S38 Impact of Diabetes Mellitus on Acute Pancreatitis Outcomes in a Large Prospective Observational Cohort

Abstract

Introduction: Acute pancreatitis (AP) is a leading indication for hospital admission. The relationship between AP and diabetes mellitus (DM) is becoming increasingly recognized. Many patients with DM have comorbid conditions (ex. heart and renal disease) that may increase the risk of severe pancreatitis or pancreatitis outcomes. We aim to identify the impact of DM on acute pancreatitis hospital outcomes including organ failure, readmission, and death. Methods: We identified patients hospitalized for acute pancreatitis between January 2015 and March 2021 using our prospective observational cohort. We included patients who had an episode of acute pancreatitis with or without pre-existing DM. Outcomes of interest included severity of pancreatitis, necessity of an intensive care unit (ICU) stay, organ failure, readmission, and death. Information on demographics, medical history, biochemical data, severity of the pancreatitis episode (Revised Atlanta Classification), and imaging were obtained for analysis. Logistic regression was used for analysis. Results: A total of 1340 unique patients were included in the analysis. 313 (23.4%) of the patients had pre-existing DM while 1027 (76.6%) did not. The overall cohort was 46.8% female and 81.3% Hispanic. The mean age in the patients with pre-existing DM was 53 ( ± 14) years old, while the non-diabetic cohort was 43 (± 15) years old. Patients with diabetes mellitus were significantly more likely to have moderate-to-severe pancreatitis [OR 1.52 (1.11-2.09)]. With regards to hospital outcomes, the diabetes cohort were more likely to have an intensive care unit (ICU) stay [2.26 (1.65-3.11)], and necessity of ICU interventions such as vasopressors [5.06 (2.25-11.38)], intubation [2.21 (1.13-4.35)], and renal replacement therapy (RRT) [4.77 (1.92-11.88)]. No significant difference was seen in readmission within 30 days [0.79 (0.51-1.23)] but patients with diabetes were more likely to have hospitalization result in death [3.49 (1.41-8.60)]. Conclusion: Within our acute pancreatitis population, patients with diabetes mellitus were more likely to have both local and systemic complications as well as necessity of more invasive hospital interventions such as intubation and vasopressors compared to their non-diabetic counterparts. These results emphasize the importance of adequately controlling patients’ underlying diabetes to minimize risk of hospital complications (Table). Table 1. - Comparison of hospitalization outcomes for acute pancreatitis in diabetics vs. non-diabetics No Diabetesn=1027, (76.6%) Diabetesn=313, (23.4%) P value OR (95% CI) Pancreatitis Severity Mild 857 (83.4%) 238 (76.0%) 0.003 Mod/Severe 170 (16.6%) 75 (24.0%) 0.003 1.52 (1.11-2.09) Organ Failure (any) 104 (10.1%) 54 (17.3%) 0.001 1.69 (1.16-2.44) Respiratory Failure 81 (7.9%) 34 (10.9%) 0.100 Circulatory Failure 20 (2.0%) 15 (4.8%) 0.006 Renal Failure 37 (3.6%) 33 (10.5%) < 0.0001 ICU Stay (yes/no) 138 (13.4%) 82 (26.2%) < 0.0001 2.26 (1.65-3.11) ICU LOHS (days) 0.8 1.5 0.031 Intubation 23 (2.2%) 16 (5.1%) 0.008 2.21 (1.13-4.35) Vasopressors 11 (1.1%) 17 (5.4%) < 0.0001 5.06 (2.25-11.38) RRT 9 (0.9%) 12 (3.8%) < 0.0001 4.77 (1.92-11.88) Readmission within 30 days 116 (11.3%) 29 (9.3%) 0.312 0.79 (0.51-1.23) Death 10 (1.0%) 12 (3.8%) < 0.0001 3.49 (1.41-8.60) Footnote: -OR=odds ratio, from multivariate analysis controlling for age, gender, and comorbidities such as heart failure, chronic kidney disease, and cirrhosis. ICU= intensive care unit; RRT = renal replacement therapy.