Clinical Outcomes of Acute Pancreatitis in Patients with Liver Cirrhosis - A Single-Center Experience

Abstract

Introduction: Acute pancreatitis (AP) is a common gastrointestinal discharge diagnosis in the US, but outcomes in cirrhotic patients has not yet been studied. We aim to investigate these outcomes. Methods: Propensity score matching was used to match patients with and without cirrhosis on a 1:2 basis. The Cleveland Clinic acute pancreatitis registry database was used. Outcomes included inpatient mortality, organs failure, systemic inflammatory response syndrome (SIRS), length of hospital stay (LOS). Subgroup analysis of cirrhotic patients according to Child-Pugh and Model of End-stage Liver Disease (MELD) scores was performed. Multivariable logistic regression models were constructed using SAS software version 9.4 Results: 819 patients with acute pancreatitis were analyzed. Cirrhosis prevalence was 6.1%. Cirrhosis patients were mostly males and younger (table 1). Mean Child-Pugh score was 8.2, mean MELD score was 16 (table 1). Etiology of AP was similar in both groups. Cirrhosis subjects had significantly higher inpatient mortality (7.5% vs. 1.3%, P=0.1), severe AP (17.5% vs. 7.5%), Shock (7.9% vs. 3%), ARDS (10% vs. 3.8%), ICU requirement (15% vs. 6.3%) although not statistically significant, the trend was present. Surprisingly, cirrhotics had lower prevalence of admission SIRS (22.5% vs. 32.5%), SIRS day 2 (25% vs. 15%). Cirrhotics had similar rates of pancreatic necrosis, ileus, BISAP score, Marshall score, admission hematocrit, BUN and LOS (table 2). Finally, cirrhotic patients who had severe AP and/or required ICU and/or die in-hospital were mainly Child-C and had high MELD score (17-38) but they had low BISAP and Marshall scores (table 5). Conclusion: Limitations: Retrospective design. Small sample size due to low prevalence of cirrhosis. Strength: First study to analyze outcomes of cirrhosis in AP and compare according to Child-Pugh and MELD scores. Adjusted for age, gender, race, CCI. Conclusion: Acute pancreatitis patients with liver cirrhosis have higher inpatient mortality, possibly related to decompensated cirrhosis - as they appear to have lower prevalence of SIRS, low BISAP and Marshall scores as well as similar rates of pancreatic necrosis compared to non-cirrhotics. Importantly, cirrhotic patients who died were mostly Child-Pugh C and had very high MELD score.32_A Figure 1. Demographic and Baseline Characteristics32_B Figure 2. Outcomes: Characteristics of cirrhotic patients with severe pancreatitis, required ICU and/or died in the hospital32_C Figure 3. Outcomes of Cirrhotic patients: Child Pugh Class A vs. B/C