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Selin D, Maret-Ouda J, Oskarsson V, Lindblad M, Arnelo U, Holmberg M, Yang B, Sema K, Nilsson M, Sadr-Azodi O. Exploring the association between acute pancreatitis and biliary tract cancer: A large-scale population-based matched cohort study. United European Gastroenterol J 2024. [PMID: 38581617 DOI: 10.1002/ueg2.12567] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2023] [Accepted: 03/08/2024] [Indexed: 04/08/2024] Open
Abstract
BACKGROUND Biliary tract cancer (BTC) often goes undetected until its advanced stages, resulting in a poor prognosis. Given the anatomical closeness of the gallbladder and bile ducts to the pancreas, the inflammatory processes triggered by acute pancreatitis might increase the risk of BTC. OBJECTIVE To assess the association between acute pancreatitis and the risk of BTC. METHODS Using the Swedish Pancreatitis Cohort (SwePan), we compared the BTC risk in patients with a first-time episode of acute pancreatitis during 1990-2018 to a 1:10 matched pancreatitis-free control group. Multivariable Cox regression models, stratified by follow-up duration, were used to calculate hazard ratios (HRs), adjusting for socioeconomic factors, alcohol use, and comorbidities. RESULTS BTC developed in 0.94% of 85,027 acute pancreatitis patients and in 0.23% of 814,993 controls. The BTC risk notably increased within 3 months of hospital discharge (HR 82.63; 95% CI: 63.07-108.26) and remained elevated beyond 10 years of follow-up (HR 1.82; 95% CI: 1.35-2.47). However, the long-term risk of BTC subtypes did not increase with anatomical proximity to the pancreas, with a null association for gallbladder and extrahepatic tumors. Importantly, patients with acute pancreatitis had a higher occurrence of early-stage BTC within 2 years of hospital discharge than controls (13.0 vs. 3.6%; p-value <0.01). CONCLUSION Our nationwide study found an elevated BTC risk in acute pancreatitis patients; however, the risk estimates for BTC subtypes were inconsistent, thereby questioning the causality of the association. Importantly, the amplified detection of early-stage BTC within 2 years after a diagnosis of acute pancreatitis underscores the necessity for proactive BTC surveillance in these patients.
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Affiliation(s)
- Daniel Selin
- Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
- Centre for Clinical Research Sörmland, Uppsala University, Eskilstuna, Sweden
- Department of Surgery, Eskilstuna County Hospital, Eskilstuna, Sweden
| | - John Maret-Ouda
- Centre for Clinical Research Sörmland, Uppsala University, Eskilstuna, Sweden
- Department of Surgery, Eskilstuna County Hospital, Eskilstuna, Sweden
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Viktor Oskarsson
- Department of Public Health and Clinical Medicine, Piteå Research Unit, Umeå University, Umeå, Sweden
| | - Mats Lindblad
- Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
- Department of Upper Abdominal Diseases, Karolinska University Hospital, Stockholm, Sweden
| | - Urban Arnelo
- Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
- Department of Surgical and Perioperative Sciences/Surgery, Umeå University, Umeå, Sweden
| | - Marcus Holmberg
- Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
- Unit of Upper Gastrointestinal Surgery, Saint Goran Hospital, Stockholm, Sweden
| | - Bei Yang
- Centre for Clinical Research Sörmland, Uppsala University, Eskilstuna, Sweden
| | - Kristiana Sema
- Department of Surgery, Eskilstuna County Hospital, Eskilstuna, Sweden
| | - Magnus Nilsson
- Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
- Unit of Upper Gastrointestinal Surgery, Saint Goran Hospital, Stockholm, Sweden
| | - Omid Sadr-Azodi
- Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
- Centre for Clinical Research Sörmland, Uppsala University, Eskilstuna, Sweden
- Unit of Upper Gastrointestinal Surgery, Saint Goran Hospital, Stockholm, Sweden
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Schell CO, Wellhagen A, Lipcsey M, Kurland L, Bjurling-Sjöberg P, Stålsby Lundborg C, Castegren M, Baker T. The burden of critical illness among adults in a Swedish region-a population-based point-prevalence study. Eur J Med Res 2023; 28:322. [PMID: 37679836 PMCID: PMC10483802 DOI: 10.1186/s40001-023-01279-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Accepted: 08/09/2023] [Indexed: 09/09/2023] Open
