From the AGA Journals

Chronic pancreatitis life expectancy dramatically decreased



Patients with chronic pancreatitis have a life expectancy that is roughly 8 years shorter than that of the general population.

Indeed, the "beyond a doubt" finding of a mortality rate up to five times higher in this cohort illustrates "the great impact the presence of this disease has on the accompanying complications," wrote Dr. Ulrich Christian Bang. The report appears in the April issue of Gastroenterology (doi:10.1053/j.gastro.2013.12.033).

Dr. Bang, of Copenhagen University Hospital Hvidovre, looked at 11,972 patients (33.5% were women) with a primary diagnosis of chronic pancreatitis between 1995 and 2010, and 119,720 age- and sex-matched controls. Median age was 54 years.

Alcoholic pancreatitis was present in just over half (52.7%) of chronic pancreatitis cases.

The primary endpoint was mortality, but the authors also assessed all inpatient and outpatient diagnoses accumulated during the study period.

Overall, the age at death was significantly lower for pancreatitis patients compared with controls (63.7 years versus 72.1 years for controls; P less than .0001).

Indeed, per 1,000 patient-years, mortality rates were 77.4 among cases (95% confidence interval, 75.4-79.5) and 16.9 among controls (95% CI, 16.7-17.2) translating to an adjusted hazard ratio of 5.0 (95% CI, 4.8-5.2).

Although mortality rates predictably increased with age for both cases and controls, "the adjusted relative risks of death were significantly higher for the younger chronic pancreatitis cases than among older patients (P less than .0001)," wrote Dr. Bang and colleagues.

Fatal diseases of the alimentary tract were the most common cause of death in cases (10.6%), followed closely by cancer (10.2%) and circulatory system diseases (5.5%).

In comparison, 0.4% of controls had mortality associated with gastrointestinal disease (adjusted HR for cases, 26.1); 3.3% developed a fatal malignancy (HR for cases, 1.4), and 3.2% had mortality caused by diseases of the circulatory system (HR for cases, 1.9).

Looking generally at all comorbidities, the researchers found that the proportion of patients with any morbidity excluding chronic pancreatitis was significantly higher among cases (78%) compared with controls (38%) (P less than .0001). That included the presence of cerebrovascular disease (adjusted HR for cases, 1.3; 94% CI, 1.2-1.4), chronic pulmonary disease (adjusted HR for cases, 1.9; 95% CI, 1.8-2.1), and chronic kidney disease (adjusted HR for cases, 1.7; 95% CI, 1.5-1.9) as well as diabetes and ulcer disease.

Only the incidence of myocardial infarction was not elevated among cases, compared with controls; in fact, after adjustment for socioeconomic status, chronic pulmonary disease, and diabetes, cases had a trend toward a slightly lower risk, at 0.9 (95% CI, 0.8-1.0).

According to the authors, one of the weaknesses of their study was that they were unable to control for lifestyle factors such as smoking and drinking, which may especially contribute to the higher mortality among younger patients with chronic pancreatitis.

"Older age groups may be able to compensate for more advanced chronic pancreatitis accompanied by fat malabsorption and secondary diabetes by adopting a healthier lifestyle including tobacco and alcohol cessation as well as better compliance with routine follow-up evaluation and medication," they added.

Copenhagen University Hospital Hvidovre funded the study. The authors stated that they had no conflicts of interest.

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