57 Risk of Venous Thromboembolism in Acute Necrotizing Pancreatitis: A Population-Based National Study

Abstract

INTRODUCTION: Studies on the incidence of venous thromboembolism (VTE), including deep venous thrombosis and pulmonary embolism (PE), in patients with acute pancreatitis (AP) with or without necrosis are scarce. We conducted a population-based national study to evaluate the incidence of VTE and PE in patients with AP using a large database. METHODS: Data were extracted from a large database which incorporates 26 major integrated healthcare systems and over 300 hospitals in the United States (Explorys, Cleveland, OH). Using Systematized Nomenclature of Medicine (SNOMED) codes we identified patients with a diagnosis of acute pancreatitis with and without necrosis in the year 2018. The primary outcome was the incidence of index (first-ever) VTE at 7-days after diagnosis of AP. Patients with a prior history of VTE were excluded. Secondary outcomes included rates of sepsis, mechanical ventilation, intensive care unit admission, acute kidney injury, need for dialysis, and all-cause mortality. Univariate analysis was performed; P value < 0.05 was considered statistically significant. RESULTS: A total of 10,840 cases of acute necrotizing pancreatitis (ANP) and 65,960 cases of AP without necrosis were identified. Cohort demographics and outcomes are shown in Table 1. At 7 days after onset of ANP, VTE occurred at a rate of 18.5%, compared with 5.9% in AP without necrosis (OR 2.75, 95% CI 2.64–2.87, P < 0.01), while PE occurred at a rate of 2.3% in ANP vs. 0.4% in AP without necrosis (OR 6.2, 95% CI 5.20–7.41, P < 0.01) (Figure 1). In the setting of ANP, VTE was associated with a significantly higher all-cause mortality (follow-up 121–485 days) (OR 1.54, 95% CI 1.36–1.73, P < 0.01). In ANP cohort, univariate analysis demonstrated significantly higher associations of VTE with baseline smoking, alcohol consumption, and elevated BMI. Secondary outcomes including sepsis, intensive care unit admission, mechanical ventilation, acute kidney injury, and the need for dialysis, were all significantly associated with the development of VTE in ANP (Table 1). CONCLUSION: Patients with ANP have a near 3-fold risk of VTE, and a 6-fold risk of PE, compared to those with AP without necrosis. The development of VTE in the setting of ANP is associated with higher all-cause mortality. This study was unable to assess whether early pharmacologic VTE prophylaxis would improve outcomes. A large prospective study would aid in investigating the effect of this intervention.