Hospitalization For Acute Pancreatitis Research Articles

Unique Case of Management of Severe Hypertriglyceridemia Secondary to Familial Chylomicronemia Syndrome

<h3>Lead Author's Financial Disclosures</h3> Nothing to disclose. <h3>Study Funding</h3> None. <h3>Background/Synopsis</h3> We review a case of a 61-year-old female diagnosed at age 21 with severe hypertriglyceridemia with debilitating, recurrent episodes of acute pancreatitis. <h3>Objective/Purpose</h3> To review a clinical scenario involving severe hypertriglyceridemia and the role of novel therapies in management. <h3>Methods</h3> Clinical management at tertiary care lipid program. <h3>Results</h3> A 61-year-old slightly overweight female with a history of congenital aplasia of the pancreas, coronary artery disease post stents, pre-diabetes, and non-alcoholic fatty liver disease was diagnosed with severe hypertriglyceridemia secondary to chylomicronemia syndrome at age 21. No secondary causes were identified. She was trialed on several cholesterol and triglyceride lowering medications including niacin, rosuvastatin, gemfibrozil, fenofibrate, fish oil supplements with minimal improvement in symptoms and/or reduction in recurrent hospitalizations for acute pancreatitis. Interestingly, she showed a dramatic ∼70% reduction in triglycerides on evinacumab based on compassionate use, resulting in significant improvement in quality of life with no episodes of acute pancreatitis while on therapy for 12 months. <h3>Conclusions</h3> Familial chylomicronemia syndrome (FCS) is an autosomal recessive disorder with a lack of lipoprotein lipase (LPL) functionality, thereby markedly impairing clearance of chylomicrons from the plasma. The primary reason for concern is an increased risk of acute pancreatitis with an estimated odds ratio of 360 in patients with FCS. Acute pancreatitis, in fact, is responsible for a significant economic burden in the United States with an estimated annual cost of care of over $2 billion, accounting for about 50% higher healthcare-related costs compared to patients without acute pancreatitis. Additionally, studies have shown that patients on statin with high residual cardiovascular risk as well as high triglycerides had higher risk for nonfatal myocardial infarction and nonfatal stroke compared to patients with normal triglycerides. Unfortunately, there are currently no FDA-approved treatments for FCS. For this reason, novel therapies are crucially needed to relieve the debilitating state of these patients. One such concept is the use of ANGPTL3 inhibitor, evinacumab, currently FDA approved for homozygous familial hypercholesterolemia. ANGPTL3 inhibition enhances the activities of endothelial lipase and lipoprotein lipase, thereby reducing levels of LDL-C independent of LDL receptor activity, HDL and triglycerides. Based on meta-analysis and a few Phase 1-2 trials, evinacumab is shown to reduce triglycerides from 50% to 80% in patients with severe hypertriglyceridemia. In our patient, with TG/TC ratio >8:1 and normal to low apoB, FCS is more likely the culprit for severe triglyceride burden, contributing to recurrent acute pancreatitis. Furthermore, our patient also suffers from mixed dyslipidemia and metabolic syndrome, which significantly raises her lifetime atherosclerotic cardiovascular risk. Thus, we propose the use of evinacumab in such patients to not only target high triglycerides to reduce risk of acute pancreatitis but also optimize overall cardiovascular risk.

S9 Does Access to Alcohol Matter? Association of Alcohol Outlet Access With Hospitalization for Acute Pancreatitis

Introduction: Alcohol is among the leading causes of acute pancreatitis. We aimed to evaluate the association of admissions for alcoholic pancreatitis and access to alcohol based upon residence within a zip code and county. Methods: Admissions for acute alcoholic pancreatitis were reviewed from 2015 to 2021 within our hospital network. Our analysis included only Pennsylvania residents, as it is an alcoholic beverage control state in which spirits are only sold in state owned stores. Data was collected regarding demographics, including zip code and county of residence. Results: A total of 415 admissions amongst 216 patients were included from 15 counties and 107 zip codes within Pennsylvania. Liquor stores per counties included range from 1 to 74; admissions per counties included range from 1 to 219 (Table 1). Liquor stores per zip codes included range from 0 to 4; admissions per zip codes included range from 1 to 8. In a univariable linear regression model, there is a strong correlation between admissions per county and stores per county, with R^2 = 0.96. This was redemonstrated in a chi-squared analysis with P < 0.05. The liquor stores per zip code did not have a strong correlation to admissions per zip code in a linear regression model. Conclusion: Our data suggests a significant relationship between the number of liquor stores within a county and patients admitted for acute alcoholic pancreatitis from that county. We suspect that increased access to alcohol may influence the rates of admission. It may be prudent for counties with more liquor stores to also have more resources for patients with alcohol use disorders, as these may prevent hospitalizations, and ultimately complications of acute alcoholic pancreatitis.Table 1.: Number of admissions per county for alcohol induced acute pancreatitis within our healthcare network in relation to number of liquor stores within those counties

S69 The Impact of Inpatient Substance Use Counseling on Hospitalizations for Acute Alcoholic Pancreatitis

S69 The Impact of Inpatient Substance Use Counseling on Hospitalizations for Acute Alcoholic Pancreatitis

A phase 2 trial of the efficacy and safety of evinacumab in patients with severe hypertriglyceridemia

Background and Aims: Severe hypertriglyceridemia (sHTG; fasting triglycerides ≥500 mg/dL) is a causal risk factor for acute pancreatitis. This phase 2 study (NCT03452228) evaluated efficacy and safety of evinacumab, an investigational angiopoietin-like protein 3 inhibitor, in patients with sHTG who had ≥1 prior hospitalization for acute pancreatitis.

Prevalence of severe hypertriglyceridemia and pancreatitis in familial partial lipodystrophy type 2

Familial partial lipodystrophy (FPLD) is a rare Mendelian condition listed in the differential diagnosis of severe hypertriglyceridemia (HTG) and pancreatitis. Here we determined the prevalence of severe HTG and pancreatitis among a cohort of 74 FPLD patients assessed in a lipid clinic. We studied lipid profiles from individuals with either of the two most common pathogenic monoallelic variants in LMNA, namely p.R482Q (N= 51) and p.R482W (N= 23). In total, 28 (37.8%) patients with a mean age of 41.8 ± 14.8 years had diabetes, while 46 (62.2%) patients with a mean age of 35.4 ± 19.4 years had no diabetes. Among patients with and without diabetes, median TG levels (interquartile range) were 2.73 (4.78) and 1.86 (1.66) mmol/L (242 [423] and 165 [147] mg/dL), respectively. Overall, 4 subjects (5.4%) had triglyceride levels > 10 mmol/L (> 885 mg/dL), of whom 3 (4.1%) had a history of hospitalization for acute pancreatitis. All 4 patients with severe HTG had diabetes, i.e. 14.3% of those with diabetes. In contrast, FPLD2 patients without diabetes had only mild HTG, with no instances of severe HTG or pancreatitis. Thus, among this selected lipid clinic cohort with lipodystrophy, severe HTG and pancreatitis in FPLD2 are relatively common when diabetes is present.

Persistent Cannabis Abuse and Risk for Hospitalization for Acute Pancreatitis: A Cross-Sectional Study in United States Hospitals.

ObjectivesTo explore the independent association between cannabis abuse and subsequent hospitalizations for acute pancreatitis (AP) and delineate the demographic differences among AP in patients with and without persistent cannabis abuse.MethodsWe conducted a retrospective cross-sectional study using the nationwide inpatient sample and included 50,444,133 patients (age 18-50 years) with a primary discharge diagnosis for medical illnesses and further grouped by presence of AP (N = 666,248). We used the logistic regression model to measure the odds ratio (OR) of the association between cannabis abuse and hospitalization for AP and adjusted it for demographic confounders and comorbid risk factors.ResultsCannabis abuse significantly increases the odds for AP-related hospitalization (OR 2.12, P <0.001). When the regression model was controlled for potential risk factors (gall stones, cystic fibrosis, hypertriglyceridemia, hypercalcemia, hyperparathyroidism, abdominal surgeries, tobacco abuse, and alcohol abuse), cannabis abuse did not increase the odds for AP-related hospitalization (OR 0.72, P <0.001) due to the significant effect caused by gallstones (OR 30.98, P <0.001) and alcohol abuse (OR 12.69, P <0.001). AP inpatients with cannabis abuse were younger compared to non-cannabis abusers (mean age, 35.7 vs. 37.9 years), and majorly male (70.9% vs. 53.8%). AP was considerably more prevalent in whites (60.6%), followed by blacks (18.3%) and Hispanics (15.2%).ConclusionCannabis abuse increased the unadjusted odds for AP-related hospitalization by two times, but after controlling for potential risk factors the adjusted odds of association significantly reduced. Cannabis-induced AP can be treated if a problematic recreational cannabis use pattern is discontinued at an earlier stage. Therefore, awareness campaigns and early supportive therapy among cannabis abusers might help diagnose and treat the comorbidity and improve the quality of life.

