The Impact of Chronic Pancreatitis Etiology on Clinical Outcomes: A Population-Based Propensity-Matched Analysis

Abstract

Background: Chronic pancreatitis (CP) is a complex disease with various underlying etiologies, including alcohol consumption, smoking, autoimmune disorders, genetic predispositions, and other less common causes. Despite extensive research, the impact of these different etiologies on disease progression, complication rates, and long-term outcomes remains insufficiently understood. In particular, the distinction between alcohol-related chronic pancreatitis (ARCP) and non-alcohol-related chronic pancreatitis (NARCP) is not well established in terms of prognosis and therapeutic needs. Methods: We conducted a retrospective cohort study utilizing the TriNetX US Collaborative Network to compare baseline characteristics and clinical outcomes of ARCP versus NARCP. Propensity score matching (PSM) was applied to balance baseline characteristics between both cohorts. Primary outcome was mortality, while secondary outcomes included exocrine pancreatic insufficiency (EPI), pseudocyst formation, development of diabetes and pancreatic cancer, and need for endoscopic retrograde cholangiopancreatography (ERCP) and celiac plexus injection. Results: A total of 203,432 patients with CP were identified, including 11,696 ARCP and 200,560 with NARCP. After PSM (11,678 per group), ARCP was associated with significantly lower rates of mortality (13.0% vs. 16.2%; risk ratio (RR) 0.80), diabetes (22.9% vs. 35.8%; RR 0.64), exocrine pancreatic insufficiency (2.0% vs. 6.1%; RR 0.32), pancreatic cancer (1.1% vs. 8.4%; RR 0.14), and pseudocyst formation (7.1% vs. 9.7%; RR 0.73) compared to NARCP (all P < 0.001). ARCP patients also had lower rates of celiac plexus injection (0.1% vs. 0.8%; RR 0.12) and ERCP (2.3% vs. 10.2%; RR 0.23) (both P < 0.001). Conclusion: In this large, retrospective cohort study, patients with ARCP demonstrated lower rates of mortality, complications, and need for interventions compared to those with NARCP. These findings highlight potential differences in disease progression and clinical management between ARCP and NARCP. Further studies are needed to elucidate underlying mechanisms contributing to these disparities and to refine patient-specific treatment approaches.