Hedong Han1, Wei Guo1, Honglei Guo2, Xin Wei3, Xiaochun Xiao1, Yiming Ruan1, Cheng Wu1, Yang Cao4, Jia He5,6. 1. Department of Health Statistics, Second Military Medical University, No. 800 Xiangyin Road, Shanghai, 200433, China. 2. Department of Gastroenterology, Changhai Hospital, Second Military Medical University, Shanghai, 200433, China. 3. Department of Cardiology, Virginia Commonwealth University, 1250 E Marshall Street, Richmond, VA, 23298, USA. 4. Clinical Epidemiology and Biostatistics, School of Medical Sciences, Örebro University, 701 82, Örebro, Sweden. 5. Department of Health Statistics, Second Military Medical University, No. 800 Xiangyin Road, Shanghai, 200433, China. hejia63@yeah.net. 6. Tongji University School of Medicine, Shanghai, 200092, China. hejia63@yeah.net.
Abstract
BACKGROUND: Compared to general population, human immunodeficiency virus (HIV) infection may increase frequency of acute pancreatitis (AP); however, evidence regarding effects of HIV infection on AP-related outcomes is limited and controversial. AIMS: We aim to investigate the temporary trend, characteristics and clinical outcomes of AP infected with HIV. METHODS: We reviewed data from the 2003-2014 National Inpatient Sample to identify patients with a primary diagnosis of AP. The primary outcomes (in-hospital mortality, acute respiratory failure, acute kidney injury, and prolonged length of stay [LOS]) and secondary outcomes (gastrointestinal hemorrhage, sepsis and total cost) were compared between patients with and without HIV infection using univariate, multivariable and propensity score matching analyses. RESULTS: Of 594,106 patients diagnosed with AP, 6775 (1.14%) had HIV infection. Patients with HIV were more likely to be younger, black, male, less likely to be gallstone-related and had lower rate of interventions. Multivariable analyses based on multiple imputation revealed that HIV infection was associated with higher risk of mortality (odds ratio [OR]: 1.74; 95% confidence interval [CI] 1.34-2.25), acute kidney injury (OR: 1.13; 95% CI 1.19-1.44), prolonged LOS (OR: 1.26; 95% CI 1.15-1.37) and 6% higher cost. There were no differences in sepsis, gastrointestinal bleeding, and respiratory failure between groups. CONCLUSIONS: HIV infection is associated with adverse outcomes including increased mortality, acute kidney injury and more healthcare utilization in AP patients. More assertive management strategies like early intravenous fluid resuscitation in HIV patients hospitalized with AP to prevent acute kidney injury may be helpful to improve clinical outcomes.
BACKGROUND: Compared to general population, human immunodeficiency virus (HIV) infection may increase frequency of acute pancreatitis (AP); however, evidence regarding effects of HIV infection on AP-related outcomes is limited and controversial. AIMS: We aim to investigate the temporary trend, characteristics and clinical outcomes of AP infected with HIV. METHODS: We reviewed data from the 2003-2014 National Inpatient Sample to identify patients with a primary diagnosis of AP. The primary outcomes (in-hospital mortality, acute respiratory failure, acute kidney injury, and prolonged length of stay [LOS]) and secondary outcomes (gastrointestinal hemorrhage, sepsis and total cost) were compared between patients with and without HIV infection using univariate, multivariable and propensity score matching analyses. RESULTS: Of 594,106 patients diagnosed with AP, 6775 (1.14%) had HIV infection. Patients with HIV were more likely to be younger, black, male, less likely to be gallstone-related and had lower rate of interventions. Multivariable analyses based on multiple imputation revealed that HIV infection was associated with higher risk of mortality (odds ratio [OR]: 1.74; 95% confidence interval [CI] 1.34-2.25), acute kidney injury (OR: 1.13; 95% CI 1.19-1.44), prolonged LOS (OR: 1.26; 95% CI 1.15-1.37) and 6% higher cost. There were no differences in sepsis, gastrointestinal bleeding, and respiratory failure between groups. CONCLUSIONS:HIV infection is associated with adverse outcomes including increased mortality, acute kidney injury and more healthcare utilization in AP patients. More assertive management strategies like early intravenous fluid resuscitation in HIVpatients hospitalized with AP to prevent acute kidney injury may be helpful to improve clinical outcomes.
Entities:
Keywords:
Acute pancreatitis; HIV; Organ failure; Propensity score
Authors: Shahzad Raza; Naueen A Chaudhry; Jordan D Brown; Sina Aghaie; Damoun Rezai; Areej Khan; Paul De Leon Tan; Barbara J Berger Journal: J Clin Med Res Date: 2013-01-11