Natural course of chronic pancreatitis and predictors of its progression
| Autor: | Samagra Agarwal, Shekhar Poudel, Anoop Saraya, Sanchit Sharma, Abhinav Anand, Ujjwal Sonika, Deepak Gunjan, Srikant Mohta, Namrata Singh, Srikant Gopi, Kanav Kaushal |
|---|---|
| Rok vydání: | 2020 |
| Předmět: |
Adult
Male medicine.medical_specialty Adolescent Databases Factual Pancreatitis Alcoholic Endocrinology Diabetes and Metabolism Pain Kaplan-Meier Estimate Tertiary care Young Adult 03 medical and health sciences 0302 clinical medicine Predictive Value of Tests Pancreatitis Chronic Pancreatic cancer Internal medicine Diabetes mellitus Pancreatic Pseudocyst medicine Humans Age of Onset Aged Retrospective Studies Aged 80 and over Natural course Hepatology business.industry Incidence Incidence (epidemiology) Gastroenterology Middle Aged Prognosis medicine.disease Survival Analysis Steatorrhea Pancreatic Neoplasms Natural history 030220 oncology & carcinogenesis Disease Progression Pancreatitis Female 030211 gastroenterology & hepatology medicine.symptom business Follow-Up Studies |
| Zdroj: | Pancreatology. 20:347-355 |
| ISSN: | 1424-3903 |
| DOI: | 10.1016/j.pan.2020.02.004 |
| Popis: | The natural course of chronic pancreatitis(CP) and its complications has been inadequately explored. We aimed to describe the natural history and factors affecting the progression of alcoholic(ACP), idiopathic juvenile(IJCP) and idiopathic senile(ISCP) variants of CP.This study was a retrospective analysis from a prospectively maintained database of patients with CP following up at a tertiary care centre from 1998 to 2019. Cumulative rates of pain resolution, diabetes, steatorrhea, pseudocysts and pancreatic cancer were computed using Kaplan-Meier analysis, and the factors affecting their incidence were identified on multivariable-adjusted Cox-proportional-hazards model.A total of 1415 patients were included, with 540(38.1%) ACP, 668(47.2%) IJCP and 207(14.6%) ISCP with a median follow-up of 3.5 years(Inter-quartile range: 1.5-7.5 years). Diabetes occurred at 11.5, 28 and 5.8 years(p 0.001) while steatorrhea occurred at 16, 24 and 18 years(p = 0.004) after onset for ACP, IJCP and ISCP respectively. Local complications including pseudocysts occurred predominantly in ACP(p 0.001). Ten-year risk of pancreatic cancer was 0.9%, 0.2% and 5.2% in ACP, IJCP and ISCP, respectively(p 0.001). Pain resolution occurred more frequently in patients with older age of onset[Multivariate Hazard Ratio(HR):1.7(95%CI:1.4-2.0; p 0.001)], non-smokers[HR:0.51(95%CI:0.34-0.78); p = 0.002] and in non-calcific CP[HR:0.81(0.66-1.0); p = 0.047]. Occurrence of steatorrhea[HR:1.3(1.03-1.7); p = 0.028] and diabetes[HR:2.7(2.2-3.4); p 0.001] depended primarily on age at onset. Occurrence of pancreatic cancer depended on age at onset[HR:12.1(4.7-31.2); p 0.001], smoking-history[HR:6.5(2.2-19.0); p 0.001] and non-alcoholic etiology[HR:0.14(0.05-0.4); p 0.001].ACP, IJCP and ISCP represent distinct entities with different natural course. Age at onset of CP plays a major prognostic role in all manifestations, with alcohol predominantly causing local inflammatory complications. |
| Databáze: | OpenAIRE |
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