Primary Diagnosis Of Acute Pancreatitis Research Articles

Predicting the risk of early intensive care unit admission for patients hospitalized with acute pancreatitis using supervised machine learning

Background Acute pancreatitis (AP) is a complex and life-threatening disease. Early recognition of factors predicting morbidity and mortality is crucial. We aimed to develop and validate a pragmatic model to predict the individualized risk of early intensive care unit (ICU) admission for patients with AP. Methods The 2019 Nationwide Readmission Database was used to identify patients hospitalized with a primary diagnosis of AP without ICU admission. A matched comparison cohort of AP patients with ICU admission within 7 days of hospitalization was identified from the National Inpatient Sample after 1:N propensity score matching. The least absolute shrinkage and selection operator (LASSO) regression was used to select predictors and develop an ICU acute pancreatitis risk (IAPR) score validated by 10-fold cross-validation. Results A total of 1513 patients hospitalized for AP were included. The median age was 50.0 years (interquartile range: 39.0–63.0). The three predictors that were selected included hypoxia (area under the curve [AUC] 0.78), acute kidney injury (AUC 0.72), and cardiac arrhythmia (AUC 0.61). These variables were used to develop a nomogram that displayed excellent discrimination (AUC 0.874) (bootstrap bias-corrected 95% confidence interval 0.824–0.876). There was no evidence of miscalibration (test statistic = 2.88; P = 0.09). For high-risk patients (total score >6 points), the sensitivity was 68.94% and the specificity was 92.66%. Conclusions This supervised machine learning-based model can help recognize high-risk AP hospitalizations. Clinicians may use the IAPR score to identify patients with AP at high risk of ICU admission within the first week of hospitalization.

The association between phosphate level at admission and early mortality in acute pancreatitis.

Abnormal phosphate levels are associated with adverse outcomes in critical illness. However, there is scarce evidence on phosphate's impact on acute pancreatitis outcomes, and the few studies examining this subject are relatively small and show conflicting data. We sought to determine the association between phosphate level at admission and the clinical course and outcomes of acute pancreatitis. In this retrospective single-center observational study, we included all adult patients admitted with a primary diagnosis of acute pancreatitis between January 2008 and June 2021. Phosphate levels at admission were classified as normal (2.8-4.5mg/dl), low (below 2.8mg/dl), or high (above 4.5mg/dl). Out of 2308 cases, 1868 patients had documented phosphate levels at admission and were thus included in our final analysis. 1096 (59%) had normal phosphate levels, 686 (37%) had hypophosphatemia, and 86 (4.6%) had hyperphosphatemia on admission. 30-day mortality rates were 3.4%, 3.8%, and 19% in normal, low, and high phosphate levels, respectively. In univariate analysis, hyperphosphatemia was significantly associated with 30-day mortality, with an OR of 6.54 (95% CI 3.39-12.2, p < 0.001; AUC = 0.58). In a multivariate analysis adjusting for age, MAP, GFR, BUN, and pH, hyperphosphatemia remained a statistically significant independent predictor of early mortality (OR-2.93, 95% CI 1.28-6.51, p = 0.009). Hypophosphatemia was not significantly associated with 30-day mortality in univariate analysis, OR of 1.13 (95% CI 0.67-1.87, p = 0.6). Hyperphosphatemia at admission was independently associated with increased 30-day mortality in patients with acute pancreatitis. Hypophosphatemia at admission was not significantly associated with 30-day mortality.

Insights Into Clinical Outcomes of Acute Pancreatitis With Concomitant Acute Myocardial Infarction Using the National Inpatient Sample Database

Acute pancreatitis (AP) and acute coronary syndrome (ACS) are common conditions, occasionally sharing overlapping symptoms, posing various clinical challenges. This study aims to investigate the demographics, outcomes, and risk factors of patients admitted with AP and ACS using the National Inpatient Sample database. The database from 2016 to 2019 was analyzed, identifying patients with a primary diagnosis of AP and dividing them into 2 groups: those with ACS and those without (non-ACS). Of the 112,874 patients with AP, 5,210 (0.46%) had ACS. The patients with AP with concomitant ACS were older, predominantly male, and had a higher prevalence of co-morbidities. Inpatient mortality was significantly higher in the AP with concomitant ACS cohort compared with the AP without ACS cohort (8.4% vs 0.5%, adjusted odds ratio 9.94, 95% confidence interval 7.79 to 12.67, p<0.05). In conclusion, patients with AP and ACS experienced worse clinical outcomes.

Mortality Trends, Outcomes, and Predictors of Portal Vein Thrombosis in Acute Pancreatitis Patients: A Propensity-Matched National Study.

