S278 The Incidence of Exocrine Pancreatic Insufficiency Following an Index Episode of Acute Necrotizing Pancreatitis: A Propensity-Matched Analysis of United States Collaborative Network Data

Introduction: Acute necrotizing pancreatitis (ANP), a severe form of acute pancreatitis, can lead to long-term metabolic complications including exocrine pancreatic insufficiency (EPI), which may cause weight loss, steatorrhea, and associated conditions such as anemia and osteoporosis which arise as a consequence of malabsorption. The incidence of EPI after acute pancreatitis has been previously described in small single- and multi-center cohort studies; however, the comparative long-term incidence of EPI in ANP and acute interstitial pancreatitis patients using real-world nationally representative data has not been previously quantified. Methods: We searched the United States Collaborative Network on the platform TriNetX from inception to May 23, 2025 using International Classification of Diseases, Tenth Revision (ICD-10) codes appropriate to ANP and acute interstitial pancreatitis. We identified all patients with a documented fecal elastase value less than 200 ug/L placed on pancreatic enzymes supplementation during a 12-month follow-up period. One-to-one propensity score matching was carried out based on demographic variables and all comorbidities associated with malabsorption. The primary outcome (EPI) was calculated and expressed as an odds ratio along with a 95% CI. Statistical significance was defined as a 2-sided P-value < 0.05. Results: Our database search found 148,135 patients with a diagnosis of acute pancreatitis and EPI in the follow-up window. After propensity-score matching was carried out, 17,176 patients were included into our study (8,588 patients in each cohort). We found an EPI incidence of 8.7% in the ANP cohort over the follow-up period, compared to an EPI incidence of 2.2% in the acute interstitial pancreatitis cohort. There were increased odds of EPI in patients with an index episode of ANP compared to patients with acute interstitial pancreatitis (odds ratio 4.2, 95% CI 3.595, 4.991, P = 0.000). Conclusion: There are significantly higher odds of developing EPI in patients with ANP over a 12-month period compared to patients with acute interstitial pancreatitis. Our findings highlight the importance of careful long-term monitoring for EPI to prevent downstream malabsorption-related complications in this patient population. Prospective studies are needed to validate our findings.