P2883 - Alcoholic Cirrhosis, Pancreatitis, and the Combination Syndrome: Differential Risk Factors and Clinical Outcomes for These Gastrointestinal Manifestations of Alcohol Overuse

David Lehoang, MD, MBA¹, Thu Anne T. Mai, MD¹, Divya Ayyala-Somayajula, MD¹, Mimi Xu, MD¹, Linda Huang, MD¹, Jin Sun Kim, MD¹, Rachel Dong, MD¹, Kidwai Yousuf, MD¹, Rachan Narala, MD¹, Sean Dewberry, MS¹, Teya Nastaskin, MD¹, Helen Lee, NP², James Buxbaum, MD, MS^1
1Keck School of Medicine of USC, Los Angeles, CA; ²University of Southern California, Los Angeles, CA

Introduction: Alcohol use disorder (AUD) may be complicated by gastrointestinal complications such as pancreatitis and cirrhosis. The differential risk factors and course for these pathways are unknown. Our aim was to evaluate the interaction and outcomes of concomitant cirrhosis and acute pancreatitis induced by alcohol.

Methods: We conducted a retrospective cohort study of three unique patient populations (cirrhosis and acute alcoholic pancreatitis, acute alcoholic pancreatitis without cirrhosis, and alcohol associated cirrhosis) presenting to a large urban medical center from 2015- 2019. Our primary outcome was mortality and secondary outcome was impact of the two disease processes on each other. Multivariate linear and logistic regression adjusted for age, sex, ethnicity and the comorbidities of obesity and diabetes were used to compare the main outcomes between groups.

Results: Among 657 patients included, 30 were confirmed to have alcohol associated cirrhosis, 323 patients with acute alcoholic pancreatitis without cirrhosis, 52 with acute alcoholic pancreatitis and cirrhosis. Patients with acute alcoholic pancreatitis were significantly younger and had a higher albumin than patients with alcoholic cirrhosis without pancreatitis and those with both disorders. Patients with pancreatitis and cirrhosis had a higher MELD-Na and were more likely to have ascites but were less likely to have hepatic encephalopathy than those with alcohol associated cirrhosis without pancreatitis.

In adjusted multivariable models, patients with alcoholic pancreatitis without cirrhosis had a lower mortality compared to alcohol associated cirrhosis patients (OR 0.107 95% CI .02 – 0.51). There was no difference in mortality among those with alcoholic cirrhosis and pancreatitis versus alcoholic cirrhosis (OR 0.998 95% CI 0.22-4.62).

Discussion: Patients with alcoholic pancreatitis are younger and have a lower inpatient mortality versus those with acute pancreatitis and cirrhosis and alcohol associated cirrhosis alone suggesting that cirrhosis is a determinant of mortality. Among patients with cirrhosis, those with pancreatitis were more likely to have ascites and higher MELD-Na. To determine the impact of pancreatitis on cirrhosis, preliminary data demonstrates more signs of decompensation in the presence of pancreatitis, but mortality was not impacted. Further studies are needed to better define the severity of pancreatitis and cirrhosis for a more definitive evaluation of the interaction.


Disclosures:


David Lehoang, MD, MBA¹, Thu Anne T. Mai, MD¹, Divya Ayyala-Somayajula, MD¹, Mimi Xu, MD¹, Linda Huang, MD¹, Jin Sun Kim, MD¹, Rachel Dong, MD¹, Kidwai Yousuf, MD¹, Rachan Narala, MD¹, Sean Dewberry, MS¹, Teya Nastaskin, MD¹, Helen Lee, NP², James Buxbaum, MD, MS¹. P2883 - Alcoholic Cirrhosis, Pancreatitis, and the Combination Syndrome: Differential Risk Factors and Clinical Outcomes for These Gastrointestinal Manifestations of Alcohol Overuse, ACG 2023 Annual Scientific Meeting Abstracts. Vancouver, BC, Canada: American College of Gastroenterology.