Abstract
BACKGROUND Patients with critical illness have a high risk of mortality. Key decision-making in the health system affecting the outcomes of critically ill patients requires epidemiological evidence, but the burden of critical illness is largely unknown. This study aimed to estimate the prevalence of critical illness in a Swedish region. Secondary objectives were to estimate the proportion of hospital inpatients who are critically ill and to describe the in-hospital location of critically ill patients. METHODS A prospective, multi-center, population-based, point-prevalence study on specific days in 2017-2018. All adult (> 18 years) in-patients, regardless of admitting specially, in all acute hospitals in Sörmland, and the patients from Sörmland who had been referred to university hospitals, were included. Patients in the operating theatres, with a psychiatric cause of admission, women in active labor and moribund patients, were excluded. All participants were examined by trained data collectors. Critical illness was defined as "a state of ill health with vital organ dysfunction, a high risk of imminent death if care is not provided and a potential for reversibility". The presence of one or more severely deranged vital signs was used to classify critical illness. The prevalence of critical illness was calculated as the number of critically ill patients divided by the number of adults in the region. RESULTS A total of 1269 patients were included in the study. Median age was 74 years and 50% of patients were female. Critical illness was present in 133 patients, resulting in an adult population prevalence of critical illness per 100,000 people of 19.4 (95% CI 16.4-23.0). The proportion of patients in hospital who were critically ill was 10.5% (95% CI 8.8-12.3%). Among the critically ill, 125 [95% CI 94.0% (88.4-97.0%)] were cared for in general wards. CONCLUSIONS The prevalence of critical illness was higher than previous, indirect estimates. One in ten hospitalized patients were critically ill, the large majority of which were cared for in general wards. This suggests a hidden burden of critical illness of potential public health, health system and hospital management significance.
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Affiliation(s)
- Carl Otto Schell
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden.
- Centre for Clinical Research Sörmland, Uppsala University, Eskilstuna, Sweden.
- Department of Medicine, Nyköping Hospital, Sörmland Region, Nyköping, Sweden.
| | - Andreas Wellhagen
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
- Centre for Clinical Research Sörmland, Uppsala University, Eskilstuna, Sweden
- Department of Anaesthesia and Intensive Care, Nyköping Hospital, Sörmland Region, Nyköping, Sweden
| | - Miklós Lipcsey
- Department of Surgical Sciences, Anaesthesiology and Intensive Care, Uppsala University, Uppsala, Sweden
- Department of Surgical Sciences, Hedenstierna Laboratory, Uppsala University, Uppsala, Sweden
| | - Lisa Kurland
- School of Medical Sciences, Örebro University, Örebro, Sweden
- Department of Emergency Medicine, Örebro University, Örebro University Hospital, Örebro, Sweden
| | - Petronella Bjurling-Sjöberg
- Centre for Clinical Research Sörmland, Uppsala University, Eskilstuna, Sweden
- Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
- Department of Patient Safety, Region Sörmland, Eskilstuna, Sweden
| | | | - Markus Castegren
- Centre for Clinical Research Sörmland, Uppsala University, Eskilstuna, Sweden
- Perioperative Medicine and Intensive Care (PMI), Karolinska University Hospital, Stockholm, Sweden
- Department of Physiology and Pharmacology (FyFa), Karolinska Institutet, Stockholm, Sweden
| | - Tim Baker
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
- Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, UK
- Department of Emergency Medicine, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
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