P0021 - Comparison of Clinical Outcomes Between Patients With Underlying Systolic and Diastolic Heart Failure Admitted With Acute Pancreatitis

Sunday, October 22, 2023

3:30 PM – 7:00 PM PT

Location: Exhibit Hall

Has Audio

Presenting Author(s)

Jiteshwar S. Pannu, MD

University of Oklahoma Health Sciences Center
Oklahoma City, OK

Jiteshwar S. Pannu, MD, Satyam Krishan, MD, Shruti Mony, MD, Mohit Pahuja, MD, Tarun Dasari, MD
University of Oklahoma Health Sciences Center, Oklahoma City, OK

Introduction: Heart failure (HF) is a major cause of morbidity and mortality in the United States. It can be caused secondary to systolic, diastolic, or combined systolic-diastolic dysfunction. There is paucity of data comparing clinical outcomes between isolated systolic and diastolic HF in patients admitted with acute pancreatitis (AP). Aggressive intravenous fluid hydration is one of the cornerstones of acute AP management and the presence of concomitant HF serves as a potential hindrance to treatment due to the risk of clinical morbidity. We postulated that presence of underlying diastolic HF would be associated with worse in-hospital clinical outcomes compared to those with underlying systolic HF in patients admitted with acute pancreatitis.

Methods: National Inpatient Sample for a two-year period (2017-2018) was analyzed using ICD-10 codes to identify patients admitted with acute pancreatitis as a primary diagnosis. Clinical outcomes of interest including inpatient mortality, rates of heart failure exacerbation, acute respiratory failure, mechanical ventilation, mean length of stay and total cost of care were compared between patients with underlying systolic and diastolic HF. Patients with concomitant end stage renal disease (ESRD) were excluded. Multivariate regression analysis adjusted for demographics, comorbidities (based on Charlson-Deyo comorbidity index) and potential confounders (Table 1) were performed to calculate adjusted odds ratio (OR) and regression coefficient. Statistical significance was considered at P< 0.05.

Results: A total of 14,535 weighted hospitalizations for acute pancreatitis were identified, out of which 6,325 had concomitant systolic HF and 8,210 had concomitant diastolic HF. Patients with concomitant diastolic HF were found to have higher rates of acute hypoxic respiratory failure (OR 1.93; 1.21-3.06; p=0.005) and requirement of mechanical ventilation (OR 7.7; 2.35-25.22, p=0.001) when compared to patients with concomitant systolic HF. We found no difference in the rates of acute HF exacerbation, inpatient mortality, mean length of stay or total cost of care between the two groups.

Discussion: The presence of HF is a risk factor for increased morbidity in patients admitted with AP, given the effect of increased cardiac preload from fluid resuscitation and AP induced inflammatory myocardial injury. To improve clinical outcomes, there is an urgent need to formulate guidelines for volume resuscitation and achieving euvolemia in patients with AP and concomitant HF.

Figure: Figure : Forest plot showing the higher rates of acute hypoxic respiratory failure and mechanical ventilation in patients admitted with acute pancreatitis with concomitant diastolic HF compared to patients with systolic HF (p<0.05)

Variables	Systolic HF	Diastolic HF
Mean Age	63.6	69.37
Female %	34.7	56.15
Race (%) : White Black Hispanic Asian Native American Other	62.5 25.56 7.34 1.69 0.32 2.58	68.75 19.81 7.19 1.75 0.81 2.08
Charlson Deyo Score (%) 1 2 3 or more	12.36 20.49 67.5	12.01 20.86 67.13
Median Household Income (%) $1-24,999 $25,000-34,999 $35,000-44,999 $45,000 or more	38.65 25.12 20.93 15.3	32.29 29.18 25.12 13.4
Insurance Status (%) Medicare Medicaid Private Insurance Self-pay	58.3 21.3 17.25 3.16	71.78 12.56 13.43 2.23
Hospital Region (%) Northeast Midwest South West	18.58 23.56 42.37 15.49	17.3 28.08 37.27 17.36
Hospital Bed Size (%) Small Medium Large	20.71 26.8 52.49	21.92 27.28 50.79
Hospital Location and Teaching Status (%) Rural Urban, non-teaching Urban, teaching	10.12 17.31 72.57	11.45 19.49 69.06

Table: Table 1 : Comparison of Baseline Characteristics Between Patients with Systolic and Diastolic HF, Admitted with a Primary Diagnosis of Acute Pancreatitis based on the National Inpatient Sample Database for 2017-2018

Disclosures:

Jiteshwar Pannu indicated no relevant financial relationships.

Satyam Krishan indicated no relevant financial relationships.

Shruti Mony indicated no relevant financial relationships.

Mohit Pahuja indicated no relevant financial relationships.

Tarun Dasari indicated no relevant financial relationships.

Jiteshwar S. Pannu, MD, Satyam Krishan, MD, Shruti Mony, MD, Mohit Pahuja, MD, Tarun Dasari, MD. P0021 - Comparison of Clinical Outcomes Between Patients With Underlying Systolic and Diastolic Heart Failure Admitted With Acute Pancreatitis, ACG 2023 Annual Scientific Meeting Abstracts. Vancouver, BC, Canada: American College of Gastroenterology.