P1062 - Extra Pancreatic Complications in Hospitalized Patients With Acute Pancreatitis Are Associated With Worse Outcomes: Results From a Single Center Study

Ishani Shah, MD¹, William Yakah, BS¹, Awais Ahmed, MD¹, Cinthana Kandasamy, MD¹, Supisara Tintara, MD¹, Cristina Sorrento, MD¹, Steven D. Freedman, MD, PhD¹, Darshan J. Kothari, MD², Sunil G. Sheth, MD^1
1Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA; ²Duke University Medical Center, Durham, NC

Introduction: Patients with acute pancreatitis (AP) have high morbidity and mortality from local and systemic complications. Limited data that exists on extra-pancreatic complications (EPC) in patients with AP and their impact on patient outcomes. In this study, we assess the prevalence of in hospital EPC in patients with AP and their impact on associated outcomes.

Methods: We retrospectively studied 878 patients admitted to a tertiary care hospital with a diagnosis of AP between 2008-2018. EPC included respiratory failure (ARF) requiring intubation, acute kidney injury (AKI) requiring dialysis, bacteremia, pneumonia, urinary tract infections (UTI), C. difficile related diarrhea (CDAD), gastrointestinal bleeding (GIB), delirium, alcohol withdrawal, and fall with injury. Outcomes were length of stay (LOS), time to refeeding, inpatient mortality, and 30-day readmission rates and were compared between those who had no EPC with those who had ≥ 1 EPC. We then performed multivariate analysis to determine independent predictors for LOS and 30-day readmission.

Results: Of the 878 patients admitted to the hospital with AP, 188 (21.4%) patients had at least one EPC. Of these, infectious complications included UTI (14.8%), CDAD (15.9%), pneumonia (11.7%) and bacteremia (25%), while non-infectious EPC included ARF requiring intubation (2.6%), AKI requiring dialysis (3.7%), GIB (12.7%), alcohol withdrawal (20.7%), delirium (16.4%) and fall with injury (1%). Patients with EPC were older (55.1 vs 51.6; p=0.013). They had longer LOS (9.51 vs 4.54 days; p< 0.001), and higher rates of 30-day readmission (31.4% vs 19%; p< 0.001). After controlling for pancreatic complications, having an EPC was independently associated with longer hospital stay and higher 30-day readmissions (table).

Discussion: EPC are common among patients hospitalized with AP. More than 60% of these complications are of infectious etiology. Such complications were associated with longer LOS, higher readmission rates and higher resource utilization. Greater effort is needed to reduce the rate of EPC in patients admitted with AP.

	Length of stay		30-day readmission
	Odds Ratio (95% CI)	P-value	Odds Ratio (95% CI)	P-value
Any extra pancreatic complication	1.75 (1.64 , 1.86 )	< 0.001	1.85 (1.25, 2.72)	0.002
Respiratory failure requiring intubation	4.93 (4.25, 5.68)	< 0.001	0.62 (0.03, 4.64)	0.669
Acute renal failure requiring dialysis	0.83 (0.64, 1.05)	0.12	0.46 (0.02, 3.08)	0.460
Bacteremia	2.79 (2.57, 3.03)	0.005	1.73 (0.86, 3.37)	0.123
Pneumonia	1.98 (1.76, 2.22)	< 0.001	0.86 (0.27, 2.3)	0.781
Urinary tract infection	1.47 (1.29, 1.67)	< 0.001	2.22 (0.94, 4.96)	0.067
C. difficile related Diarrhea	1.24 (1.09, 1.41)	0.001	2.85 (1.3, 6.12)	0.009
Gastrointestinal Bleeding	2.01 (1.77, 2.26)	< 0.001	1.31 (0.49, 3.16)	0.574
Delirium	1.88 (1.69, 2.08)	< 0.001	1.03 (0.41, 2.32)	0.953
Alcohol withdrawal	0.78 (0.66, 0.91)	0.002	1.08 (0.47, 2.28)	0.841
Fall with injury	1.23 (0.62, 2.16)	0.52	5.48 (0.21, 14.72)	0.257

Table: Multivariate analysis predicting independent association between extra pancreatic complications and length of stay and 30-day readmissions


Disclosures:
Ishani Shah indicated no relevant financial relationships.
William Yakah indicated no relevant financial relationships.
Awais Ahmed indicated no relevant financial relationships.
Cinthana Kandasamy indicated no relevant financial relationships.
Supisara Tintara indicated no relevant financial relationships.
Cristina Sorrento indicated no relevant financial relationships.
Steven Freedman indicated no relevant financial relationships.
Darshan Kothari indicated no relevant financial relationships.
Sunil Sheth indicated no relevant financial relationships.


Ishani Shah, MD¹, William Yakah, BS¹, Awais Ahmed, MD¹, Cinthana Kandasamy, MD¹, Supisara Tintara, MD¹, Cristina Sorrento, MD¹, Steven D. Freedman, MD, PhD¹, Darshan J. Kothari, MD², Sunil G. Sheth, MD¹. P1062 - Extra Pancreatic Complications in Hospitalized Patients With Acute Pancreatitis Are Associated With Worse Outcomes: Results From a Single Center Study, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.