Risk factor analysis and nomogram development for steatorrhea in idiopathic chronic pancreatitis

Abstract

Objectives: Steatorrhea, a sign of severe pancreatic exocrine insufficiency (PEI), is related to consequences caused by pancreatitis. This study aimed to identify predictors and to construct a nomogram for steatorrhea in idiopathic chronic pancreatitis (ICP). Methods: ICP patients admitted to our hospital from January 2000 to December 2013 were enrolled in this retrospective-prospective cohort study and randomly assigned to the training and validation cohorts. The cumulative rate of steatorrhea was calculated. A Cox proportional hazard regression model was used to identify predictors for steatorrhea and construct the nomogram. Internal and external validation of the nomogram was then performed.Results: There were 1633 ICP patients enrolled, with a median follow-up duration of 9.8 years and 20.8% (339/1633) of patients developed steatorrhea following onset of ICP. Steatorrhea was observed in 93, 115, and 133 patients at 1, 3, and 5 years following diagnosis of CP, with a cumulative rate of 6.5% (95% confidence interval[CI] 5.1%-7.9%), 8.0% (95% CI 6.2%-9.8%), and 9.3% (95% CI 6.6%-12.0%), respectively. Male sex (hazard ratio [HR] 2.479, P < 0.001), diabetes mellitus at/before diagnosis of ICP (HR 2.274, P = 0.003), and aged less than 18 years at onset of ICP (HR 0.095, P < 0.001) were identified risk factors for steatorrhea. Initial

Evaluation and management of exocrine pancreatic insufficiency: pearls and pitfalls

“…Where available, more elaborate testing may be performed to increase the specificity of the result, such as the malabsorption blood test or 13 C -mixed triglyceride breath test [14,19 ▪▪ ,20–23]. Finally, clinical decision-support tools that do not rely on stool-based testing are being developed, but these require additional validation studies prior to widespread adoption [24,25].…”

Adherence to pancreatic enzyme replacement therapy among patients with chronic pancreatitis in East China: a mixed methods study

“…Steatorrhea occurs when pancreatic enzyme production decreases by more than 90% 7 . PEI is associated with maldigestion and significantly affects the absorption of protein, fat, micronutrients, and fat-soluble vitamins, resulting in nutritional deficiencies 8 , 9 , complications such as osteoporosis 10 , adverse cardiovascular events 11 , infections 12 and an increased risk of death 13 . Guidelines have recommended pancreatic enzyme replacement therapy (PERT) as the cornerstone and preferred treatment method for PEI to improve malabsorption and malnutrition and prevent their adverse outcomes in CP patients 14 , 15 .…”