Chronic pancreatitis decreases life expectancy

Patients with chronic pancreatitis have a life expectancy roughly eight years shorter than the general population.

This “beyond doubt” findings 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 the Copenhagen University Hospital Hvidovre looked at 11,972 patients (33.5 percent 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 52.7 percent of chronic pancreatitis cases.

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

Age at death was significantly lower for pancreatitis patients than for controls.

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

Moreover, “the adjusted relative risks of death were significantly higher for the younger chronic pancreatitis cases than among older patients.

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

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

The researchers found that the proportion of patients with any morbidity excluding chronic pancreatitis was significantly higher among cases (78 percent) than controls (38 percent) (P less than .0001). That included the presence of cerebrovascular disease, chronic pulmonary disease, and chronic kidney disease as well as diabetes and ulcer disease.

Only the incidence of MI was not elevated among cases, compared with controls. After adjustment for socioeconomic status, chronic pulmonary disease, and diabetes, cases had a trend toward a slightly lower risk, at 0.9.

They were unable to control for lifestyle factors such as smoking and drinking, which may contribute to the higher mortality among the younger patients.