B0438 - Hypoglycemia Is Associated With Worse Outcomes in Patients Admitted With Cholangitis and Underwent Endoscopic Retrograde Cholangiopancreatography

Introduction: Hypoglycemia has been associated with poorer outcomes in hospitalized patients undergoing surgical interventions. In cholangitis, endoscopic retrograde cholangiopancreatography (ERCP) is often a critical adjunct to surgery, capable of diagnosing and treating various biliary and pancreatic pathologies. While technically less invasive than surgery, the effect of hypoglycemia on clinical outcomes of patients with cholangitis undergoing ERCP has not been elucidated.

Methods: Data were extracted from the National Inpatient Sample (NIS) database from 2016-2019. Using the ICD-10-CM codes, patients diagnosed with cholangitis and underwent ERCP were identified. Baseline demographic data, comorbidities, in-hospital mortality, hospital charges, and hospital length of stay (LOS) were extracted and compared based on the presence or absence of hypoglycemia. Statistical analysis was done using t-test and Chi-squared analyses. A multivariate analysis for the mortality odds ratio (OR) was calculated to adjust for possible confounders.

Results: A total of 256,540 patients with cholangitis underwent ERCP were identified, 2,810 of them had hypoglycemia during their hospitalization. The mean age of the hypoglycemia group was 64.41 years. Most patients were females (54%) and whites (57%). More patients in the hypoglycemia group had a history of alcoholism and congestive heart failure (CHF). Hypoglycemia was associated with higher odds of in-hospital mortality (OR 6.71, CI 5.49-8.2; p < 0.0001). In addition to hypoglycemia, age > 65 years, non-white race, and CHF were independently associated with higher mortality (Table 1). Moreover, patients with hypoglycemia had higher total hospital charges ($87,147 vs. $133,400; P < 0.0001) and a significant increase in the LOS (9.7 vs. 6.7 days; P < 0.0001).

Discussion: Previous studies in the surgical literature have linked hypoglycemia to increased incidence of atrial fibrillation, usage of mechanical ventilation, and application of circulatory support. Hypoglycemia may also affect the metabolism of the heart, leading to myocardial ischemia and malignant arrhythmias. However, it is unclear if hypoglycemia represents a proxy for the severity of patient illness, as septic shock and renal insufficiency are common etiologies that may strongly impact mortality. Therefore, careful glycemic control during hospitalization should be practiced, as hypoglycemia serves as a poor prognostic indicator that should not be overlooked.