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©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
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
ARTICLE HIGHLIGHTS
Research background
Heavy alcohol use is a known cause of liver and pancreatic injury that can lead to alcohol-related liver cirrhosis (ALC) and alcohol-related chronic pancreatitis (ACP). These diseases are associated with significant morbidity, mortality, and healthcare utilization and spending.
Research motivation
While both ALC and ACP are well-characterized, there is a subset of patient with both ALC and ACP (coexistent disease) that is poorly understood.
Research objectives
We aim to characterize the clinical profile of patients with coexistent disease (CD) and its differences from those with ALC Only or ACP Only.
Research methods
The study population consisted of adult patient encounters at UPMC facilities from 2006 to 2017 with more than 12 mo of contact. We identified subsets of patients with ACP Only, ALC Only, and CD based on international classifications of diseases codes and reviewed the Electronic Health Record to verify diagnoses and abstract clinical information. Statistical comparisons were made using t-test and Kruskal-Wallis test for continuous variables and chi-square tests for categorical variables. Survival from time of first diagnosis is reported using the Kaplan-Meier method. Cox proportional-hazards models are used to report the hazard ratio and 95% confidence intervals while adjusting for age at diagnosis, sex, and race.
Research results
The median duration of contact was greater than 10 years and was comparable between groups. The median number of non-elective hospital admissions for CD and ACP Only were comparable and significantly greater than patients with ALC Only. The number of patients who died in follow-up in CD, ALC Only, and ACP Only groups was 80 (60%), 82 (61%), and 36 (41%). Using Cox regression, survival was similar between ALC Only vs ACP Only and CD vs ACP Only. Despite comparable MELD-Na and Child-Pugh scores between CD and ALC Only patients, those with ALC Only were more likely to have esophageal varices, need for variceal banding, treatment with beta blockers, and hepatocellular carcinoma. Patients with ACP Only were more likely to have acute pancreatitis, need for endoscopic or surgical intervention, and endocrine dysfunction.
Research conclusions
Patients with CD did not have a worse phenotype compared to patients with ACP Only or ALC Only.
Research perspectives
As the largest study of its kind, this work hopes to characterize patients at the intersection of ALC and ACP. Given our findings, we observed that the dominant phenotype in CD is similar to that of ALC Only, suggesting that patients with alcohol-related pancreatic disease who are newly identified to have alcohol-related liver disease should be closely monitored for liver cirrhosis and its complications.