Portal vein thrombosis (PVT) is a rare complication of acute pancreatitis (AP) and might be associated with worse outcomes. We aimed to study trends, outcomes, and predictors of PVT in AP patients. The National Inpatient Sample database was utilized to identify the adult patients (≥ 18years) with primary diagnosis of AP from 2004 to 2013 using International Classification of Disease, Ninth Revision. Patients with and without PVT were entered into propensity matching model based on baseline variables. Outcomes were compared between both groups and predictors of PVT in AP were identified. Among the total of 2,389,337 AP cases, 7046 (0.3%) had associated PVT. The overall mortality of AP decreased throughout the study period (p trend ≤ 0.0001), whereas mortality of AP with PVT remained stable (1-5.7%, p trend = 0.3). After propensity matching, AP patients with PVT patients had significantly higher in-hospital mortality (3.3% vs. 1.2%), AKI (13.4% vs. 7.7%), shock (6.9% vs. 2.5%), and need for mechanical ventilation (9.2% vs. 2.5%) along with mean higher cost of hospitalization and length of stay (p < 0.001 for all). Lower age (Odd ratio [OR] 0.99), female (OR 0.75), and gallstone pancreatitis (OR 0.79) were negative predictors, whereas alcoholic pancreatitis (OR 1.51), cirrhosis (OR 2.19), CCI > 2 (OR 1.81), and chronic pancreatitis (OR 2.28) were positive predictors of PVT (p < 0.001 for all) in AP patients. PVT in AP is associated with significantly higher risk of death, AKI, shock, and need for mechanical ventilation. Chronic and alcoholic pancreatitis is associated with higher risk of PVT in AP.

Malnutrition Imparts Worse Outcomes in Patients Admitted for Acute Pancreatitis.

Purpose Cessation of enteral nutrition is usually a part of the early stage of acute pancreatitis (AP) treatment. To our knowledge, there is no large database study that examines the effects of preexisting malnutrition on the morbidities of patients admitted for acute pancreatitis. We aimed to investigate the effects of malnutrition on patients admitted for acute pancreatitis. Methods Data between 2008 and 2014 from the National Inpatient Sample (NIS) database was extracted. Inclusion criteria included patients with a primary diagnosis of AP using the International Classification of Diseases, Ninth Revision (ICD-9) codes, and ages greater than 17. Exclusion criteria included ICD-9 codes for chronic pancreatitis. The study group consisted of patients with a primary diagnosis of AP and a concurrent diagnosis of malnutrition. In-hospital mortality was compared using univariate and multivariate analyses to generate odds ratios. Elixhauser comorbidity scores predicting mortality and readmission were calculated based on weighted scores from 29 different comorbidities and compared using univariate analysis. Results Patients with malnutrition were significantly more likely to experience in-hospital mortality, sepsis, severe sepsis, septic shock, and respiratory failure. Malnutrition was found to increase mortality. Female sex and Black or Hispanic race showed lower mortality. Conclusion We hypothesize that there are likely other preexisting comorbidities that lead to malnutrition before the onset of pancreatitis. Malnutrition can cause impaired healing and the ability to recover from acute inflammation, which may be why the study group had a higher rate of sepsis.

The effect of anemia on the severity and prognosis of patients with acute pancreatitis: A single-center retrospective study

Anemia was a risk factor for a worse prognosis of many diseases. This study aims to investigate the relationship between anemia and the severity and prognosis of acute pancreatitis (AP). Inpatients hospitalized at the First Affiliated Hospital of Guangdong Pharmaceutical University with a primary diagnosis of AP between 1st July 2016 to 31st December 2020 were enrolled. Subsequently, disease severity, the incidence of complications, and the prognosis of patients with AP were compared between the anemic group and the non-anemic group. A total of 282 patients with acute pancreatitis were enrolled; 68.43% of them were also diagnosed with anemia. Notably, these patients had more severe disease (higher RANSON, acute physiologic assessment and chronic health evaluation-II, bedside index for severity in acute pancreatitis, and multiple organ dysfunction syndrome scores); higher incidence of organ failure (acute kidney injury [AKI] and acute heart failure); worse prognosis (higher incidence of vasoactive and diuretic agent use, longer hospital stays, and higher hospital costs) compared to that of patients without anemia (all P < .05). After adjusting for potential confounders, acute physiologic assessment and chronic health evaluation-II, bedside index for severity in acute pancreatitis, multiple organ dysfunction syndrome scores, hospital stay, and hospital costs in anemic patients were higher than those in non-anemic patients; besides, the incidence of AKI and using a diuretic agent in anemic patients was 6.645 and 4.053 times that of non-anemic patients in AP, respectively (all P < .05). Acute pancreatitis patients with anemia have more disease severity, higher incidence of AKI, and worse prognosis compared to those without anemia.

