Acute Pancreatitis Linked to Adverse Outcomes in Patients with Bone Marrow Transplantation

A study presented at the 2021 Digestive Disease Week (DDW) Virtual Meeting, analyzed data on the impact of acute pancreatitis (AP) on mortality and hospital outcomes among pediatric populations with bone marrow transplantation (BMT).

Investigators, led by Aravind Thavamani, MD, UH Rainbow Babies and Children’s Hospital, found that AP in BMT populations had an increased in-hospital mortality rate, prolonger hospital stay and higher hospitalization charge.

Study

The team analyzed national, non-overlapping years of the National Inpatient Sample and Kids inpatient database between 2003 and 2016.

Patients ≤20 years old who underwent bone marrow transplantation were included in the study.

Then, investigators divided patients based on the presence of concomitant diagnosis of acute pancreatitis during the hospital stay.

Thavamani and colleagues compared demographic characteristics, clinical and comorbid conditions associated with bone marrow transplantation, and acute pancreatitis for outcomes.
The primary outcome for the study was in-hospital mortality, while the secondary outcome was healthcare resource utilization.

Results

A total of 97,119 hospitalizations with BMT were included in the analysis, with an overall AP incidence of 1.1%.

The team found BMT patients with AP were older, compared to BMT patients without AP (11 years versus 9.5 years, P <.001). The team noted that patients with AP had an increased rate of females, Hispanic patients, and patients with public insurance (P <.001).

The team also found increased incidence rate of AP in patients with underlying myelodysplastic syndromes, lymphoid leukemia, non-Hodgkin's lymphoma, aplastic anemias and related bone marrow failure syndromes, and hemophagocytic lymphohistiocytosis (HLH), compared to other indications of BMT (P <.001).

Investigators found the overall mortality rate was 4.2%, or 4059 patients. However, it was found to be significantly higher in patients with AP (15.3% versus 4.1%, P <.001).

Further, multivariate regression analysis found AP was independently associated with 1.8 times increased risk of in-hospital mortality (95% CI, 1.46 – 2.31, P <.001).

The team noted that BMT patients with AP had higher incidence of end-organ failure such as acute kidney injury, respiratory failure with need for intubation and mechanical ventilation, and hypertension (P <.001).

Patients with AP had an increased incidence of sepsis, deep vein thrombosis, and parenteral nutrition.

Linear regression models showed AP was associated with 22 additional days of hospitalization (95% CI, 20.60 – 23.64, P <.001). Investigators also noted that AP incurred $190,409 in hospitalization chargers (95% CI, 16,934 – 211,484, P <.001).

Conclusion

Investigators concluded that AP in BMT patients is associated with adverse outcomes, including increased mortality and prolonged hospital stay.

“Further studies are necessary to predict the risk of AP development for improved clinical outcomes,” investigators wrote.

The study, “Acute Pancreatitis is Associated with Increased Risk of Mortality and Health Care Utilization Among Hospitalized Patients with Bone Marrow Transplantations,” was published by DDW.