B0005 - Incidence and Risk Factors for Deep Vein Thrombosis (DVT) and Pulmonary Embolism (PE) in Necrotizing Pancreatitis (NP) - An Underappreciated Sequalae

Monday, October 24, 2022

10:00 AM – 12:00 PM ET

Location: Crown Ballroom

Presenting Author(s)

David Jonason, MD

University of Minnesota Medical Center
Minneapolis, MN

Award: Presidential Poster Award

David Jonason, MD¹, Satish Munigala, MBBS, MPH², Gaurav Suryawanshi, MD¹, Amanda Hjeltness, PA-C¹, Stuart K. Amateau, MD, PhD¹, Nabeel Azeem, MD¹, Shawn Mallery, MD¹, Martin L. Freeman, MD¹, Guru Trikudanathan, MD¹
¹University of Minnesota Medical Center, Minneapolis, MN; ²Saint Louis University Center for Health Outcomes Research, St. Louis, MO

Introduction: Inflammatory dysregulation of the coagulation cascade and vascular stasis in hospitalized necrotizing pancreatitis (NP) patients serve as a milieu for venous thromboembolism which is often underrecognized. We aimed to identify the incidence and independent risk factors for deep vein thrombosis (DVT) and pulmonary embolism (PE) in our NP cohort.

Methods: All adult NP patients hospitalized at our center between 2009-2022 were identified from a prospective database and categorized into two groups based on development of DVT or PE (cases) or not (controls), within 6 months after NP hospitalization. Baseline data included demographics, ASA score, SIRS and organ failure on admission and at 48 hours, interventions (endoscopic, percutaneous or surgical), length of stay, transfer status, need for ICU, clinical and imaging characteristics and anticoagulation during admission. Univariable and multivariable analysis identified independent predictors for DVT and PE. P< 0.05 was considered significant.

Results: Among 641 NP patients, 510 patients [males-349 (68%), median age- 52 years (IQR 38-64)] were eligible for inclusion. DVT/PE developed in 62 (12%) patients; 26 DVT (5%), 22 PE (4%) and 14 with both (3%) after a median 17 (IQR 7-34) days from NP. Demographics were similar between groups though cases were older with more comorbidities (higher ASA) including a personal history of cancer. Nearly all patients [n=506, (99%)] including all cases were on DVT prophylaxis (pharmacologic or mechanical) during hospitalization. Significant clinical and imaging predictors for DVT/PE on multivariable analysis were age ( >50 years) [OR 2.1 (1.05-4.13)], personal history of cancer [OR 5.02 (1.30-19.35)], peripancreatic extent [OR 7.15 (3.7-13.81)], infected necrosis [OR 2.00 (1.01-3.96)] and increased length of stay (LOS) [OR 1.01 (1.00-1.02)].

Discussion: Incidence of DVT/PE in our NP cohort was 12% (comparable to incidence rates in cancer and IBD), usually diagnosed within one month of NP hospitalization. Age >50, peripancreatic necrosis extent, personal history of cancer, infected necrosis, and prolonged hospitalization were independent risk factors. This high-risk group of patients may benefit from intensified DVT prophylaxis during hospitalization and closer follow up after discharge.

Characteristic	Univariable OR (95% CI)	P-Value	Multivariable OR (95% CI)	P-Value
Age ( >50 years)	2.26 (1.26-4.02)	0.006	2.1 (1.05-4.13)	0.035
Personal h/o cancer	3.89 (1.41-10.78)	0.009	5.02 (1.30-19.35)	0.019
ASA score	2.21 (1.46-3.34)	0.0002	1.29 (0.72-2.32)	0.397
Persistent multiorgan failure	3.04 (1.59-5.80)	< 0.0001	2.05 (0.81-5.17)	0.128
Peripancreatic involvement	6.94 (3.94-12.21)	< 0.0001	7.15 (3.7-13.81)	< 0.0001
Infected necrosis	3.07 (1.74-5.44)	0.0001	2.00 (1.01-3.96)	0.046
TLOS	1.03 (1.02-1.03)	< 0.0001	1.01 (1.00-1.02)	0.016
Collection Size	1.07 (1.02-1.12)	0.005	1.01 (0.95-1.08)	0.663

Table: Univariable and Multivariable Analysis of Clinical and Imaging Predictors for DVT and PE in NP.

ASA- American society of anesthesiologists; TLOS- total length of stay

Disclosures:

David Jonason indicated no relevant financial relationships.

Satish Munigala indicated no relevant financial relationships.

Gaurav Suryawanshi indicated no relevant financial relationships.

Amanda Hjeltness indicated no relevant financial relationships.

Stuart Amateau: Boston Scientific Corporation – Consultant. Merit Medical – Consultant. Olympus Medical – Advisor or Review Panel Member. Olympus Medical – Consultant. Steris – Consultant.

Nabeel Azeem: Boston Scientific – Consultant.

Shawn Mallery indicated no relevant financial relationships.

Martin Freeman: Boston Scientific Corporation – Consultant.

Guru Trikudanathan: Boston Scientific Corporation – Consultant.

David Jonason, MD¹, Satish Munigala, MBBS, MPH², Gaurav Suryawanshi, MD¹, Amanda Hjeltness, PA-C¹, Stuart K. Amateau, MD, PhD¹, Nabeel Azeem, MD¹, Shawn Mallery, MD¹, Martin L. Freeman, MD¹, Guru Trikudanathan, MD¹. B0005 - Incidence and Risk Factors for Deep Vein Thrombosis (DVT) and Pulmonary Embolism (PE) in Necrotizing Pancreatitis (NP) - An Underappreciated Sequalae, ACG 2022 Annual Scientific Meeting Abstracts. Charlotte, NC: American College of Gastroenterology.