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Readmission Rates After Acute Pancreatitis in Two Safety Net Hospitals
AGA Abstracts
Figure 2: ROC curves for different predictive models for endpoint mortality; ROC: receiver operating characteristic
Sa1334
Sa1335
QUICK SOFA: AN ACCURATE PREDICTOR OF MORTALITY AND NEED FOR ADVANCED ORGAN SUPPORT IN SEVERE ACUTE PANCREATITIS Dharani Guttikonda, Mohannad Abou Saleh, Dong Wu, Matthew Hoscheit, Vijit Chouhan, Ashwinee Natu, Michael Enzerra, Raj M. Paspulati, Brooke Glessing, Tiffany Chua, Kunjam Modha, David Ngendahimana, Daniel Jang, Lorna Kang, Peter Junwoo Lee, Neetika Srivastava, Amitabh Chak, Jiaming QIan, Tyler Stevens
READMISSION RATES AFTER ACUTE PANCREATITIS IN TWO SAFETY NET HOSPITALS Kelly Fujikawa, Jonathan Kung, Christopher Hwe, Chirag Rajyaguru, Meenu Pamula, Viktor E. Eysselein, Sofiya Reicher Introduction: Acute Pancreatitis (AP) is the most common cause of gastrointestinal hospitalizations in the US. Our goal was to identify factors at discharge that were associated with higher rates of readmission amongst a safety net patient population. Methods: This is a two-center retrospective study of patients who presented to Harbor UCLA (HUMC) and UCSF-Fresno with an episode of AP requiring inpatient hospitalization. 152 and 176 patients were included from HUMC and UCSF-Fresno cohorts, respectively. Cases were retrospectively identified based on ICD9 and ICD10 codes and included those who met clinical criteria for AP. Data including SIRS criteria, Marshall and SOFA criteria, numerical rating of abdominal pain (0-10 scale), opiate use (reported as equivalent morphine IV mg) and diet were collected from the last 12 hours prior to discharge. Analysis was performed using a two-sided Z test. Baseline patient demographics and AP etiologies are in Table 1. Results: At HUMC, 7.9% of patients (12 of 152) were readmitted within 30 days. 9.1% of patients (16 of 176) were readmitted within 30 days at UCSF Fresno. At HUMC, 4.8% of patients (6 of 125) who were tolerating >50% of a solid diet in the 12 hours prior to discharge were readmitted in <30 days versus 22 % of patients (6 of 27) who were not tolerating a solid diet prior to discharge (p<0.01). In the UCSF Fresno cohort, 8.9% of patients (14 of 158) who were tolerating a solid diet were readmitted compared to 11% of patients (2 of 18) who were not tolerating a solid diet (p=0.76). At HUMC, 5.4% of patients(6 of 111) who reported abdominal pain of less than 6 prior to discharge were readmitted in <30 days compared to 15% of patients (6 of 41) who reported abdominal pain of 6 or greater (p= 0.06). At UCSF Fresno, 8.7% of patients (15 of 173) who reported pain of less than 6 were readmitted compared to 33% of patients (1 of 3) who reported pain >6 at discharge (p= 0.14). At HUMC, 6.5% of patients (8 of 124) who required less than 4mg of morphine iv were readmitted compared to 14% of patients (4 of 28) who required 4mg or more of morphine iv (p=0.16). At UCSF-Fresno, 9.3% of patients (16 of 172) who required less than 4mg of morphine iv were readmitted compared to 0% of patients (0 of 2) who required 4mg or more of morphine iv (p=0.65). Number of SIRS criteria met, or evidence of organ failure through both the Marshall and SOFA scoring systems were not significantly associated with readmission < 30d amongst both cohorts. Conclusion: Tolerance of a solid diet at discharge was significantly associated with decreased readmission at 30 day. Self-report of abdominal pain of less than 6 at discharge and morphine use < 4mg IV in the last 12 hours trended towards decreased readmission rates. Baseline Patient Demographics and AP Etiologies
