Impact of comorbidities on hospital mortality in patients with acute pancreatitis: a population-based study of 110,021 patients

Abstract

Acute pancreatitis; Comorbidity; Hospital mortality

Pancreatitis aguda; Comorbilidad; Mortalidad hospitalaria

Pancreatitis aguda; Comorbilitat; Mortalitat hospitalària

Background The impact of pre-existing comorbidities on acute pancreatitis (AP) mortality is not clearly defined. Our study aims to determine the trend in AP hospital mortality and the role of comorbidities as a predictor of hospital mortality. Methods We analyzed patients aged ≥ 18 years hospitalized with AP diagnosis between 2016 and 2019. The data have been extracted from the Spanish National Hospital Discharge Database of the Spanish Ministry of Health. We performed a univariate and multivariable analysis of the association of age, sex, and comorbidities with hospital mortality in patients with AP. The role of the Charlson and Elixhauser comorbidity indices as predictors of mortality was evaluated. Results A total of 110,021 patients diagnosed with AP were hospitalized during the analyzed period. Hospital mortality was 3.8%, with a progressive decrease observed in the years evaluated. In multivariable analysis, age ≥ 65 years (OR: 4.11, p < 0.001), heart disease (OR: 1.73, p < 0.001), renal disease (OR: 1.99, p < 0.001), moderate-severe liver disease (OR: 2.86, p < 0.001), peripheral vascular disease (OR: 1.43, p < 0.001), and cerebrovascular disease (OR: 1.63, p < 0.001) were independent risk factors for mortality. The Charlson > 1.5 (OR: 2.03, p < 0.001) and Elixhauser > 1.5 (OR: 2.71, p < 0.001) comorbidity indices were also independently associated with mortality, and ROC curve analysis showed that they are useful for predicting hospital mortality. Conclusions Advanced age, heart disease, renal disease, moderate-severe liver disease, peripheral vascular disease, and cerebrovascular disease before admission were independently associated with hospital mortality. The Charlson and Elixhauser comorbidity indices are useful for predicting hospital mortality in AP patients. Peer Review reports Background Acute pancreatitis (AP) is a prevalent acute inflammatory disease that affects the pancreas, with an increased incidence in recent years [1, 2]. Most cases are mild with a self-limited course [3]. However, patients with severe acute pancreatitis have a high mortality rate (20–50%) [4,5,6]. For this reason, many efforts have been made to find predictors of severity and mortality in patients with AP [7,8,9,10,11] to identify patients who need admission to an intensive care unit or specific treatment. In clinical practice, systems such as the Ranson score, the Acute Physiology and Chronic Health Evaluation II (APACHE II) score, the Computed Tomography Severity Index (CTSI), the Bedside Index for Severity in Acute Pancreatitis (BISAP), and various biochemical markers are used to predict severe AP and mortality [3, 12,13,14,15,16]. However, hospital mortality in AP could also be related to intrinsic patient characteristics, such as individual comorbidities. Most classic scores do not consider comorbidities before admission, except for APACHE II, but are restricted to severe chronic diseases. According to some previous studies, patients with certain comorbidities, such as obesity [17], hypertriglyceridemia [18], chronic renal failure [19], diabetes [20, 21], and systemic lupus erythematosus [22], are associated with a higher risk of AP severity and mortality. However, few studies currently evaluate the impact of comorbidities on AP severity and mortality. Our study aimed to determine the relevance of comorbidities and their indexes (Charlson and Elixhauser) as predictors of hospital mortality in patients with AP.