Risk factors and prediction score for chronic pancreatitis: a nationwide population-based cohort study
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chronic pancreatitis, acute pancreatitis, prediction score, endoscopic ultrasound, recurrent acute pancreatitis

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Lin, Y.-C., Kor, C.-T., Su, W.-W., & Hsu, Y.-C. (2020). Risk factors and prediction score for chronic pancreatitis: a nationwide population-based cohort study. Herald of Pancreatic Club, 46(1), 23-35. https://doi.org/10.33149/vkp.2020.01.03

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To explore the risk factors of developing chronic pancreatitis (CP) in patients with acute pancreatitis (AP) and develop a prediction score for CP.


Using the National Health Insurance Research Database in Taiwan, we obtained large, population-based data of 5971 eligible patients diagnosed with AP from 2000 to 2013. After excluding patients with obstructive pancreatitis and biliary pancreatitis and those with a follow-up period of less than 1 year, we conducted a multivariate analysis using the data of 3739 patients to identify the risk factors of CP and subsequently develop a scoring system that could predict the development of CP in patients with AP. In addition, we validated the scoring system using a validation cohort.


Among the study subjects, 142 patients (12.98%) developed CP among patients with RAP. On the other hand, only 32 patients (1.21%) developed CP among patients with only one episode of AP. The multivariate analysis revealed that the presence of recurrent AP (RAP), alcoholism, smoking habit, and age of onset of < 55 years were the four important risk factors for CP. We developed a scoring system (risk score 1 and risk score 2) from the derivation cohort by classifying the patients into low-risk, moderate-risk, and high-risk categories based on similar magnitudes of hazard and validated the performance using another validation cohort. Using the prediction score model, the area under the curve (AUC) (95% confidence interval (CI)) in predicting the 5-year CP incidence in risk score 1 (without the number of AP episodes) was 0.83 (0.79, 0.87), whereas the AUC (95%CI) in risk score 2 (including the number of AP episodes) was 0.84 (0.80, 0.88). This result demonstrated that the risk score 2 has somewhat better prediction performance than risk score 1. However, both of them had similar performance between the derivation and validation cohorts.


In the study, we identified the risk factors of CP and developed a prediction score model for CP.

Core tip In this large number, nationwide population-based cohort study, we concluded that the presence of recurrent acute pancreatitis (RAP), along with alcohol consumption, age of onset, and smoking habit are 4 important risk factors of chronic pancreatitis (CP). We developed a novel prediction score model for CP with excellent discrimination and successfully validated this model in our study. Using this scoring system, a clinician can predict the outcome of a patient with AP episode easily and arrange further examination such as pancreatic functional test or endoscopic ultrasound after the acute stage for the high-risk category to diagnose CP as early as possible (incidence rate of CP about 31 per 1000 person-years in high-risk group, based on our study) since CP is an important risk factor of pancreatic cancer.

