Data on the association between comorbid diabetes mellitus (DM) and acute pancreatitis (AP) remains limited. Utilizing a large, nationwide database, we aimed to examine the impact of comorbid diabetes mellitus on patients admitted for acute pancreatitis.
This was a retrospective case-control study of adult patients with AP utilizing the National Inpatient Sample from 2015–2018, using ICD–10 codes. Hospitalization outcomes of patients admitted for AP with comorbid DM were compared to those without comorbid DM at the time of admission. The primary outcome was a mortality difference between the cohorts. Multivariable-adjusted cox proportional hazards model analysis was performed. Data was analyzed as both sex aggregated, and sex segregated.
940,789 adult patients with AP were included, of which 256,330 (27.3%) had comorbid DM. Comorbid DM was associated with a 31% increased risk of inpatient mortality (aOR: 1.31; p = 0.004), a 53% increased risk of developing sepsis (aOR: 1.53; p = 0.002), increased hospital length of stay (LOS) (4.5 days vs. 3.7 days; p < 0.001), and hospital costs ($9934 vs. $8486; p < 0.001). Whites admitted for AP with comorbid DM were at a 49% increased risk of mortality as compared to Hispanics (aOR: 1.49; p < 0.0001). Different comorbidities had sex-specific risks; men admitted for AP with comorbid DM were at a 28% increased risk of mortality (aOR: 1.28; p < 0.0001) as compared to women. Men with comorbid DM plus obesity or hypertension were also at increased risk of mortality as compared to women, whereas women with comorbid DM plus renal failure were at greater risk of mortality as compared to men.
Comorbid DM appears to be a risk factor for adverse hospitalization outcomes in patients admitted for AP with male sex and race as additional risk factors. Future prospective studies are warranted to confirm these findings to better risk stratify this patient population.
Citation: Simcha Weissman, Stephen J. Pandol, Umar Ghaffar, Melody Boafo, Chukwuemeka E. Ogbu, Tamer Zahdeh, Mohammed Ashary, Vignesh Krishnan Nagesh, Anushka Kigga, Ayrton Bangolo, Aditi Bhargava. Impact of sex and comorbid diabetes on hospitalization outcomes in acute pancreatitis: A large United States population-based study[J]. AIMS Public Health, 2023, 10(1): 105-115. doi: 10.3934/publichealth.2023009
Data on the association between comorbid diabetes mellitus (DM) and acute pancreatitis (AP) remains limited. Utilizing a large, nationwide database, we aimed to examine the impact of comorbid diabetes mellitus on patients admitted for acute pancreatitis.
This was a retrospective case-control study of adult patients with AP utilizing the National Inpatient Sample from 2015–2018, using ICD–10 codes. Hospitalization outcomes of patients admitted for AP with comorbid DM were compared to those without comorbid DM at the time of admission. The primary outcome was a mortality difference between the cohorts. Multivariable-adjusted cox proportional hazards model analysis was performed. Data was analyzed as both sex aggregated, and sex segregated.
940,789 adult patients with AP were included, of which 256,330 (27.3%) had comorbid DM. Comorbid DM was associated with a 31% increased risk of inpatient mortality (aOR: 1.31; p = 0.004), a 53% increased risk of developing sepsis (aOR: 1.53; p = 0.002), increased hospital length of stay (LOS) (4.5 days vs. 3.7 days; p < 0.001), and hospital costs ($9934 vs. $8486; p < 0.001). Whites admitted for AP with comorbid DM were at a 49% increased risk of mortality as compared to Hispanics (aOR: 1.49; p < 0.0001). Different comorbidities had sex-specific risks; men admitted for AP with comorbid DM were at a 28% increased risk of mortality (aOR: 1.28; p < 0.0001) as compared to women. Men with comorbid DM plus obesity or hypertension were also at increased risk of mortality as compared to women, whereas women with comorbid DM plus renal failure were at greater risk of mortality as compared to men.
