John H. Stroger, Jr. Hospital of Cook County Oklahoma City, OK
Mihir P. Shah, MD1, Pius E. Ojemolon, MD2, Charmy Parikh, MD3, Dushyant S. Dahiya, MD4, Ruchir D. Paladiya, MD5, Yash R. Shah, MD6, Rohan Gajjar, MD2, Gautam Maddineni, MD7, Benjamin mba, MD8, Seema Gandhi, MD2 1John H. Stroger, Jr. Hospital of Cook County, Cook County, IL; 2John H. Stroger, Jr. Hospital of Cook County, Chicago, IL; 3Mercy Catholic Medical Center, Darby, PA; 4University of Kansas Medical Center, Kansas City, KS; 5University of Connecticut Health Center, Farmington, CT; 6Trinity Health Oakland / Wayne State University School of Medicine, Pontiac, MI; 7Florida State University, Cape Coral, FL; 8Yale New Haven Health, New Haven, CT
Introduction: Acute pancreatitis can lead to various local and systemic complications. Liver cirrhosis is a significant global public health problem with a high worldwide prevalence. The initial treatment for acute pancreatitis is early, rapid intravenous fluid resuscitation, which can be challenging in patients with cirrhosis, especially those in decompensation. We aimed to assess the impact of cirrhosis on acute pancreatitis outcomes.
Methods: We retrospectively analyzed the National Inpatient Sample (NIS) for 2016 to 2020 to identify patients admitted with a principal diagnosis of acute pancreatitis. We divided these patients into three groups (without cirrhosis, with compensated cirrhosis, and with decompensated cirrhosis). In-hospital mortality, healthcare utilization, and other secondary outcomes were compared between these groups using multivariate regression analysis and propensity score matching.
Results: 1.38 million patients were admitted with acute pancreatitis, with 2.2% having compensated cirrhosis and another 2.1% having decompensated cirrhosis. Patients with decompensated cirrhosis had higher odds of mortality (OR 4.27) as well as worse secondary outcomes [like GI bleeding (OR 5.08), portal vein thrombosis (OR 9.22), sepsis (OR 2.59), AKI (OR 1.64), shock (OR 2.80), acute respiratory failure (OR 1.76)] compared to patients without cirrhosis. Compared to patients without cirrhosis, those with compensated cirrhosis had similar odds of mortality; however, they had higher odds of gastrointestinal bleeding (OR 1.92) and portal vein thrombosis (OR 1.93), similar odds of AKI and shock with lower odds of acute respiratory failure (OR 0.77), deep vein thrombosis (OR 0.69), and odds of undergoing gastrointestinal procedures (OR 0.84).
Discussion: Patients with decompensated cirrhosis had higher odds of mortality and worse clinical outcomes compared to the other two groups. Patients with compensated cirrhosis had similar odds of mortality while having higher odds of GI bleeding and portal vein thrombosis, similar odds of AKI and shock, and lower odds of acute respiratory failure. Complications for cirrhosis and portal hypertension itself are likely the primary drivers behind increased odds of mortality in patients with acute pancreatitis, however patients with decompensated cirrhosis also seem to be at a higher risk of complications due to acute pancreatitis.
Figure: Adult patient hospitalizations with acute pancreatitis between 2016-2020, divided into groups based on the presence of cirrhosis.
Note: The table for this abstract can be viewed in the ePoster Gallery section of the ACG 2024 ePoster Site or in The American Journal of Gastroenterology's abstract supplement issue, both of which will be available starting October 27, 2024.
Disclosures:
Mihir Shah indicated no relevant financial relationships.
Pius Ojemolon indicated no relevant financial relationships.
Charmy Parikh indicated no relevant financial relationships.
Dushyant Dahiya indicated no relevant financial relationships.
Ruchir Paladiya indicated no relevant financial relationships.
Yash Shah indicated no relevant financial relationships.
Rohan Gajjar indicated no relevant financial relationships.
Gautam Maddineni indicated no relevant financial relationships.
Benjamin mba indicated no relevant financial relationships.
Seema Gandhi indicated no relevant financial relationships.
Mihir P. Shah, MD1, Pius E. Ojemolon, MD2, Charmy Parikh, MD3, Dushyant S. Dahiya, MD4, Ruchir D. Paladiya, MD5, Yash R. Shah, MD6, Rohan Gajjar, MD2, Gautam Maddineni, MD7, Benjamin mba, MD8, Seema Gandhi, MD2. P1762 - The Impact of Cirrhosis on Clinical Outcomes in Patients with Acute Pancreatitis? A Propensity-Matched Nationwide Analysis, ACG 2024 Annual Scientific Meeting Abstracts. Philadelphia, PA: American College of Gastroenterology.
