S3211 Outcomes of Patients Admitted With Concurrent Pancreatitis and Rhabdomyolysis: An NIS Database Study

Abstract

Introduction: There have been numerous studies on acute pancreatitis; however, the effect of acute pancreatitis and rhabdomyolysis have yet to be studied. Here, we aim to assess rhabdomyolysis in patients hospitalized with acute pancreatitis. Methods: Data between 2008 and 2016 from the Nationwide Inpatient Sample database was extracted. Inclusion criteria for both groups included patients over the age of 17 with a primary diagnosis of acute pancreatitis using International Classification of Diseases, 9th and 10th revision codes. Exclusion criteria included all ICD-9 and ICD-10 codes for chronic pancreatitis and malignant pancreatico-biliary disorders and indeterminate rhabdomyolysis status. The study group consisted of patients with a primary diagnosis of acute pancreatitis and a concurrent diagnosis of rhabdomyolysis. Other co-morbidities were then compared between the two groups. Univariate and multivariate analyses were used to generate odds ratios. Results: There were a total of 1,946,591 patients in the control group, and 5,421 patients in the study group. In univariate analysis, there was a statistically significant increase in severe sepsis, respiratory failure, septic shock, calculus and HIV, but not pseudocyst in the study group. In multivariate analysis with rhabdomyolysis as the dependent variable, the odds ratio was highest for respiratory failure (OR=7.749, p < 0.001), followed by HIV (OR = 2.070, p < 0.001), septic shock (OR = 1.586, p < 0.001) and severe sepsis (OR = 1.532, p < 0.001). Calculus had an odds ratio of 0.470 (p < 0.001), suggesting a negative association with rhabdomyolysis. A multivariate analysis with patient morbidity as a dependent variable showed that patients with respiratory failure and septic shock are most likely to die in the hospital, with respiratory failure having an odds ratio of 8.292 (p < 0.001) and septic shock having an odds ratio of 3.729 (P = 0.01431). Conclusion: Rhabdomyolysis appears to confer elevated risk to patients with acute pancreatitis. Patients that are admitted with acute pancreatitis along with rhabdomyolysis also have a high rate of other conditions such as respiratory failure, HIV, septic shock and severe sepsis. Of these, respiratory failure and septic shock are the most dangerous, as they are tied to the highest mortality among patients that have both acute pancreatitis and rhabdomyolysis. We suspect the additional mortality may be due to respiratory muscle weakness and the release of intracellular substances from damaged muscle cells.