Outcomes of Acute Pancreatitis in Patients with Heart Failure: Insights from the Nationwide Inpatient Sample

Abstract

Introduction Acute pancreatitis (AP) is an inflammatory process involving the pancreas that presents as severe epigastric pain, associated with nausea and vomiting. Aggressive fluid resuscitation is extremely important to prevent local and systemic complications of AP and has been shown to reduce mortality from AP. However, limited data exists to assess the safety of fluid resuscitation among patients predisposed to volume overload, specifically congestive heart failure (CHF). The aim of our study was to assess mortality outcomes and complications of AP in patients with a concurrent CHF. Methods Using the Nationwide Inpatient Sample (NIS), retrospective analysis of hospitalized patients ≥18 years, with a primary diagnosis of acute pancreatitis during a five-year period (2010-2014) was performed. Patients were divided into two groups - with and without CHF. Primary outcomes were inpatient mortality and length of stay. Secondary outcomes were respiratory failure, mechanical ventilation, and need for vasopressors. Descriptive analyses were compared using the t-test for continuous data and chi-square test for categorical data. Statistical significance was assigned at P Results A total of 1,356,659 patients were hospitalized with a primary diagnosis of AP, out of which 69,657 patients had CHF. Patients in the CHF group were older (68.29 vs 51.13 years, p Conclusion Our study showed that patients with AP associated with CHF have significantly higher mortality in comparison with those without CHF. While acute respiratory distress syndrome is a known complication of AP, concomitant CHF was shown to have a higher rate of respiratory failure, requiring intubation and mechanical ventilation. Volume resuscitation in patients with CHF and AP can be challenging, as there is a very fine balance to tip them from euvolemic to volume overload state. Future studies are needed to determine methods to improve volume resuscitation in these patients.