Impact of sex and comorbid diabetes on hospitalization outcomes in acute pancreatitis: A large United States population-based study

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; 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

doi:10.3934/publichealth.2023009

AIMS Public Health

2023, Volume 10, Issue 1: 105-115. doi: 10.3934/publichealth.2023009

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Research article Topical Sections

Impact of sex and comorbid diabetes on hospitalization outcomes in acute pancreatitis: A large United States population-based study

1.
Department of Medicine, Hackensack Meridian Health Palisades Medical Center, North Bergen, NJ, USA
2.
Division of Gastroenterology, Cedars-Sinai Medical Center, Los Angeles, CA, USA
3.
Center for Reproductive Sciences, Department of Obstetrics and Gynecology, University of California San Francisco, San Francisco, CA, USA

Received: 30 August 2022 Revised: 16 January 2023 Accepted: 01 February 2023 Published: 23 February 2023

Backgrounds
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.
Methods
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.
Results
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.
Conclusions
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.
- acute pancreatitis,
- diabetes,
- hospitalization outcomes,
- race, renal failure,
- sex differences
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

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Abstract

Backgrounds

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.

Methods

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.

Results

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.

Conclusions

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.

Conflict of interest

The authors declare no conflict of interest.

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