HPB P44 Incidence of pancreatitis induced splanchnic venous thrombosis in a tertiary care hospital

Abstract Background Splanchnic venous thrombosis (SPVT) is a well-recognized vascular complication of acute pancreatitis (AP). Exact incidence is not clear, however in recent years, the incidence of SPVT is on the rise. This is partially attributed by the availability of computed tomography. Most commonly involved veins are splenic vein (SV), superior mesenteric vein (SMV) and portal vein (PV) in the same order of frequency. Systemic anticoagulation is the presumed treatment for SPVT but evidence of benefit is still not clear. Further complications such as gastrointestinal bleeding, intestinal ischemia, anaemia, thrombocytopenia, infection and oesophageal or gastric varices has been documented which may worsen patient's outcomes. Currently, no data on incidence has been documented in Scotland and there are no national guidelines on the anticoagulation management for SPVT in acute pancreatitis. This study aims to determine the incidence of SPVT complicating AP, the possible aetiological risk factor, the correlation of severity of AP with the development of SPVT, the current practice in management via anticoagulation and outcome of these patients, all in a single health board. Methods A cross-sectional study was conducted, including patients admitted to Aberdeen Royal Infirmary (ARI) and Dr. Gray's Hospital (DGH) with the primary diagnosis of AP from 1st January 2017 to 31st March 2018. Data was obtained from the health intelligence as per NHS Grampian protocol. Data collection was conducted retrospectively by assessing patient's electronic records via TrakCare on NHS Grampian computers, then inputted into REDCap software. Variables instruments heading patient background, admission/diagnosis background, pancreatitis severity, microbiology, organ support, feeding and nutrition, imaging/complications, SPVT, inpatient intervention and follow-up was set up. CT severity index (CTSI) was used to stratify pancreatitis severity. These scores were made based on interpretation of CT scans formal reports. Outcomes parameters were measured by length of hospital stay (LOS) in days and death during admission. Lastly, data was exported from REDCap and statistical analyses were conducted in IBM SPSS Statistics Version 27. Mean, standard deviation and range were calculated for continuous variables while frequencies and percentages for categorical variables. Chi-square test was used for correlation between categorical variables. P value of &amp;lt; 0.05 was set as level of significance. Results Of 219 patients admitted with AP, 202 had either CT scan or/and ultrasound scan conducted, recording incidence of SPVT to be 16/202(7.92%). Patients without scans were excluded as presence of undiagnosed due to its asymptomatic nature. Among SPVT group, 8/16(50%) were gallstone-related, 4/16(25%) alcohol, 1/16(6.25%) post-instrumental(iatrogenic) and 3/16(18.75%) idiopathic. Location of thromboses categorised into SV only in 7(43.8%), SMV only 2(12.5%), PV only 1(6.3%), SV+SMV 4(25%) and SV+ SMV+PV 2(12.5%). 125 patients received CT scan, SPVT group displayed 6/125(4.8%) CTSI ranging 0–5 and 9/125(7.2%) for 6–10, while non-SPVT group 101/125(80.8%) and 9/125(7.2%) respectively, p=0.000. Mortality rate due to SPVT recorded 1/10(10%) and LOS ranged from 0–360 days, mean:14.91, SD:41.43, p=0.000. 4/16(25%) SPVT patients had therapeutic anticoagulation, 3/16(18.8%) not anti-coagulated and 9/16(56.4%) had no data. In relation to thromboses site, 1/7(14.29%) SV only thrombosis received anticoagulation, ½(50%) for SMV only, ¼(25%) for SV+SMV and ½(50%) for SMV+SV+PV. On discharge, 5(62.5%) received anticoagulation, 3 months for 4 patients and 6 months for 1, 2/5(40%) oral and 3(60%) injectable. Conclusions Incidence of pancreatitis induced SPVT was 7.29% during the study period. No aetiological risk factor was determined. Severity of pancreatitis measured by CTSI was directly correlated with increased incidence of SPVT. Besides that, a high rate of idiopathic pancreatitis (37.9%) was found which is not in line with NICE guidance. Hence, further investigations should be offered to establish the aetiology of pancreatitis. In NHS Grampian, we observed mainly supportive management in SV thrombosis while anticoagulation commenced for PV and SMV involvement. Extension of thrombosis also prompted initiation of treatment. For future studies, state of splanchnic circulation after anticoagulation, locations of collaterals, acute and late complications among SPVT can be better analysed.

