Abstract
Study design
Retrospective cohort study.
Objective
To evaluate the risk of acute pancreatitis (AP) in persons with spinal cord injury (SCI) based on a nationally representative sample.
Setting
A retrospective cohort study using Taiwan’s National Health Insurance Research Database.
Methods
Drawing on Taiwan’s Longitudinal Health Insurance Database 2005, the researchers created an SCI group consisting of 2280 persons with SCI aged 20–74 years. Propensity-score matching was then used to generate a non-SCI group of 9120 participants with similar baseline characteristics to the SCI group. These two groups’ respective cumulative incidence of AP was compared, and the effect of SCI on AP risk was then assessed using stratified Cox proportional-hazards regression.
Results
For the SCI and non-SCI groups, the respective incidence rates of AP were 1.34 per 1000 person-years (95% confidence interval [CI], 0.83–2.05) and 0.79 per 1000 person-years (95% CI, 0.61–1.01). Compared with the non-SCI group, the hazard ratio of AP for the SCI group was 1.96 (95% CI 1.19–3.25, p = 0.0088); and the SCI group’s cumulative incidence of AP was significantly higher than that of the non-SCI group (p = 0.0227).
Conclusion
This population-based longitudinal follow-up study indicates that there is an increased long-term risk of AP in persons with SCI.
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Data availability
The datasets generated during and/or analyzed during the current study are not publicly available due to person’s health information privacy but are available from the corresponding author on reasonable request.
References
Ebert E. Gastrointestinal involvement in spinal cord injury: a clinical perspective. J Gastrointestin Liver Dis. 2012;21:75–82.
Bar OnZ, Orhy A. The acute abdomen in spinal cord injury individuals. Spinal Cord. 1995;33:704–6.
Boxhoorn L, Voermans RP, Bouwense SA, Bruno MJ, Verdonk RC, Boermeester MA, et al. Acute pancreatitis. Lancet (Lond, Engl). 2020;396:726–34.
Schepers NJ, Bakker OJ, Besselink MG, Ahmed Ali U, Bollen TL, Gooszen HG, et al. Impact of characteristics of organ failure and infected necrosis on mortality in necrotising pancreatitis. Gut. 2019;68:1044–51.
Nobel D, Baumberger M, Eser P, Michel D, Knecht H, Stocker R. Nontraumatic pancreatitis in spinal cord injury. Spine. 2002;27:228–32.
Carey ME, Nance FC, Kirgis HD, Young HF, Megison LC, Kline DG. Pancreatitis following spinal cord injury. J Neurosurg. 1977;47:917–22.
Brookhart MA, Wyss R, Layton JB, Stürmer T. Propensity score methods for confounding control in nonexperimental research. Circ Cardiovasc Qual Outcomes. 2013;6:604–11.
Saydah SH, Imperatore G, Beckles GL. Socioeconomic status and mortality: contribution of health care access and psychological distress among US adults with diagnosed diabetes. Diabetes Care. 2013;36:49–55.
Liu CY, Hung YT, Chuang YL, Chen YJ, Weng WS, Liu JS, et al. Incorporating development stratification of Taiwan townships into sampling design of large scale health interview survey. J Health Manag. 2006;4:1–22.
Wu CY, Chen YJ, Ho HJ, Hsu YC, Kuo KN, Wu MS, et al. Association between nucleoside analogues and risk of hepatitis B virus–related hepatocellular carcinoma recurrence following liver resection. JAMA. 2012;308:1906–13.
D’Agostino RB Jr. Propensity score methods for bias reduction in the comparison of a treatment to a non‐randomized control group. Stat Med. 1998;17:2265–81.
Parsons LS. Performing a 1:N case-control match on propensity score. In: Proceedings of the 29th Annual SAS Users Group International Conference, SAS Institute, 2004.
Mergener K, Baillie J. Fortnightly review. BMJ. 1998;316:44–8.
Popa C, Badiu D, Rusu O, Grigorean V, Neagu S, Strugaru C. Mortality prognostic factors in acute pancreatitis. J Med Life. 2016;9:413.
Pirolla E, de Barros Filho TE, Godoy-Santos A, Fregni F. Association of acute pancreatitis or high level of serum pancreatic enzymes in patients with acute spinal cord injury: a prospective study. Spinal cord. 2014;52:817–20.
Chen J, Thomas A, Woods C, Schloithe A, Toouli J, Saccone G. Sphincter of Oddi dysfunction produces acute pancreatitis in the possum. Gut. 2000;47:539–45.
