Different Demographic, Clinical and Severity Profile between Patients with Recurrent and First Attack of Acute Pancreatitis (AP)

comorbidity, diabetes status and alcoholic etiology, HTG ≥ 1000 mg/dl was independently associated with organ failure, pancreatic necrosis, ICU need and mortality. Conclusion: HTG was observed in 2.3% of AP episodes. More than half of the patients with Tg serum levels ≥ 1000 mg/dl were alcoholic. HTG ≥ 1000 mg/dl is independently associated with greater organ failure, pancreatic necrosis, ICU admission and mortality. Results (demographics and clinical characteristics)

Sa1340 OUTCOMES OF WEEKEND VERSUS WEEKDAY ADMISSION FOR ACUTE PANCREATITIS: A NATIONWIDE ANALYSIS Huafeng Shen, Maen M. Masadeh, Kaartik Soota, Randhir Jesudoss, Suthat Liangpunsakul

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Background and Aims: Day of admission may affect the outcomes in patients with acute pancreatitis (AP). A Japanese study revealed no weekend effect in severe AP admissions. The aim of this study was to investigate the impact of weekend versus weekday admission on in-hospital mortality and other outcomes of patients with AP by using a US nationwide database. Method: We performed a retrospective study collecting data from the National Inpatient Sample (2009-2011). We compared the outcomes including in-hospital mortality, length of stay, and total hospitalization charges between weekend and weekday admissions. Results: A total of 265,381 discharges with AP were identified, of which 197,944 (75%) were weekday admissions and 67,437 (25%) were weekend admissions. Compared with patients admitted on weekdays, those admitted on weekends had similar in-hospital mortality rates ((odds ratio [OR] 0.99; 95% confidence interval [CI], 0.93-1.06), but lower lengths of hospital stay (mean decrease, 0.25 days, P < 0.01) and lower hospitalization charges (mean decrease, $1,512, P < 0.01). Conclusion: Compared to patients admitted on weekdays, patients with AP admitted on weekends had similar in-hospital mortality rates, but lower lengths of stay and hospitalization charges.

Sa1339 NATIONAL TRENDS IN ACUTE PANCREATITIS IN UNITED STATES: 20002014 Ru Min Lee, Manoj A. Shirodkar Purpose: Acute pancreatitis is one of the most frequent gastrointestinal causes for hospital admission in the US. The incidence of acute pancreatitis (AP) has increased over time. This study aims to estimate the characteristics, outcomes, and cost burden of patients hospitalized for AP by using a large national database. Methods: The Nationwide Inpatient Sample (NIS) database was used to obtain data from 2000-2014. The NIS contains data from over 7 million hospital stays in the US per year generalizable to the American population. The NIS was queried for ICD-9 codes for primary diagnosis of acute pancreatitis (577.0). Information for demographic data, length of stay (LOS), mortality, and hospital charges was evaluated. Results: (Table 1 summaries epidemiological data) There were 3,784,981 total discharges from 2000-2014 with AP as the primary diagnosis. The number of hospitalizations for AP increased from 204,077 in 2000 to 279,145 in 2014. Mean length of stay decreased from 6.0 days to 4.6 during this period. The mean charges per hospitalization increased from $17,727 to $35,728. Aggregate charges increased from $3.66 billion to $9.98 billion annually. Inpatient mortality of acute pancreatitis has decreased from 1.82% to 0.66%. The proportion of males to females with AP was almost equivalent from 2000-2005, but the proportion of males with pancreatitis compared to females is trending upwards. In 2014, 52.6% of patients admitted for AP were male. Conclusion: This study demonstrates that the number of hospitalizations for AP has increased by 37% from 2000 to 2014. However, inpatient mortality of acute pancreatitis has decreased from 1.82% to 0.66%, likely from improvements in intensive and supportive care. These findings affirm that AP remains a significant source of morbidity and mortality with substantial hospitalization and cost burden. Further investigation is needed regarding the reasons behind the increasing numbers of AP hospitalizations and efforts must be made to prevent the continued increase of AP cases. Table 1. Epidemiological and Economic Data for Acute Pancreatitis, Nationwide Inpatient Sample, 2000-2014 (Q3 years and 2000)

Table 1. Selected characteristics of the study participants, according to day of admission; NIS, 2009 - 2011.* Abbreviations: NIS, national inpatient sample * Values are percentages ± standard errors (SE) for categorical variables and means ± SE for continuous variables £ From Student t-test for continuous variables and chi square test for categorical variables

