2816 Mortality of Different Etiologies of Acute Pancreatitis and Effect of Aggressive vs. Non-Aggressive Fluid Resuscitation

Abstract

INTRODUCTION: Acute pancreatitis (AP) is a common cause of GI-related hospitalization. AP can be classified into mild AP, moderately severe AP and severe AP. Severe acute pancreatitis (SAP) and necrotizing pancreatitis (NP) or localized complications with infections account for > 40% of pancreatitis related mortality. Common etiologies include acute biliary pancreatitis (ABP) and alcohol ( AAP). We aimed to study the mortality rate and effect of fluid resuscitation in AP (SAP, NP). METHODS: Patients with SAP and NP who received PEG-J were collected retrospectively from a single tertiary care center by utilizing ICD-9 and ICD-10 codes (International Classification of Diseases). Each case was confirmed by manual review. SAP and NP were defined per the 2012 revised Atlanta classification. Descriptive analysis was done by Excel. Fluid resuscitation was defined as aggressive hydration (AH) infusion of crystalloids given at a rate of at least 3.0 mL/kg/h after a bolus of 10-20 mL/kg within 24 hours of presentation. RESULTS: Seventy-nine patients with SAP or NP underwent PEG-J placement. Demographics, labs and comorbidities (Table 1). Etiologies of pancreatitis were alcohol 30% (24), biliary 39%, idiopathic 23%. Distribution based on Atlanta classification (Table 2). All-cause mortality of the patients was 12 (15%) and among this group 7 (9%) were related to pancreatitis related complications whereas 4 (5%) patients opted for palliative care and 1 was found to have pancreatic cancer. Among AAP, 4 patients died from reasons not related to pancreatitis, as compared to 4 patients (13%) who died in ABP group which were all related to pancreatitis. In ABP, 28 (90%) patients had data available for fluid. 8 (29%) received AH within first 24 hours and none of them died. 20 (71%) did not receive AH and 3 of them died. This was not significant at P < 0.05 using Fisher exact test. In AAP, 21 (87.5%) had data for fluid. Six (29%) received AH and none of them died. Fifteen (71%) did not receive AH and 3 of them died but the deaths were not related to pancreatitis. Average ICU stay of the overall subjects was 8 days and median hospital stay was 12 days. Average duration of hospital stay in AAP was 19.8 days compared to 20.5 days in ABP. Average ICU stay was 9 days in both groups. CONCLUSION: ABP carries higher mortality and more LOS related to pancreatitis compared with AAP. The AH is associated with decreased mortality in ABP but was not statistically significant perhaps due to small sample size.