B0014 - Presentation and Management of Fluid Status for Cirrhotic Patients With Acute Pancreatitis in a Prospective Cohort Study

David Lehoang, MD, MBA¹, Mimi Xu, MD¹, Thu Anne Mai, MD¹, Jin Sun Kim, MD¹, Niwen Kong, MD¹, Yousuf Kidwai, MD¹, Linda Huang, MD¹, Rachel Dong, MD¹, Kevin Yu, MD¹, Collin Mayemura, MD², Megan Chang, RN³, Selena Zhou, MD¹, Patrick W. Chang, MD¹, James L. Buxbaum, MD^1
1University of Southern California, Los Angeles, CA; ²Keck School of Medicine, University of Southern California, Los Angeles, CA; ³Los Angeles County University of Southern California Medical Center, Los Angeles, CA

Introduction: Research regarding cirrhotic patients with acute pancreatitis has been limited and inconclusive. A vital topic is the fluid management volume of fluids given to this population given their sensitivity to hemodynamic changes.

Methods: We analyzed all unique patients presenting with acute pancreatitis to LAC+USC Medical Center captured in a prospective cohort. Our main predictor was the pre-existence of cirrhosis based on clinical exam, laboratory, diagnostic findings. Our primary outcome was development of moderately severe and severe pancreatitis, and our secondary outcomes were volume overload, organ failure, ICU admission, mortality, and new volume overload. Linear and logistic regression analyses were performed, controlling for both patient (age, sex, ethnicity) and clinical (etiology of pancreatitis, comorbidities) factors.

Results: Between January 2015 and March 2021, 1,433 patients presented to LAC+USC Medical Center with acute pancreatitis. Of those patients, 87 (6.1%) patients had a diagnosis of cirrhosis. Patients with cirrhosis received less fluids in the first 24 hours compared to patients without cirrhosis (mean volume 2351.02 (1947.77-1755.24) ml vs 3512.33 (3398.03-3626.63) ml, p< .01). In multivariate analysis, cirrhotic patients more likely presented with volume overload (OR 18.52 95% CI 9.17-37.0). There were similar rates of local complications of pancreatitis and ICU admission. However cirrhotic patients were more likely to have new acute kidney injury (OR 2.31 95% CI 1.34-3.98), severe pancreatitis (OR 2.75, 95% CI 1.37-5.56), and mortality (OR 8.33 95% CI (3.36-20.83) during inpatient stay.

Discussion: Patients with cirrhosis were more likely to present volume overloaded and received less fluids than patients without. Despite the presentation of their volume status, patients with severe liver disease were more likely to have AKI, severe pancreatitis, and mortality. Our study highlights the importance of further research regarding fluid management in this hemodynamically complex population.


Disclosures:


David Lehoang, MD, MBA¹, Mimi Xu, MD¹, Thu Anne Mai, MD¹, Jin Sun Kim, MD¹, Niwen Kong, MD¹, Yousuf Kidwai, MD¹, Linda Huang, MD¹, Rachel Dong, MD¹, Kevin Yu, MD¹, Collin Mayemura, MD², Megan Chang, RN³, Selena Zhou, MD¹, Patrick W. Chang, MD¹, James L. Buxbaum, MD¹. B0014 - Presentation and Management of Fluid Status for Cirrhotic Patients With Acute Pancreatitis in a Prospective Cohort Study, ACG 2022 Annual Scientific Meeting Abstracts. Charlotte, NC: American College of Gastroenterology.