Multivariate Predictors of In-hospital Mortality With Acute Pancreatitis Admissions in the United States

Abstract

Introduction: Acute Pancreatitis (AP) is one of the common gastrointestinal disease associated with long term hospitalizations and higher in-mortality rate. Most AP presentations are self-limited but ranges from mild to life threatening attack and mortality associated with AP can be up to 30% which depends on the area of sterile versus infected necrosis. Timely identification of severity of the disease is important which can help alleviate further complications. Although all scoring systems have been shown to correlate with mortality, it remains difficult to accurately identify severity of AP patient on admission. We have analyzed multivariate predictors of in-hospital mortality with AP admissions in the US. Methods: It is a retrospective, observational study which analyzes various factors that estimate in-hospital mortality in patient with AP using mixed-effect multivariate predictor model. The sample for this study was obtained from the National Inpatient Sample (NIS) for the years 2010-2014 using ICD-9 CM diagnostic code of 577.0 which is specific for AP. Analysis were performed in SAS 9.4 (SAS institute Inc., Cary, NC). Results: A total of 449,357 patients were identified with diagnosis of AP. Higher age is associated with higher mortality. Black patients have higher odds of in-hospital mortality compared to white. Because of more high-risk patients admitting to urban hospitals compared to rural, these hospitals have higher odds of in-hospital mortality. Also, presence of liver disease, electrolyte disorder, neurological disorder, chronic pulmonary disease, congestive heart failure, renal failure, and cancers were associated with greater risk of mortality. In contrast, females, private insurance as a primary payer, diabetes, hypertension, anemia and depression are associated with lower risk of mortality. Conclusion: Patients presenting with positive predictors identified our study requires close monitoring and extra-care to further avoid in-hospital mortality. Black patients with higher age and multiple comorbidities should be well evaluated as they have higher risk of in-mortality. Further prediction models require addition of biomarkers, inflammatory mediators, and genetic factors to better predict the severity with AP admissions.Table: Multivariate Predictors of In-hospital Mortality with Acute Pancreatitis.