In children in Mexico diagnosed with acute pancreatitis (AP), obesity and traumatic, biliary, or systemic etiologies were associated with a higher risk for early local and systemic complications.

A study published in the Revista de Gastroenterología de México highlighted the need to identify clinical indicators during the initial evaluation to help clinicians predict disease severity and guide treatment decisions in children with AP, a rare but increasingly recognized condition.

Speaking with Medscape’s Spanish edition, Yaneth Martínez Tovilla, MD, PhD, pediatrician and pediatric intensivist, professor and secretary of research and postgraduate studies at the Faculty of Medicine, Benemérita Universidad Autónoma de Puebla in Puebla, Mexico, and one of the study authors, said, “In clinical practice, the findings underscore the need for early risk stratification in every pediatric patient with acute pancreatitis. This approach helps clinicians identify which patients require care in a pediatric intensive care unit and which can be managed in a conventional inpatient setting with close monitoring. The study also highlights important areas for future research.”

Study Methods

This descriptive, retrospective study included 143 patients younger than 18 years (mean age, 10 years; 51% female) who received treatment for AP at the Hospital de la Niñez Poblana (formerly known as Hospital para el Niño Poblano) in Puebla, between 2014 and 2024.

All patients met at least two of the three diagnostic criteria established by the International Study Group of Pediatric Pancreatitis: In Search for a Cure — abdominal pain characteristic of or suggestive of AP; serum amylase or lipase levels at least three times the upper limit of normal; and imaging findings consistent with or suggestive of pancreatic inflammation on abdominal ultrasonography, CT, or MRI.

Researchers assessed early local complications, including pancreatic necrosis and acute peripancreatic fluid collections, and systemic complications involving the pulmonary, cardiac, metabolic, and renal systems.

Potential risk factors for poorer clinical outcomes included sex, age, nutritional status, BMI, AP etiology, serum lipase levels, white blood cell count, and serum albumin levels.

Clinical Findings

Adolescents accounted for 45% of the cases, and 54% of the patients had normal weight. Approximately 37% of episodes were classified as severe, with organ failure lasting more than 48 hours.

Trauma was the most common cause, accounting for 22.4% of cases, followed by systemic diseases (18.2%), drug-induced pancreatitis (16.9%; n = 28, including 19 cases associated with L-asparaginase), idiopathic pancreatitis (14.7%), gallstones (11.9%), and congenital abnormalities or periampullary obstruction (7.7%).

Among the local complications occurring within the first 4 weeks, 16% of the patients developed pancreatic necrosis, 12.6% developed acute peripancreatic fluid collections, and 4.2% required surgery.

The most frequently reported systemic complications were cardiac (51.7%), renal (31.4%), pulmonary (18.1%), and metabolic (16%). The overall mortality rate was 11.8%.

Risk Factors

Statistical analysis identified several variables associated with local and systemic complications.

Biliary etiology was associated with pancreatic necrosis (odds ratio [OR], 9.0) and acute peripancreatic fluid collections (OR, 7.3). Obesity (OR, 3.3) and idiopathic etiology (OR, 3.6) were also associated with acute peripancreatic fluid collections.

Cardiac complications were associated with trauma (OR, 5.5) and systemic diseases (OR, 5.0). Metabolic complications were associated with obesity (OR, 4.0) and gallstone disease (OR, 3.4). Renal complications were associated with adolescence (OR, 2.1) and systemic disease (OR, 3.2).

The researchers did not identify any risk factors for pulmonary complications. However, hypoalbuminemia was significantly associated with these complications (OR, 0.24; P = .005).

Leukopenia was associated with fatal outcomes in children with AP (OR, 3.2).

The authors acknowledged the limitations of the retrospective study design and advised caution in the interpretation of the findings. Martínez Tovilla emphasized the need for prospective multicenter studies to validate these risk factors across different hospital settings. She also called for research on whether early nutritional and therapeutic interventions could reduce systemic complications and whether biomarkers of inflammation and organ damage could improve the prediction of adverse outcomes.

Prediction Tools

Despite the study’s methodological limitations, Daniel Montaño Ríos, MD, pediatric gastroenterologist and nutrition specialist at Private Children’s Hospital in Mexico City, Mexico, described it as “a good study.” Although he was not involved in the research, he noted that identifying risk factors could help clinicians prevent complications in patients with pancreatitis, particularly in Mexico, where data on this patient population are limited.

“It’s a small study, but it provides us with several factors to consider in future research and to determine whether these can be used as predictors or whether other factors that the researchers did not consider might be useful,” he said.

AP is rare in children, with an incidence of 1-13 cases per 100,000 pediatric patients. Unlike in adults, in whom more than 60% of cases are attributed to causes such as alcohol consumption or gallstones, AP in children has a more varied etiology.

Most children with AP experience mild symptoms, although previous studies have reported that up to 30% develop local and systemic complications requiring early multidisciplinary treatment.

In this Mexican study, the incidence of complications ranged from 12% to 51%. However, the reported mortality rate of 11.8% was concerning because it was higher than the rates reported in studies from other countries, which were less than 5%.

No prognostic tool has been adequately validated to predict severe outcomes in children with AP, unlike the Ranson criteria, which are used in adults.

Martínez Tovilla emphasized the importance of developing clinical tools to identify children who need intensive monitoring from the outset. Such tools could help clinicians make more informed treatment decisions, allocate hospital resources more efficiently, prioritize referrals to critical care units, and respond more quickly to potentially serious complications.

“Having predictive clinical tools not only strengthens pediatric practice but also helps ensure safe and timely care for this vulnerable population,” she said.

Montaño Ríos agreed that identifying new predictive tools is important and said, “Unfortunately, of all the tools that have been tried, none has been validated for use in pediatric patients. We need to do more work to standardize criteria and develop a scale that is sufficiently valid for this patient population.”

Treatment Recommendations

The treatment of AP focuses on fluid resuscitation, pain management, and nutritional support.

“One of the most important therapeutic considerations is avoiding unnecessary fasting, since it has been well established that starting to eat as soon as possible helps reduce complications and shorten the length of hospital stay,” Montaño said.

He also emphasized the importance of identifying the underlying cause of pancreatitis and using additional tests when appropriate to the hospital’s capabilities, instead of limiting management to symptom relief alone.

“Properly managing the patient’s pain and identifying complications early on, such as pancreatic pseudocysts or necrosis, helps us avoid prolonged hospital stays and provide timely treatment,” he added.

Martínez Tovilla recommended standardizing the initial assessment of pediatric patients using clinical and biochemical parameters associated with complication risk. She also emphasized the need to train pediatric staff to recognize early signs of systemic compromise and ensure timely referral to hospitals with critical care capabilities when high-risk factors are identified.

“Although rare in childhood, this disease can rapidly progress to multiorgan involvement, as evidenced by the cardiac, renal, and pulmonary complications described in our study,” Martínez Tovilla concluded.

Montaño Ríos and Martínez Tovilla reported having no relevant conflicts of interest.

This story was translated from Medscape’s Spanish edition.