Søren S Olesen1, Jakob Lykke Poulsen2, Marie C H Broberg2, Adnan Madzak3, Asbjørn M Drewes4. 1. Centre for Pancreatic Diseases, Department of Gastroenterology and Hepatology, Aalborg University Hospital, Aalborg, Denmark; Mech-Sense, Department of Gastroenterology and Hepatology, Aalborg University Hospital, Aalborg, Denmark; Department of Clinical Medicine, Aalborg University, Aalborg, Denmark. Electronic address: soso@rn.dk. 2. Centre for Pancreatic Diseases, Department of Gastroenterology and Hepatology, Aalborg University Hospital, Aalborg, Denmark; Mech-Sense, Department of Gastroenterology and Hepatology, Aalborg University Hospital, Aalborg, Denmark. 3. Centre for Pancreatic Diseases, Department of Gastroenterology and Hepatology, Aalborg University Hospital, Aalborg, Denmark; Department of Radiology, Aalborg University Hospital, Aalborg, Denmark. 4. Centre for Pancreatic Diseases, Department of Gastroenterology and Hepatology, Aalborg University Hospital, Aalborg, Denmark; Mech-Sense, Department of Gastroenterology and Hepatology, Aalborg University Hospital, Aalborg, Denmark; Department of Clinical Medicine, Aalborg University, Aalborg, Denmark.
Abstract
BACKGROUND/ OBJECTIVES: Chronic pancreatitis (CP) is a complex and debilitating disease with high resource utilisation. Prospective data on hospital admission rates and associated risk factors are scarce. We investigated hospitalisation rates, causes of hospitalisations and associated risk factors in CP outpatients. METHODS: This was a prospective cohort study comprising 170 patients with CP. The primary outcome was time to first pancreatitis related hospitalisation and secondary outcomes were the annual hospitalisation frequency (hospitalisation burden) and causes of hospitalisations. A number of clinical and demographic parameters, including pain pattern and severity, opioid use and parameters related to the nutritional state, were analysed for their association with hospitalisation rates. RESULTS: Of the 170 patients, 57 (33.5%) were hospitalised during the follow-up period (median 11.4 months [IQR 3.8-26.4]). The cumulative hospitalisation incidence was 7.6% (95% CI; 4.5-12.2) after 30 days and 28.8% (95% CI; 22.2-35.7) after 1 year. Eighteen of the hospitalised patients (32%) had three or more admissions per year. High dose opioid treatment (>100 mg per day) (Hazard Ratio 3.1 [95% CI; 1.1-8.5]; P = 0.03) and hypoalbuminemia (<36 g/l) (Hazard Ratio 3.8 [95% CI; 2.0-7.8]; P < 0.001) were identified as independent risk factors for hospitalisation. The most frequent causes of hospitalisations were pain exacerbation (40%) and common bile duct stenosis (28%). CONCLUSIONS: One-third of CP outpatients account for the majority of hospital admissions and associated risk factors are high dose opioid treatment and hypoalbuminemia. This information should be implemented in outpatient monitoring strategies to identify risk patients and improve treatment.
BACKGROUND/ OBJECTIVES:Chronic pancreatitis (CP) is a complex and debilitating disease with high resource utilisation. Prospective data on hospital admission rates and associated risk factors are scarce. We investigated hospitalisation rates, causes of hospitalisations and associated risk factors in CP outpatients. METHODS: This was a prospective cohort study comprising 170 patients with CP. The primary outcome was time to first pancreatitis related hospitalisation and secondary outcomes were the annual hospitalisation frequency (hospitalisation burden) and causes of hospitalisations. A number of clinical and demographic parameters, including pain pattern and severity, opioid use and parameters related to the nutritional state, were analysed for their association with hospitalisation rates. RESULTS: Of the 170 patients, 57 (33.5%) were hospitalised during the follow-up period (median 11.4 months [IQR 3.8-26.4]). The cumulative hospitalisation incidence was 7.6% (95% CI; 4.5-12.2) after 30 days and 28.8% (95% CI; 22.2-35.7) after 1 year. Eighteen of the hospitalised patients (32%) had three or more admissions per year. High dose opioid treatment (>100 mg per day) (Hazard Ratio 3.1 [95% CI; 1.1-8.5]; P = 0.03) and hypoalbuminemia (<36 g/l) (Hazard Ratio 3.8 [95% CI; 2.0-7.8]; P < 0.001) were identified as independent risk factors for hospitalisation. The most frequent causes of hospitalisations were pain exacerbation (40%) and common bile duct stenosis (28%). CONCLUSIONS: One-third of CP outpatients account for the majority of hospital admissions and associated risk factors are high dose opioid treatment and hypoalbuminemia. This information should be implemented in outpatient monitoring strategies to identify risk patients and improve treatment.
Authors: Furqan A Bhullar; Mahya Faghih; Venkata S Akshintala; Ahmed I Ahmed; Katie Lobner; Elham Afghani; Anna E Phillips; Phil A Hart; Mitchell L Ramsey; Benjamin L Bick; Louise Kuhlmann; Asbjørn M Drewes; Dhiraj Yadav; Søren S Olesen; Vikesh K Singh Journal: Pancreatology Date: 2021-11-18 Impact factor: 3.996
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Authors: M Gordian Adam; Georg Beyer; Julia Mayerle; Markus M Lerch; Nicole Christiansen; Beate Kamlage; Christian Pilarsky; Marius Distler; Tim Fahlbusch; Ansgar Chromik; Fritz Klein; Marcus Bahra; Waldemar Uhl; Robert Grützmann; Ujjwal M Mahajan; Frank U Weiss Journal: Gut Date: 2021-02-04 Impact factor: 23.059