Incidence and Predictors of Acute Pancreatitis in Patients With Diabetic Ketoacidosis (DKA) and Hyperosmolar Hyperglycemic State (HHS): A Multicenter Retrospective Study.

OBJECTIVES

Acute pancreatitis (AP) complicates hyperglycemic crisis, yet incidence and predictors remain unclear. We evaluated the incidence and predictors of AP in patients with diabetic ketoacidosis (DKA) and hyperosmolar hyperglycemic state (HHS).

METHODS

This retrospective multicenter study included patients with hyperglycemic crisis between January 2015 and August 2025 at 3 tertiary hospitals. DKA/HHS and AP were diagnosed per American Diabetes Association and revised Atlanta criteria, respectively. Multivariable analysis was performed for the total cohort and DKA subgroup.

RESULTS

Among 406 patients (303 with DKA, 103 with HHS), 60 (14.8%) developed AP, more frequently in DKA than in HHS (17.5% vs6.8%). Patients with AP more often presented with abdominal pain and shock and had higher serum γ-glutamyl transferase (γ-GTP) and triglyceride levels. Higher body mass index, abdominal pain, shock, elevated γ-GTP, and hypertriglyceridemia independently predicted AP. In the DKA subgroup, alcohol consumption, type 2 diabetes, abdominal pain, shock, and γ-GTP were independent predictors. While AP was associated with increased intensive care unit admission, it did not result in increased hospital stay or in-hospital mortality.

CONCLUSION

AP occurs in a substantial proportion of hyperglycemic crises. Its development is linked to specific metabolic and hemodynamic stressors, suggesting a multifactorial pathophysiology.