Risk factors and prediction score for chronic pancreatitis: A nationwide population-based cohort study

Table 1 Demographic characteristics of 3739 patients n (%)

	Total	Derivationcohort	Validation cohort	P value
Sample size	3739	2493	1246
Age, yr	53.04 ± 17	52.98 ± 17.08	53.18 ± 16.84	0.735
Gender, male	2400 (64.19)	1590 (63.78)	810 (65.01)	0.460
Monthly income, NTD	15423.5 ± 13018.5	15405.6 ± 13071.9	15459.1 ± 12916.2	0.906
Geographic location
Northern Taiwan	1619 (43.3)	1085 (43.52)	534 (42.86)	0.725
Central Taiwan	780 (20.86)	518 (20.78)	262 (21.03)	0.893
Southern Taiwan	1183 (31.64)	790 (31.69)	393 (31.54)	0.957
Eastern Taiwan and Islands	157 (4.2)	100 (4.01)	57 (4.57)	0.470
Charlson’s comorbidity index score	2.55 ± 2.21	2.56 ± 2.22	2.52 ± 2.19	0.574
Comorbidities
Obesity	17 (0.45)	11 (0.44)	6 (0.48)	0.863
Hypertension	1456 (38.94)	984 (39.47)	472 (37.88)	0.348
Hyperlipidemia	1048 (28.03)	698 (28)	350 (28.09)	0.953
Diabetes mellitus	994 (26.58)	658 (26.39)	336 (26.97)	0.709
Chronic kidney disease	498 (13.32)	332 (13.32)	166 (13.32)	0.996
Alcohol use-related codes	806 (21.56)	533 (21.38)	273(21.91)	0.710
Smoking related codes	1261 (33.73)	849 (34.06)	412 (33.07)	0.546
Long-term medication use
Statin	569 (15.22)	385 (15.44)	184 (14.77)	0.588
Angiotensin-converting enzyme inhibitor	472 (12.62)	327 (13.12)	145 (11.64)	0.199
Prednisolone	74 (1.98)	56 (2.25)	18 (1.44)	0.097
Hydrochlorothiazide	41 (1.1)	29 (1.16)	12 (0.96)	0.580
Sex hormone	180 (4.81)	129 (5.17)	51 (4.09)	0.145
Metformin	434 (11.61)	290 (11.63)	144 (11.56)	0.946
Number of episode RAP
1	2645 (70.74)	1769 (70.96)	876 (70.3)	0.707
2	599 (16.02)	403 (16.17)	196 (15.73)	0.768
3	234 (6.26)	153 (6.14)	81 (6.5)	0.718
≥ 4	261 (6.98)	168 (6.74)	93 (7.46)	0.452
Outcomes
Chronic pancreatitis	174 (4.65)	113 (4.53)	61 (4.90)	0.619
Follow-up duration, yr	6.13 ± 3.53	6.12 ± 3.52	6.17 ± 3.57	0.685

RAP: Recurrent acute pancreatitis; NTD: New Taiwan Dollars.

Table 2 Adjusted hazard ratio and 95% confidence interval for chronic pancreatitis associated with recurrent acute pancreatitis, smoking, comorbidities, and medication use

	Adjusted HRfull model (95%CI)	P value	Adjusted HRbackward model (95%CI)	P value	Adjusted HRbackward+episode (95%CI)	P value
Smoking related codes	1.57 (1.07, 2.32)	0.022	1.53 (1.04, 2.25)	0.029	1.48 (1.01, 2.17)	0.047
RAP	8.96 (5.37, 14.93)	< 0.001	8.65 (5.2, 14.38)	< 0.001
1 episode					1
2 episode					5.03 (2.75, 9.22)	< 0.001
3 episode					8.47 (4.36, 16.45)	< 0.001
> 3 episode					15.64 (8.91, 27.47)	< 0.001
Geographic location
Northern Taiwan	1
Central Taiwan	0.53 (0.28, 0.99)	0.047
Southern Taiwan	1.45 (0.94, 2.23)	0.090
Eastern Taiwan and Islands	1.2 (0.57, 2.53)	0.626
Age category
Age < 55	2.67 (1.35, 5.29)	0.005	2.43 (1.31, 4.49)	0.005	2.04 (1.06, 3.93)	0.033
Age ≥ 55	1		1		1
Gender, male	1.31 (0.72, 2.41)	0.381
Income	1.1 (0.86, 1.41)	0.440
CCI	0.96 (0.84, 1.1)	0.576
Hypertension	1.14 (0.7, 1.84)	0.601
Hyperlipidemia	0.82 (0.5, 1.35)	0.435
Diabetes mellitus	0.73 (0.39, 1.35)	0.314
Chronic kidney disease	1.64 (0.79, 3.39)	0.181
Alcohol use-related codes	3.06 (1.83, 5.12)	< 0.001	3.10 (1.96, 4.92)	< 0.001	2.66 (1.66, 4.25)	< 0.001
Statin	0.97 (0.43, 2.16)	0.937
Angiotensin-converting enzyme inhibitor	1.05 (0.42, 2.63)	0.922
Prednisolone	1.28 (0.28, 5.85)	0.751
Sex hormone	1.64 (0.52, 5.2)	0.398
Metformin	2.09 (0.83, 5.29)	0.120

RAP: Recurrent acute pancreatitis; HR: Hazard ratio; CI: Confidence interval; CCI: Charlson’s comorbidity index.

Table 3 Risk score for progression to chronic pancreatitis after acute pancreatitis

	Model coefficient	Risk factor point1
Risk Score 1
Smoking related codes	0.43	1
Age of onset < 55	0.89	2
Alcohol use-related codes	1.13	3
RAP (present or not)	2.16	5
Risk Score 2
Smoking related codes	0.39	1
Age of onset < 55	0.71	2
Alcohol use-related codes	0.98	3
Numbers of RAP
2 episode	1.62	4
3 episode	2.14	5
> 3 episode	2.75	7
	Total	13

¹Risk score was calculated by dividing each model coefficient by the smallest coefficient in the model and rounding the ratio to the integer. RAP: Recurrent acute pancreatitis.