Lazar_2026_Front.Cell.Infect.Microbiol_16_1808503

BACKGROUND: Superinfection of pancreatic fluid collections (PFCs) is a major determinant of late morbidity and mortality in acute pancreatitis (AP). Persistent Pancreatic Enzyme Elevation (PPEE), may contribute to fluid stasis and infection; however, its clinical impact remains incompletely defined. METHODS: From 3,694 patients with AP enrolled in the Acute Pancreatitis Registry (2012-2023, 22 centres), 912 patients with PFCs were analysed. Based on pancreatic enzyme dynamics, patients were classified as having PPEE (n=276; amylase or lipase level <=300U/l for at least one day, or mean amylase or lipase level <=150U/l on or after day 5 of admission) or normal enzyme kinetics (NEK) (n=503). The primary outcome was PFC infection rate; secondary outcomes included mortality, organ failure, Intensive Care Unit (ICU) requirement, need for intervention, and length of hospitalisation (LOH). RESULTS: Patients with PPEE were younger (mean age: 56.9 vs. 52.7 years, p<0.001) and had lower body mass index (BMI) (mean BMI: 29.3 vs. 26.4 kg/m(2), p<0.001), while sex distribution was similar between groups. Alcoholic aetiology (20% vs. 31%, OR;1.79; CI:1.28-2.5; p<0.001), history of smoking (47.5% vs. 61.3%, OR: 1.76; CI: 1.3-2.38; p<0.001), and previous pancreatic disease (29.1% vs. 41.8%, OR: 1.75; 1.27-2.41, p<0.001) were independently associated with PPEE. Superinfection occurred more frequently in patients with PPEE compared with those with NEK (25.0% vs. 16.0%; OR 1.86, 95% CI 1.15-3.00; p=0.011). PPEE was also associated with a higher need for endoscopic ultrasound-guided and percutaneous interventions. In contrast, PPEE was not associated with differences in mortality, disease severity, organ failure, ICU requirement, or LOH. CONCLUSION: PPEE are associated with an increased risk of superinfection and the need for intervention in PFCs, without affecting disease severity or mortality in AP. Regular enzyme monitoring and early ductal assessment may enhance patient management.