Resident Creighton University Arizona Health Education Alliance Phoenix, Arizona
Ishani Shah, MD1, Abhishek Bhurwal, MBBS, MD2, Harsh Mehta, MD3, Savio Reddymasu, MD4; 1St. Joseph's Hospital and Medical Center, Creighton University School of Medicine, Pheonix, AZ; 2Robert Wood Johnson Medical School, Rutgers University, New Brunswick, NJ; 3Saint Barnabas Medical Center, West Orange, NJ; 4Creighton University Arizona Health Education Alliance, Phoenix, AZ
Introduction: Non-alcoholic Fatty Liver Disease (NAFLD) is known to induce a chronic inflammatory state and might augment the systemic inflammatory response associated with acute pancreatitis (AP). The purpose of our study was to assess the temporal trends and effects of NAFLD on outcomes of AP in the United States. Methods: Using the Nationwide Inpatient Sample (NIS), all adults admitted with AP during the years 2010 to 2014 were identified. These patients were then divided into two cohorts - those with NAFLD (study group) and those without NAFLD (control group). We compared demographic characteristics, comorbidities, complications and outcomes between the two groups. Results: During the study period, 2,147,200 patients were admitted with a diagnosis of AP. Of these, 102,415 patients had a co-diagnosis of NAFLD. Prevalence of NAFLD among AP patients was 19.8% in 2010 and increased to 24.08% in 2014 (graph 1). Demographic characteristics of patients in both study groups are described in table 1. Comparing AP etiologies revealed that biliary obstruction (21.25% vs 9.09; P< 0.001) and hypertriglyceridemia (12.01% vs 9.12%; p=0.2) were more common among patients with NAFLD while alcohol use (10.27% vs 12.25%; p< 0.001) was more common among patients without NAFLD. AP-associated complications such as pancreatic pseudocyst (5.72% vs 3.67%; p=0.7), intra-abdominal infections (3.8% vs 0.52%; p=0.62), sepsis (11.83% vs 5.67%; p=0.41) and septic shock (3.12% vs 0.19%; p=0.05) were more common among patients with NAFLD. Overall inpatient mortality (6.21% vs 2.22%; p< 0.001) and total charges of hospitalization ($48,578 vs $40,234; p< 0.001) were higher among patients with NAFLD. Length of stay (5.30 vs 5.78 days; p< 0.001) was shorter among patients with NAFLD. Multivariate logistic regression revealed that NAFLD was independently associated with increased odds of death (OR 1.23 [CI 1.13 to 1.86]; p=0.001) but shorter hospital stays (OR -0.10 [CI -0.12 to -0.79]; p< 0.001). Discussion:
NAFLD is present in a significant percentage of patients with AP and its prevalence appears to be rising over the years.
NAFLD appears to be a risk factor for the development of local and systemic complications such as pancreatic pseudocysts, intra-abdominal infections, and sepsis in AP.
Mortality and cost per hospitalization is higher in patients with AP who have NAFLD.
Although these findings need to be confirmed in a randomized control setting, clinicians need to consider presence of NAFLD when prognosticating patients with AP.
Trend of NAFLD prevalence in acute pancreatitis
Outcomes of acute pancreatitis among patients with and without NAFLD
Disclosures: Ishani Shah indicated no relevant financial relationships. Abhishek Bhurwal indicated no relevant financial relationships. Harsh Mehta indicated no relevant financial relationships. Savio Reddymasu indicated no relevant financial relationships.