P1456 - Progression from Recurrent Acute to Chronic Pancreatitis During Long-Term Follow-Up of Up to 22 Years in a Well-Defined North American Cohort

Award: Presidential Poster Award

Vu Dinh, MD, PhD¹, Ravy Vajravelu, MD, MSCE², Chaeryon Kang, PhD², Melissa Saul, MS², Anna Phillips, MD, MS³, Randall Brand, MD³, Adam Slivka, MD, PhD³, David Whitcomb, MD, PhD³, Dhiraj Yadav, MD, MPH^3
1University of Pittsburgh Medical Center, Cranberry Township, PA; ²University of Pittsburgh, Pittsburgh, PA; ³University of Pittsburgh Medical Center, Pittsburgh, PA

Introduction: According to the mechanistic definition, in the disease continuum from acute (AP) to chronic pancreatitis (CP), patients who experience recurrent acute pancreatitis (RAP) are a high-risk group. An accurate assessment of risk and factors associated with progression can inform primary and secondary prevention strategies for CP. We hypothesized that demographic, patient and disease-related factors affect the risk of incident CP.

Methods: We reviewed data for 195 RAP patients enrolled in the North American Pancreatitis Studies (NAPS2) from UPMC between 2000-2014 who had follow-up information available. Baseline data were retrieved from NAPS2 database while follow-up information was collected by review of electronic health records. The primary outcome of interest was a new diagnosis of CP (defined by any combination of pancreatic calcifications, moderate-severe pancreatic duct dilatation, stricture and/or atrophy). Censoring criteria included the date at first occurrence of either - diagnosis of CP, death, date of last contact or end of follow-up period (10/2022). We used multivariable Cox regression models with stepwise selection procedure to evaluate the impact of covariates of interest (demographics, patient and disease-related factors) on incident CP during follow-up.

Results: The mean age of patients at enrollment was 43.8±14.4 years, at first AP episode was 38.6±15.2 years, 48.3% were male, 88.2% were white, 29.7% were current smokers, 20.5% were current drinkers and 19.5% were diabetic. Physician-defined etiology included alcohol (22%), idiopathic (26.2%), genetic (14.4%) and other factors (37.4%). Prior endoscopic therapy or pancreatic surgery was noted in 30.8% and 5.6%, respectively. During a median of 12 years (interquartile range, IQR 8, 17; maximum 22), 46 (23.6%) progressed to CP (median time to diagnosis 4 years [IQR 1, 7]) (Figure 1). On multivariable regression (Table 1), the risk of CP was highest among patients aged 35-60 years at first AP diagnosis (vs. < 35 years and >60 years), in those with BMI 25-30 (vs. < 25 and >30), was higher in those with genetic etiology (vs. alcohol) and in those with pre-existing diabetes. No association was noted with current smoking and current drinking likely due to small sample sizes.

Discussion: Progression to CP is seen in up to 40% of patients with RAP during long-term follow-up. Several patient and disease-related factors are associated with disease progression.



Disclosures:


Vu Dinh, MD, PhD¹, Ravy Vajravelu, MD, MSCE², Chaeryon Kang, PhD², Melissa Saul, MS², Anna Phillips, MD, MS³, Randall Brand, MD³, Adam Slivka, MD, PhD³, David Whitcomb, MD, PhD³, Dhiraj Yadav, MD, MPH³. P1456 - Progression from Recurrent Acute to Chronic Pancreatitis During Long-Term Follow-Up of Up to 22 Years in a Well-Defined North American Cohort, ACG 2023 Annual Scientific Meeting Abstracts. Vancouver, BC, Canada: American College of Gastroenterology.