Early Versus Late Laparoscopic Cholecystectomy in Patients with Acute Gallstone Pancreatitis

The laparoscopic cholecystectomy is the definite treatment of acute gallstone pancreatitis, but the timing remains controversial. We aimed to evaluate trends, prevalence, and outcomes of laparoscopic cholecystectomy amongst patients with acute gallstone pancreatitis in index hospitalization done at different time intervals. We performed a retrospective study using Nationwide Inpatient Sample (years 2003–2014) with adult hospitalizations with acute gallstone pancreatitis who underwent laparoscopic cholecystectomy using ICD-9-CM codes and divided them into subgroups of those who underwent immediately (72 h), early (1 week), and delayed (> 1 week) laparoscopic cholecystectomy. The weighted analysis using chi-square, paired Wilcoxon-rank-sum test, Cochran-Armitage trend test, and multivariable survey logistic regression analysis was performed to evaluate prevalence and outcomes. There was a total of 582,406 acute gallstone pancreatitis admissions of which 291,701 (50.09%) patients had laparoscopic cholecystectomy (p < 0.0001). Prevalence of immediate laparoscopic cholecystectomy 114,629 (40.55%) showed incremental trend (32.61 to 49.82%) compared to early 149,931 (53.03%) (57.83 to 46.59%), and late laparoscopic cholecystectomy 18,158 (6.42%) (9.56 to 3.59%) from 2003 to 2014. Immediate and early laparoscopic cholecystectomy had lower prevalence and odds of mortality [0.24% versus 0.37% versus 2.46%; aOR-immediate: 0.614; aOR-early: 0.615; p < 0.0001], morbidity [1.36% versus 3.64% versus 27.57%; aOR-immediate: 0.088; aOR-early:0.161; p < 0.0001], disability [62.47% versus 70.15% versus 84.26%; aOR-immediate: 0.584; aOR-early: 0.68; p < 0.0001], discharge to non-home [7.07% versus 13.04% versus 31.84%; %; aOR-immediate: 0.346; aOR-early: 0.473; p < 0.0001], hospital cost $39,466 versus $52,018 versus $129,317 (p < 0.0001) and stay 3 days versus 6 days versus 19 days (p < 0.0001) than delayed laparoscopic cholecystectomy. The immediate laparoscopic cholecystectomy showed better outcomes; more prospective studies with large numbers of patients should be planned to evaluate the beneficial effects of immediate cholecystectomy in severe acute pancreatitis hospitalizations.

Effect of probiotics on length of hospitalization in mild acute pancreatitis: A randomized, double-blind, placebo-controlled trial.

BACKGROUNDAcute pancreatitis is the leading cause of hospitalization for acute gastrointestinal disease worldwide. The effects of probiotics in mild acute pancreatitis have not been studied. We hypothesized that the administration of probiotics may accelerate the recovery of intestinal function and shorten the length of hospital stay (LOS) in patients with mild pancreatitis.AIMTo investigate the value of probiotics in reducing the LOS in patients with mild acute pancreatitis.METHODSWe conducted a double-blind randomized clinical trial to evaluate the effects of probiotics administered to patients with mild acute pancreatitis at a tertiary medical center. The patients were given probiotics capsules (a mixed preparation of Bacillus subtilis and Enterococcus faecium) or placebo. The primary study endpoint was the LOS. The secondary endpoints included time to abdominal pain relief, recurrent abdominal pain, and time to successful oral feeding.RESULTSA total of 128 patients were included, with 64 patients in each arm. The severity of illness and the etiological distribution of disease were similar in the two groups. There was a significant reduction in the LOS in the probiotics treatment group vs the placebo group (5.36 ± 0.15 vs 6.02 ± 0.17 d, P < 0.05). The probiotics group was associated with a shorter time to abdominal pain relief and time to successful oral feeding (P < 0.01 for both) than the placebo group. No statistical difference was found in recurrent abdominal pain between the two groups.CONCLUSIONThe study results showed that the administration of probiotics capsules is associated with a shorter duration of hospitalization in patients with mild acute pancreatitis.