Background: Patients with severe acute pancreatitis (SAP) carry a significant risk of death from organ failure. The Quick Sequential Organ Failure Assessment (qSOFA) score is a validated mortality prediction tool that can be calculated at the bedside with ease in patients with possible sepsis. The aim of the study is to assess the performance of qSOFA score as a tool to predict mortality and need for advanced organ support in patients with SAP. Methods: This was a multicenter study that included three tertiary referral centers. Relevant laboratory and clinical data, including the Charlson Comorbidity Index (CCI), were extracted from the electronic medical record. Severity was defined as per the Revised Atlanta Criteria (single or multi-organ failure >48 hours). Organ failure was defined as per Modified Marshall Score. Advanced organ support was defined as the need for pulmonary (mechanical ventilation), renal (hemodialysis), or cardiac (pressor) support. qSOFA score was calculated at the time of diagnosis of SAP using the published definitions: 1 point each for altered mental status, systolic blood pressure <100mmHg, and respiratory rate >22/minute. Receiver operating characteristics and areas under the curve (AUC) were used to measure qSOFA score's performance in predicting need for advanced organ support and mortality. Results: Two hundred fifteen patients with SAP were identified. Mortality within the overall cohort was 33%. Sixty percent of patients required at least one of the three organ supports. qSOFA score accurately predicted need for advanced organ support (AUC 0.81) and mortality (AUC 0.81). Its performance improved when the recurrence status of pancreatitis was entered into the model. BISAP score performed poorly predicting both need for advanced organ support (AUC 0.62) and death (AUC 0.59). (Figures 1 and 2) Conclusions: The qSOFA score, an appealing bedside tool, accurately predicts the need for advanced organ support and mortality in SAP patients. Applying qSOFA scores once a patient is diagnosed with SAP may result in an expedited escalation of care, with aim to improve outcomes.
Figure 1: ROC curves for different predictive models for endpoint need for advanced organ support; ROC: receiver operating characteristic
AGA Abstracts
S-280
Figure 2: ROC curves for different predictive models for endpoint mortality; ROC: receiver operating characteristic
Sa1334
Sa1335
QUICK SOFA: AN ACCURATE PREDICTOR OF MORTALITY AND NEED FOR ADVANCED ORGAN SUPPORT IN SEVERE ACUTE PANCREATITIS Dharani Guttikonda, Mohannad Abou Saleh, Dong Wu, Matthew Hoscheit, Vijit Chouhan, Ashwinee Natu, Michael Enzerra, Raj M. Paspulati, Brooke Glessing, Tiffany Chua, Kunjam Modha, David Ngendahimana, Daniel Jang, Lorna Kang, Peter Junwoo Lee, Neetika Srivastava, Amitabh Chak, Jiaming QIan, Tyler Stevens
READMISSION RATES AFTER ACUTE PANCREATITIS IN TWO SAFETY NET HOSPITALS Kelly Fujikawa, Jonathan Kung, Christopher Hwe, Chirag Rajyaguru, Meenu Pamula, Viktor E. Eysselein, Sofiya Reicher Introduction: Acute Pancreatitis (AP) is the most common cause of gastrointestinal hospitalizations in the US. Our goal was to identify factors at discharge that were associated with higher rates of readmission amongst a safety net patient population. Methods: This is a two-center retrospective study of patients who presented to Harbor UCLA (HUMC) and UCSF-Fresno with an episode of AP requiring inpatient hospitalization. 152 and 176 patients were included from HUMC and UCSF-Fresno cohorts, respectively. Cases were retrospectively identified based on ICD9 and ICD10 codes and included those who met clinical criteria for AP. Data including SIRS criteria, Marshall and SOFA criteria, numerical rating of abdominal pain (0-10 scale), opiate use (reported as equivalent morphine IV mg) and diet were collected from the last 12 hours prior to discharge. Analysis was performed using a two-sided Z test. Baseline patient demographics and AP etiologies are in Table 1. Results: At HUMC, 7.9% of patients (12 of 152) were readmitted within 30 days. 9.1% of patients (16 of 176) were readmitted within 30 days at UCSF Fresno. At HUMC, 4.8% of patients (6 of 125) who were