Incidence and Outcomes of Acute Respiratory Distress Syndrome in Patients With Acute Pancreatitis

Abstract

Introduction: Acute pancreatitis is the leading gastrointestinal cause of hospitalization in the United States. Severe pancreatic damage leads to systemic inflammatory response syndrome (SIRS) and affects multiple organs including lungs, the severe form of which is acute respiratory distress syndrome (ARDS). We seek to analyze the incidence and in-hospital mortality in ARDS associated with pancreatitis. We also analyzed the predictors associated with the development of ARDS and the predictors of in-hospital mortality in these patients. Methods: Using the National Inpatient Sample 2003-2013, we identified adults (age>18 years) admitted for acute pancreatitis with ICD-9-CM code 577.0 Among these patients, ARDS was identified by ICD-9 code 518.82. Patients with missing data for age and gender were excluded. To identify the predictors associated with development of ARDS, we created a multivariate logistic regression model with covariates including demographics, Elixhauser comorbidities, and etiology of pancreatitis (alcohol/gallstone/hypertriglyceridemia). In-hospital mortality and length of stay (LOS) among these patients was studied. Predictors of in-hospital mortality were examined using similar multivariate logistic regression. Results: Between 2003-2013, there were a total of 2,787,590 hospitalizations for acute pancreatitis. Among these, 6,163 (0.2%) developed ARDS. The independent predictors for development of ARDS in these patients were age >65 (OR 1.52, P<0.001), male sex (OR 1.45, P<0.001), alcohol use (OR 1.18, P<0.001), hypertriglyceridemia (OR 1.56, P<0.001) and obesity (OR 1.43, P<0.001) Among patients with acute pancreatitis and ARDS, the mean age (SD) was 55.6 (17.6) years and 60.4% were males. Median LOS was 11 days and the in-hospital mortality was 11.4%. The independent predictors of inhospital mortality were age >65 (OR 5.93, P<0.001), male sex (OR 1.80, P<0.001) and underlying liver disease (OR 1.79, P<0.001) Conclusion: We noticed that the incidence of ARDS is low among individuals with acute pancreatitis and the mortality of ARDS in pancreatitis is 11%, which is lower than the mortality of ARDS from other disease processes.We also noticed that older males are more likely to develop ARDS and have higher incidence of in-hospital mortality. Furthermore, alcohol use, obesity and hypertriglyceridemia are associated with increased incidence of ARDS and underlying liver disease is associated with increased in-hospital mortality.