AbstractAim: The aim of this study was to identify the etiological differences and prognostic predictors of recurrent acute pancreatitis (RAP) in patients diagnosed with acute pancreatitis (AP), in comparison with those experiencing a single attack.Materials and Methods: A total of 457 patients diagnosed with AP between January 2023 and May 2025 were retrospectively evaluated. Patients were divided into two groups: those with a single episode (n = 335) and those with recurrent attacks (n = 122). Demographic characteristics, etiology, laboratory findings, complications, and mortality rates were compared between the groups. Logistic regression analyses were performed to determine independent predictors of RAP. Additionally, the discriminative performance of multivariate models was assessed using receiver operating characteristic (ROC) curve analysis.Results: Male sex was identified as an independent risk factor for RAP (adjusted OR: 3.18; p = 0.0001). Post‑ERCP pancreatitis (55.7%) and idiopathic pancreatitis (23.0%) were the predominant etiologies in the RAP group, whereas biliary etiology was most common in patients with a single attack (79.4%) (p 0.001). The HAPS score was significantly higher in the recurrent group (p = 0.005). Gamma‑glutamyl transferase (GGT) levels were significantly lower in the RAP group (p = 0.015), which may be explained by the lower prevalence of biliary etiology in this group. Local complications were observed more frequently in patients with a single episode (p = 0.008), while systemic complications and in‑hospital mortality rates were comparable between the groups. The multivariate model demonstrated good discriminative performance, with an AUC of 0.894 and an overall accuracy of 85.2%. Simplified models including only etiology and sex also showed high discriminative ability (AUC: 0.872).Conclusion: Although RAP does not appear to differ markedly from a single episode of AP in terms of overall clinical severity, it may follow a milder course with respect to local complications. Factors such as sex, etiology, HAPS score, and GGT levels play an important role in predicting RAP. Current severity scoring systems should be re‑evaluated for their applicability in the diagnosis and management of RAP.
İnan et al. (Mon,) studied this question.