Award: Fellows-in-Training Award (Biliary/Pancreas Category)
Award: Presidential Poster Award
Amandeep Singh, MD1, Mohamed Tausif Siddiqui, MD2, Rajat Garg, MD2, Pravallika Chadalavada, MD2, Wael Al Yaman, MD2, Donald F. Kirby, MD, FACG, CNSC, CPNS2, Tyler Stevens, MD2, Prabhleen Chahal, MD2; 1Cleveland Clinic, Cleveland, OH; 2Cleveland Clinic Foundation, Cleveland, OH
Introduction: Acute pancreatitis (AP) is a condition of high metabolic stress and presence of malnutrition can worsen this condition leading to various complications. However, data are lacking on this particular matter. We aimed to assess the prevalence and outcomes of malnutrition in patients with AP. Methods: Using ICD- 9 codes all patients with the diagnosis of AP between 2005-2014 were identified from National Inpatient Sample (NIS) database. Malnutrition was identified and degree of malnutrition was assessed using ICD-9 codes. Unadjusted and adjusted analyses were performed to assess overall mortality associated with malnutrition, its impact on hospitalization cost and length of stay, use of total parenteral nutrition (TPN) and its impact on mortality. Results: A total of 2,593,832 patients were admitted between 2005-2014 with the diagnosis of AP and 4.2% (n=109,113) had malnutrition. Severe malnutrition was present in 14.2%, moderate in 10.0%; mild n 5.0% and 70.7% had unspecified degree of malnutrition. Alcohol abuse was not associated with any difference in the patterns of malnutrition in patients with AP. Compared to patients without malnutrition in-hospital mortality in AP with malnutrition was more than 4-fold higher (0.8% vs. 3.5%, p< 0.05). Out of 109,113 malnourished AP patients 19.95% (n=21,776) received TPN during their in-patient hospitalization. After adjusting for confounding effects of age, gender, race, primary payer/insurance status, hospital factors (region, location/teaching status, hospital bed size) and all of the Elixhauser comorbidities except weight loss in-hospital mortality associated with TPN use in AP patients was more than time 2-times higher than in patients who did not receive TPN (adjusted odd ratio [aOR]: 2.195, p< 0.01). Compared to patients with no malnutrition, mean LOS and cost of hospitalization increased with severity of malnutrition. In AP patients with severe malnutrition, compared to AP with no malnutrition LOS was ~3 fold (15.38 vs. 5.04 days, p< 0.01) and cost of hospitalization ($33,210 vs. $8, 803, p< 0.01) was 3.7-fold higher. Discussion: Our study suggests that in patients with AP, presence of malnutrition increases the in-hospital mortality by 4-fold, LOS by ~ 3 fold and hospitalization cost by 3.7 times than in AP without any malnutrition. TPN use in these patients was also associated with increased in-hospital mortality.
Disclosures: Amandeep Singh indicated no relevant financial relationships. Mohamed Tausif Siddiqui indicated no relevant financial relationships. Rajat Garg indicated no relevant financial relationships. Pravallika Chadalavada indicated no relevant financial relationships. Wael Al Yaman indicated no relevant financial relationships. Donald Kirby indicated no relevant financial relationships. Tyler Stevens indicated no relevant financial relationships. Prabhleen Chahal indicated no relevant financial relationships.