Pancreatology : official journal of the International Association of Pancreatology (IAP) ... [et al.] · 2026
Cirrhosis of the liver adversely affects the clinical outcomes in patients with acute pancreatitis: A propensity-matched nationwide analysis (2016-2020).
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Shah Mihir Prakash, Ojemolon Pius, Dahiya Dushyant Singh, Parikh Charmy, Paladiya Ruchir Damjibhai, Shah Yash R, Gajjar Rohan, Mutneja Hemant Raj, Mba Benjamin, Gandhi Seema, Mony Shruti
Аннотация
BACKGROUND: Acute pancreatitis (AP) may develop in patients with cirrhosis of the liver due to higher prevalence of etiological factors such as alcoholism and gallstones in them. However, the data are limited regarding the clinical outcomes in patients with AP and underlying cirrhosis.
METHODS: National Inpatient Sample (2016-2020) was reviewed to identify adult inpatients with AP. They were divided into three groups based on presence of cirrhosis. STATA was used to compare clinical outcomes and resource utilization using multivariate and propensity score-matched analyses.
RESULTS: 1.38 million patients were admitted with AP, with 2.2 % and 2.1 % having compensated and decompensated cirrhosis respectively. Compared to non-cirrhotics, patients with decompensated cirrhosis had higher odds of mortality (OR 4.27,95 %C.I.:3.53-5.17,p = 0.001), length of stay (LOS) (1.9 days,95 %C.I.:1.69-2.10,p = 0.001) and total hospitalization charges (THC) (9544$,95 %C.I.:16,484-22,603,p = 0.001); worse secondary outcomes including AP-related: sepsis (OR 2.59,95 %C.I.:2.23-3.00,p-0.001), acute kidney injury (AKI) (OR 1.64,95 %C.I.:1.53-1.77,p = 0.001), shock (OR 2.8,95 %C.I.:2.23-3.51,p = 0.001), acute respiratory failure (OR 1.76,95 %C.I.:1.56-1.99,p = 0.001); and cirrhosis-related: gastrointestinal bleeding (OR 5.08,95 %C.I.:4.62-5.59,p = 0.001) and portal vein thrombosis (OR 9.22,95 %C.I.:8.22-10.36,p = 0.001). Patients with compensated cirrhosis had similar odds of mortality, lower LOS (-0.23 days,95 %C.I.: 0.34 to -0.12,p = 0.001) and THC (-2727$,95 %C.I.: 4091 to -1362,p = 0.001) but higher odds of gastrointestinal bleeding (OR 1.92,95 %C.I.:1.50-2.45,p = 0.001), blood transfusion requirements (OR 1.52,95 %C.I.:1.16-2.00,p = 0.002) and portal vein thrombosis (OR 1.93,95 %C.I.:1.53-2.44,p = 0.001).
CONCLUSION: Patients with decompensated cirrhosis had higher odds of mortality, higher healthcare resource utilization, and worse clinical outcomes compared to those without cirrhosis. Patients with compensated cirrhosis had higher odds of portal vein thrombosis, GI bleeding, and blood transfusion. Complications of portal hypertension are likely the primary drivers behind increased odds of mortality in cirrhotic patients with AP. Patients with decompensated cirrhosis also seem to be at a higher risk of complications due to AP.
METHODS: National Inpatient Sample (2016-2020) was reviewed to identify adult inpatients with AP. They were divided into three groups based on presence of cirrhosis. STATA was used to compare clinical outcomes and resource utilization using multivariate and propensity score-matched analyses.
RESULTS: 1.38 million patients were admitted with AP, with 2.2 % and 2.1 % having compensated and decompensated cirrhosis respectively. Compared to non-cirrhotics, patients with decompensated cirrhosis had higher odds of mortality (OR 4.27,95 %C.I.:3.53-5.17,p = 0.001), length of stay (LOS) (1.9 days,95 %C.I.:1.69-2.10,p = 0.001) and total hospitalization charges (THC) (9544$,95 %C.I.:16,484-22,603,p = 0.001); worse secondary outcomes including AP-related: sepsis (OR 2.59,95 %C.I.:2.23-3.00,p-0.001), acute kidney injury (AKI) (OR 1.64,95 %C.I.:1.53-1.77,p = 0.001), shock (OR 2.8,95 %C.I.:2.23-3.51,p = 0.001), acute respiratory failure (OR 1.76,95 %C.I.:1.56-1.99,p = 0.001); and cirrhosis-related: gastrointestinal bleeding (OR 5.08,95 %C.I.:4.62-5.59,p = 0.001) and portal vein thrombosis (OR 9.22,95 %C.I.:8.22-10.36,p = 0.001). Patients with compensated cirrhosis had similar odds of mortality, lower LOS (-0.23 days,95 %C.I.: 0.34 to -0.12,p = 0.001) and THC (-2727$,95 %C.I.: 4091 to -1362,p = 0.001) but higher odds of gastrointestinal bleeding (OR 1.92,95 %C.I.:1.50-2.45,p = 0.001), blood transfusion requirements (OR 1.52,95 %C.I.:1.16-2.00,p = 0.002) and portal vein thrombosis (OR 1.93,95 %C.I.:1.53-2.44,p = 0.001).
CONCLUSION: Patients with decompensated cirrhosis had higher odds of mortality, higher healthcare resource utilization, and worse clinical outcomes compared to those without cirrhosis. Patients with compensated cirrhosis had higher odds of portal vein thrombosis, GI bleeding, and blood transfusion. Complications of portal hypertension are likely the primary drivers behind increased odds of mortality in cirrhotic patients with AP. Patients with decompensated cirrhosis also seem to be at a higher risk of complications due to AP.