tolerating >50% of a solid diet in the 12 hours prior to discharge were readmitted in <30 days versus 22 % of patients (6 of 27) who were not tolerating a solid diet prior to discharge (p<0.01). In the UCSF Fresno cohort, 8.9% of patients (14 of 158) who were tolerating a solid diet were readmitted compared to 11% of patients (2 of 18) who were not tolerating a solid diet (p=0.76). At HUMC, 5.4% of patients(6 of 111) who reported abdominal pain of less than 6 prior to discharge were readmitted in <30 days compared to 15% of patients (6 of 41) who reported abdominal pain of 6 or greater (p= 0.06). At UCSF Fresno, 8.7% of patients (15 of 173) who reported pain of less than 6 were readmitted compared to 33% of patients (1 of 3) who reported pain >6 at discharge (p= 0.14). At HUMC, 6.5% of patients (8 of 124) who required less than 4mg of morphine iv were readmitted compared to 14% of patients (4 of 28) who required 4mg or more of morphine iv (p=0.16). At UCSF-Fresno, 9.3% of patients (16 of 172) who required less than 4mg of morphine iv were readmitted compared to 0% of patients (0 of 2) who required 4mg or more of morphine iv (p=0.65). Number of SIRS criteria met, or evidence of organ failure through both the Marshall and SOFA scoring systems were not significantly associated with readmission < 30d amongst both cohorts. Conclusion: Tolerance of a solid diet at discharge was significantly associated with decreased readmission at 30 day. Self-report of abdominal pain of less than 6 at discharge and morphine use < 4mg IV in the last 12 hours trended towards decreased readmission rates. Baseline Patient Demographics and AP Etiologies
Background: Patients with severe acute pancreatitis (SAP) carry a significant risk of death from organ failure. The Quick Sequential Organ Failure Assessment (qSOFA) score is a validated mortality prediction tool that can be calculated at the bedside with ease in patients with possible sepsis. The aim of the study is to assess the performance of qSOFA score as a tool to predict mortality and need for advanced organ support in patients with SAP. Methods: This was a multicenter study that included three tertiary referral centers. Relevant laboratory and clinical data, including the Charlson Comorbidity Index (CCI), were extracted from the electronic medical record. Severity was defined as per the Revised Atlanta Criteria (single or multi-organ failure >48 hours). Organ failure was defined as per Modified Marshall Score. Advanced organ support was defined as the need for pulmonary (mechanical ventilation), renal (hemodialysis), or cardiac (pressor) support. qSOFA score was calculated at the time of diagnosis of SAP using the published definitions: 1 point each for altered mental status, systolic blood pressure <100mmHg, and respiratory rate >22/minute. Receiver operating characteristics and areas under the curve (AUC) were used to measure qSOFA score's performance in predicting need for advanced organ support and mortality. Results: Two hundred fifteen patients with SAP were identified. Mortality within the overall cohort was 33%. Sixty percent of patients required at least one of the three organ supports. qSOFA score accurately predicted need for advanced organ support (AUC 0.81) and mortality (AUC 0.81). Its performance improved when the recurrence status of pancreatitis was entered into the model. BISAP score performed poorly predicting both need for advanced organ support (AUC 0.62) and death (AUC 0.59). (Figures 1 and 2) Conclusions: The qSOFA score, an appealing bedside tool, accurately predicts the need for advanced organ support and mortality in SAP patients. Applying qSOFA scores once a patient is diagnosed with SAP may result in an expedited escalation of care, with aim to improve outcomes.
Figure 1: ROC curves for different predictive models for endpoint need for advanced organ support; ROC: receiver operating characteristic
AGA Abstracts
S-280