Published online Mar 27, 2023. doi: 10.4254/wjh.v15.i3.431
Peer-review started: December 7, 2022
First decision: December 19, 2022
Revised: February 3, 2023
Accepted: March 9, 2023
Article in press: March 9, 2023
Published online: March 27, 2023
Processing time: 105 Days and 7.5 Hours
Heavy alcohol use is a known cause of liver and pancreatic injury that can lead to alcohol-related liver cirrhosis (ALC) and alcohol-related chronic pancreatitis (ACP). These diseases are associated with significant morbidity, mortality, and healthcare utilization and spending.
While both ALC and ACP are well-characterized, there is a subset of patient with both ALC and ACP (coexistent disease) that is poorly understood.
We aim to characterize the clinical profile of patients with coexistent disease (CD) and its differences from those with ALC Only or ACP Only.
The study population consisted of adult patient encounters at UPMC facilities from 2006 to 2017 with more than 12 mo of contact. We identified subsets of patients with ACP Only, ALC Only, and CD based on international classifications of diseases codes and reviewed the Electronic Health Record to verify diagnoses and abstract clinical information. Statistical comparisons were made using t-test and Kruskal-Wallis test for continuous variables and chi-square tests for categorical variables. Survival from time of first diagnosis is reported using the Kaplan-Meier method. Cox proportional-hazards models are used to report the hazard ratio and 95% confidence intervals while adjusting for age at diagnosis, sex, and race.
The median duration of contact was greater than 10 years and was comparable between groups. The median number of non-elective hospital admissions for CD and ACP Only were comparable and significantly greater than patients with ALC Only. The number of patients who died in follow-up in CD, ALC Only, and ACP Only groups was 80 (60%), 82 (61%), and 36 (41%). Using Cox regression, survival was similar between ALC Only vs ACP Only and CD vs ACP Only. Despite comparable MELD-Na and Child-Pugh scores between CD and ALC Only patients, those with ALC Only were more likely to have esophageal varices, need for variceal banding, treatment with beta blockers, and hepatocellular carcinoma. Patients with ACP Only were more likely to have acute pancreatitis, need for endoscopic or surgical intervention, and endocrine dysfunction.
Patients with CD did not have a worse phenotype compared to patients with ACP Only or ALC Only.
As the largest study of its kind, this work hopes to characterize patients at the intersection of ALC and ACP. Given our findings, we observed that the dominant phenotype in CD is similar to that of ALC Only, suggesting that patients with alcohol-related pancreatic disease who are newly identified to have alcohol-related liver disease should be closely monitored for liver cirrhosis and its complications.