28 Clinical Outcomes of Acute Pancreatitis in Patients With Cirrhosis: 5-Years Update of the National Readmission Database in the United States

Abstract

INTRODUCTION: Cirrhosis affects the outcome of non–liver-related illnesses requiring hospitalization, but its impact on acute pancreatitis (AP) patients requiring hospitalization has not yet been studied. We aim to investigate the prevalence of cirrhosis among AP patients and outcomes of mortality, morbidity and cost. METHODS: Data from Nationwide Readmission database from 2010 to 2015 was analyzed. All adult patients who were hospitalized for a primary diagnosis of acute pancreatitis were identified and patients who had a history of cirrhosis were compared to patients with no cirrhosis, using the appropriate ICD 9 codes. Continuous variables were expressed as means ± standard deviation or median (IQR), and categorical variables were expressed as percentages. All statistical tests were two-sided. RESULTS: A total of 1,575,148 patients were admitted for AP were included in this cohort, and out of those 46,904 patients (3.0%) had a history of cirrhosis. Patients in the cirrhosis group were significantly older, mean age 53.42 ± 11.885 vs. 51.55 ± 17.627 years, P-value < 0.001, mostly males 62.0% vs. 52.3%, P-value < 0.001, and admitted emergently, 97.0% vs. 95.5%, P-value < 0.001. Alcohol abuse was more common among cirrhosis patients 69.1% vs. 28.7%, P-value < 0.001 as well as drug abuse, 12.1% vs. 6.7%, P-value < 0.001. Cirrhosis patients had higher rates of in-hospital AP complications: acute kidney injury 11.7% vs. 8.2%, P-value < 0.001, pneumonia 3.6% vs. 2.8%, P-value < 0.001, acute respiratory distress syndrome and/or ventilation need, 3.0% vs. 2.2%, P-value < 0.001, transfusion requirement 8.9% vs. 2.8%, P-value < 0.001, sepsis, 2.1% vs. 1.6%, P-value < 0.001. SIRS: no difference. In-hospital mortality was higher in patients with cirrhosis 1.8% vs. 0.8%, P-value < 0.001. Median length of stay (LOS) was not significantly different 4.00 (2–6) days vs. 4.00 (2–6), P-value = 0.751. Charges of hospitalization were significantly higher in the cirrhosis group 24,819 USD vs. 20,918 USD, P-value < 0.001. CONCLUSION: Acute pancreatitis patients with liver cirrhosis have higher mortality, possibly related to cirrhosis-related comorbidities (sepsis, AKI, GI bleed/transfusion requirement, and ARDS) and not due to AP. Interestingly, they had lower prevalence of SIRS and LOS was not different.