P1082 - Frailty Status as a Novel Risk Stratification Tool in Patients With Acute Pancreatitis

Monday, October 25, 2021

10:30 AM – 4:15 PM PT

Location: Shoreline Exhibit Hall

Has Audio

Presenting Author(s)

Camilo J. Acosta, MD

University of Miami, Jackson Memorial Hospital
Miami, FL, United States

Camilo J. Acosta, MD¹, Sunil Amin, MD, MPH², Jodie A. Barkin, MD²
¹University of Miami, Jackson Memorial Hospital, Miami, FL; ²University of Miami, Leonard M. Miller School of Medicine, Miami, FL

Introduction: Although frailty is a known predictor of mortality and complications across various disease states, it remains an understudied topic among patients with acute pancreatitis (AP). The aim of this study was to assess the impact of frailty on outcomes in patients with AP.

Methods: Merged data was obtained from the 2016 - 2017 National Inpatient Sample (NIS) database. We performed a nationwide cohort study utilizing International Classification of Diseases (ICD) diagnostic codes to identify adult patients with AP. The Hospital Frailty Risk Score (HFRS) was used to classify patients as frail or non-frail. The primary outcome was complications related to AP including all-cause mortality. Secondary outcomes were length of stay and total hospitalization costs. Multivariable logistic regression models, adjusting for clinically pertinent confounders (i.e. age, sex, comorbidities using the Charlson comorbidity index), were used to determine the association between frailty and complications.

Results: 902,684 patients were represented; 33.5% (302,489) characterized as frail and 66.5% (600,195) as non-frail. 35.2% of frail patients suffered composite complications related to AP versus 12.9% of non-frail patients (P < 0.001). Frail patients had more cardiovascular, pulmonary, gastrointestinal, and infectious adverse events compared to non-frail patients. Frail patients also had higher mortality rates (5.6% vs 0.3% P < 0.001), increased length of stay (11.2 days vs 8.4, P < 0.001) and total hospitalization charges ($191,034 vs $52,537, P < 0.001). On multivariable analysis, positive frailty status was associated with 3.28 times increased odds of having composite complications.

Discussion: In hospitalized patients with acute pancreatitis, frailty status is associated with increased complications including all-cause mortality during hospitalization. Frail patients with AP also have increased length of stay and total hospitalization costs during admission. The use of frailty assessments can thus be utilized as an adjunct to validated scoring systems to improve risk stratification and clinical management of patients with AP.

Table 3. Difference in Complications between Frail and Non-frail patients with Acute Pancreatitis
Complications, no (%)	Frail (n = 302,489)	Non-frail (n = 600,195)	P value
Composite	111,919 (37.0)	86,000 (14.3)	< 0.001
Cardiovascular [i.e., pulmonary embolus, DVT, portal vein thrombosis, mesenteric vein thrombosis, vasopressor use]	18,063 (6.0)	10,094 (1.7)	< 0.001
Pulmonary [i.e., pleural effusion, ARDS, pulmonary edema, respiratory arrest, mechanical ventilation]	62,049 (20.5)	22,229 (3.7)	< 0.001
Gastrointestinal [i.e., pancreatic necrosis, ileus, pancreatic pseudocyst, intestinal obstruction, ascites, parenteral nutrition]	44,840 (14.8)	51,742 (8.6)	< 0.001
Infectious [i.e., SIRS, sepsis, severe sepsis]	47,270 (15.6)	15,949 (2.7)	< 0.001
SIRS (systemic inflammatory response syndrome)	10,484 (3.5)	12,934 (2.2)	< 0.001
Other infectious [i.e. sepsis, severe sepsis]	36,926 (12.2)	3,040 (0.5)	< 0.001
Mortality	16,834 (5.6)	1,576 (0.3)	< 0.001

Table: Abbreviations: DVT, Deep Vein Thrombosis, ARDS, Acute Respiratory Distress Syndrome, SIRS, Systemic Inflammatory Response Syndrome
*Acute renal failure was not included as a complication as it is included in the Hospital Frailty Risk Score.

Disclosures:
Camilo Acosta indicated no relevant financial relationships.
Sunil Amin indicated no relevant financial relationships.
Jodie Barkin indicated no relevant financial relationships.

Camilo J. Acosta, MD¹, Sunil Amin, MD, MPH², Jodie A. Barkin, MD². P1082 - Frailty Status as a Novel Risk Stratification Tool in Patients With Acute Pancreatitis, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.