P0017 - Outcomes in Idiopathic Acute Pancreatitis: 10-Year Experience at a Tertiary Care Center

Sunday, October 24, 2021

3:30 PM – 7:00 PM PT

Location: Shoreline Exhibit Hall

Has Audio

Presenting Author(s)

Supisara Tintara, MD

Beth Israel Deaconess Medical Center, Harvard Medical School
Boston, MA, United States

Supisara Tintara, MD¹, Ishani Shah, MD¹, William Yakah, BS¹, Awais Ahmed, MD¹, Cinthana Kandasamy, MD¹, Cristina Sorrento, MD¹, Steven D. Freedman, MD, PhD¹, Darshan J. Kothari, MD², Sunil G. Sheth, MD¹
¹Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA; ²Duke University Medical Center, Durham, NC

Introduction:

While most cases of acute pancreatitis (AP) are caused by gallstones or heavy alcohol use, up to 30% of AP cases do not have established etiology after standard diagnostic work-up. As a result, managing patients with idiopathic AP (IAP) could be potentially challenging with respect to preventing recurrence and progression to chronic pancreatitis. Our study aims to elucidate the characteristics and outcomes of IAP patients compared to those with established causes of AP (non IAP).

Methods:

We conducted a retrospective cohort study of patients admitted with AP at a tertiary care center from 2008-2018. Inclusion criteria includes patients with established causes of AP including gallstone, alcohol use, hypertriglyceridemia, medications, etc., as well as IAP patients. T-test were used for analysis. Primary outcomes included 30-day and 1-year readmission rates, length of stay (LOS), complications in IAP compared to non IAP patients.

Results:

We identified 577 patients who met the inclusion criteria. There were 142 IAP patients and 435 non IAP patients (235 gallstone, 179 alcohol, 12 drug-induced, 9 HTG). Compared to patients with non IAP, patients with IAP were younger (49.3 vs 52.7 years-old, p=0.002) but had no other demographic or severity differences. IAP patients were more likely to have prior history of AP (60.6 vs 37.7%, p< 0.001). Baseline labs were notable for lower white blood cell count (9.4 vs 11.1, p< 0.001), lower lipase (965 vs 2191, p< 0.001), lower transaminases, alkaline phosphatase and total bilirubin in IAP patients. The two groups had similar incidence of pancreatic necrosis but IAP patients had lower incidence of pleural effusion (10.0 vs 21.2%, p=0.005). Patients with IAP had fewer MRIs (14.8 vs 24.1%, p=0.027) and ERCPs (8.45 vs 33.5%, p< 0.001). IAP patients had a higher rate of 1-year readmission (89.4 vs 53.2%, p< 0.001) but similar 30-day readmission rates. The 1-year mortality was lower in IAP (0.70 vs 2.99%, p=0.049). Both groups had similar LOS, time to enteral nutrition and inpatient complications.

Discussion:

A large number of AP patients do not have an established AP etiology which could lead to difficulty in targeting appropriate treatment and preventing chronic pancreatitis. They tend to have recurrent AP and more readmissions in 1 year, but lower mortality.

