Retrospective Cohort Study
Copyright ©The Author(s) 2018. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Nov 28, 2018; 24(44): 5034-5045
Published online Nov 28, 2018. doi: 10.3748/wjg.v24.i44.5034
Risk factors and prediction score for chronic pancreatitis: A nationwide population-based cohort study
Yen-Chih Lin, Chew-Teng Kor, Wei-Wen Su, Yu-Chun Hsu
Yen-Chih Lin, Wei-Wen Su, Yu-Chun Hsu, Division of Gastroenterology, Department of Internal Medicine, Changhua Christian Hospital, Changhua 50006, Taiwan
Chew-Teng Kor, Internal Medicine Research Center, Changhua Christian Hospital, Changhua 50006, Taiwan
Author contributions: All the authors solely contributed to this paper.
Institutional review board statement: The study was reviewed and approved for publication by our Institutional Reviewer.
Informed consent statement: The data of our study cohort was obtained retrospectively from the Taiwan National Health Insurance Research Database, hence informed consent statement is unnecessary.
Conflict-of-interest statement: All the Authors have no conflict of interest related to the manuscript.
Data sharing statement: The original anonymous dataset is available on request from the corresponding author at 144315@cch.org.tw
STROBE statement: The authors have read the STROBE Statement-checklist of items, and the manuscript was prepared and revised according to the STROBE Statement-checklist of items.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author to: Yen-Chih Lin, MD, Attending Doctor, Division of Gastroenterology, Department of Internal Medicine, Changhua Christian Hospital, No.135 Nanhsiao Street, Changhua 50006, Taiwan. 144315@cch.org.tw
Telephone: +886-4-7238595 Fax: +886-4-7232942
Received: September 8, 2018
Peer-review started: September 10, 2018
First decision: October 24, 2018
Revised: October 29, 2018
Accepted: November 9, 2018
Article in press: November 9, 2018
Published online: November 28, 2018
Processing time: 80 Days and 13.6 Hours
Abstract
AIM

To explore the risk factors of developing chronic pancreatitis (CP) in patients with acute pancreatitis (AP) and develop a prediction score for CP.

METHODS

Using the National Health Insurance Research Database in Taiwan, we obtained large, population-based data of 5971 eligible patients diagnosed with AP from 2000 to 2013. After excluding patients with obstructive pancreatitis and biliary pancreatitis and those with a follow-up period of less than 1 year, we conducted a multivariate analysis using the data of 3739 patients to identify the risk factors of CP and subsequently develop a scoring system that could predict the development of CP in patients with AP. In addition, we validated the scoring system using a validation cohort.

RESULTS

Among the study subjects, 142 patients (12.98%) developed CP among patients with RAP. On the other hand, only 32 patients (1.21%) developed CP among patients with only one episode of AP. The multivariate analysis revealed that the presence of recurrent AP (RAP), alcoholism, smoking habit, and age of onset of < 55 years were the four important risk factors for CP. We developed a scoring system (risk score 1 and risk score 2) from the derivation cohort by classifying the patients into low-risk, moderate-risk, and high-risk categories based on similar magnitudes of hazard and validated the performance using another validation cohort. Using the prediction score model, the area under the curve (AUC) [95% confidence interval (CI)] in predicting the 5-year CP incidence in risk score 1 (without the number of AP episodes) was 0.83 (0.79, 0.87), whereas the AUC (95%CI) in risk score 2 (including the number of AP episodes) was 0.84 (0.80, 0.88). This result demonstrated that the risk score 2 has somewhat better prediction performance than risk score 1. However, both of them had similar performance between the derivation and validation cohorts.

CONCLUSION

In the study,we identified the risk factors of CP and developed a prediction score model for CP.

Keywords: Chronic pancreatitis; Acute pancreatitis; Prediction score; Endoscopic ultrasound; Recurrent acute pancreatitis

Core tip: In this large number, nationwide population-based cohort study, we concluded that the presence of recurrent acute pancreatitis (RAP), along with alcohol consumption, age of onset, and smoking habit are 4 important risk factors of chronic pancreatitis (CP). We developed a novel prediction score model for CP with excellent discrimination and successfully validated this model in our study. Using this scoring system, a clinician can predict the outcome of a patient with AP episode easily and arrange further examination such as pancreatic functional test or endoscopic ultrasound after the acute stage for the high-risk category to diagnose CP as early as possible (incidence rate of CP about 31 per 1000 person-years in high-risk group, based on our study) since CP is an important risk factor of pancreatic cancer.