C0021 - Presentation, Management, and Outcomes in Patients With Concomitant Acute Pancreatitis and Acute Kidney Injury

Thu Anne Mai, MD¹, Jin Sun Kim, MD¹, David Lehoang, MD, MBA¹, Mimi Xu, MD¹, Selena Zhou, MD¹, Rachel Dong, MD¹, Yousuf Kidwai, MD¹, Linda Huang, MD¹, Kevin Yu, MD¹, Niwen Kong, MD¹, Kabir Rahal, ², James L. Buxbaum, MD^3
1University of Southern California, Los Angeles, CA; ²University of California Los Angeles, Los Angeles, CA; ³Keck School of Medicine, University of Southern California, Los Angeles, CA

Introduction: Patients with acute pancreatitis(AP) as well as acute kidney injury(AKI) have been shown to have increased mortality. Although aggressive fluid resuscitation is the mainstay in management for acute pancreatitis, the optimal fluid management strategy in patients with concomitant AKI remain uncertain. We aim to characterize their presentation, management, and clinical outcomes.

Methods: As part of an ongoing prospective study of patients presenting with AP between 1/2015 and 3/2021 to a safety-net tertiary care hospital, we evaluated patients who presented with AKI, defined as a creatinine(Cr) increase of ≥0.3mg/dL from baseline or increase in serum Cr to 1.5 times baseline. Our primary outcome was the development of volume overload as evidenced by granular data such as pleural effusions or peripheral edema. Secondary outcomes were mortality, ICU admission, development of severe pancreatitis, and length of stay. Categorical variables were compared using chi square analysis and continuous variables were compared using Student’s t-test. Logistic and linear multivariate regression models were performed controlling for baseline characteristics (age, sex, race) and clinical features such as etiology of pancreatitis and co-morbidities.

Results: A total of 1494 patients who presented with AP were included in the analysis; among those, 214 also had an AKI(14%). The mean admission Cr in the AKI cohort was 2.07 mg/dL. Baseline characteristics are described in table 1. Patients with co-morbidities such as DM, CHF, and cirrhosis were more likely to present with AKI. Patients with an AKI were more likely to have SIRS on presentation and require ICU on admission. They also received more fluids, 3,974mL on average in the first 24 hours, with a mean difference of 590mL above the non-AKI cohort (p = .002).

In a multivariate analysis, patients with concomitant AKI and AP were more likely to develop signs of volume overload including new pleural effusions (OR 2.29, 95% CI 1.26 – 4.15) and peripheral edema (OR 2.52, 95% CI 1.02 – 6.21). They were also more likely to develop severe pancreatitis (OR 8.7 95% CI 4.8 – 15.6) and had an increased length of stay of 4.7 days over the average 5.7 days (95% CI 1.67 – 7.8).

Discussion: Patients with concurrent AP and AKI are at risk for both more severe pancreatitis and adverse events related to volume overload. This highlights the challenges with defining a fluid management strategy in this population. More studies are needed to optimize the care of these patients.



Disclosures:


Thu Anne Mai, MD¹, Jin Sun Kim, MD¹, David Lehoang, MD, MBA¹, Mimi Xu, MD¹, Selena Zhou, MD¹, Rachel Dong, MD¹, Yousuf Kidwai, MD¹, Linda Huang, MD¹, Kevin Yu, MD¹, Niwen Kong, MD¹, Kabir Rahal, ², James L. Buxbaum, MD³. C0021 - Presentation, Management, and Outcomes in Patients With Concomitant Acute Pancreatitis and Acute Kidney Injury, ACG 2022 Annual Scientific Meeting Abstracts. Charlotte, NC: American College of Gastroenterology.