	Non-idiopathic AP (n=435)	Idiopathic AP (n=142)	p-value
Demographics
Age (SD)	52.7 (16.5)	49.3 (14.7)	0.022
Body mass index, BMI (SD)	27.6 (7.41)	27.3 (7.51)	0.683
Female (%)	200 (46.0%)	79 (55.6%)	0.057
Race (%)			0.218
Caucasian	292 (68.9%)	105 (76.6%)
African American	110 (25.9%)	27 (19.7%)
Other	22 (5.19%)	5 (3.65%)
History of pancreatitis (%)	164 (37.7%)	86 (60.6%)	< 0.001
Congestive heart failure (%)	16 (3.69%)	2 (1.41%)	0.266
Stroke (%)	19 (4.38%)	5 (3.52%)	0.840
Chronic obstructive pulmonary disease, COPD (%)	56 (12.9%)	14 (9.86%)	0.420
Liver disease (%)	35 (8.05%)	19 (13.4%)	0.084
Diabetes mellitus (%)	69 (15.9%)	40 (28.2%)	0.002
Chronic kidney disease (%)	16 (3.68%)	17 (12.0%)	0.001
Alcohol use (%)	195 (45.1%)	24 (17.1%)	< 0.001
Tobacco use (%)	125 (29.0%)	38 (27.5%)	0.870
Charlson comorbidity index (%)			0.433
0	121 (27.8%)	34 (23.9%)
1-2	156 (35.9%)	57 (40.1%)
3-5	114 (26.2%)	32 (22.5%)
6 and above	44 (10.1%)	19 (13.4%)
Vital signs and baseline labs
Heart rate (SD)	84.9 (18.3)	81.4 (17.6)	0.051
Temperature (SD)	98.3 (0.99)	98.1 (1.13)	0.060
Respiratory rate (SD)	17.9 (3.54)	17.6 (2.15)	0.229
Creatinine (SD)	1.03 (1.56)	1.02 (0.76)	0.949
Hematocrit (SD)	39.4 (17.2)	37.1 (6.03)	0.022
White blood cell count (SD)	11.1 (5.79)	9.44 (4.45)	< 0.001
Lactate (SD)	1.94 (1.43)	2.38 (1.49)	0.152
Lipase (SD)	2191 (3874)	965 (3059)	< 0.001
Alanine transaminase (SD)	185 (298)	45.1 (76.5)	< 0.001
Aspartate aminotransferase (SD)	198 (450)	50.4 (79.2)	< 0.001
Alkaline phosphatase (SD)	145 (117)	107 (112)	0.001
Total billirubin (SD)	1.84 (4.74)	0.65 (0.91)	< 0.001
Triglyceride (SD)	429 (1268)	834 (1758)	0.091
Severity of pancreatitis
BISAP (%)			0.055
0	186 (46.2%)	73 (57.9%)
1-2	198 (49.1%)	50 (39.7%)
3 and above	19 (4.71%)	3 (2.38%)
Atlanta Criteria (%)			0.324
Mild	312 (73.9%)	112 (80.0%)
Moderate	94 (22.3%)	23 (16.4%)
Severe	16 (3.79%)	5 (3.57%)
Pleural effusion (%)	84 (21.2%)	14 (10.0%)	0.005
Pancreas necrosis (%)	102 (25.6%)	26 (18.7%)	0.129
Studies
MRI (%)	104 (24.1%)	21 (14.8%)	0.027
X-ray (%)	242 (55.9%)	79 (55.6%)	1.000
Ultrasound (%)	225 (52.0%)	60 (42.3%)	0.056
CT (%)	208 (48.0%)	77 (54.2%)	0.237
ERCP (%)	145 (33.5%)	12 (8.45%)	< 0.001
EGD (%)	33 (7.67%)	16 (11.3%)	0.249

Table: Table 1: Demographics and characteristics of patients with idiopathic acute pancreatitis (IAP) compared to those with other common causes of AP (gallstone, alcohol, hypertriglyceridemia, medications). MRI = magnetic resonance imaging, CT = computed tomography, ERCP = endoscopic retrograde cholangiopancreatography, EGD = esophagogastroduodenoscopy

Disclosures:

Supisara Tintara indicated no relevant financial relationships.

Ishani Shah indicated no relevant financial relationships.

William Yakah indicated no relevant financial relationships.

Awais Ahmed indicated no relevant financial relationships.

Cinthana Kandasamy indicated no relevant financial relationships.

Cristina Sorrento indicated no relevant financial relationships.

Steven Freedman indicated no relevant financial relationships.

Darshan Kothari indicated no relevant financial relationships.

Sunil Sheth indicated no relevant financial relationships.

Supisara Tintara, MD¹, Ishani Shah, MD¹, William Yakah, BS¹, Awais Ahmed, MD¹, Cinthana Kandasamy, MD¹, Cristina Sorrento, MD¹, Steven D. Freedman, MD, PhD¹, Darshan J. Kothari, MD², Sunil G. Sheth, MD¹. P0017 - Outcomes in Idiopathic Acute Pancreatitis: 10-Year Experience at a Tertiary Care Center, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.