Toouli J. The sphincter of Oddi and acute pancreatitis‐revisited. HPB. 2003;5:142–5.
Karlsson AK. Overview: Autonomic dysfunction in spinal cord injury: clinical presentation of symptoms and signs. Prog Brain Res. 2006;152:1–8.
Yadav D, Lowenfels AB. The epidemiology of pancreatitis and pancreatic cancer. Gastroenterology. 2013;144:1252–61.
Nino Murcia M, Burton D, Chang P, Stone J, Perkash I. Gallbladder contractility in patients with spinal cord injuries: a sonographic investigation. AJR Am J Roentgenol. 1990;154:521–4.
Xia CS, Yang XY, Hong GX. 99Tcm-DISIDA hepatobiliary imaging in evaluating gallbladder function in patients with spinal cord injury. Hepatobiliary Pancreat Dis Int. 2007;6:204–7.
Apstein MD, Dalecki Chipperfield K. Spinal cord injury is a risk factor for gallstone disease. Gastroenterology. 1987;92:966–8.
v Linstow M, Biering-Sørensen F. Immobilisation-induced hypercalcemia following spinal cord injury affecting the kidney function in two young native Greenlanders. Spinal Cord Ser Cases. 2017;3:1–2.
Tori J, Hill L. Hypercalcemia in children with spinal cord injury. Arch Phys Med Rehabil. 1978;59:443.
Shen HN, Lu CL, Li CY. Epidemiology of first-attack acute pancreatitis in Taiwan from 2000 through 2009: a nationwide population-based study. Pancreas. 2012;41:696–702.
Yadav D, Lowenfels AB. Trends in the epidemiology of the first attack of acute pancreatitis: a systematic review. Pancreas. 2006;33:323–30.
Lowenfels AB, Maisonneuve P, Sullivan T. The changing character of acute pancreatitis: epidemiology, etiology, and prognosis. Curr Gastroenterol Rep. 2009;11:97–103.
Miller BJ, Geraghty TJ, Wong C, Hall DF, Cohen JR. Outcome of the acute abdomen in patients with previous spinal cord injury. ANZ J Surg. 2001;71:407–11.
Eldahan KC, Rabchevsky AG. Autonomic dysreflexia after spinal cord injury: systemic pathophysiology and methods of management. Auton Neurosci. 2018;209:59–70.
Hsieh CY, Su CC, Shao SC, Sung SF, Lin SJ, Kao Yang YH, et al. Taiwan’s National Health Insurance Research Database: past and future. Clin Epidemiol. 2019;11:349–58.
Irving HM, Samokhvalov AV, Rehm J. Alcohol as a risk factor for pancreatitis. A systematic review and meta-analysis. JOP. 2009;10:387.
Majumder S, Gierisch JM, Bastian LA. The association of smoking and acute pancreatitis: a systematic review and meta-analysis. Pancreas. 2015;44:540–6.
Sadr Azodi O, Andrén Sandberg Å, Orsini N, Wolk A. Cigarette smoking, smoking cessation and acute pancreatitis: a prospective population-based study. Gut. 2012;61:262–7.
Vij N, Chandramani-Shivalingappa P, Van Westphal C, Hole R, Bodas M. Cigarette smoke-induced autophagy impairment accelerates lung aging, COPD-emphysema exacerbations and pathogenesis. Am J Physiol Cell Physiol. 2018;314:73–87.
Kim EJ, Yoon SJ, Kim YE, Go DS, Jung Y. Effects of aging and smoking duration on cigarette smoke-induced COPD severity. J Korean Med Sci. 2018;34:e90.
Funding
This work was supported by grant MOST 109-2314-B-002-117 from the Ministry of Science and Technology, Executive Yuan, Republic of China.
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WTH participated in conception and design, drafting the article, analysis and interpretation of data, and revising the text critically for major intellectual content and final approval. KCY participated in acquisition, analysis, and interpretation of data. SLP participated in conception and design, analysis and interpretation of data, revising the text critically for major intellectual content and final approval, and taking responsibility for the integrity of the work.
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This study was approved by the National Taiwan University Hospital Research Ethics Committee. (Reference number: 201912207RIND).
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Ho, WT., Yeh, KC. & Pan, SL. Increased risk of acute pancreatitis in persons with spinal cord injury: a population-based, propensity score-matched longitudinal follow-up study. Spinal Cord 59, 1170–1176 (2021). https://doi.org/10.1038/s41393-021-00643-3
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DOI: https://doi.org/10.1038/s41393-021-00643-3
