Simons-Linares C Roberto, Jang Sunguk, Sanaka Madhusudan, Bhatt Amit, Lopez Rocio, Vargo John, Stevens Tyler, Chahal Prabhleen
Gastroenterology and Hepatology Department, Digestive Disease Institute.
Center for Populations Health Research, Lerner Research Institute, Cleveland Clinic Foundation, Cleveland, OH, USA.
Medicine (Baltimore). 2019 Feb;98(7):e14378. doi: 10.1097/MD.0000000000014378.
The triad of acute pancreatitis (AP) coexisting with diabetes ketoacidosis (DKA) and hypertriglyceridemia (HTG) has been reported, but no impact on mortality has been found to date. We aim to assess if patients with this triad are at a higher inpatient mortality compared to patients with acute pancreatitis only.Retrospective cohort. The National Inpatient Sample (NIS) database from 2003 to 2013 was queried for patients with a discharge diagnosis of AP and presence of DKA and HTG was ascertained based on International Classification of Diseases, 9th revision (ICD9) codes. Adjusted for age, gender, race, Charlson comorbidity index (CCI), median income quartile, and hospital characteristics.Over 2.8 million AP patients were analyzed. When compared with patients with AP-only, patients with the triad of AP + DKA + HTG had higher inpatient mortality (aOR 2.8, P < .001; CI: 1.9 - 4.2), Acute Kidney Injury (AKI) (aOR 4.1, P < .001; CI: 3.6-4.6), Systemic Inflammatory Response Syndrome (SIRS) (aOR 4.9, P < .001), Shock (aOR 4.3, P < .001), Acute Respiratory Distress Syndrome (ARDS) (aOR 3.0, P < .001), sepsis (aOR 2.6, P < .001), ileus (aOR 2.1, P < .001), parenteral nutrition requirement (aOR 1.8, P < .001), inflation-adjusted hospital charges (US$ 17,704.1), and had longer length of stay (LOS) (aOR 2.0, P < .001; CI 1.8-2.3). Furthermore, when compared to AP-only, patients with AP + HTG had lower mortality, which is different from the current AP knowledge. Finally, it appears that the driving force for the increased in mortality of patients with the triad (AP, DKA, HTG) is the DKA rather than the HTG.Patients with the triad of AP, DKA, and HTG constitute a unique subgroup of patients that has higher inpatient mortality, multi-organ failure, hospital charges, and longer hospital length of stay. Therefore, hospital protocols targeting this subgroup of AP patients could improve mortality and outcomes.
急性胰腺炎（AP）合并糖尿病酮症酸中毒（DKA）和高甘油三酯血症（HTG）的三联征已有报道，但迄今为止尚未发现其对死亡率有影响。我们旨在评估与仅患有急性胰腺炎的患者相比，患有这种三联征的患者住院死亡率是否更高。
回顾性队列研究。查询了2003年至2013年国家住院样本（NIS）数据库中出院诊断为AP的患者，并根据国际疾病分类第9版（ICD9）编码确定是否存在DKA和HTG。对年龄、性别、种族、查尔森合并症指数（CCI）、收入中位数四分位数和医院特征进行了调整。
分析了超过280万例AP患者。与仅患有AP的患者相比，患有AP + DKA + HTG三联征的患者住院死亡率更高（调整后比值比[aOR]为2.8，P <.001；置信区间[CI]：1.9 - 4.2）、急性肾损伤（AKI）（aOR为4.1，P <.001；CI：3.6 - 4.6）、全身炎症反应综合征（SIRS）（aOR为4.9，P <.001）、休克（aOR为4.3，P <.001）、急性呼吸窘迫综合征（ARDS）（aOR为3.0，P <.001）、脓毒症（aOR为2.6，P <.001）、肠梗阻（aOR为2.1，P <.001）、需要肠外营养（aOR为1.8，P <.001）、经通胀调整后的住院费用（17,704.1美元），且住院时间更长（aOR为2.0，P <.001；CI：1.8 - 2.3）。此外，与仅患有AP的患者相比，患有AP + HTG的患者死亡率更低，这与当前关于AP的认知不同。最后，似乎三联征（AP、DKA、HTG）患者死亡率增加的驱动因素是DKA而非HTG。
患有AP、DKA和HTG三联征的患者构成了一个独特的患者亚组，其住院死亡率更高、多器官功能衰竭、住院费用更高且住院时间更长。因此，针对这一亚组AP患者的医院诊疗方案可能会改善死亡率和治疗结果。
