Patient- and hospital-based factors at admission associated with outcomes of patients hospitalized for acute pancreatitis: a retrospective cohort study

Although significant effort has been made to diagnose and treat patients with acute pancreatitis (AP), knowledge of the risk factors and their relationship with patient outcomes is still lacking. Little is known about whether clinical outcomes, such as mortality or being cured of AP, may be influenced by certain factors, including season of admission; place of residence; time of admission; insurance status; lifestyle habits, such as smoking; pretreatment methods and durations; and other clinical conditions at admission. This study aimed to investigate the association between potential risk factors and clinical outcomes in patients with AP. A retrospective cohort study of adult patients at the initial onset of AP was carried out. The patients were identified using a pancreatitis database in the tertiary referral hospital. Information on place of residence, season of admission, insurance status, lifestyle habits and plasma biochemical indexes were retrieved from clinical profiles and reviewed by two independent researchers. Recovery, partially recovery and death were considered to be the categorical primary outcomes and group classification evidence. One-way ANOVA and the chi-square test were performed to compare the differences of all characteristics between the three groups. Adjusted odds ratios and 95% confidence intervals were calculated using multinomial logistic regression. Data of 684 (365 M, 319 F) patients from 2008 to 2012 were retrieved. There were 518, 147 and 19 patients in the recovery, partially recovery and dead groups, respectively, with an overall death rate of 2.7% and a rate of 9.4% among sever acute pancreatitis (SAP) patients. Risk factors for death compared to the recovery group were hypertriglyceridemic acute pancreatitis (HTAP) (OR: 3.364; 95% CI=1.237-9.144; P=0.017); classification of AP (OR: 7.023; 95% CI=2.317-21.288; P=0.001); blood creatinine level (OR: 7.259; 95% CI=2.442-21.575; P<0.001); blood AST level (OR: 11.345; 95% CI=2.355-54.651; P<0.001); and blood albumin level (OR: 3.389; 95% CI=1.032-11.130; P=0.044). Being over 61 years of age was also a risk factor for mortality. Alcoholic AP, severity diagnosis and Alb level were risk factors for poor improvement. None of the hospital-based factors were risk factors for the outcomes. Patients older than 61 years had a higher risk of mortality than those of other ages. Patients who were diagnosed with HTAP or SAP were also at greater risk for mortality. Moreover, blood creatinine, AST and Alb levels, which may be indicative of mild organ dysfunction and malnutrition, could also be considered predictors for mortality.