TSH secreting pituitary tumor — an experience of 20 years follow-up

Thyrotropinoma is a rare pituitary tumor that causes the development of thyrotoxicosis syndrome as a result of hyperproduction of thyroid stimulating hormone (TSH). In the Russian literature over the past 10 years, one case of thyrotropinoma in a child, four cases of TSH-producing pituitary adenoma in women and only one in a man have been described. The article presents a unique clinical case of a 20-years history of observation of a patient with TSH-oma. The rarity of this disease led to the fact that it took more than 10 years to make a correct diagnosis. The first operation of thyroid gland was performed before the diagnosis of pituitary adenoma and inappropriate TSH secretion syndrome. That right hemithyroidectomy was supposed to cure a toxic adenoma of thyroid gland. The diagnosis of thyrotropin-secreting piruitary tumor was established only after 6 years even after finding a combination of pituitary adenoma and thyrotoxicosis. After that, the patient steadfastly refuses neurosurgical treatment, despite the presence of macroadenoma with intrasellar growth. The therapy with somatostatin analogs led to patient’s intolerance with gastrointestinal side effects and hospitalization for acute pancreatitis. The absence of the therapy due to low compliance led to long-term persistence of thyrotoxicosis. The absence of signs and symptoms of expanding tumor mass (visual field defects, loss of vision, headache, partial or total hypopituitarism) demonstrates the slow growth of this kind of pituitary tumor. The long-term effect of elevated TSH levels led to diffuse goiter with compression of the neck organs, and the need of the surgical treatment of the thyroid. Stable euthyroidism after the operation led to stable normoglycemia in the patient with previously diagnosed diabetes mellitus type 2. This fact should keep an attention of physicians and endocrinologists to screen for the secondary reasons of hyperglycemia in a patient with diabetes mellitus manifestation. Long-term history of thyrotoxicosis led to the deleterious effects of thyroid hormone excess on the heart (atrial fibrillation, cardiomyopathy, cardiac failure). Those effects are still observed even after thyroidectomy and medical euthyroidism achievement. This fact demonstrates the importance of early diagnosis and treatment of TSH-omas.

Primary Emphysematous Pancreatitis Caused by Clostridium Perfringens Infection

A 66-year-old male was admitted to a close hospital for acute pancreatitis. 48h hours after developed clinical worsening. Therefore, a CT scan was performed showing signs of Emphysematous Severe Acute Pancreatitis. A transfer to our hospital was granted, being admitted to the ICU. A follow-up CT scan was performed, showing an increase in the size of abdominal collections and pneumoretroperitoneum. For this reason, an open pancreatic necrosectomy was performed. However, the patient showed an overall excellent response allowing for weaning and extubation. 15 days after the surgery, bleeding from the abdominal wall is detected. A CT scan was performed showing epigastric artery bleeding. After infructuous endovascular embolization, a surgery was required. During the stay in the ICU the patient suffered through diverse nosocomial infections by multiresistant bacteria. The patient’s condition worsened. Due to an absence in response to therapy, the patient died 58 days after being admitted to the hospital. Discussion: Clostridium’s perfringens necrotizing acute pancreatitis is a rare condition that can usually be suspected by the presence of gas around the pancreas and characteristically pneumoretroperitoneum. Its origin is usually linked to invasive procedures of the bile duct. It can also appear on collections or necrotic tissue related to previous acute pancreatitis or chronic pancreatitis. Conclusion: The Clostridium perfringens confers a raise in morbidity and mortality in spite of optimal treatment decisions. Therefore, an early diagnosis and admission to ICUs, as well as an early appliance of surgical measures, might lower the chances of adverse outcomes.

Trend and Predictors of the Utilization of Endoscopic Retrograde Cholangiopancreatography in Acute Pancreatitis Hospitalizations.

