Outcomes and Incidence of Thrombotic Events in Patients with Pancreatic Cancer: Insights from the National Inpatient Database from 2016 to 2020

Abstract

Introduction: Pancreatic cancer represents the seventh cause of mortality in cancer-related deaths, and despite efforts to improve this, survival rates have not decreased. Additionally, in the last decade, there has been an increase in its incidence, and there is a rising concern regarding earlier age of onset. Its clinical presentation at earlier stages varies from asymptomatic to vague abdominal pain, jaundice, and thrombotic events. Regarding thromboembolic events, pancreatic cancer is one of the most common malignancies associated with a hypercoagulable state, reported in around 12-36% of the cases. One of the hypotheses proposed is based on the elevated expression of tissue factor and activation of extracellular tramps. We aimed to study the prevalence, trends, and outcomes of thrombotic events in patients admitted with pancreatic cancer over six years. Methods: We quired the National Inpatient Sample Database from 2016-2020 by identifying hospitalization with corresponding international disease classification ICD-10 for pancreatic cancer and further stratifying the cohort into those with pulmonary embolism (PE), deep venous thrombosis (DVT), portal vein thrombosis (PVT), and mesenteric ischemia. We also analyzed the hospital resource utilization by examining the length of stay (LOS), and total hospital Charge (TOTCHG) Results: Univariate analysis revealed a significant correlation between acute pancreatic cancer and the incidence of all thromboembolic events with an odds ratio (OR) of 7.13 (95% CI: 6.99-7.27, P < 0.01). For specific events, the OR was 6.11 (95% CI: 5.93-6.30, P < 0.01) for PE, 5.97 (95% CI: 5.82-6.12, P < 0.01) for DVT, and a notably high 28.53 (95% CI: 27.44-29.67, P < 0.01) for PVT. After adjusting for potential confounding factors in the multivariate analysis, the odds ratios reduced but remained significant: 4.15 (95% CI: 1.53-1.98, P < 0.01) for all thromboembolic events, 4.19 (95% CI: 1.21-1.45, P < 0.01) for PE, 3.40 (95% CI: 1.12-1.48, P < 0.01) for DVT, and 12.40 (95% CI: 2.16-3.49, P < 0.01) for PVT. Regarding clinical outcomes such as mortality and acute kidney injury (AKI), thromboembolic events like PE, DVT, PVT, and mesenteric ischemia are significantly associated with increased mortality and AKI. For example, PE had an OR of 1.75 (95% CI: 1.54-1.99, P < 0.01) for mortality and 0.82 (95% CI: 0.74-0.91, P < 0.01) for AKI. The study also evaluated the impact of these thromboembolic events on hospital resource utilization. PE, for instance, was associated with an increase in the length of stay (LOS) by 0.55 days (95% CI: 0.28-0.82, P < 0.01) and additional costs of $6272.16 (95% CI: $2985.40-$9558.93, P < 0.01) Conclusion: Thromboembolic events in patients with pancreatic cancer have increased mortality rates and hospital costs. It is essential to quantify and better understand this association to formulate adequate strategies to improve early diagnosis and survival. Further studies are needed to better characterize ways to prevent thromboembolic events cost-effectively in an attempt to improve mortality rates in this patient population.