S53 Disparities in the Readmission Rates After Hospitalization for Acute Pancreatitis

Introduction: Acute pancreatitis (AP) is one of the leading causes of hospitalization in the United States. Patients with AP frequently get readmitted and that proves to be a great burden on our healthcare system. Age, male sex, tobacco use, alcohol use, and necrotizing pancreatitis have been linked to a higher readmission rate in AP patients. However, studies on the impact of socioeconomic status are lacking. Our study attempts to find the impact of income on the readmission rates in patients admitted for AP. Methods: We queried the National Readmission Database (NRD) from 2017 to 2018 to identify patients with a primary diagnosis of AP. Those who died during the index hospitalization were excluded when examining readmission rates. Multivariable Cox proportional-hazards regression was used to study the impact of income on 90-day readmission adjusted for age, sex, comorbidities, hospital characteristics, and primary payer. Results: A total of 313,565 AP patients were identified, 99,023 of whom belonged to median income quartile 1, 89,582 to quartile 2, 74,027 to quartile 3, and 50,933 to quartile 4 with quartile 4 having the highest income. Slightly more than half of each quartile group were men (53.1%, 52.8%, 53.0%, 53.5%, respectively). Patients with lower income had higher prevalence of comorbidities. Among those who survived the index hospitalization, 21,694 (21.9%), 18,880 (21.1%), 15,264 (20.6%), and 9,854 (19.3%) patients in quartiles 1, 2, 3, and 4 were readmitted within 90 days, respectively. When compared with the highest income quartile (quartile 4), patients in quartiles 1, 2, and 3 were associated with an increasingly higher hazard of readmission (quartile 1, aHR 1.09, p< 0.001; quartile 2, aHR 1.07, p< 0.001; quartile 3, aHR 1.06, p< 0.001). (Figure) Conclusion: Our study finds a positive correlation between poverty and the 90-day readmission rate in AP patients. Alcohol use is one of the top causes of pancreatitis in the US. It would be interesting to investigate if there is a difference in the prevalence of substance use in patients of various economic strata that could be impacting the readmission. Furthermore, it is imperative that we bring reforms in our financial and health policy to make it more equiTable in order to alleviate some of the disparities we see.Figure 1.: Kaplan-Meier curves of readmissions after acute pancreatitis stratified to median income quartile

S105 Acute Pancreatitis in a Los Angeles Safety Net Hospital System: Patient Characteristics and Predictors of Readmission

Introduction: Acute pancreatitis (AP) is the most common gastrointestinal cause for hospital admission in the United States and may disproportionately affect minority populations. We aimed to characterize patients with AP and identify predictors of readmission in hospitals belonging to the Los Angeles County Department of Health Services, a large safety net hospital system. Methods: A database of patient encounters at Olive View-UCLA, Harbor-UCLA, and LAC+USC Medical Centers was queried for patients seen in 2017 with an elevated lipase or diagnosis matching ICD-10-AM codes K85.0, K85.1, K85.2, K85.3, K85.8, or K85.9. Patients were included in the study if they met at least 2 of the following 3 criteria: 1) lipase >3x the upper limit of normal, 2) radiographic findings suggestive of AP, or 3) abdominal pain. Patients were excluded if radiographic evidence of chronic pancreatitis was present. Outcomes included overall length of stay (LOS), mortality due to AP during the index admission, and readmission for AP or AP-related complications. A multiple logistic regression model was used to identify predictors of readmission for AP. Results: Six hundred and twenty-three patients with median age 45 years, 83% Hispanic, and 51% male met inclusion criteria for the study. The most common AP etiology was gallstones, seen in 251 patients (40%), followed by alcohol, seen in 144 (23%). Radiographic evidence of acute interstitial edematous (IEP) and necrotizing pancreatitis (NP) was seen in 61% and 7% of patients, respectively. Greater than half of all patients with IEP developed an acute peripancreatic fluid collection, while 48% and 39% of patients with NP developed an acute necrotic collection or walled-off necrosis, respectively. The median LOS was 4 days (IQR 2 – 6). Five patients (1%) died during the index admission due to an AP-related complication, while 48 (8%) had a readmission for AP at a median of 91 days (IQR 15 – 178) from discharge. Increasing age (OR = 0.97, P = 0.038) was associated with decreased odds of readmission for AP when controlling for sex, BMI, and presence of any local complication on imaging. (Table) Conclusion: In our safety net patient population, gallstones and alcohol were the most common AP etiologies and increasing age at admission was associated with decreased odds of readmission for AP, mirroring findings reported in the literature. Our mortality rate was comparatively low at just 1%, however this may be because we did not limit our study cohort to patients with a primary diagnosis of AP. Table 1. - Predictors of readmission for AP modeled using multiple logistic regression Predictor Odds Ratio Std. Err. P-Value 95% Confidence Interval Male 1.578 0.634 0.256 0.718 – 3.470 Age 0.972 0.013 0.038 0.947 – 0.998 BMI 1.009 0.021 0.678 0.968 – 1.050 Presence of local complications 1.560 0.618 0.261 0.718 – 3.391

Factors Affecting the Circulating Levels of Oxyntomodulin in Health and After Acute Pancreatitis