Comorbid DM appears to be a risk factor for adverse hospitalization outcomes in patients admitted for AP with male sex and race as additional risk factors. Future prospective studies are warranted to confirm these findings to better risk stratify this patient population.
| [1] |
Hines OJ, Pandol SJ (2019) Management of severe acute pancreatitis. BMJ 367: l6227. https://doi.org/10.1136/bmj.l6227 
|
| [2] |
Yadav D, Lowenfels AB (2013) The epidemiology of pancreatitis and pancreatic cancer. Gastroenterology 144: 1252-1261. https://doi.org/10.1053/j.gastro.2013.01.068
|
| [3] |
Peery AF, Dellon ES, Lund J, et al. (2012) Burden of gastrointestinal disease in the United States: 2012 update. Gastroenterology 143: 1179-1187. https://doi.org/10.1053/j.gastro.2012.08.002
|
| [4] |
Romagnuolo J, Talluri J, Kennard E, et al. (2016) Clinical profile, etiology, and treatment of chronic pancreatitis in North American women: Analysis of a large multicenter cohort. Pancreas 45: 934-940. https://doi.org/10.1097/MPA.0000000000000616
|
| [5] | Forsmark CE, Vege SS, Wilcox CM (2017) Acute pancreatitis. N Engl J Med 376: 598-599. https://doi.org/10.1056/NEJMc1616177 |
| [6] |
Singh VK, Bollen TL, Wu BU, et al. (2011) An assessment of the severity of interstitial pancreatitis. Clin Gastroenterol Hepatol 9: 1098-1103. https://doi.org/10.1016/j.cgh.2011.08.026
|
| [7] |
Francisco M, Valentín F, Cubiella J, et al. (2013) Factors related to length of hospital admission in mild interstitial acute pancreatitis. Rev Esp Enferm Dig 105: 84-92. https://doi.org/10.4321/S1130-01082013000200005
|
| [8] |
Fang M (2018) Trends in the prevalence of diabetes among U.S. adults: 1999–2016. Am J Prev Med 55: 497-505. https://doi.org/10.1016/j.amepre.2018.05.018
|
| [9] |
Nordström A, Hadrévi J, Olsson T, et al. (2016) Higher prevalence of type 2 diabetes in men than in women is associated with differences in visceral fat mass. J Clin Endocrinol Metab 101: 3740-3746. https://doi.org/10.1210/jc.2016-1915
|
| [10] | Zarnescu NO, Costea R, Zarnescu Vasiliu EC, et al. (2015) Clinico-biochemical factors to early predict biliary etiology of acute pancreatitis: age, female gender, and ALT. J Med Life 8: 523-526. |
| [11] |
Zhao ZH, Hu LH, Ren HB, et al. (2017) Incidence and risk factors for post-ERCP pancreatitis in chronic pancreatitis. Gastrointest Endosc 86: 519-524. https://doi.org/10.1016/j.gie.2016.12.020
|
| [12] |
Sharma S, Weissman S, Aburayyan K, et al. (2021) Sex differences in outcomes of acute pancreatitis: Findings from a nationwide analysis. J Hepatobiliary Pancreat Sci 28: 280-286. https://doi.org/10.1002/jhbp.890
|
| [13] |
Navina S, Acharya C, DeLany JP, et al. (2011) Lipotoxicity causes multisystem organ failure and exacerbates acute pancreatitis in obesity. Sci Transl Med 3: 107ra10. https://doi.org/10.1126/scitranslmed.3002573
|
| [14] |
Durgampudi C, Noel P, Patel K, et al. (2014) Acute lipotoxicity regulates severity of biliary acute pancreatitis without affecting its initiation. Am J Pathol 184: 1773-1784. https://doi.org/10.1016/j.ajpath.2014.02.015
|
| [15] |
Camhi SM, Bray GA, Bouchard C, et al. (2011) The relationship of waist circumference and BMI to visceral, subcutaneous, and total body fat: sex and race differences. Obesity 19: 402-408. https://doi.org/10.1038/oby.2010.248
|
Figures(3) / Tables(2)
Simcha Weissman, Stephen J. Pandol, Umar Ghaffar, Melody Boafo, Chukwuemeka E. Ogbu, Tamer Zahdeh, Mohammed Ashary, Vignesh Krishnan Nagesh, Anushka Kigga, Ayrton Bangolo, Aditi Bhargava. Impact of sex and comorbid diabetes on hospitalization outcomes in acute pancreatitis: A large United States population-based study[J]. AIMS Public Health, 2023, 10(1): 105-115. doi: 10.3934/publichealth.2023009
DownLoad: