Acute Pancreatitis Is Linked to Long-Term Mortality

TOPLINE:

Acute pancreatitis was associated with increased long-term mortality, particularly among patients with non–gallstone-related pancreatitis and severe acute pancreatitis. The increased mortality rate persisted for more than 10 years after discharge.

METHODOLOGY:

• In this nationwide matched cohort study, researchers aimed to assess long-term mortality over three decades in adult patients with acute pancreatitis.
• They utilised the Swedish Patient Register to identify a cohort of 89,465 individuals (median age, 62 years; 52.5% men) with a first-time diagnosis of acute pancreatitis from 1990 to 2019. A control group of 890,837 matched individuals was drawn from the general Swedish population.
• Acute pancreatitis cases were categorised as gallstone-related or non–gallstone-related, with the latter further subcategorised into alcohol-related or non–alcohol-related cases.
• Recurrent acute pancreatitis was defined as acute pancreatitis requiring a new hospital admission after the index hospital stay. Chronic pancreatitis was identified using specific diagnostic codes, and severe acute pancreatitis was defined by criteria such as intensive care admission, prolonged hospital stay, or specific diagnosis codes.
• Data on mortality were obtained from the Swedish Cause of Death Register, and multivariable conditional Cox proportional hazard models were used for analyses. The mean follow-up duration was 10 years.

TAKEAWAY:

• Over the follow-up duration, the mortality rate was 37.7% among individuals with acute pancreatitis and 29.8% among control individuals.
• Compared with control individuals, those with acute pancreatitis had increased mortality rates shortly after discharge — specifically during the 0-1 month (adjusted hazard ratio, [aHR], 3.54; 95% CI, 3.26-3.84) and 1-3 month (aHR, 2.48; 95% CI, 2.32-2.65) periods. Thereafter, the rates declined but remained elevated for over 10 years.
• Severe gallstone‐related acute pancreatitis and both severe and non-severe non–gallstone-related cases were associated with increased long-term mortality; however, no such association was observed for non-severe gallstone‐related cases.
• Non–gallstone-related acute pancreatitis was associated with increased mortality beyond 10 years for both non-severe (aHR, 1.27; 95% CI, 1.23-1.33) and severe (aHR, 1.47; 95% CI, 1.33-1.63) episodes, even after censoring for recurrent acute pancreatitis and chronic pancreatitis. A similar association was observed for non–alcohol-related non–gallstone-related episodes (aHR, 1.46; 95% CI, 1.32-1.62).

IN PRACTICE:

“Improved understanding of these factors is likely to support the development of tailored follow-up of patients with acute pancreatitis to treat or prevent long-term consequences of the disease,” the authors wrote. “The results stress the need for patient-tailored follow-up to prevent or treat sequelae following acute pancreatitis,” they added.

SOURCE:

The study was led by Daniel Selin, Karolinska Institutet, Stockholm, Sweden. It was published online on February 28, 2025, in United European Gastroenterology Journal.

LIMITATIONS:

The study’s limitations included a lack of detailed information on confounders such as smoking and body mass index, potentially affecting the results. The Swedish Patient Register validated the diagnosis of acute pancreatitis but not its cause, which may have led to underreporting, particularly for alcohol-induced cases. Register-based data collection may have introduced misclassification bias. Additionally, as primary care diagnoses were not included, some comorbidities may not have been captured, leading to potential underestimation.

DISCLOSURES:

This study was supported by grants from the Centre for Clinical Research Sörmland, Uppsala University, and the Stockholm Research Council. The authors reported no relevant conflicts of interest.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.