Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA.
Division of Gastroenterology, Hepatology, and Nutrition, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA.
J Gastroenterol Hepatol. 2020 Feb;35(2):284-290. doi: 10.1111/jgh.14775. Epub 2019 Jul 24.
Despite higher rates of gallstones in patients with cirrhosis, there are no population-based studies evaluating outcomes of acute biliary pancreatitis (ABP). Therefore, we sought to evaluate the predictors of early readmission and mortality in this high-risk population.
We utilized the Nationwide Readmission Database (2011-2014) to evaluate all adults admitted with ABP. Multivariable logistic regression models were used to assess independent predictors for 30-day readmission, index admission mortality, and calendar year mortality.
Among 184 611 index admissions with ABP, 4344 (2.4%) subjects had cirrhosis (1649 with decompensation). Subjects with cirrhosis, when compared with those without, incurred higher rates of 30-day readmission (20.9% vs 11.2%; P < 0.001), index mortality (2.0% vs 1.0%; P < 0.001), and calendar year mortality (4.2% vs 0.9%; P < 0.001). Decompensation in cirrhosis was associated with significantly fewer cholecystectomies (26.7% vs 60.2%; P < 0.001) and endoscopic retrograde cholangiopancreatographies (23.3% vs 29.9%; P < 0.001). Multivariate analysis revealed that severe acute pancreatitis (odds ratio [OR]: 14.8; 95% confidence interval [CI]: 5.3, 41.2), sepsis (OR: 12.6; 95% CI: 5.8, 27.4), and decompensation (OR: 3.1; 96% CI: 1.4, 6.6) were associated with increased index admission mortality. Decompensated cirrhosis (OR: 1.8; 95% CI: 1.1, 3.0) and 30-day readmission (OR: 5.6; 95% CI: 3.3, 9.5) were predictors of calendar year mortality. However, index admission cholecystectomy was associated with decreased 30-day readmissions (OR: 0.6; 95% CI: 0.4, 0.7) and calendar year mortality (OR: 0.44; 95% CI: 0.25, 0.78).
The presence of cirrhosis adversely impacts hospital outcomes of patients with ABP. Among modifiable factors, index admission cholecystectomy portends favorable prognosis by reducing risk of early readmission and consequent calendar year mortality.
尽管肝硬化患者的胆结石发病率较高，但目前尚无针对急性胆源性胰腺炎（ABP）的基于人群的研究来评估其结局。因此，我们旨在评估该高危人群中早期再入院和死亡率的预测因素。
我们利用全国再入院数据库（2011-2014 年）评估所有因 ABP 入院的成年人。多变量逻辑回归模型用于评估 30 天再入院、指数入院死亡率和历年死亡率的独立预测因素。
在 184611 例 ABP 的指数入院中，4344 例（2.4%）患者患有肝硬化（1649 例为失代偿期）。与无肝硬化患者相比，肝硬化患者的 30 天再入院率（20.9% vs. 11.2%；P<0.001）、指数入院死亡率（2.0% vs. 1.0%；P<0.001）和历年死亡率（4.2% vs. 0.9%；P<0.001）均更高。肝硬化失代偿与胆囊切除术（26.7% vs. 60.2%；P<0.001）和内镜逆行胰胆管造影术（23.3% vs. 29.9%；P<0.001）的应用显著减少相关。多变量分析显示，严重急性胰腺炎（比值比 [OR]：14.8；95%置信区间 [CI]：5.3，41.2）、败血症（OR：12.6；95% CI：5.8，27.4）和失代偿（OR：3.1；96% CI：1.4，6.6）与指数入院死亡率增加相关。失代偿性肝硬化（OR：1.8；95% CI：1.1，3.0）和 30 天再入院（OR：5.6；95% CI：3.3，9.5）是历年死亡率的预测因素。然而，指数入院胆囊切除术与降低 30 天再入院率（OR：0.6；95% CI：0.4，0.7）和历年死亡率（OR：0.44；95% CI：0.25，0.78）相关。
肝硬化的存在会对 ABP 患者的住院结局产生不利影响。在可改变的因素中，指数入院胆囊切除术通过降低早期再入院和随之而来的历年死亡率的风险，预示着良好的预后。
