40 Predictors of Acute Respiratory Distress Syndrome in Patients Hospitalized With Acute Pancreatitis

Abstract

INTRODUCTION: Acute Pancreatitis (AP) has been associated with organ failures and systemic complications, with acute respiratory failure (ARF) being the most common followed by acute kidney injury (AKI). Population-based data on the effect of ARF in AP is limited. Previous studies are derived from single-tertiary care referral centers, which do not represent the community setting of all patients with AP, but rather a “sicker” group of patients. The aims of this study are: (1) to measure the prevalence of ARF in AP, (2) to analyze the trends of ARF in AP patients, (3) to investigate the clinical predictors for ARF in patients with AP, and (4) to measure the outcome comparisons such as length of stay in hospital, hospital cost, and mortality for patients with and without ARF. METHODS: This is a retrospective cohort study using the Nationwide Inpatient Sample (NIS) database from the year 2005 to 2014. The study population consisted of all hospitalizations with a primary or secondary discharge diagnosis of AP using the ICD-9-CM code 577.0. Patients with ARF were identified through querying the ICD-9 CM codes 518.5, 518.81, or 518.82. RESULTS: During the 10-year period from 2005 to 2014, there were approximately 4.2 million hospitalizations with a discharge diagnosis of AP, out of which 5.1% were associated with ARF. The mortality rate in patients with AP-ARF is 26.1% when compared with the overall mortality rate of 2% in AP patients. A significant proportion of patients with AP-ARF also had co-existing organ failures, mainly acute renal failure (56% vs. 10.1%), hematological dysfunction (19.3% vs. 5.2%), cardiogenic shock (12% vs. 2.5%) and hepatic failure (13.8% vs. 2.3%). Patients with severe sepsis/septic shock are the strongest predictor for developing ARF with an odds ratio (OR) of 9.5, followed by acute renal failure (OR 4.2), hepatic dysfunction (OR 2.4) and cardiogenic shock (OR 2.3). The occurrence of ARF was also associated with increased length of stay (19.9 days vs 6.4 days), increased need for mechanical ventilation (65.5% vs 0.8%), and increased hospital charges ($237,082 vs $55,961) compared to AP patients without ARF. CONCLUSION: In this study, we demonstrate that ARF is a significant risk factor for increased hospital mortality, greater length of stay and higher hospitalization charges in patients with AP. This underlines significantly higher resource utilization in patients with a dual diagnosis of AP-ARF.