C0013 - Acute Pancreatitis Is Associated With Increased Risk of In-Hospital Mortality and Healthcare Utilization Among Patients With Hematopoietic Stem Cell Transplantation

Monday, October 24, 2022

3:00 PM – 5:00 PM ET

Location: Crown Ballroom

Presenting Author(s)

Hunza Chaudhry, MD

UCSF-Fresno
Fresno, CA

Hunza Chaudhry, MD¹, Armaan Dhaliwal, MBBS², Aalam Sohal, MD³, Sohail Sodhi, MD⁴, Gagan Gupta, MBBS⁵, Piyush Singla, MBBS⁶, Raghav Sharma, MBBS⁷, Dino Dukovic, ⁸, Devang Prajapati, MD³
¹UCSF-Fresno, Fresno, CA; ²University of Arizona, Tucson, AZ; ³UCSF Fresno, Fresno, CA; ⁴Rutgers Health/Trinitas Regional Medical Center, Elizabeth, NJ; ⁵Dayanand Medical College and Hospital, Phillaur, Punjab, India; ⁶Dayanand Medical College and Hospital, Ludhiana, Punjab, India; ⁷Punjab Instute of Medical Sciences, Jalandhar, Jalandhar, Punjab, India; ⁸Ross University School of Medicine, Anaheim, CA

Introduction: Acute pancreatitis (AP) carries a significantly increased morbidity and mortality worldwide. AP is a potential complication of hematopoietic stem cell transplantation (HSCT) although its incidence remains unclear. HSCT recipients are at increased risk of AP due to various factors but the effect of AP on mortality and resource utilization in the adult population has not been studied. We investigated the impact of AP on hospitalization outcomes among patients following HSCT.

Methods: We queried the National Inpatient Sample (NIS) database using the ICD-10 codes. All adult patients with a diagnosis or procedure code of HSCT were included in the study. Patients were divided into those with a diagnosis of AP and those without. Sensitivity analysis was performed for patients with length of stay greater than 28 days. The relationship between AP and mortality, length of stay, total hospitalization cost and charge was assessed using multivariate analysis. Adjustments were made for patient demographics, hospital characteristics, etiology of pancreatitis, common indications for stem cell transplant and common biliary interventions.

Results: Of the 140,130 adult patients with HSCT, 855 (0.61%) patients developed acute pancreatitis. A complete list of demographics is presented in Table 1. There was a 2.2 times higher risk of mortality in patients with AP as compared to controls (aOR: 2.2, p-0.012). There was no statistically significant difference in the length of stay, hospitalization charge or cost before sensitivity analysis. After sensitivity analysis, 13,240 patients were included, from which 125 (0.94%) had AP. There was 4.25 times higher risk of mortality in patients who developed AP as compared to controls (aOR: 4.25, p-0.002). There was a statistically significant increase noted in the length of stay (adj coeff: 19.96 days, p-0.02), hospital charge (+$354,527.3, p-0.014) and cost (+$119,822, p-0.001) in patients with AP as compared to those who did not develop AP.

Discussion: Recipients of HSCT who develop AP have shown to have higher mortality in both initial analysis as well as sensitivity analysis. This study highlights that acute pancreatitis in HSCT patients is associated with worse outcomes and higher resource utilization. Physicians should be aware about this association as presence of pancreatitis portends poor prognosis.

	Without pancreatitis n (%)	With pancreatitis n (%)	p-value
Age category			< 0.001
18-45	30,045 (21.57)	360 (42.11)
45-65	63,845 (45.84)	330 (38.6)
>65	45,385 (32.59)	165 (19.30)
Sex			0.26
Male	79,465 (57.06)	450 (52.60)
Female	59,810 (42.94)	405 (47.40)
Race			0.38
White	97,105 (69.72)	540 (63.16)
African American	17,020 (12.22)	140 (16.37)
Hispanic	14,695 (10.55)	110 (12.87)
Asian/Pacific islander	4,405 (3.16)	35 (4.09)
Native American	475 (0.34)	0 (0)
Other	5,575 (4.00)	30 (3.51)
Insurance			0.05
Medicare	53,505 (38.42)	260 (30.41)
Medicaid	15,735 (11.3)	180 (21.05)
Private	64,080 (46.01)	365 (42.69)
Uninsured	1,485 (1.07)	25 (2.92)
Income			0.27
Lowest quartile	28,760 (20.65)	190 (22.22)
Second quartile	32,890 (23.62)	235 (27.49)
Third quartile	37,755 (27.11)	175 (20.47)
Highest quartile	39,870 (28.63)	255 (29.82)
Indications of HSCT
Myelodysplastic	9,375 (6.73)	50 (5.85)	0.64
Lymphoid leukemia	11,595 (8.33)	120 (14.04)	0.009
Myeloid leukemia	26,095 (18.74)	155 (18.13)	0.84
Hodgkin lymphoma	4,430 (3.18)	20 (2.34)	0.53
Non-Hodgkin lymphoma	3,505 (2.52)	15 (1.75)	0.52
Bone marrow failure syndromes	30 (0.02)	0 (0)	0.85
HLH	290 (0.21)	0 (0)	0.57
Thalassemia	290 (0.21)	0 (0)	0.57
Sickle cell disease	1,590 (1.14)	25 (2.92)	0.06
Metabolism error diseases	210 (0.15)	0 (0)	0.64
Primary immunodeficiency	5,710 (4.10)	35 (4.09)	0.99
GVHD	19,390 (13.92)	185 (21.64)	0.005
Hemolytic uremic	130 (0.09)	0 (0)	0.73
Conditions related to pancreatitis
Cholangitis	660 (0.47)	55 (6.43)	< 0.001
Choledocholithiasis	1,680 (1.21)	135 (15.79)	< 0.001
Other biliary conditions	1,680 (1.21)	55 (6.43)	< 0.001
Hypertriglyceridemia	1,025 (0.74)	90 (10.53)	< 0.001
SLE	455 (0.33)	10 (1.17)	0.06
Diabetic ketoacidosis	255 (0.18)	25 (2.92)	< 0.001
Alcohol-related pancreatitis	1,805 (1.30)	50 (5.85)	< 0.001

HLH: hemophagocytic lymphohistiocytosis, GVHD: graft versus host disease, SLE: systemic lupus erythematosus

Table: Table 1- Characteristics of patients with hematopoietic stem cell transplant (HSCT) stratified by presence of acute pancreatitis

Disclosures:

Hunza Chaudhry indicated no relevant financial relationships.

Armaan Dhaliwal indicated no relevant financial relationships.

Aalam Sohal indicated no relevant financial relationships.

Sohail Sodhi indicated no relevant financial relationships.

Gagan Gupta indicated no relevant financial relationships.

Piyush Singla indicated no relevant financial relationships.

Raghav Sharma indicated no relevant financial relationships.

Dino Dukovic indicated no relevant financial relationships.

Devang Prajapati indicated no relevant financial relationships.

Hunza Chaudhry, MD¹, Armaan Dhaliwal, MBBS², Aalam Sohal, MD³, Sohail Sodhi, MD⁴, Gagan Gupta, MBBS⁵, Piyush Singla, MBBS⁶, Raghav Sharma, MBBS⁷, Dino Dukovic, ⁸, Devang Prajapati, MD³. C0013 - Acute Pancreatitis Is Associated With Increased Risk of In-Hospital Mortality and Healthcare Utilization Among Patients With Hematopoietic Stem Cell Transplantation, ACG 2022 Annual Scientific Meeting Abstracts. Charlotte, NC: American College of Gastroenterology.