Abstract
It’s a controversy if pancreatitis can be considered one of the extraintestinal manifestations of Crohn’s disease (CD). (Barthet et al AJG) CD patients have a fourfold increase in the risk of acute pancreatitis (AP) compared to the general population. (Rasmussen et al Scan J Gastroenterol) The annual incidence of AP in the general population ranges from 13 to 45/100,000 persons. (Dhiraj et al Gastroenterology)
We collected data from the publicly available Healthcare Cost and Utilization Project (HCUP) Nationwide Readmission Databases (NRD) 2017-2018. We identified individuals discharged with a diagnosis of CD or one of its complications. The case selection process is summarized in Figure 1. We studied the burden of AP in patients with Crohn’s disease, hospitalization outcomes, and predictors of hospital readmissions with AP. Median and IQR were used to describe Continuous variables, and proportions were used with categorical variables. Comparison between groups was performed by Mann Whitney test for continuous variables and Chi-Square test for Categorical variables. We performed a binary logistic regression analysis for predictors of 90-day readmission with AP. Statistical analyses were performed using SPSS Version 25 (IBM Corporation, Armonk, NY, USA).
We analyzed 147,501 index hospital discharges with Crohn’s disease or one of its complications, 0.9% had chronic pancreatitis, and 1.6% had a diagnosis of AP. Around 14% of AP was biliary, 13% was Alcohol-induced, 7% was drug-induced, while 66% was classified as idiopathic, other, or unspecified AP. Table 1 shows a Comparison between CD patients with AP and CD patients without AP. Having AP on index hospitalization wasn’t related to CD complication status as those without AP had a higher prevalence of complications (P values <0.001). After excluding those who died in index hospitalization, those with Chronic Pancreatitis, and those discharged in Oct-Dec, 0.3% of patients had 90-day readmission with AP. Characteristics of CD patients with 90-day readmission with AP are illustrated in Table 2. A binary logistic regression for predictors of 90-day readmission with AP is illustrated in Table 3. The chi-square test results indicate that our regression model is a significant improvement in fit relative to an intercept-only model (χ2= 498.489, p<.001).
AP is associated with higher morbidity and mortality in patients with CD. Age, number of comorbidities, and having AP in index hospitalization are significant predictors of 90-day readmission with AP. Further biochemical studies would be needed to investigate the association between AP and CD. The study was limited by the lack of a specific ICD-10 code for autoimmune pancreatitis and the inability to account for common CD drugs associated with Pancreatitis.
Figure 1. Case selection and study groups
Figure 2. Table 1, 2 and 3