To investigate the factors associated with the circulating levels of oxyntomodulin in healthy individuals and individuals after an episode of acute pancreatitis (AP). Blood samples were collected from all participants after an overnight fast and analyzed for 28 biomarkers. Participants also underwent comprehensive body composition analysis on a 3-T magnetic resonance imaging scanner. Regression analyses were done to investigate the associations between oxyntomodulin and the studied factors. The study included 105 individuals who had a primary diagnosis of AP and 58 healthy individuals. Peptide YY (B coefficient, 0.094; 95% confidence interval [95% CI], 0.164-0.123), pancreatic polypeptide (0.048; 95% CI, 0.030-0.066), and leptin (0.394; 95% CI, 0.128-0.661) had significant associations with oxyntomodulin in healthy individuals. Peptide YY was the most prominent factor associated with oxyntomodulin, explaining 60% of its variance in health. Cholecystokinin (0.014; 95% CI, 0.010-0.018), amylin (-0.107; 95% CI, -0.192 to -0.021), and glycated hemoglobin (-0.761; 95% CI, -1.249 to -0.273) had significant associations with oxyntomodulin in individuals after AP. Cholecystokinin was the most prominent factor associated with oxyntomodulin, explaining 44% of its variance after AP. Factors affecting the circulating levels of oxyntomodulin are different in health and after AP. These insights will enable the determination of populations that benefit from oxyntomodulin therapeutics in the future.

Clostridioides difficile Infection Is Associated with Adverse Outcomes among Hospitalized Pediatric Patients with Acute Pancreatitis.

PurposeStudies in adults have shown an increasing incidence of Clostridioides difficile infection (CDI) in patients hospitalized with acute pancreatitis (AP). There is lack of epidemiological data on CDI and its impact on hospitalized pediatric patients with AP.MethodsWe analyzed the National Inpatient Sample and Kids' Inpatient Database between the years 2003 and 2016 and included all patients (age <21 years) with a primary diagnosis of AP using specific International Classification of Diseases codes. We compared clinical outcomes between children with CDI and those without CDI. Our primary outcome was severe AP and secondary outcomes included length of stay and hospital charges.ResultsA total of 123,240 hospitalizations related to AP were analyzed and CDI was noted in 0.6% of the hospital. The prevalence rate of CDI doubled from 0.4% (2003) to 0.8% (2016), p=0.03. AP patients with CDI had increased comorbidities, and also underwent more invasive surgical procedures, p<0.05. AP patients with CDI had a higher in-hospital mortality rate and increased prevalence of severe AP, p<0.001. Multivariate regression models showed that CDI was associated with 2.4 times (confidence interval [CI]: 1.91 to 3.01, p<0.001) increased odds of severe AP. CDI patients had 7.24 (CI: 6.81 to 7.67, p<0.001) additional hospital days while incurring $59,032 (CI: 54,050 to 64,014, p<0.001) additional hospitalization charges.ConclusionCDI in pediatric patients with AP is associated with adverse clinical outcomes and increased healthcare resource utilization. Further studies are needed to elucidate this association to prevent the development of CDI and to improve outcomes.

Prevalence of Chronic Metabolic Comorbidities in Acute Pancreatitis and Its Impact on Early Gastrointestinal Symptoms during Hospitalization: A Prospective Cohort Study

Background: The prevalence of chronic comorbidities is increasing worldwide, and this has been paralleled by a growing interest in how these comorbidities affect patients with acute pancreatitis. The aim was to investigate the associations between pre-existing diabetes mellitus, obesity, metabolic syndrome, and gastrointestinal symptoms during the early course of acute pancreatitis. Methods: This was a prospective cohort study of patients with a primary diagnosis of acute pancreatitis. Study groups were formed based on the presence of metabolic comorbidities (pre-existing diabetes mellitus, obesity, and metabolic syndrome). Patient-reported outcomes (nausea, bloating, and abdominal pain) were collected prospectively every 24 h (including weekends and public holidays) over the first 72 h of hospitalization. Results: A total of 183 consecutive patients were enrolled. Of them, 111 (61%) had at least one major metabolic comorbidity. Patients with pre-existing diabetes mellitus and those with metabolic syndrome had worse nausea at 49–72 h of hospitalization (p = 0.017 and p = 0.012, respectively), but not at other time points. Bloating and abdominal pain did not differ between the study groupings throughout the study period. The studied patient-reported outcomes did not differ significantly between acute pancreatitis patients with and without obesity at any point in time. Conclusion: More than 3 out of 5 patients hospitalized for acute pancreatitis have at least one major chronic metabolic comorbidity. The presence of metabolic comorbidities does not considerably and consistently affect early gastrointestinal symptoms in patients with acute pancreatitis.

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

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.

Clinical Characteristics and Prognosis of Idiopathic Acute Pancreatitis.