BackgroundAcute pancreatitis is a sudden inflammation of the pancreas, and biliary pancreatitis remains the most common cause of acute pancreatitis. Endoscopic retrograde cholangiopancreatography (ERCP) is both a diagnostic and therapeutic invasive procedure to evaluate and treat pancreaticobiliary system diseases. ERCP is very commonly used in acute pancreatitis with coexisting acute cholangitis or biliary obstruction. There was a need for a nationwide study to evaluate ERCP utilization trends and health-care costs among acute pancreatitis patients.AimWe sought to determine the prevalence trend, hospitalization cost and stay, and predictors of utilization of ERCP amongst patients with acute pancreatitis.MethodsWe performed a population-based retrospective analysis of national data in adult acute pancreatitis hospitalizations. We evaluated the characteristics of the ERCP cohort, prevalence trend, and hospital utilization cost and stay using univariate analysis. Multivariable survey logistic regression analysis was performed to evaluate predictors of utilization for ERCP among acute pancreatitis hospitalization.ResultsAmong 2,632,309 hospitalizations for acute pancreatitis, 49108 (1.87%) had ERCP. The prevalence trend of ERCP declined from 3.88% in 2003 to 0.97% in 2014.(pTrend<0.0001). Patients with ERCP were older (>55-years old) (53.01% vs 39.36%;p<0.0001), female (58.45% vs 48.04%; p<0.0001), Hispanic (16.30% vs 12.86%; p<0.0001), utilizing Medicare (40.29% vs 31.88%; p<0.0001), elective admission (8.15% vs 4.98%; p<0.0001), and with gallbladder etiology (65.98% vs 26.06%; p<0.0001). Acute pancreatitis hospitalization with ERCP had a higher cost of utilization (Costdiff:+$25077;p<0.0001) and mean stay (LOSdiff:+3.5 days; p<0.0001). In regression analysis, old adults [Odds ratio(OR):1.087; Confidence interval (CI):1.008-1.173), Hispanic (OR:1.086; CI:1.019-1.156), asian (OR:1.146; CI:1.007-1.304), female (OR:1.074; CI:1.028-1.122), elective admission (OR:1.649; CI:1.524-1.785), gallbladder etiology (OR:4.437; CI:4.224-4.662), concurrent chronic pancreatitis (OR:1.643; CI:1.536-1.757), systemic inflammatory response syndrome (SIRS) (OR:1.264; CI:1.112-1.436), pleural effusion (OR:1.874; CI:1.231-2.854), and portal vein thrombosis (OR:1.646; CI:1.221-2.219).ConclusionIn nationwide data, we have found a decreased utilization trend and higher hospital utilization cost and stay associated with ERCP. The predictors of utilization will be helpful to examine the cost-utility of ERCP, especially with the advent of acute pancreatitis treatment systems to mitigate the health care burden.

Trends and seasonality in hospitalizations for acute alcohol-related and biliary pancreatitis in the USA

BackgroundThe incidence of acute pancreatitis (AP) is characterized by circannual and geographical variation. The aim of this study was to describe seasonal variation and trends in hospitalizations for AP in the USA with respect to AP etiology. MethodsThe Nationwide Inpatient Sample data (2000–2016) from the Healthcare Cost and Utilization Project were used. The study population included all primary hospitalizations for AP. Biliary AP (BAP) and alcohol-induced AP (AAP) were distinguished by diagnostic and procedural ICD codes. Seasonal trend decomposition was performed. ResultsThere was a linear increase in annual incidence (per 100 000 population) of AAP in the USA (from 17.0 in 2000 to 22.9 in 2016), while incidence of BAP, equaled 19.9 in 2000, peaked at 22.1 in 2006 and decreased to 17.4 in 2016. AP incidence demonstrated 18% annual incidence amplitude with summer peak and winter trough, more prominent in AAP. In 2016, within AAP, the highest incidence (per 100 000 population) was noted among African-Americans (up to 50.4), followed by males aged 56–70 years (26.5) and Asians of low income (25.5); within BAP, above the average incidence was observed in Hispanic (up to 25.8) and Asian (up to 25.0) population. The most consistent and rapid increase in AP incidence was noted in males aged 56–70 years with an alcoholic etiology (average 6% annual incidence growth). ConclusionsThe incidence and annual trends of AP vary significantly among demographic and socioeconomic groups and this knowledge may be useful for the planning of healthcare resources and identification of at-risk populations.

