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QUANTIFYING THE IMPACT OF ACUTE KIDNEY INJURY ON MORTALITY, MORBIDITY AND RESOURCE UTILIZATION IN ACUTE PANCREATITIS: A DECADE OF NATIONAL OUTCOMES
Paul T. Kroner*2, Pichamol Jirapinyo1, Marwan S. Abougergi3, Thomas Clancy1, Christopher C. Thompson1
1Brigham & Women's Hospital, Boston, MA; 2Mt. Sinai St. Luke's / Mt. Sinai West, New York, NY; 3johns hopkins bayview medical center, Baltimore, MD
Introduction
Acute kidney injury (AKI) is a well-recognized negative prognostic factor for morbidity and mortality in acute pancreatitis (AP). Although several studies have documented a markedly increased incidence of AKI complicating AP, these studies are relatively small and include a limited number of outcomes, with mortality rates ranging from 5% to 80%. As such, quantification of AKI’s effect on AP outcomes is challenging. The aim of this study was to assess the impact of AKI on mortality, morbidity and resource utilization among patients with AP over the past decade using a large national database.
Materials and Methods
This is a retrospective cohort study using the National Inpatient Sample, the largest publically available inpatient database in the USA, from 2004 to 2013. All patients with an ICD-9 CM code for a principal diagnosis of AP were included. There were no exclusion criteria. The primary outcome was in-hospital mortality. Secondary outcomes were morbidity measured by intensive care unit (ICU) admission, shock and multi- organ failure; resource utilization measured by abdominal CT, total parenteral nutrition (TPN) use, length of hospital stay (LOS) and total hospitalization costs. Patients who had a concomitant diagnosis of AKI were identified using the appropriate ICD-9 CM codes. Using multivariate regression analysis, odds ratios and means were adjusted for age, sex, race, income in the patient’s zip code, Charlson Comorbidity Index, hospital region, urban location, size and teaching status.
Results
2,690,774 patients with AP were included in the study, of which 182,448 (6.8%) had a diagnosis of AKI. Mean age was 52 years and 48% were female. For the primary outcome, mortality in patients with AP and AKI was significantly higher compared to patients without AKI (adjusted OR: 11.94, 95%CI: 11.01-12.95, p<0.01). For the secondary outcomes, patients with AKI displayed increased odds of shock, multi-organ failure and ICU admission when compared to patients without AKI. For resource utilization, patients with AKI had higher odds of TPN use and a longer mean LOS compared to patients without AKI. Total hospital costs were also significantly increased in patients with AKI. Table 1 displays all adjusted odds rations and means with p-values.
Conclusion
Patients with acute pancreatitis who develop acute kidney injury have an almost 12-fold greater in-hospital mortality rate compared with patients without acute kidney injury. In addition, acute kidney injury development is associated with significant morbidity in acute pancreatitis, as measured by greater rates of shock, ICU admission and multi-organ failure. Finally, acute kidney injury in acute pancreatitis has a profound effect on resource utilization, with increased TPN use as well as longer length of stay and higher total hospitalization costs.
Table 1 - Adjusted means and odds ratios for patients with acute pancreatitis with and without acute kidney injury
| | Adjusted Odds Ratio
(95% Confidence Interval) | p-value | | Mortality | 11.93 (11.01-12.95) | <0.01 | | ICU Admission | 13.89 (13.10-14.74) | <0.01 | | Shock | 30.18 (27.57-33.05) | <0.01 | | Multi-Organ Dysfunction | 47.02 (38.26-57.80) | <0.01 | | TPN use | 3.49 (3.32-3.68) | <0.01 | | CT abdomen use | 0.92 (0.84-1.01) | 0.06 | | | Adjusted Means
(95% Confidence Interval) | | | Additional Length of Stay | 5.35 (5.14 - 5.57) | <0.01 | | Additional Total Costs | $13,754 ($13,129 - $14,380) | <0.01 |
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