Assessment of Factors Affecting Intensive Care Unit Admission and Extended Hospitalization in Patients Admitted With Acute Pancreatitis

Abstract

Introduction: Acute pancreatitis is associated with substantial morbidity. The severity of the disease should be assessed as part of the initial evaluation, and aid with management of fluid resuscitation, organ failure, and nutritional support. Transfer to an intensive care unit should be considered in all patients with severe acute pancreatitis, making risk stratification crucial in this disorder. Our aims were to determine (1) the risk factors for intensive care unit admission and (2) extended length of stay (LOS) in patients diagnosed with acute pancreatitis. Methods: This was a retrospective cohort study of adults admitted to Brigham and Women's Hospital with a diagnosis of acute pancreatitis from the emergency department, outpatient clinic, transferred from an outside hospital (OSH) or while hospitalized. Patient demographics, etiology of pancreatitis (alcohol versus gallstone), revised Atlanta 2012 classification (mild, moderately severe and severe acute pancreatitis), episode number, transfer status, smoking status, and pain category (categorized as 0-3, 4-7, or 8-10) were recorded. The primary outcome was admission to the intensive care unit (ICU). The secondary outcome was extended LOS defined by greater than 75th percentile for the population (>8 days). Fisher-exact test for binary variables and student t-test for continuous variables were used for univariate analyses. Multivariate analysis was performed using modified purposeful selection. Results: 338 subjects [median age: 52 yrs, 52% female] met inclusion criteria. On univariate and multivariate analyses, alcoholic etiology, severe acute pancreatitis, and OSH transfer were significant and independent predictors for ICU admission (Table 1). On unviariate analysis, severe acute pancreatitis, OSH transfer, male sex and first episode number were significant predictors of extended LOS. On multivariate analysis, severe acute pancreatitis, OSH transfer, and first episode were independent predictors for extended LOS (Table 2).Figure 1Figure 2Conclusion: In our retrospective cohort, severe acute pancreatitis and transfer from an OSH were independent predictors for ICU admission and extended LOS in patients with acute pancreatitis. Future studies should focus on these factors as predictors of a more significant disease course and their role in the assessment of patients with acute pancreatitis.