Тиреотропинома — опыт 20-летнего наблюдения

Thyrotropinoma is a rare pituitary tumor that causes the development of thyrotoxicosis syndrome as a result of hyperproduction of thyroid stimulating hormone (TSH). In the Russian literature over the past 10 years, one case of thyrotropinoma in a child, four cases of TSH-producing pituitary adenoma in women and only one in a man have been described. The article presents a unique clinical case of a 20-years history of observation of a patient with TSH-oma. The rarity of this disease led to the fact that it took more than 10 years to make a correct diagnosis. The first operation of thyroid gland was performed before the diagnosis of pituitary adenoma and inappropriate TSH secretion syndrome. That right hemithyroidectomy was supposed to cure a toxic adenoma of thyroid gland. The diagnosis of thyrotropin-secreting piruitary tumor was established only after 6 years even after finding a combination of pituitary adenoma and thyrotoxicosis. After that, the patient steadfastly refuses neurosurgical treatment, despite the presence of macroadenoma with intrasellar growth. The therapy with somatostatin analogs led to patient’s intolerance with gastrointestinal side effects and hospitalization for acute pancreatitis. The absence of the therapy due to low compliance led to long-term persistence of thyrotoxicosis. The absence of signs and symptoms of expanding tumor mass (visual field defects, loss of vision, headache, partial or total hypopituitarism) demonstrates the slow growth of this kind of pituitary tumor. The long-term effect of elevated TSH levels led to diffuse goiter with compression of the neck organs, and the need of the surgical treatment of the thyroid. Stable euthyroidism after the operation led to stable normoglycemia in the patient with previously diagnosed diabetes mellitus type 2. This fact should keep an attention of physicians and endocrinologists to screen for the secondary reasons of hyperglycemia in a patient with diabetes mellitus manifestation. Long-term history of thyrotoxicosis led to the deleterious effects of thyroid hormone excess on the heart (atrial fibrillation, cardiomyopathy, cardiac failure). Those effects are still observed even after thyroidectomy and medical euthyroidism achievement. This fact demonstrates the importance of early diagnosis and treatment of TSH-omas.

S0091 Admission Outcomes and Risk Factors for Patients Presenting With Acute Pancreatitis and Concomitant Diabetic Ketoacidosis

INTRODUCTION: Admissions for acute pancreatitis and diabetic ketoacidosis (DKA) often overlap. Presenting features such as abdominal pain, elevated lipase levels, and anion gap acidosis may make differentiation and management challenging. To date, studies on admission and follow up outcomes in patients presenting with concomitant DKA and acute pancreatitis has been incompletely characterized. METHODS: The clinical course of consecutive patients admitted to Los Angeles County + University of Southern California Hospital for acute pancreatitis between March 2015 and February 2020 was reviewed through April 2020. Patients with diabetes were identified and stratified by presence of DKA on admission. The outcomes of interest included the diagnosis of diabetes mellitus following index hospitalization in our hospital for acute pancreatitis, as well as general admission outcomes such as length of stay (LOS), intensive care unit admission (ICU), ICU LOS, organ failure, and pancreatitis severity as based on the Revised Atlanta Criterion. RESULTS: Among a total cohort of 1081 patients with acute pancreatitis, 252 had diabetes mellitus (DM), and 37 of the patients with DM presented in DKA. Those presenting in DKA were more likely to develop moderately severe pancreatitis by the Revised Atlanta Classification (40.5% vs. 13.5%, P < 0.0001) and new onset renal failure (21.6% vs. 7.9%, P = 0.01). Hypertriglyceridemia was more commonly identified as the etiology of acute pancreatitis in the DKA cohort (32.4% vs. 9.3%, P < 0.0001). Though rates of ICU admission were higher among DKA patients, this was largely due to the requirement for ICU monitoring for continuous insulin infusions at our center. Concomitant recurrent pancreatitis (37.8% vs. 14.4%, P = 0.001) and chronic pancreatitis (13.5% vs. 3.3%, P = 0.003) were significantly more common among patients presenting in DKA. CONCLUSION: Acute pancreatitis with concomitant DKA is associated with greater pancreatitis severity as scored by the Revised Atlanta Criterion. These patients are also much more likely to have recurrent acute and chronic pancreatitis.Table 1.: Comparison of admission outcomes for acute pancreatitis between diabetics and diabetics presenting in DKATable 2.: Recurrent pancreatitis and chronic pancreatitis among diabetics vs. diabetics presenting with DKATable 3.: Comparison of imaging features among diabetics vs. diabetics presenting in DKA

S0057 Gender Differences in Outcomes in Patients With Pancreatitis: A Contemporary Analysis

