Division of Gastroenterology, Department of Internal Medicine, East Tennessee State University, Johnson City, TN, USA.
Saint Peter's University Hospital/Rutgers, Robert Wood Johnson Medical School, New Brunswick, NJ, USA.
Pancreatology. 2018 Dec;18(8):870-877. doi: 10.1016/j.pan.2018.10.002. Epub 2018 Oct 5.
To assess national trends of AP (acute pancreatitis) admissions, outcomes, prevalence of AKI (acute kidney injury) in AP, and impact of AKI on inpatient mortality.
We queried the Nationwide Inpatient Sample database from 2003 to 2012 to identify AP admissions using ICD-9-CM codes. After excluding patients with missing information on age, gender, and inpatient mortality, we used ICD-9-CM codes to identify complications of AP, specifically AKI. We examined trends with survey-weighted multivariable regressions and analyzed predictors of AKI and inpatient mortality by multivariate logistic regression. Additionally, both AKI and non-AKI groups were propensity-matched and regressed against mortality.
A total of 3,466,493 patients (1.13% of all discharges) were hospitalized with AP, of which 7.9% had AKI. AP admissions increased (1.02%→1.26%) with rise in concomitant AKI cases (4.1%→11.7%) from year 2003-2012. Mortality rate decreased (1.8%→1.1%) in the AP patients with a substantial decline noted in AKI subgroup (17.4%→6.4%) during study period. Length of stay (LOS) and cost of hospitalization decreased (6.1→5.2 days and $13,654 to $10,895, respectively) in AKI subgroup. Complications such as AKI (OR: 6.08, p < 0.001), septic shock (OR: 46.52, p < 0.001), and acute respiratory failure (OR: 22.72, p < 0.001) were associated with higher mortality. AKI, after propensity matching, was linked to 3-fold increased mortality (propensity-matched OR: 3.20, P < 0.001).
Mortality, LOS, and cost of hospitalization in AP has decreased during the study period, although hospitalization and AKI prevalence has increased. AKI is independently associated with higher mortality.
评估急性胰腺炎（AP）入院、结局、AP 中急性肾损伤（AKI）的流行率以及 AKI 对住院死亡率的影响。
我们使用国际疾病分类第 9 版临床修订版（ICD-9-CM）代码从 2003 年至 2012 年查询全国住院患者样本数据库，以确定 AP 入院患者。在排除年龄、性别和住院死亡率信息缺失的患者后，我们使用 ICD-9-CM 代码来识别 AP 的并发症，特别是 AKI。我们使用具有调查加权的多变量回归来检查趋势，并通过多变量逻辑回归来分析 AKI 和住院死亡率的预测因素。此外，我们对 AKI 和非 AKI 两组进行倾向匹配，并针对死亡率进行回归。
共有 3466493 名（占所有出院人数的 1.13%）患者因 AP 住院，其中 7.9%患有 AKI。AP 入院人数增加（从 2003 年的 1.02%增加到 2012 年的 1.26%），同时 AKI 病例也有所增加（从 4.1%增加到 11.7%）。在研究期间，AP 患者的死亡率从 1.8%下降到 1.1%，AKI 亚组的死亡率显著下降（从 17.4%下降到 6.4%）。AKI 亚组的住院时间（LOS）和住院费用分别减少（从 6.1 天减少到 5.2 天，从 13654 美元减少到 10895 美元）。AKI（OR：6.08，p<0.001）、感染性休克（OR：46.52，p<0.001）和急性呼吸衰竭（OR：22.72，p<0.001）等并发症与更高的死亡率相关。在进行倾向匹配后，AKI 与死亡率增加 3 倍相关（倾向匹配 OR：3.20，p<0.001）。
尽管住院和 AKI 的流行率有所增加，但在研究期间，AP 的死亡率、LOS 和住院费用有所下降。AKI 与更高的死亡率独立相关。