Table 2 and 3

Sa1341 DIFFERENT DEMOGRAPHIC, CLINICAL AND SEVERITY PROFILE BETWEEN PATIENTS WITH RECURRENT AND FIRST ATTACK OF ACUTE PANCREATITIS (AP) Jorge D. Machicado, Amir Gougol, Mohannad Dugum, Carl E. Manzo, Gong Tang, David C. Whitcomb, Dhiraj Yadav, Adam Slivka, Georgios I. Papachristou Background: Few studies have studied the differences between a first attack of AP and subsequent attacks of recurrent acute pancreatitis (RAP). Our aim was to compare the demographic factors, clinical profile, and outcomes between patients with a first and recurrent AP attack. Methods: We used data from a single-center prospective cohort that has enrolled

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such as age, gender, race, obesity, CCI, etiology, and prior attacks of AP. Results: Out of 471 patients, 105 (22%) had pre-existing diabetes. Median age was 51 (IQR 36-67), 50% were female, 88% were white, 46% were obese, 69% had no prior AP attacks, and 41% had gallstone etiology. Compared with non-diabetics, those with diabetes had higher CCI (P<0.001) and were more likely to be older (P=0.02), black (P=0.01), and obese (P=0.001). Biliary (47 vs. 39%) and hypertrygliceredemic (25 vs. 4%) etiologies were more common in diabetics vs. non-diabetics (P<0.001). On logistic regression models, pre-existing diabetes was independently associated with larger odds of moderately AP (RR=2.2), severe AP (RR= 2), pancreatic interventions (OR=2.1), and prolonged LOS (OR=1.7) than nondiabetics (Table 1). The odds of multisystem organ failure or mortality were not different between AP patients with and without pre-existent diabetes. Conclusions: Pre-existing diabetes is an independent risk factor for moderately severe and severe AP, pancreatic interventions, and prolonged length of stay in AP patients. Larger multicenter studies are needed to validate our findings. Table 1: Association of pre-existing diabetes with severity and outcomes of AP in logistic regression models, after controlling for demographics, comorbidities, etiology, and prior attacks of AP.

*Adjusted for male gender, age ≥ 60, white race, obesity (BMI ≥ 30), Charlson Comorbidity Index ≥ 3, alcohol etiology, and first attack of AP **OR was calculated for dichotomous outcomes (multisystem organ failure, pancreatic interventions, prolonged LOS, mortality) and RR for severity

Sa1343 FREQUENCY AND CLINICAL PREDICTORS OF PAIN AND DISABILITY AFTER 1 YEAR OF AP: A SINGLE CENTER PROSPECTIVE STUDY Jorge D. Machicado, Amir Gougol, Mohannad Dugum, Adam Slivka, David C. Whitcomb, Dhiraj Yadav, Georgios I. Papachristou Background: Little is known about the natural history and risk factors of pain and disability in survivors of acute pancreatitis (AP). The aim of this study was to assess the frequency and clinical predictors of pain and disability after 1 year of AP. Methods: Consecutive patients prospectively enrolled between September 2011 and June 2015 at UPMC during first or recurrent AP attack, were followed-up approximately 1 year after enrollment (median: 14 months, IQR: 11-15). Baseline data including demographics, comorbidities, history of recurrent AP (RAP), etiology, severity by Revised Atlanta Classification (RAC), and outcomes, were prospectively obtained during hospitalization. Patients with chronic pancreatitis, or who died before follow-up were excluded. Eligible subjects (n=153) were approached through a telephone or regular mail survey that included items on pain, analgesic use, and disability. Presence in the last 4 weeks of pain that interfered with their normal work or abdominal pain subjectively attributed to pancreatitis (presence, pattern) was recorded. Logistic regression analysis was used to assess predictors of abdominal pain at follow-up, and final models included only factors with P<0.05. Given the small sample size of patients with disability, regression models were not performed in this group, and results of univariable analyses are presented. Results: A total of 110 (72%) AP patients responded the survey. Median age was 51 years (IQR, 36-67), 42% were male, 95% were white, 64% had first attack, 47% had biliary etiology, and 14% had severe AP. During the 4-week period before follow-up, 41% had any type of pain that interfered with their work, 24% had abdominal pain (62% intermittent, 38% constant), and 10% used analgesics on a regular basis (63% opiates). Disability was reported by 8% of patients. Factors associated on logistic regression models with abdominal pain at follow-up included idiopathic etiology (OR: 3.8), history of RAP (OR: 2.9), and organ failure (OR: 3.3) (Table 1). Younger age (P<0.01), obesity (P<0.05), current smoking (P<0.05), alcoholic etiology (P<0.05), and pancreatic necrosis (P<0.05), were associated with abdominal pain at follow-up on univariable analysis but not in multivariate models. Disability at follow-up was associated with current smoking (P<0.001) and ICU admission (P<0.05) on univariable analysis. Comorbidities, severity by RAC and pancreatic interventions, were not associated with abdominal pain or disability at follow-up. Conclusion: After one year of AP, pain is occasionally present and disability is usually absent. Idiopathic etiology, history of RAP, and organ failure are independent factors associated with abdominal pain at 1-year follow-up of AP. Future research is needed to understand the mechanisms of pain following AP recovery. Table 1: Final logistic regression model of significant predictors of abdominal pain at one year after of AP

