David U. Lee, MD, Gregory H. Fan, BA, Raffi Karagozian, MD; Tufts Medical Center, Boston, MA
Introduction: There is a clinical overlap between acute pancreatitis and cirrhosis due to shared etiologies including alcohol use and other metabolic causes. However, despite this, there is relatively little knowledge about the effect of cirrhosis on the outcomes of patients hospitalized with acute pancreatitis. Methods: 2011-2017 National Inpatient Sample was used to select hospitalized patients with acute pancreatitis, who were further stratified according to the presence of cirrhosis. The endpoints included mortality, length of stay (LOS), hospitalization costs, and the pancreatitis-related events. Univariate and multivariate analyses were performed to identify the relationship between the variables. Results: There were total 571213 hospitalized patients with acute pancreatitis identified from the database. Of this, there were 25847 (4.52%) with inpatient diagnosis of cirrhosis. Compared to non-cirrhosis cohort, the cirrhosis cohort was older in age (54.1 vs 52.7y p< 0.01) and were more likely to be male (62.8 vs 50.5% p< 0.01). The mortality was higher in the cirrhosis cohort (5.81 vs 1.82% p< 0.01, OR 3.32 95%CI 3.14-3.51), as were the LOS (6.76 vs 5.65d p< 0.01) and hospitalization costs ($64,075 vs $52,541 p< 0.01). In terms of pancreatitis-related outcomes, the patients with cirrhosis had higher incidence of acute kidney injury (23.7 vs 15.0% p< 0.01, OR 1.76 95%CI 1.71-1.81), disseminated intravascular coagulation (0.99 vs 0.33% p< 0.01, OR 3 95%CI 2.63-3.42), abdominal compartment syndrome (0.16 vs 0.10% p< 0.01, OR 1.57 95%CI 1.14-2.16), acute intestinal ischemia/thrombosis (0.43 vs 0.34% p=0.02, OR 1.27 95%CI 1.05-1.54), acidosis (13.9 vs 7.74% p< 0.01, OR 1.92 95%CI 1.85-1.99), hypocalcemia (3.49 vs 2.60% p< 0.01, OR 1.36 95%CI 1.27-1.45), and sepsis (11.2 vs 7.10% p< 0.01, OR 1.65 95%CI 1.59-1.72). However, no difference was found in the incidence of pseudocyst (5.65 vs 5.50% p=0.32, OR 1.03, 95%CI 0.97-1.09) and the rate of ileus was lower in cirrhosis cohort (3.26 vs 3.69% p< 0.01, OR 0.88 95%CI 0.82-0.94). In a multivariate analysis, the presence of cirrhosis was associated with increased hospital mortality (p< 0.01, aOR 1.47 95%CI 1.34-1.61). Discussion: In hospitalized patients with acute pancreatitis, cirrhosis increases the risk of hospital mortality and pancreatitis-related complications. Alongside standard treatment of pancreatitis, these patients require multidisciplinary management of thrombotic, hemorrhagic, metabolic, and infectious complications of acute pancreatitis.
Multivariate model: cirrhosis is associated with increased hospital mortality in patients with acute pancreatitis
Disclosures: David Lee indicated no relevant financial relationships. Gregory Fan indicated no relevant financial relationships. Raffi Karagozian indicated no relevant financial relationships.