P0006 - Head-to-Head Comparison of Alcoholic, Biliary, & Hypertriglyceridemia-Induced Acute Pancreatitis: A Nationwide Analysis

Sunday, October 22, 2023

3:30 PM – 7:00 PM PT

Location: Exhibit Hall

Has Audio

Presenting Author(s)

AJ

Ali Jaan, MD

Rochester General Hospital
Rochester, NY

Ali Jaan, MD¹, Umer Farooq, MD¹, Sheza Malik, MD¹, Chengu Niu, MD¹, Ahmed Shehadah, MD¹, Tausif Syed, MD¹, Le Yu Naing, MD², Karin Dunnigan, MD¹, Patrick Okolo, MD, MPH, FACG¹
¹Rochester General Hospital, Rochester, NY; ²University of Louisville, Louisville, KY

Introduction: Acute pancreatitis (AP) is one of the most common gastrointestinal hospitalizations and is associated with significant morbidity, mortality, and healthcare costs. There is limited published literature comparing the outcomes of different types of pancreatitis. The aim of this study is to compare outcomes of patients hospitalized with AP secondary to alcoholism, hypertriglyceridemia (HTG), and biliary etiologies.

Methods: Using the National Inpatient Sample (NIS) 2017-2020, we employed International Classification of Diseases, Tenth Revision, Clinical Modifications (ICD-10- CM) codes, and identified adult patients (aged ≥18 years) who were admitted with a principal diagnosis of alcoholic AP, biliary AP, and HTG-induced AP. Multivariate regression models were used to compare outcomes among these groups and adjust for confounding variables. STATA 14.2 was utilized for statistical analysis.

Results: A total of 219,835 adult patients admitted with a principal diagnosis of AP were included. Of these, 60,579 (28 %) patients had alcoholic AP, 13,239 (6%) had HTG-AP, and 37,580 (17%) had biliary AP. The remainder of the population had either an unspecified AP diagnosis or AP secondary to other etiologies. We observed no significant difference in mortality among the major types of AP (P > 0.5) (Table 1). However, compared to alcohol-induced AP, patients with biliary and HTG-induced AP had a lower risk of acute respiratory distress syndrome (adjusted odds ratio [aOR] 0.43 & aOR 0.58 respectively, P< 0.05), and mechanical ventilation requirement (aOR 0.55& aOR 0.56 respectively, P< 0.01). The odds for shock (aOR 0.81, P = 0.04), acute kidney injury (aOR 0.8, P< 0.01), disseminated intravascular coagulation (aOR 0.7, P = 0.02), and portal venous thrombosis (aOR 0.7, P< 0.01) were lower in biliary AP than in alcoholic AP patients. However, the need for invasive interventions (pancreatic drainage [aOR 1.37, P = 0.03], pancreatic necrosectomy [aOR 1.47, P = 0.03]) and overall length of hospital stay were higher (adjusted mean difference 0.25 days, P< 0.01) in biliary AP compared to alcoholic AP.

Discussion: Our study highlights that AP morbidity varies depending on the underlying etiology of pancreatitis. Because none of the commonly used scoring systems have compared AP outcomes based on etiology, future systematic reviews or prospective multicenter studies are warranted to establish new scoring systems.

Outcomes (n= 111,398)	Alcoholic pancreatitis (n= 60,579)	HTG-induced pancreatitis (n= 13,239)	Biliary pancreatitis (n= 37,580)	HTG-induced pancreatitis	Biliary pancreatitis
Outcomes (n= 111,398)	Alcoholic pancreatitis (n= 60,579)	HTG-induced pancreatitis (n= 13,239)	Biliary pancreatitis (n= 37,580)	*Adjusted OR (P-value)	*Adjusted OR (P-value)
Mortality, %	0.42	0.40	0.77	0.94 (0.75)	1.09 (0.52)
Shock, %	1.06	1.14	1.09	0.87 (0.25)	0.81 (0.04)
ARDS, %	0.29	0.23	0.15	0.58 (0.03)	0.43 (< 0.01)
Mechanical ventilation, %	2.06	1.41	1.43	0.56 (< 0.01)	0.55 (< 0.01)
AKI, %	11.31	13.51	12.18	0.94 (0.14)	0.80 (< 0.01)
DIC, %	1.39	1.1	0.59	0.99 (0.90)	0.70 (0.02)
Portal venous thrombosis, %	1.39	1.1	0.59	0.99 (0.94)	0.70 (< 0.01)
Requirement of pancreatic drainage, %	0.56	0.54	0.6	0.86 (0.40)	1.37 (0.03)
Pancreatic necrosectomy, %	0.34	0.45	0.46	0.99 (0.90)	1.47 (0.03)
Adjusted Mean Difference
Mean length of hospital stay, days (95% CI)	4.2 (4.25 – 4.34)	4.50 (4.42 – 4.57)	4.90 (4.84 – 4.95)	- 0.08 (0.20)	0.25 (< 0.01)
Total Hospitalization Charges, mean, USD	38,381 (37,697 – 39,065)	44,201 (42,955 – 45,448)	61,525 (60,399 – 62,650)	- 1326 (0.20)	16647 (< 0.01)

Table: Table 1: Unadjusted and adjusted outcomes of alcoholic, biliary, and hypertriglyceridemia-induced acute pancreatitis.
*Adjusted for sex, age, hospital bed size, Charlson index, hospital location, hospital teaching status, race, insurance status, cirrhosis, obesity, end-stage renal disease, congestive heart failure, nicotine dependence, and diabetes mellitus.
CI means confidence interval.
Abbreviations- HTG: hypertriglyceridemia; ARDS: Acute respiratory distress syndrome; DIC: Disseminated intravascular coagulation; AKI: Acute kidney injury.

Disclosures:

Ali Jaan indicated no relevant financial relationships.

Umer Farooq indicated no relevant financial relationships.

Sheza Malik indicated no relevant financial relationships.

Chengu Niu indicated no relevant financial relationships.

Ahmed Shehadah indicated no relevant financial relationships.

Tausif Syed indicated no relevant financial relationships.

Le Yu Naing indicated no relevant financial relationships.

Karin Dunnigan indicated no relevant financial relationships.

Patrick Okolo indicated no relevant financial relationships.

Ali Jaan, MD¹, Umer Farooq, MD¹, Sheza Malik, MD¹, Chengu Niu, MD¹, Ahmed Shehadah, MD¹, Tausif Syed, MD¹, Le Yu Naing, MD², Karin Dunnigan, MD¹, Patrick Okolo, MD, MPH, FACG¹. P0006 - Head-to-Head Comparison of Alcoholic, Biliary, & Hypertriglyceridemia-Induced Acute Pancreatitis: A Nationwide Analysis, ACG 2023 Annual Scientific Meeting Abstracts. Vancouver, BC, Canada: American College of Gastroenterology.