INTRODUCTION: As the management of acute pancreatitis continues to improve over the past 2 decades, we sought to evaluate the impact of gender on in-hospital outcomes for patients with pancreatitis using contemporary inpatient data. METHODS: The Nationwide Inpatient Sample (2016) was used to identify adult patients who required hospitalization with a primary diagnosis of acute and chronic pancreatitis. Primary outcomes studied included mortality, acute renal failure, acute respiratory failure and septic shock as well as secondary outcomes including length of stay and hospital cost. These were analyzed using univariate and multivariate comparisons. RESULTS: In 2016, the national estimate for inpatient acute and chronic pancreatitis hospitalizations was 519,035. Of these, 247,505 (48%) patients were female. When comparing baseline characteristics such as mean age at time of hospitalization, mean income, and distribution of ethnicity were similar among the male and female groups. Females were less likely to have alcohol as a cause of pancreatitis (13.2% vs 27.8%, P < 0.001). In regards to clinical outcomes, female patients with pancreatitis had a lower mortality (1.8% vs 2.2%, P < 0.001), respiratory failure (6.5% vs 8.0%, P < 0.001), GI Bleeding (3.6% vs 5.2%, P < 0.001) and septic shock (2.6% vs 3.0%, P < 0.001) while need for endoscopy, length of stay and hospitalization cost were similar. CONCLUSION: Female gender generally tends to fare better when studying in-hospital outcomes in patients with acute pancreatitis. More research is needed into the causes of this gender gap, especially in patients with GI bleeding.

Acute pancreatitis: 31-Year trends in incidence and mortality – A Danish population-based cohort study

BackgroundObjectives: Increasing incidence rates and declining mortality rates have made acute pancreatitis a common cause of hospitalization. We aimed to examine 31-year trends in first-time hospitalization for acute pancreatitis, the subsequent short-term and long-term mortality, and the prognostic impacts of age, sex, and comorbidity. MethodsIn this nationwide Danish population-based cohort study of 47,711 incident cases, we computed the annual sex-specific age-standardized incidence rates of acute pancreatitis for 1988–2018. Among patients with incident hospitalization for acute pancreatitis, we computed sex-specific 30-day and 31–365-day mortality rates, stratified them, and performed proportional-hazards regression to estimate mortality rate ratios adjusted for sex, age, and comorbidity, measured by Charlson Comorbidity Index categories. ResultsFrom 1988 to 2018, the standardized incidence rate of acute pancreatitis per 100,000 person-years increased by 29% for men (28.8–37.0%) and by 148% for women (15.7–38.9%). Among patients with pancreatitis, the 30-day mortality declined from 10.0% in those diagnosed in 1988–1992 to 6.3% for those diagnosed in 2013–2017. The corresponding 31–365 day mortality increased from 5.5% to 6.0%. In comparing periods 1988–1992 and 2013–17, the adjusted 30-day mortality rate ratio was 0.36 (95% confidence interval: 0.32–0.41) and the adjusted 31–365 day mortality rate ratio was 0.64 (95% confidence interval: 0.56–0.74). Comorbidity was a strong predictor of mortality among patients with pancreatitis. ConclusionsOver the 31 years of observations, annual rates of acute pancreatitis more than doubled among women, converging with those among men. The comorbidity burden was a strong prognostic factor for short and long-term mortality. Treatments for acute pancreatitis should focus on existing comorbidities.

Reducing Hospitalization in Mild Acute Pancreatitis: Results of Long-term Follow-up.

Acute pancreatitis (AP) is a common emergency department (ED) diagnosis, amounting to enormous costs. Our previous pilot study demonstrated the feasibility of reducing hospitalization using an ED-based observation pathway. In this follow-up study, we hypothesize that the pathway is durable in clinical practice, outside of research supervision, and patients can safely be managed without hospitalization. We reviewed patients prospectively enrolled in the observation pathway after the end of the pilot study. We compared outcomes to patients enrolled in our pilot study and with a historic cohort of patients admitted with mild AP. Our primary outcome was hospitalization rate during the enrollment period and secondary outcomes included length of stay, 30-day readmissions, mortality, and health care utilization. Over a 2-year period 165 patients met criteria for AP with 118 (71.5%) having mild AP. Fifty-four of 118 patients (45.8%) were enrolled in the observation pathway and of these, 45 patients were discharged from the ED, reducing hospitalization by 31.2%, compared with pilot study (22.2%) and historic cohort (0%) (P<0.05). Median length of stay was shorter [19.9 (observation) vs. 72.0 h (historic cohort), P<0.01]. There were fewer radiographic examinations in the observation cohorts (pilot and current study) than in the historic cohort (P<0.05), with similar 30-day readmissions, and no reported deaths. This follow-up study demonstrates the durability of an observation-based pathway to manage mild AP outside of a research protocol and maintain its ability to reduce hospitalizations without affecting readmission rates or mortality.

