Cirrhosis Is Associated With Poor Outcomes in Patients With Acute Pancreatitis: National Inpatient Sample Data Analysis (2003-2011)

Abstract

Introduction: Pancreatic and liver diseases coexist frequently as more chronic pancreatitis patients have cirrhosis than patients with cirrhosis have chronic pancreatitis.The aim was to define the effect of concomitant diagnosis of cirrhosis on outcomes in acute pancreatitis(AP). Methods: We employed the 2003-2011 National Inpatient Sample databases using the ICD-9-CM diagnosis codes to identify patients aged ≥18 years with the primary diagnosis of AP (570.1) and secondary diagnosis of cirrhosis or its complications.Categorical variables were tested for statistical significance using the Pearson chisquare test while the Student's t test was used for continuous variables.Independent predictors were identified using multivariable logistic regression for dichotomous inhospital outcome (inpatient mortality),while Multivariable linear regression models were fit when the outcome variables were continuous. Data weights provided in the NIS file were used to calculate national level estimates with appropriate survey estimation commands. Results: From 2003 to 2011, there were 2,257,366 admissions for AP of which 105,518 (4.67%) had coexistent cirrhosis. Compared with non-cirrhotic patients, patients with cirrhosis were younger (51.8 ± 29.5 vs 52.6 ± 38.5 p < 0.001) male (63.38 vs 50.83 p < 0.001) with more comorbidities (3.03 ± 3.52 vs 2.21 ± 3.36 p < 0.001).On Univariate analysis, patients admitted with acute pancreatitis with coexistent cirrhosis had a significantly higher mortality (2.78 % vs. 1.00 %, p < 0.001), length of stay (LOS) (7.8 days vs. 5.2 days,p < 0.001), and hospital charges ($49,190 vs. $27,593, p < 0.001) compared with those without cirrhosis.After extensive adjustment for patient and hospital characteristics on multivariable analysis, cirrhosis was independently associated with higher mortality (odds ratio (OR) 2.359,95 % confidence interval (CI) 2.148--2.592), charges ($15,386 13,535--17,237), and Length of stay (1.78 1.60--1.94). Conclusion: Our study demostrates that cirrhosis is associated with a higher risk of mortality, hospitalization charges, and Length of hospital stay among patients admitted with acute pancreatitis even after controlling for co-morbid conditions, hospital and patient characteristics.These findings warrant aggressive monitoring for and prompt treatment of AP in hospitalized patients with cirrhosis.Table: No Caption available