Prognosis of Chronic Pancreatitis: An International Multicenter Study

Objectives: Tbe aim of this study was to determine which factors predict mortality in a cobort of patients with cbronic alcoholic and nonalcoholic pancreatitis. Patients with chronic pancreatitis are known to have a reduced life expectancy, but the quantitative relationship between various clinical features and survival is unclear. Methods: We evaluated survival among 2015 subjects with chronic pancreatitis treated at seven centers located in six countries. Results: Mean age at diagnosis was 46 ± 13 yr and mean duration of follow‐up was 7.4 ± 6.2 yr. Overall survival at 10 yr was 70% (95% confidence interval (CI), 68–73%) and at 20 yr was 45% (95% CI, 41–49%). Survival was significantly less than in the background population. There were 559 deaths observed among those with chronic pancreatitis compared with an expected number of 157.4, yielding a standardized mortality ratio (SMR) of 3.6 (95% CI, 3.3–3.9). Older subjects and those with alcoholic pancreatitis had a significant reduction in survival. In a mul‐tivariate analysis, mortality of middle‐aged and older subjects was 2.3 (95% CI, 1.8–2.8) and 6.3 (95% CI, 4.7–8.3) times greater than subjects less than 40 yr at diagnosis. Smoking (hazard ratio, 1.4; 95% CI, 1.0–1.9), drinking (hazard ratio, 1.6; 95% CI, 1.2–2.2), or development of cirrhosis (hazard ratio, 2.5; 95% CI, 2.0–3.2) increased the risk of death during the observation period, but we observed no survival difference in operated vs. nonoperated patients. Conclusions: Age at diagnosis, smoking, and drinking are major predictors of mortality in patients with chronic pancreatitis.