Evaluation of Opioid Use in Acute Pancreatitis in Absence of Chronic Pancreatitis: Absence of Opioid Dependence an Important Feature

BackgroundChronic opioid use and dependence is common in patients with chronic pancreatitis. Patients with acute pancreatitis are frequently treated with opioids, but their risk for ongoing use is not well known. The aim of our study is to characterize opioid use in patients after an episode of acute pancreatitis and to assess persistent, chronic, and daily opioid use in such patients in the absence of chronic pancreatitis. MethodsThis is a single-center review of prospectively enrolled patients with acute pancreatitis. Using the Massachusetts Prescription Awareness Tool, we recorded all opioid prescriptions (ie, frequency, duration, and amount) for patients from December 2016 to September 2019, after index hospitalization for acute pancreatitis. Patients with chronic pancreatitis were excluded. We used univariate and multivariate analysis to determine predictors of opioid use at discharge and subsequent follow-up over 18 months. ResultsOf 235 enrolled patients who were opioid-naïve, 123 patients (52.3%) received opioids at discharge after index hospitalization. In follow-up over 18 months, 40 patients (17.0%) received additional opioid prescriptions. These patients had more severe disease, longer length of stay, and higher pain score at discharge. Patients with prior history of acute pancreatitis, local complications, and higher pain scores were twice as likely to subsequently be prescribed opioids. Persistent opioid use was seen only in recurrent acute pancreatitis. There was no daily or chronic opioid use. ConclusionsIn the absence of chronic pancreatitis, there was no daily or chronic use of opioids in patients with acute pancreatitis. Persistent use was only seen in patients with recurrent acute pancreatitis. These patients are at increased risk of chronic opioid use and dependence.

Acute pancreatitis and the weekend effect: does weekend admission affect patient outcome?

IntroductionWhen a patient is admitted to a hospital for acute pancreatitis (AP), the day of the week on which the admission occurs may influence the outcome of care. The link between reduced weekend staffing practices and outcomes for patients hospitalised for AP, however, has been inadequately studied.AimTo evaluate the relationship between weekend admission and AP outcome.Material and methodsOne hundred and twenty-six patients were prospectively included, assessed according to the revised Atlanta criteria, and observed until discharge or death. Weekend and weekday admissions were compared in terms of severity, aetiology, length of hospital stay, and in-hospital mortality.ResultsPatients were divided into two groups according to the timing of admission (weekday, n = 99, 78.6%; or weekend, n = 27, 21.4%). AP was considered severe in 33 (26.2%) patients, moderately severe AP in 37 (29.4%) patients, and mild in 56 (44.4%) patients. No significant differences were found with regard to the distribution of AP severity between the two groups. The impact of weekend admission was not significant for aetiology or for the length of hospital stay (median of 9 vs. 10 days). In-hospital mortality rates were not significantly different for weekday and weekend admissions.ConclusionsPatients admitted for hospitalisation during a weekend received the same level and quality of care at the facility under study as AP patients admitted during the week. Additionally, the rate of favourable outcomes for patients admitted during the weekend was found to be similar to the outcomes of patients admitted on a weekday.

Colonic hematoma after extracorporeal shock wave lithotripsy for pancreatic stones: a case report

BackgroundDespite pancreatic extracorporeal shock wave lithotripsy (P-ESWL) is a minimally invasive treatment for pancreatic stones, complications exist.Case presentationA 37-year-old male was diagnosed with chronic pancreatitis and admitted to our hospital for recurrent acute pancreatitis. After the first P-ESWL session, the patient complained of a new type of pain different from the previous pain pattern. Computerized tomography and colonoscopy were arranged and colonic hematoma was found. Since the patient had stable vital signs, no special treatment was given focusing on the colonic hematoma. Five days later, P-ESWL treatment was repeatedly performed for four consecutive days. Two days after the last P-ESWL session, the patient underwent endoscopic retrograde cholangiopancreatography. At the three-month follow up visit, the colonic hematoma disappeared and pancreatic stones decreased significantly.ConclusionsTo the best of our knowledge, colonic hematoma after P-ESWL for pancreatic stones has never been reported. Here, we present the only case of colonic hematoma after P-ESWL, which was coincidentally found in more than 6000 P-ESWL sessions in our hospital. As the symptoms of colonic hematoma are mild, we believe the incidence of colonic hematoma has been underestimated. Many people with colonic hematoma after P-ESWL may be undiagnosed or misdiagnosed. Treatment for colonic hematoma depends on whether there is severe clinical state. Exploration of more precise location method for pancreatic stones may reduce the probability of P-ESWL complication.