ObjectiveAcute pancreatitis is a serious diagnosis with an increasing incidence in the Western world. In this study we sought to investigate the incidence of idiopathic AP and to compare clinical and prognostic characteristics of idiopathic cases with cases of AP with known etiology.MethodsIn this retrospective study of adult hospitalized patients diagnosed with acute pancreatitis between 2012 and 2015, a comparison was made between admissions of patients with known etiology and those for whom no cause was found. Primary outcome was defined as composite outcome of 30-day mortality and complications.ResultsAmong 560 admissions of 437 patients with a primary diagnosis of acute pancreatitis, the main factors identified were gallstones (51.2%) and idiopathic pancreatitis (35.9%), with alcohol ranked third at only 4.8%. Mortality rate within 30 days of hospitalization was 2.9% and within one year was 7.1%. Use of lipid-lowering, anti-hypertensive, and anti-diabetic medications was more frequent among patients with “idiopathic” disease (70%, 68%, and 33% versus 59%, 56%, and 27%, respectively). Patients admitted with idiopathic AP, in comparison to patients with known AP etiology, had milder disease with shorter hospital stay (3 days versus 4, respectively), and less re-admission in 30 days (7.5% versus 21.2%). Idiopathic AP patients had better prognosis in terms of 30-day death and complication (HR 0.33, 95% CI 0.08–0.40, P<0.001).ConclusionIdiopathic disease is common among acute pancreatitis patients; the two study groups differed in severity of disease and prognosis. Common use of medications with doubtful value suggests possible under-diagnosis of drug-induced acute idiopathic pancreatitis.

Prevalence and impact of acute kidney injury in hospitalized pediatric patients with acute pancreatitis.

The incidence of acute pancreatitis (AP) in pediatric patients is rising with accompanying increased hospitalizations. Acute kidney injury (AKI) is associated with worse clinical outcomes in adults, and similar data in the pediatric age group is limited. We analyzed non-overlapping years of National Inpatient Sample (NIS) and Kids Inpatient Database (KID) to include all patients less than 21 years old with primary diagnosis of AP between 2003 and 2016. Patients with concomitant diagnosis of AKI were compared with patients without AKI for demographics, comorbid/etiologic conditions, procedures, complications, and mortality. Length of stay and inflation-adjusted hospitalization charges were used to compare health care resource utilization. In total, 123,185 AP-related hospitalizations were analyzed. Overall prevalence of AKI among AP patients was 1.5% during the study period. The prevalence rate of AKIincreased almost five-fold from 0.6% (2003) to a peak rate of 2.9% (2016), P < 0.001. Patients with AKI were older, more often male and had either more systemic diseases or chronic comorbid conditions such as malignancies, systemic lupus erythematosus, solid organ transplantation, hypertriglyceridemia, and hypercalcemia. Multivariate analysis demonstrated AP-related hospitalizations with AKI were 1.97 (CI 1.27-3.08, P < 0.001) times more likely to be associated with in-hospital mortality and contributed to 4.3 additional days of hospitalization (CI 4.02-4.6, P < 0.001), also incurring an additional $51,830 (CI 48571-55088, P < 0.001) in hospital charges. The prevalence of AKI is increasing steadily among pediatric patients with AP and is associated with increased risk of mortality and higher health care resource expenditure.

Appraisal of the diagnostic procedures of acute pancreatitis in the guidelines

ObjectivesThe purpose of this study was to comprehensively assess the heterogeneity of procedures in the diagnostic guidelines for acute pancreatitis and to identify gaps limiting knowledge in diagnosing this disease.MethodsA systematic search of a number of databases was performed to determine the guidelines for the diagnosis of acute pancreatitis in patients with severe pancreatitis. The guidelines for the diagnosis of severe pancreatitis were evaluated by AGREE II. The Measurement Scale of Rate of Agreement (MSRA) was used to assess the guidelines (2015–2020) and extract evidence supporting these recommendations for analysis.ResultsSeven diagnostic guidelines for acute pancreatitis were included. Only the 2019 WSES Guidelines for the Management of Severe Acute Pancreatitis and the Japanese Guidelines for the Management of Acute Pancreatitis: Japanese Guidelines 2015 had a total score of more than 60%, which is worthy of clinical recommendation. The average scores of the Scope and Purpose domain and the Clarity and Expression domain were the highest at 71.62% and 75.59%, respectively, while the average score of the Applicability area was the lowest at 16.67%. The included guidelines were further analyzed to determine the heterogeneity of the diagnosis of acute pancreatitis. The main reasons for the heterogeneity were the citation of low-quality evidence, the presence of far too many indicators for the classification of acute pancreatitis, unclear depictions of the standard, and poorly comprehensive recommendations for the diagnosis of the aetiology in the primary diagnosis of acute pancreatitis, the severity classification, the aetiological diagnosis, and the diagnosis of comorbidities.ConclusionsThe quality of different diagnostic guidelines for severe pancreatitis is uneven. The recommendations are largely based on low-quality evidence, and the guidelines still have much room for improvement to reach a high level of quality. The diagnostic procedures for acute pancreatitis vary widely in different guidelines. There are large differences between them, and resolving the abovementioned reasons would be a very wise choice for guideline developers to revise and upgrade the guidelines in the future.