Table 2: Association of RAP attacks with outcomes in logistic regression models, after controlling for demographics, comorbidities, etiology, and transfer status.

* Adjusted for male gender, age ≥ 60, white race, obesity (BMI ≥ 30), Charlson Comorbidity Index ≥ 3, alcohol etiology, and transfer status † OR was calculated for binary outcomes (multisystem organ failure, pancreatic interventions, prolonged hospital stay, mortality) and RR for severity

Sa1342 PRE-EXISTING DIABETES IS AN INDEPENDENT RISK FACTOR OF SEVERITY, PANCREATIC INTERVENTIONS, AND LENGTH OF STAY IN PATIENTS WITH ACUTE PANCREATITIS Jorge D. Machicado, Amir Gougol, Mohannad Dugum, Carl E. Manzo, Gong Tang, Adam Slivka, David C. Whitcomb, Dhiraj Yadav, Georgios I. Papachristou Background: Diabetes mellitus is associated with increased risk of acute pancreatitis (AP). However, the effect of pre-existing diabetes on the clinical course of AP has not been well established. Therefore, our aim was to determine the effect of pre-existing diabetes in severity and outcomes of AP. Methods: The Severity of Acute Pancreatitis/Pancreatitis-associated Risk of Organ Failure (SAPS/PROOF) is a prospective study at the University of Pittsburgh that has enrolled a large number of well-phenotyped AP patients between 2004-2015. A casecontrol design was used to compare demographics, comorbidities by Charlson Comorbidity Index (CCI), etiology, severity by Revised Atlanta Classification, pancreatic interventions (drainage, debridement), mortality, and prolonged length of stay (LOS, > 7 days), between AP patients with and without pre-existing diabetes. To determine the independent effect of pre-existing diabetes, odds ratio (OR) was calculated using binomial logistic regression for dichotomous outcomes and relative risk (RR) with multinomial logistic regression for outcomes with more than 2 categories (severity). Models were adjusted for other covariates

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well-phenotyped AP patients at the University of Pittsburgh Medical Center between 20042015. RAP was defined as at least two documented episodes of AP with more than three months in between attacks. Patients with chronic pancreatitis were excluded. Data on demographics, comorbidities by Charlson Comorbidity Index (CCI), etiology, severity by Revised Atlanta Classification, interventions, multisystem organ failure, pancreatic interventions, prolonged length of stay (LOS, > 7 days), and mortality was obtained. To determine the independent effect of a RAP attack, odds ratio (OR) was calculated with binomial logistic regression for binary outcomes and relative risk (RR) with multinomial logistic regression for outcomes with more than 2 categories (severity). Covariates such as age, gender, race, obesity, CCI, etiology, and transfer status were adjusted in these models. Results: 145 (31%) patients had RAP, and 326 (69%) first AP attack. RAP patients were significantly younger (P<0.001), less obese (P<0.01), more likely to be smokers (P<0.001), and less likely have been transferred from another institution (P<0.001), than those with first-episode AP (Table 1). Alcoholic, hypertryglyceridemic, and idiopathic etiology occurred more likely in RAP vs. first AP attack (P<0.001). In logistic regression models, RAP attacks were associated with decreased odds of severe AP (RR 0.4, CI 0.2-0.9), multiorgan system failure (OR 0.4, CI 0.2-1) and prolonged hospital stay (OR 0.6, CI 0.4-1) than first AP attacks. No difference in the odds of moderately severe AP, need for pancreatic interventions or mortality was seen between AP patients with first or recurrent attacks. Conclusions: RAP attacks tends to be less severe than first AP attacks. Furthermore, RAP patients have different demographic and clinical profile than those with first attack of AP. More studies are needed to better characterize the clinical profile and natural history of RAP. Table 1: Demographics, comorbidities, and etiology in patients with recurrent and first AP attacks