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Increased Early Post-Discharge Mortality in Patients With Acute Pancreatitis
Line Davidsen1,2, Cecilie S Knoph1,2, Mathias E Cook1,2
1Centre for Pancreatic Diseases and Mech-Sense, Department of Gastroenterology and Hepatology, Aalborg University Hospital, Aalborg, Denmark.
Background:
Emerging evidence suggests that individuals who recover from acute pancreatitis may face a significant risk of mortality during the early post-discharge period. Despite these concerns, comprehensive population-based studies on this issue are lacking.
Objectives:
To study in-hospital and post-discharge mortality in patients with acute pancreatitis and how it has changed over time.
Methods:
In a Danish nationwide population-based cohort study, we included all adults discharged after an incident episode of acute pancreatitis between 2002 and 2017. For each patient, five individuals from the general population, matched by age and sex, were selected as controls. We used Cox regression analysis to assess all-cause mortality at 90 days, 1, 2, and 5 years post-discharge and to examine trends in in-hospital and post-discharge mortality over the study period. Models were adjusted for comorbidities, heavy smoking, alcohol abuse and sociodemographic factors.
Results:
Of 28,759 adults with incident acute pancreatitis, 956 (3.3%) died in hospital. The 27,803 patients discharged from the hospital following an incident episode of acute pancreatitis were matched with 139,035 individuals (mean age 58.1 years, 51.1% men). The cumulative post-discharge mortality at 90 days was 5.0% for the acute pancreatitis cohort and 0.55% for controls. The mortality risk was significantly increased in acute pancreatitis patients at 90 days post-discharge (adjusted hazard ratio [aHR] 7.62; 95% CI 6.86-8.45); the risk attenuated over time but remained elevated for up to five years (aHR 1.85; 95% CI 1.79-1.92). In-hospital mortality decreased over the study period (aHR 0.65; 95% CI 0.53-0.81) from 2002-2005 to 2014-2017, while post-discharge mortality risk remained stable (aHR 0.85; 95% CI 0.72-1.01). Gastrointestinal and cardiovascular diseases accounted for 59.4% of 90-day post-discharge deaths.
Conclusions:
In-hospital mortality for acute pancreatitis has improved in recent years. However, the risk of post-discharge mortality remains high, especially in the first 90 days after discharge.
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