurred, and over one-third of the RAP cases progressed to CP. The risk of RAP is influenced by the underlying etiology and severity of the initial episode, whereas structural and genetic factors are associated with later progression.