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Risk factor analysis and nomogram development for steatorrhea in idiopathic chronic pancreatitis
Yu Liu1,2, Xiao Yi Yin3, Dan Wang2
1Department of Gastroenterology and Hepatology, Jinling Hospital, Medical School of Nanjing University, Nanjing, Jiangsu Province, China.
Insights
This study identified male sex, diabetes, and young age as key predictors for steatorrhea in idiopathic chronic pancreatitis (ICP). A predictive nomogram was developed to aid early diagnosis and management of pancreatic exocrine insufficiency (PEI).
Area of Science:
- Gastroenterology
- Clinical Prediction Modeling
- Pancreatic Diseases
Background:
- Steatorrhea is a significant indicator of pancreatic exocrine insufficiency (PEI), often linked to pancreatitis complications.
- Idiopathic chronic pancreatitis (ICP) presents challenges in predicting steatorrhea development.
- Early identification of steatorrhea risk is crucial for timely intervention.
Purpose of the Study:
- To identify predictors of steatorrhea in patients with idiopathic chronic pancreatitis (ICP).
- To develop and validate a nomogram for predicting steatorrhea risk in ICP patients.
- To facilitate early diagnosis and management of PEI.
Main Methods:
- A retrospective-prospective cohort study involving 1633 ICP patients.
- Patients were randomly assigned to training and validation cohorts.
- Cox proportional hazard regression model used to identify predictors and construct the nomogram.
Main Results:
- 20.8% of ICP patients developed steatorrhea over a median follow-up of 9.8 years.
- Key predictors identified: male sex (HR 2.479), diabetes mellitus at/before ICP diagnosis (HR 2.274), and age < 18 years at ICP onset (HR 0.095).
- The developed nomogram demonstrated good concordance for predicting steatorrhea.
Conclusions:
- Predictors for steatorrhea in ICP were identified, enabling the creation of a predictive nomogram.
- The nomogram can assist in identifying high-risk populations for closer follow-up.
- Early detection and treatment of PEI may be improved through the use of this predictive tool.
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 manifestations were associated with development of steatorrhea. The nomogram was proven to have good concordance indexes.
Conclusions:
We identified predictors and developed a nomogram for predicting steatorrhea in ICP. It was recommended that high-risk populations be followed up closely, which might contribute to the early diagnosis and treatment of PEI.
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