Khanna Tejasvini, Patel Jay, Singh Ishandeep, Kalra Shivam, Dhiman Mukul, Kohli Isha, Chaudhry Hunza, Dukovic Dino, Sohal Aalam, Yang Juliana
Medical School, Maulana Azad Medical College, New Delhi, IND.
Internal Medicine, Orange Park Medical Center, Orange Park, USA.
Cureus. 2023 Aug 25;15(8):e44113. doi: 10.7759/cureus.44113. eCollection 2023 Aug.
Introduction Acute pancreatitis (AP) is a common inflammatory disorder with acute onset and rapid progression. Studies have reported cardiac injury in patients with AP. It is often thought that stress cardiomyopathy can induce these changes leading to type 2 myocardial infarction (type 2 MI) in AP. Our study aims to assess the prevalence as well as the impact of type 2 MI on outcomes in patients with AP. Methods National Inpatient Sample (NIS) 2016-2020 was used to identify adult patients (age>18) with acute pancreatitis. We excluded patients with STEMI, NSTEMI, pancreatic cancer, or chronic pancreatitis. Patients with missing demographics and mortality were also excluded. Patients were stratified into two groups, based on the presence of type 2 MI. Multivariate logistic regression analysis was performed to assess the impact of concomitant type 2 MI on mortality, sepsis, acute kidney injury (AKI), ICU admission, deep venous thrombosis (DVT), and pulmonary embolism (PE) after adjusting for patient demographics, hospital characteristics, etiology of AP and the Elixhauser comorbidities. Results Of the 1.1 million patients in the study population, only 2315 patients had type 2 MI. The majority of the patients in the type 2 MI group were aged >65 years (49.2%, p<0.001), males (54.6%, p=0.63), White (67.6%, p=0.19), had Medicare insurance (55.5%, p<0.001), and were in the lowest income quartile (34.8%, p=0.12). Patients in the type 2 MI group had a higher incidence of mortality (5.4% vs 0.6%, p<0.001), sepsis (7.1% vs 3.7%, p<0.001), shock (9.3% vs 0.9%, p<0.001), AKI (42.9% vs. 11.8%, p<0.001) and ICU admission (12.1% vs 1.4%, p<0.001). After adjusting for confounding factors, patients in the type 2 MI group were noted to be at higher odds of mortality (aOR=2.4; 95% CI 1.5-3.8, p<0.001). Patients in the type 2 MI group had a longer length of stay (adjusted coefficient=2.1 days; 95% CI 1.4-2.8; p<0.001) and higher total hospitalization charges (adjusted coefficient=$45,088; 95% CI $30,224-$59,952; p<0.001). Conclusion Although the prevalence of type 2 MI in AP is low, the presence of type 2 MI is associated with increased mortality and worse outcomes. Physicians should be aware of this association and these patients should be monitored carefully to prevent worse outcomes.
引言 急性胰腺炎（AP）是一种起病急、进展快的常见炎症性疾病。研究报告了AP患者存在心脏损伤。人们通常认为应激性心肌病可引发这些变化，导致AP患者发生2型心肌梗死（2型MI）。我们的研究旨在评估2型MI在AP患者中的患病率及其对预后的影响。
方法 利用2016 - 2020年全国住院患者样本（NIS）来确定成年（年龄>18岁）急性胰腺炎患者。我们排除了ST段抬高型心肌梗死（STEMI）、非ST段抬高型心肌梗死（NSTEMI）、胰腺癌或慢性胰腺炎患者。还排除了人口统计学数据缺失和死亡的患者。根据是否存在2型MI将患者分为两组。在对患者人口统计学、医院特征、AP病因和埃利克斯豪泽合并症进行校正后，进行多因素逻辑回归分析，以评估合并2型MI对死亡率、脓毒症、急性肾损伤（AKI）、入住重症监护病房（ICU）、深静脉血栓形成（DVT）和肺栓塞（PE）的影响。
结果 在研究人群的110万患者中，只有2315例患者发生2型MI。2型MI组中的大多数患者年龄>65岁（49.2%，p<0.001），为男性（54.6%，p = 0.63），是白人（67.6%，p = 0.19），有医疗保险（55.5%，p<0.001），且处于最低收入四分位数（34.8%，p = 0.12）。2型MI组患者的死亡率（5.4%对0.6%，p<0.001）、脓毒症（7.1%对3.7%，p<0.001）、休克（9.3%对0.9%，p<0.001）、AKI（42.9%对11.8%，p<0.001）和入住ICU（12.1%对1.4%，p<0.001）发生率更高。在对混杂因素进行校正后，发现2型MI组患者的死亡几率更高（校正比值比[aOR]=2.4；95%置信区间[CI]为1.5 - 3.8，p<0.001）。2型MI组患者的住院时间更长（校正系数=2.1天；95%CI为1.4 - 2.8；p<0.001），总住院费用更高（校正系数=$45,088；95%CI为$30,224 - $59,952；p<0.001）。
结论 虽然AP中2型MI的患病率较低，但2型MI的存在与死亡率增加和预后较差相关。医生应了解这种关联，并且应对这些患者进行密切监测，以防止出现更差的预后。