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1. Ahmed Ali U., Issa Y., Hagenaars J. C., Bakker O. J., van Goor H., Nieuwenhuijs V. B., Bollen T. L., van Ramshorst B., Witteman B. J., Brink M. A., Schaapherder A. F., Dejong C. H., Spanier B. W., Heisterkamp J., van der Harst E., van Eijck C. H., Besselink M. G., Gooszen H. G., van Santvoort H. C., Boermeester M. A., Dutch Pancreatitis Study Group. Risk of recurrent pancreatitis and progression to chronic pancreatitis after a first episode of acute pancreatitis. Clin. Gastroenterol. Hepatol. 2016. Vol. 14. P. 738–746.
2. Alexandre M., Pandol S. J., Gorelick F. S., Thrower E. C. The emerging role of smoking in the development of pancreatitis. Pancreatology. 2011. Vol. 11. P. 469–474.
3. Banks P. A. Epidemiology, natural history, and predictors of disease outcome in acute and chronic pancreatitis. Gastrointest. Endosc. 2002. Vol. 56. P. S226–230.
4. Banks P. A., Bollen T. L., Dervenis C., Gooszen H. G., Johnson C. D., Sarr M. G., Tsiotos G. G., Vege S. S., Acute Pancreatitis Classification Working Group. Classification of acute pancreatitis — 2012: revision of the Atlanta classification and definitions by international consensus. Gut. 2013. Vol. 62. P. 102–111.
5. Beyer G., Mahajan U. M., Budde C., Bulla T. J., Kohlmann T., Kuhlmann L., Schütte K., Aghdassi A. A., Weber E., Weiss F. U., Drewes A. M., Olesen S. S., Lerch M. M., Mayerle J. Development and validation of a chronic pancreatitis prognosis score in 2 independent cohorts. Gastroenterology. 2017. Vol. 153. P. 1544–1554.e2.
6. Centers for Disease Control and Prevention (CDC). Smoking-attributable mortality, years of potential life lost, and productivity losses — United States, 2000–2004. MMWR Morb. Mortal. Wkly Rep. 2008. Vol. 57. P. 1226–1228.
7. Cheng C. L., Kao Y. H., Lin S. J., Lee C. H., Lai M. L. Validation of the National Health Insurance Research Database with ischemic stroke cases in Taiwan. Pharmacoepidemiol. Drug Saf. 2011. Vol. 20. P. 236–242.
8. Cheng C. L., Lee C. H., Chen P. S., Li Y. H., Lin S. J., Yang Y. H. Validation of acute myocardial infarction cases in the national health insurance research database in Taiwan. J. Epidemiol. 2014. Vol. 24. P. 500–507.
9. Deyo R. A., Cherkin D. C., Ciol M. A. Adapting a clinical comorbidity index for use with ICD-9-CM administrative databases. J. Clin. Epidemiol. 1992. Vol. 45. P. 613–619.
10. Di Leo M., Leandro G., Singh S. K., Mariani A., Bianco M., Zuppardo R. A., Goni E., Rogger T. M., Di Mario F., Guslandi M., De Cobelli F., Del Maschio A., Testoni P. A., Cavestro G. M. Low alcohol and cigarette use is associated to the risk of developing chronic pancreatitis. Pancreas. 2017. Vol. 46. P. 225–229.
11. Etemad B., Whitcomb D. C. Chronic pancreatitis: diagnosis, classification, and new genetic developments. Gastroenterology. 2001. Vol. 120. P. 682–707.
12. Garg P. K. Chronic pancreatitis in India and Asia. Curr. Gastroenterol. Rep. 2012. Vol. 14. P. 118–124.
13. Hartwig W., Werner J., Ryschich E., Mayer H., Schmidt J., Gebhard M. M., Herfarth C., Klar E. Cigarette smoke enhances ethanol-induced pancreatic injury. Pancreas. 2000. Vol. 21. P. 272–278.
14. Henfling P. A., Lowry L. W. Nursing shortage. Catalyst for administrative/educational partnership. J. Nurs. Staff Dev. 1990. Vol. 6. P. 121–125.
15. Hsu T. W., Liu J. S., Hung S. C., Kuo K. L., Chang Y. K., Chen Y. C., Hsu C. C., Tarng D. C. Renoprotective effect of renin-angiotensin- aldosterone system blockade in patients with predialysis advanced chronic kidney disease, hypertension, and anemia. JAMA Intern Med. 2014. Vol. 174. P. 347–354.
16. Ito T., Ishiguro H., Ohara H., Kamisawa T., Sakagami J., Sata N., Takeyama Y., Hirota M., Miyakawa H., Igarashi H., Lee L., Fujiyama T., Hijioka M., Ueda K., Tachibana Y., Sogame Y., Yasuda H., Kato R., Kataoka K., Shiratori K., Sugiyama M., Okazaki K., Kawa S., Tando Y., Kinoshita Y., Watanabe M., Shimosegawa T. Evidence-based clinical practice guidelines for chronic pancreatitis 2015. J. Gastroenterol.2016. Vol. 51. P. 85–92.
17. Keim V. Role of genetic disorders in acute recurrent pancreatitis. World J. Gastroenterol. 2008. Vol.14. P. 1011–1015.
18. Lai S. W., Muo C. H., Liao K. F., Sung F. C., Chen P. C. Risk of acute pancreatitis in type 2 diabetes and risk reduction on anti¬diabetic drugs: a population-based cohort study in Taiwan. Am. J. Gastroenterol. 2011. Vol. 106. P. 1697–1704.
19. Lankisch P. G., Breuer N., Bruns A., Weber-Dany B., Lowenfels A. B., Maisonneuve P. Natural history of acute pancreatitis: a long-term population-based study. Am. J. Gastroenterol. 2009. Vol. 104. P. 2797–2805; quiz 2806.
20. Layer P., Yamamoto H., Kalthoff L., Clain J. E., Bakken L. J., DiMagno E. P. The different courses of early- and late-onset idiopathic and alcoholic chronic pancreatitis. Gastroenterology. 1994. Vol. 107. P. 1481–1487.
