Baseline current smoking and time-varying recurrence risk after first-episode of hypertriglyceridemia-induced acute pancreatitis: A multicenter retrospective cohort study

Evidence on behavioral predictors of recurrence after first-episode of hypertriglyceridemia-induced acute pancreatitis (HTG-AP) is limited. We investigated the association between baseline current smoking status and post-discharge recurrence and whether this association varied over follow-up.

This multicenter retrospective cohort included patients with first-episode of HTG-AP hospitalized at three centers between January 2020 and March 2025. Smoking status was determined at the index hospitalization. Cox regression assessed time to first recurrence, and negative binomial regression assessed recurrence burden. Landmark and time-varying coefficient Cox models evaluated temporal variation in the association, with center-stratified and overlap-weighted analyses used for robustness.

Among 311 patients, 111 were baseline current smokers and 84 experienced recurrence. Baseline current smoking status was associated with a higher cumulative recurrence probability (log-rank P = 0.009), an increased hazard of first recurrence (HR 3.00, 95% CI 1.69-5.33; P < 0.001), and greater recurrence burden (IRR 3.69, 95% CI 1.79-7.63; P < 0.001). No significant multiplicative interaction was observed between current smoking and current alcohol consumption, with an adjusted interaction term HR of 1.60 (95% CI: 0.49-5.29, P = 0.439). Current alcohol consumption was not independently associated with recurrence (center-stratified HR 0.75, 95% CI 0.44-1.29; P = 0.303). Landmark analysis showed no significant association within 6 months, whereas the association was evident thereafter. The time-varying coefficient Cox model indicated that the association was not constant over follow-up, and overlap weighting showed greater between-group differences during mid-to long-term follow-up.

Baseline current smoking status was associated with higher recurrence risk and burden after first-episode of HTG-AP. The association appeared stronger during later follow-up, supporting its potential use as a simple behavioral marker for risk assessment and follow-up planning.