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

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.