21. Lin H. Y., Lai J. I., Lai Y. C., Lin P. C., Chang S. C., Tang G. J. Acute renal failure in severe pancreatitis: a population-based study. Ups. J. Med. Sci. 2011. Vol. 116. P. 155–159.
22. Lowenfels A. B., Maisonneuve P., Cavallini G., Ammann R. W., Lankisch P. G., Andersen J. R., Dimagno E. P., Andren-Sandberg A., Domellof L. Pancreatitis and the risk of pancreatic cancer. International Pancreatitis Study Group. N. Engl. J. Med. 1993. Vol. 328. P. 1433–1437.
23. Maisonneuve P., Lowenfels A. B., Mullhaupt B., Cavallini G., Lankisch P. G., Andersen J. R., Dimagno E. P., Andren-Sandberg A., Domellof L., Frulloni L., Ammann R. W. Cigarette smoking accelerates progression of alcoholic chronic pancreatitis. Gut. 2005. Vol. 54. P. 510–514.
24. Nejgaard C., Becker U., Matzen P., Andersen J. R., Holst C., Bendtsen F. Progression from acute to chronic pancreatitis: prognostic factors, mortality, and natural course. Pancreas. 2011. Vol. 40. P. 1195–1200.
25. Polonikov A. V., Samgina T. A., Nazarenko P. M., Bushueva O. Y., Ivanov V. P. Alcohol consumption and cigarette smoking are important modifiers of the association between acute pancreatitis and the PRSS1-PRSS2 locus in men. Pancreas. 2017. Vol. 46. P. 230–236.
26. Quan H., Parsons G. A., Ghali W. A. Validity of information on comorbidity derived from ICD-9-CCM administrative data. Med. Care. 2002. Vol. 40. P. 675–685.
27. Sankaran S. J., Xiao A. Y., Wu L. M., Windsor J. A., Forsmark C. E., Petrov M. S. Frequency of progression from acute to chronic pancreatitis and risk factors: a meta-analysis. Gastroenterology. 2015. Vol. 149. P. 1490–1500.e1.
28. Sekimoto M., Takada T., Kawarada Y., Hirata K., Mayumi T., Yoshida M., Hirota M., Kimura Y., Takeda K., Isaji S., Koizumi M., Otsuki M., Matsuno S., JPN. JPN Guidelines for the management of acute pancreatitis: epidemiology, etiology, natural history, and outcome predictors in acute pancreatitis. J. Hepatobiliary Pancreat Surg. 2006. Vol. 13. P. 10–24.
29. Shen H. N., Lu C. L. Incidence, resource use, and outcome of acute based study in Taiwan. Pancreas. 2011. Vol. 40. P. 10–15.
30. Shen H. N., Lu C. L., Li C. Y. Epidemiology of first-attack acute pancreatitis in Taiwan from 2000 through 2009: a nationwide population-based study. Pancreas. 2012. Vol. 41. P. 696–702.
31. Shen H. N., Yang C. C., Chang Y. H., Lu C. L., Li C. Y. Risk of diabetes mellitus after first-attack acute pancreatitis: a national population-based study. Am. J. Gastroenterol. 2015. Vol. 110. P. 1698–1706.
32. Wang L. W., Li Z. S., Li S. D., Jin Z. D., Zou D. W., Chen F. Prevalence and clinical features of chronic pancreatitis in China: a retrospective multicenter analysis over 10 years. Pancreas. 2009. Vol. 38. P. 248–254.
33. Wang W., Sun X. T., Weng X. L., Zhou D. Z., Sun C., Xia T., Hu L. H., Lai X. W., Ye B., Liu M. Y., Jiang F., Gao J., Bo L. M., Liu Y., Liao Z., Li Z. S. Comprehensive screening for PRSS1, SPINK1, CFTR, CTRC and CLDN2 gene mutations in Chinese paediatric patients with idiopathic chronic pancreatitis: a cohort study. BMJ Open 2013. Vol. 3. P. e003150.
34. Whitlock T. L., Tignor A., Webster E. M., Repas K., Conwell D., Banks P. A., Wu B. U. A scoring system to predict readmission of patients with acute pancreatitis to the hospital within thirty days of discharge. Clin. Gastroenterol. Hepatol. 2011. Vol. 9. P. 175–180; quiz e18.
35. Wittel U. A., Singh A. P., Henley B. J., Andrianifahanana M., Akhter M. P., Cullen D. M., Batra S. K. Cigarette smoke-induced differential expression of the genes involved in exocrine function of the rat pancreas. Pancreas. 2006. Vol. 33. P. 364–370.
36. Yadav D., Hawes R. H., Brand R. E., Anderson M. A., Money M. E., Banks P. A., Bishop M. D., Baillie J., Sherman S., DiSario J., Burton F. R., Gardner T. B., Amann S. T., Gelrud A., Lawrence C., Elinoff B., Greer J. B., O’Connell M., Barmada M. M., Slivka A., Whitcomb D. C., North American Pancreatic Study Group. Alcohol consumption, cigarette. Intern. Med. 2009. Vol. 169. P. 1035–1045.
37. Yadav D., Slivka A., Sherman S., Hawes R. H., Anderson M. A., Burton F. R., Brand R. E., Lewis M. D., Gardner T. B., Gelrud A., Disario J., Amann S. T., Baillie J., Lawrence C., O’Connell M., Lowenfels A. B., Banks P. A., Whitcomb D. C. Smoking is underrecognized as a risk factor for chronic pancreatitis. Pancreatology. 2010. Vol. 10. P. 713–719.
38. Yamabe A., Irisawa A., Shibukawa G., Sato A., Fujisawa M., Arakawa N., Yoshida Y., Abe Y., Igarashi R., Maki T., Yamamoto S. Early diagnosis of chronic pancreatitis: understanding the factors associated with the development of chronic pancreatitis. Fukushima J. Med. Sci. 2017. Vol. 63. P. 1–7.