S3070 Severity of Biliary Pancreatitis in Hispanics vs Non-Hispanics: Are There Any Differences?

Abstract

INTRODUCTION: Biliary pancreatitis manifests as pancreatic inflammation due to ductal obstruction by a stone at the sphincter of Oddi. Often presenting as acute-onset abdominal pain with elevated biochemical markers, it can be a life-threatening disease requiring urgent evaluation. Contrast-enhanced computed tomography (CT) identifies the presence and extent of pancreatitis necrosis, and the CT Severity Index (CTSI) is a reliable predictor of severity and mortality of acute biliary pancreatitis. Mortality due to biliary pancreatitis ranges from 3% in patients with interstitial edematous pancreatitis to 17% in those who develop pancreatic necrosis, demonstrating the need for early identification and intervention. This study compared the severity of disease in Hispanic and non-Hispanic patients based on the CTSI as well as the Revised Atlanta Classification for Acute Pancreatitis. METHODS: A retrospective analysis of 303 biliary pancreatitis cases in patients aged 18-80 years from 2012 to 2019 were reviewed. Initial CT findings were standardized by a single reader. Patients were excluded if they did not have a diagnosis of biliary pancreatitis or an initial CT scan on admission. Data was analyzed with R, using univariate and multivariable logistic regression and Fisher’s exact test. RESULTS: 185 patients (average age 53.5 years) were Hispanic, and 118 (average age 49 years) were non-Hispanic. 21/185 (11.4%) patients in the Hispanic group presented with a fluid collection on initial CT versus 19/118 (16.1%) non-Hispanic patients (P = 0.309). 9/185 (4.9%) Hispanics had an acute necrotic collection (ANC), compared to 6/118 (5.1%) non-Hispanics (P = 0.44). 8/185 (4.3%) Hispanics had an acute peripancreatic fluid collection (APFC) associated with interstitial edematous pancreatitis, compared to 10/118 (8.5%) non-Hispanics. 5 total patients presented with a pancreatic pseudocyst, of which 4 were Hispanic. The average CTSI score was 2.14 +/- 1.96 for non-Hispanics and 1.82 +/- 1.76 (P = 0.132) for Hispanics. CONCLUSION: No statistical differences were noted in severity of biliary pancreatitis based on imaging evaluation among the two groups. The absolute difference of patients with pancreatic pseudocyst suggests that Hispanics may have stayed home longer between the onset of symptoms and hospital admission. This is the first study to classify ethnic differences in severity based on CT imaging. Larger cohort population studies are necessary to determine if statistically significant differences are present or not.Table 1.: Patient DemographicsTable 2.: Presence/Type of Fluid Collection on CT Scan and CTSI in Hispanics versus Non-Hispanics