Retrospective Study
Copyright ©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Hepatol. Mar 27, 2023; 15(3): 431-440
Published online Mar 27, 2023. doi: 10.4254/wjh.v15.i3.431
Coexistent alcohol-related cirrhosis and chronic pancreatitis have a comparable phenotype to either disease alone: A comparative retrospective analysis
Michael Lu, Yujie Sun, Robert Feldman, Melissa Saul, Andrew Althouse, Gavin Arteel, Dhiraj Yadav
Michael Lu, Yujie Sun, Melissa Saul, Department of Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA 15213, United States
Robert Feldman, Andrew Althouse, Department of Medicine, Center for Research on Health Care Data, Pittsburgh, PA 15213, United States
Gavin Arteel, Division of Gastroenterology, Hepatology, and Nutrition, University of Pittsburgh Medical Center, Pittsburgh, PA 15213, United States
Dhiraj Yadav, Department of Medicine, Division of Gastroenterology, Hepatology and Nutrition, University of Pittsburgh Medical Center, Pittsburgh, PA 15213, United States
Author contributions: Yadav D designed the research, contributed to the analysis and wrote the paper; Lu M, Sun Y performed the research, contributed to the analysis and wrote the paper; Arteel G contributed to the design of the study and provided clinical advice; Saul M retrieved patient information from UPMC databases, Feldman R, Althouse A performed the research and statistical analysis. All authors reviewed and approved the final version of the manuscript.
Institutional review board statement: This study was reviewed and approved by the Institutional Review Board of the University of Pittsburgh (STUDY 20100015).
Informed consent statement: We obtained a waiver of informed consent since the research represents no more than minimal risk of harm to subjects and involves no procedures for which written consent is normally required outside of the research context.
Conflict-of-interest statement: All the authors declare that they have no conflict of interest.
Data sharing statement: The dataset for this study is available from the corresponding author on reasonable request and fulfilment of regulatory requirements.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Dhiraj Yadav, MD, Full Professor, Department of Medicine, Division of Gastroenterology, Hepatology and Nutrition, University of Pittsburgh Medical Center, 200 Lothrop Street, M2, C-Wing, Pittsburgh, PA 15213, United States. yadavd@upmc.edu
Received: December 7, 2022
Peer-review started: December 7, 2022
First decision: December 19, 2022
Revised: February 3, 2023
Accepted: March 9, 2023
Article in press: March 9, 2023
Published online: March 27, 2023
Abstract
BACKGROUND

Alcohol use disorder is a prevalent disease in the United States. It is a well-demonstrated cause of recurrent and long-standing liver and pancreatic injury which can lead to alcohol-related liver cirrhosis (ALC) and chronic pancreatitis (ACP). ALC and ACP are associated with significant healthcare utilization, cost burden, and mortality. The prevalence of coexistent disease (CD) ranges widely in the literature and the intersection between ALC and ACP is inconsistently characterized. As such, the clinical profile of coexistent ALC and ACP remains poorly understood. We hypothesized that patients with CD have a worse phenotype when compared to single organ disease.

AIM

To compare the clinical profile and outcomes of patients with CD from those with ALC or ACP Only.

METHODS

In this retrospective comparative analysis, we reviewed international classification of disease 9/10 codes and electronic health records of adult patients with verified ALC Only (n = 135), ACP Only (n = 87), and CD (n = 133) who received care at UPMC Presbyterian-Shadyside Hospital. ALC was defined by histology, imaging or clinical evidence of cirrhosis or hepatic decompensation. ACP was defined by imaging findings of pancreatic calcifications, moderate-severe pancreatic duct dilatation, irregularity or atrophy. We compared demographics, pertinent clinical variables, healthcare utilization, and mortality for patients with CD with those who had single organ disease.

RESULTS

Compared to CD or ACP Only, patients with ALC Only were more likely to be older, Caucasian, have higher body mass index, and Hepatitis B or C infection. CD patients (vs ALC Only) were less likely to have imaging evidence of cirrhosis and portal hypertension despite possessing similar MELD-Na and Child C scores at the most recent contact. CD patients (vs ACP Only) were less likely to have acute or recurrent acute pancreatitis, diabetes mellitus, insulin use, oral pancreatic enzyme therapy, and need for endoscopic therapy or pancreatic surgery. The number of hospitalizations in patients with CD were similar to ACP Only but significantly higher than ALC Only. The overall mortality in patients with CD was similar to ALC Only but trended to be higher than ACP Only (P = 0.10).

CONCLUSION

CD does not have a worse phenotype compared with single organ disease. The dominant phenotype in CD is similar to ALC Only which should be the focus in longitudinal follow-up.

Keywords: Alcohol, Cirrhosis, Chronic pancreatitis, Overlap, Phenotype

Core Tip: Patients with coexistent alcohol-related cirrhosis and alcohol-related chronic pancreatitis do not have a worse phenotype when compared with single organ disease patients. The dominant phenotype in patients with coexistent disease (CD) in terms of overall survival and markers of advanced liver disease was similar to patients with Alcohol-related Cirrhosis Only. Coexistent disease patients also had lower prevalence of disease-related manifestations when compared with those who had single organ disease. Patients with CD may not need to be monitored at a higher degree, but the primary focus for longitudinal follow-up should be on alcohol-related cirrhosis.