Undernutrition and Obesity Are Associated with Adverse Clinical Outcomes in Hospitalized Children and Adolescents with Acute Pancreatitis.

Background: Adult studies demonstrated that extremes of nutritional status adversely impact clinical outcomes in acute pancreatitis (AP). With rising prevalence of undernutrition/obesity in children, we analyzed the effect of nutritional status on the clinical outcomes in children and adolescents with acute pancreatitis. Methodology: We analyzed the Kids’ Inpatient Database (KID) between 2003 and 2016 to include all patients with a primary diagnosis of AP using specific International Classification of Diseases (ICD) codes. We classified into (1) undernutrition, (2) obesity and (3) control groups, based on ICD codes, and we compared severe acute pancreatitis and healthcare utilization (length of stay and hospitalization costs). Results: Total number of AP admissions was 39,805. The prevalence of severe AP was higher in the undernutrition and obesity groups than the control group (15.7% vs. 5.8% vs. 3.5% respectively, p < 0.001). Multivariate analyses demonstrated that undernutrition and obesity were associated with 2.5 and 1.6 times increased risk of severe AP, p < 0.001. Undernutrition was associated with an additional six days of hospitalization and almost $16,000 in hospitalization costs. Obesity was associated with an additional 0.5 day and almost $2000 in hospitalization costs, p < 0.001. Conclusion: Undernutrition and obesity were associated with greater severity of AP, as well as prolonged hospitalization stay and costs. It is imperative for treating clinicians to be aware of these high-risk groups to tailor management and strive for improved outcomes.

Predictors of hospital transfer and associated risks of mortality in acute pancreatitis

BackgroundThere is limited research in prognosticators of hospital transfer in acute pancreatitis (AP). Hence, we sought to determine the predictors of hospital transfer from small/medium-sized hospitals and outcomes following transfer to large acute-care hospitals. MethodsUsing the 2010–2013 Nationwide Inpatient Sample (NIS), patients ≥18 years of age with a primary diagnosis of AP were identified. Hospital size was classified using standard NIS Definitions. Multivariable analyses were performed for predictors of “transfer-out” from small/medium-sized hospitals and mortality in large acute-care hospitals. ResultsAmong 381,818 patients admitted with AP to small/medium-sized hospitals, 13,947 (4%) were transferred out to another acute-care hospital. Multivariable analysis revealed that older patients (OR = 1.04; 95%CI 1.03–1.06), men (OR = 1.15; 95%CI 1.06–1.24), lower income quartiles (OR = 1.54; 95%CI 1.35–1.76), admission to a non-teaching hospital (OR = 3.38; 95%CI 3.00–3.80), gallstone pancreatitis (OR = 3.32; 95%CI 2.90–3.79), pancreatic surgery (OR = 3.14; 95%CI 1.76–5.58), and severe AP (OR = 3.07; 95%CI 2.78–3.38) were predictors of “transfer-out”. ERCP (OR = 0.53; 95%CI 0.43–0.66) and cholecystectomy (OR = 0.14; 95%CI 0.12–0.18) were associated with decreased odds of “transfer-out”.Among 507,619 patients admitted with AP to large hospitals, 31,058 (6.1%) were “transferred-in” from other hospitals. The mortality rate for patients “transferred-in” was higher than those directly admitted (2.54% vs. 0.91%, p < 0.001). Multivariable analysis revealed that being “transferred-in” from other hospitals was an independent predictor of mortality (OR = 1.47; 95% CI 1.22–1.77). ConclusionsPatients with AP transferred into large acute-care hospitals had a higher mortality than those directly admitted likely secondary to more severe disease. Early implementation of published clinical guidelines, triage, and prompt transfer of high-risk patients may potentially offset these negative outcomes.

