Long-Term Mortality in Acute Pancreatitis-A Population-Based Cohort Study

Abstract

Background: Acute pancreatitis is a potentially life-threatening inflammation of the pancreas, with a rising incidence in most countries. Recent studies have suggested that acute pancreatitis is associated with increased long-term mortality. However, the extent to which this association is influenced by the development of chronic pancreatitis or comorbid conditions, such as malignant disease, remains unclear.

Objective: To assess the association between acute pancreatitis and long-term all-cause mortality.

Methods: The Swedish Pancreatitis Cohort (SwePan) was used, including all individuals with a first-time episode of acute pancreatitis in Sweden between 1990 and 2019 who survived the index hospital stay and 1:10 matched pancreatitis-free individuals from the general population. Multivariable conditional Cox proportional hazard models were used to compare mortality among individuals with acute pancreatitis compared with the matched pancreatitis-free control group.

Results: In total, 89,465 individuals discharged from hospital with acute pancreatitis and 890,837 matched pancreatitis-free individuals were followed up for 10,155,039 person-years (mean 10.0 years). There were 33,764 (37.7%) deaths among individuals with acute pancreatitis and 265,403 (29.8%) deaths among controls. In multivariable adjusted models, mortality was increased in individuals with acute pancreatitis throughout the follow-up period, particularly among those with severe and non-gallstone-related acute pancreatitis as compared to the matched controls. These results remained statistically significant after censoring the follow-up time for recurrent acute pancreatitis or a diagnosis of chronic pancreatitis.

Conclusions: Acute pancreatitis was associated with increased long-term mortality, even after adjusting for comorbidities, including cancer, and censoring for recurrent acute pancreatitis or chronic pancreatitis. Future research should assess causes of death and focus on understanding long-term morbidity to facilitate prevention through tailored follow-up strategies.

Keywords: acute pancreatitis; chronic pancreatitis; epidemiology; gall stone pancreatitis; mortality; population‐based.

FIGURE 1

Hazard ratios (HR) and corresponding 95% confidence intervals (CI) for all‐cause mortality in individuals with acute pancreatitis compared with matched individuals (without the disease), with and without adjustment for covariates (alcohol abuse, cardiovascular disease, chronic obstructive pulmonary disease, obesity, hypertriglyceridemia, liver disease, dementia, diabetes, renal failure, cancer, autoimmune disease, education level, country of birth and disposable income) and censoring for recurrent acute pancreatitis (RAP) and/or chronic pancreatitis (CP). All models were adjusted for the matching variables (year of birth, sex, municipality of residence and calendar period). Follow‐up was started at the date of hospital discharge.

FIGURE 2

Restricted cubic spline model of mortality after hospital discharge for gallstone‐related acute pancreatitis. Hazard ratios and corresponding 95% confidence intervals based on multivariable Cox regression models adjusted for the matching variables (year of birth, sex, municipality of residence and calendar period), alcohol abuse, cardiovascular disease, chronic obstructive pulmonary disease, obesity, hypertriglyceridemia, liver disease, dementia, diabetes mellitus, renal failure, diagnosis of cancer within 5 years of the index date, autoimmune disease, education level, country of birth and disposable income. Severe gallstone‐related acute pancreatitis (blue) and non‐severe gallstone‐related acute pancreatitis (green).

FIGURE 3

Restricted cubic spline model of mortality after hospital discharge for non‐gallstone‐related acute pancreatitis. Hazard ratios and corresponding 95% confidence intervals based on multivariable Cox regression models adjusted for the matching variables (year of birth, sex, municipality of residence and calendar period), alcohol abuse, cardiovascular disease, chronic obstructive pulmonary disease, obesity, hypertriglyceridemia, liver disease, dementia, diabetes mellitus, renal failure, diagnosis of cancer within 5 years of the index date, autoimmune disease, education level, country of birth and disposable income. Severe nongallstone‐related acute pancreatitis (blue) and nonsevere nongallstone‐related acute pancreatitis (green).