Increased Risk of Mortality Associated With Pancreatic Exocrine Insufficiency in Patients With Chronic Pancreatitis

<jats:sec> <jats:title>Background:</jats:title> <jats:p>Pancreatic exocrine insufficiency (PEI) is a common serious complication in chronic pancreatitis (CP); however, little is known about its effect on mortality in these patients. In this study, we assessed the mortality risk of PEI in patients with CP.</jats:p> </jats:sec> <jats:sec> <jats:title>Study:</jats:title> <jats:p>A prospective, longitudinal cohort study conducted in patients with CP under long-term follow-up. CP and PEI were diagnosed using pancreatic imaging and the <jats:sup>13</jats:sup>C-labeled mixed triglyceride breath test, respectively. Multivariate analysis was performed to evaluate the impact of PEI and other clinical features on mortality risk.</jats:p> </jats:sec> <jats:sec> <jats:title>Results:</jats:title> <jats:p>Patients (N=430) were analyzed (79.1% male; mean age, 47.8 y) during a mean follow-up of 8.6±4.6 years. PEI prevalence was 29.3% and mortality was 10.9%. Most frequent causes of death were cancer (40.4%), infection (21.3%), and acute cardiovascular event (14.9%). Multivariate analyses showed associations between increased mortality and presence of PEI [hazard ratio (HR), 2.59; 95% confidence interval (CI), 1.42-4.71; <jats:italic toggle="yes">P</jats:italic><0.003], liver cirrhosis (HR, 3.87; 95% CI, 1.95-7.69; <jats:italic toggle="yes">P</jats:italic><0.001), age at diagnosis (HR, 1.05; 95% CI, 1.03-1.09; <jats:italic toggle="yes">P</jats:italic><0.001), toxic etiology of CP (HR, 3.11; 95% CI, 1.11-8.70; <jats:italic toggle="yes">P</jats:italic><0.05) and respiratory comorbidity (HR, 2.19; 95% CI, 1.12-4.31; <jats:italic toggle="yes">P</jats:italic><0.03). Nutritional markers were significantly lower in patients with PEI versus those without PEI (<jats:italic toggle="yes">P</jats:italic><0.001) and in those who died versus survivors (<jats:italic toggle="yes">P</jats:italic><0.001).</jats:p> </jats:sec> <jats:sec> <jats:title>Conclusions:</jats:title> <jats:p>PEI was a significant independent risk factor for mortality in patients with CP. These results support further research into the optimal treatment of PEI to reduce mortality in this population.</jats:p> </jats:sec>