S0042 Acute Biliary Pancreatitis Has Better In-Hospital Outcomes Compared to Acute Alcohol-Induced Pancreatitis: Results of a Nationwide Analysis

INTRODUCTION: Acute pancreatitis (AP) is an acute inflammatory process involving the pancreas with considerable morbidity and mortality. The most common cause of AP is biliary disease followed by alcohol, accounting for estimated 70–80 percent of all cases of AP. Determination of the etiology may reliably guide immediate management of patient. METHODS: We queried the National Inpatient Sample (NIS) databases 2016 and 2017 using the International Classification of Diseases, 10th revision, Clinical Modification (ICD-10-CM) coding system to identify the following: (A) Patients with primary diagnosis of Acute Pancreatitis (AP) (B) Patients with a primary diagnosis of Acute Alcohol-induced Pancreatitis (AAP) and Acute Biliary Pancreatitis (ABP). Analysis was performed with STATA software. RESULTS: 553,480 adult patients who were diagnosed with AP during hospitalization in 2016 and 2017 were identified. Mean age was 51.8 years, and majority of patients were male (53.22%). 25.3% patients had AAP and 17.44% patients had ABP. Patients with ABP were more likely to be females compared to patients with AAP (59.4% vs 30.73%, P < 0.01), and were older (57.03 years vs 45.31 years, P < 0.01).The total mortality in patients with AAP was 0.42% and in patients with ABP was 0.82% with no significant difference on multivariate analysis (aOR: 0.95, 95% CI: 0.69–1.31, P = 0.79). Patients with ABP had a significantly longer Length of Stay (LOS) when compared with patients with APP (+0.48 days, P < 0.01). In addition, the ABP group had a significantly higher mean adjusted hospitalization charges and costs with a difference of $ +19,958 (P < 0.01) in charges and $+4,848 (P < 0.01) in cost. Patients with ABP had significantly lower likelihood of shock when compared to patients with AAP (aOR: 0.75, 95% CI: 0.59–0.95, P < 0.05). They were significantly less likely to develop AKI (aOR 0.76, 95% CI: 0.71-0.82, P < 0.01) or to be admitted to ICU (aOR 0.74, 95% CI: 0.62–0.88, P < 0.01). They were more likely to be discharged home (aOR 1.26, 95% CI: 1.18–1.34, P < 0.01). CONCLUSION: Our study showed no difference in mortality between patients with AAP and ABP. We found that patients with ABP had increased resource utilization. Patients with ABP are more likely to undergo invasive procedures like ERCP/cholecystectomy and this is likely the reason for increased resource use. Patients with ABP had significantly lower odds of AKI, shock and ICU stay. Further studies are needed to assess the reason for this difference and guide clinical practice.Figure 3.: Pooled rates of technical success, clinical success, and AE of POP, EHL and LL.

S0114 Demographics and Outcomes of Acute Necrotizing Pancreatitis Hospitalizations in Acute Pancreatitis Patients: A Nationwide Inpatient Cohort Study

INTRODUCTION: Acute Pancreatitis (AP) is a common gastrointestinal complication leading to hospitalization. AP can be mild, moderate or severe. While mild pancreatitis is commonly self-limited, severe pancreatitis can be associated with development of complications such as necrotizing pancreatitis (NP). Demographics of NP have not been previously defined. Our aim was to determine the demographic factors leading to the development of necrotizing pancreatitis (NP). METHODS: We analyzed the National Inpatient Sample (NIS) database via ICD 10 codes during period from 2016 to 2017. Inclusion criteria were age between 18 and 90 years, elective admission, and with the primary diagnosis of AP. Patients were stratified by the presence of NP. Multivariate logistic and linear regression models were fit to adjust for patient demographics (age, gender, race, type of insurance, income quartile, Charlson Comorbidity Index) and odds ratio (OR) were determined. The primary outcome measure was demographic predictors of developing NP in all patients with AP. Secondary outcomes were potential causes of NP as well as mortality, hospitalization charges/costs and length of stay associated with NP. RESULTS: Out of 575,229 hospitalizations for AP, 13,205 hospitalizations (2.3%) presented with NP. As shown in Figure 1, males were significantly more likely to develop NP (OR 1.85; 95% CI 1.69–2.02; P < 0.001). Additionally, following demographic groups were less likely to develop NP: African Americans (OR 0.72; 95% CI 0.63–0.83; P < 0.001), older age groups including 50–64 years (OR 0.83; 95% CI 0.71–0.96; P < 0.05) and above 64 years (OR 0.72; 95% CI 0.62–0.85; P < 0.001). Overall inpatient mortality for NP was 3.34%, with average length of stay of 11.2 days and hospitalization costs of $29,168. Comparatively, mortality associated with AP was 0.53%, with average length of stay of 4.2 days and hospitalization costs of $9,042. Overall, 52.9% of NP hospitalizations were classified as idiopathic, 29.4% were associated with alcohol toxicity, 16.5% had biliary origin, and 1.2% were related to drug toxicity. CONCLUSION: NP represent a significant contributor to morbidity and mortality when compared to AP patients without necrosis. There were several demographic predictors of developing NP which require further physiological elucidation. Additionally, majority of NP cases were idiopathic, with alcohol, biliary and drug toxicity representing minority of cases in the stated order.Figure 1.: Demographic predictors of developing necrotizing pancreatitis among patients with acute pancreatitis using multivariate regression model.