What Are the Outcomes of Acute Pancreatitis in Patients with Liver Cirrhosis in the United States?

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Introduction: Acute pancreatitis (AP) is a frequent gastrointestinal discharge diagnosis in the United States with an estimated cost of $2.6 billion per year. Cirrhosis is the eighth leading cause of death in the United States. Cirrhosis impact on acute pancreatitis patients requiring hospitalization has not yet been studied. We aim to investigate the prevalence of cirrhosis among acute pancreatitis patients and outcomes of mortality, morbidity and cost. Methods: The National Inpatient Sample (NIS) database from 2003 to 2013 was queried for patients with a discharge diagnosis of AP (ICD-9 577.0) and liver cirrhosis (ICD9 571.5). Cirrhosis was further classified as compensated cirrhosis (CC) and decompensated cirrhosis (DC) as per the well validated Baveno IV criteria. Outcomes included inpatient mortality, organs failure, systemic inflammatory response syndrome (SIRS), parenteral nutrition, length of hospital stay (LOS), US$ inflation-adjusted Charges. Results were adjusted for age, gender, race, Charlson comorbidity index (CCI), median income quartile, and hospital characteristics. Multivariable logistic regression models were constructed using SAS software version 9.4 Results: Over 2.8 million patients with acute pancreatitis were analyzed. Cirrhosis prevalence was 2.8% (80,093). Cirrhosis patients were mostly likely to be males, Hispanics and older age. Both Compensated and Decompensated cirrhosis subjects had significantly higher mortality and worse outcomes (table 2). Highest odds ratios (OR) were:: inpatient mortality (OR 3.4, P<0.001), Shock (OR 1.5, P=0.02), Ileus (OR: 1.3, p=0.02, ARDS (OR 1.2, p=0.03), upper endoscopy performed (OR 2.0, p<0.001), blood transfusions (OR 3.1, p<0.001), gastrointestinal bleed (OR 5.5, p<0.001), sepsis (OR 1.3, p=0.005), portal vein thrombosis (PVT) (OR 7.2, p<0.001), acute cholecystitis (AC) (OR 1.3, p<0.001). Interestingly, cirrhosis patients had lower length of stay, (OR 0.16, p<0.001), AKI (OR 0.93, p=0.06), myocardial infarction (OR 0.31, p<0.001), SIRS (OR 0.62, p<0.001), parenteral nutrition (OR 0.84, p=0.002). Decompensated cirrhosis had higher inflation-adjusted hospital charges ($39,585 vs. $27,313; p<0.001) compared to noncirrhosis patients. Conclusion: Acute pancreatitis patients with liver cirrhosis have higher inpatient mortality, but unlikely to be due to AP severity as in our cohort they had lower prevalence of SIRS, AKI. It is possibly related to complications of cirrhosis.31_A Figure 1. Association Between Cirrhosis and Binary Outcomes of AP.31_B Figure 2. Association Between Cirrhosis and Continuous Outcomes of AP31_C Figure 3. Trends in charges