Risk factors for intensive care unit admission in hospitalized patients with acute pancreatitis

Acute pancreatitis (AP) is afflicted by substantial morbidity and mortality. Besides local/systemic complications and pancreatic necrosis, patients' comorbidities might be underrated as risk factor for intensive care unit (ICU) admission in AP.

We screened the German nationwide inpatient statistics identifying patients admitted due to AP (ICD-code K85) 2005-2019. AP hospitalizations were stratified for necessity of ICU admission and risk-factors for ICU admission were investigated.

Overall, 797,364 patient-hospitalizations due to AP (median age 56.0 [IQR 44.0-71.0] years, 39.2% females) were detected in Germany 2005-2019. Among these, 78,437 (9.8 %) were treated at an ICU. AP patients admitted to an ICU were significantly older (59.0 [46.0-73.0] vs. 56.0 [44.0-71.0], P < 0.001), less often female (35.4 % vs. 39.6 %, P < 0.001), showed an aggravated comorbidity-profile and higher case-fatality than those without ICU admission (13.7 % vs. 1.6 %, P < 0.001). ICU admission was independently associated with increased in-hospital case-fatality (OR 9.82 [95%CI 9.54-10.12], P < 0.001). Strongest independent risk factors for ICU admission regarding patient-characteristics were male sex (OR 1.26 [95%CI 1.23-1.28], P < 0.001), obesity (OR 1.53 [95%CI 1.49-1.57], P < 0.001), diabetes mellitus (OR 1.35 [95%CI 1.33-1.38], P < 0.001), heart failure (OR 2.43 [95%CI 2.37-2.49], P < 0.001) and atrial fibrillation/flutter (OR 1.87 [95%CI 1.82-1.91], P < 0.001).

Approximately 10 % of the hospitalized AP patients had to be admitted on an ICU. Besides AP complications, male sex, obesity, diabetes mellitus, heart failure and atrial fibrillation/flutter were associated with ICU admission.