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©The Author(s) 2023.
World J Hepatol. Jun 27, 2023; 15(6): 797-812
Published online Jun 27, 2023. doi: 10.4254/wjh.v15.i6.797
Published online Jun 27, 2023. doi: 10.4254/wjh.v15.i6.797
Table 1 Trends of hospitalization characteristics for liver transplant hospitalizations with acute pancreatitis in the United States from 2007–2019, n (%)
| Epidemiologicalvariable | Years | Trend (P value) | ||||||||||||
| 2007 | 2008 | 2009 | 2010 | 2011 | 2012 | 2013 | 2014 | 2015 | 2016 | 2017 | 2018 | 2019 | ||
| Total number of hospitalizations | 305 | 600 | 550 | 520 | 453 | 590 | 455 | 500 | 460 | 650 | 505 | 665 | 610 | -- |
| Mean age in yr (standard error) | 53.08 (1.52) | 51.00 (1.35) | 52.01 (1.59) | 51.32 (1.45) | 51.79 (1.49) | 52.02 (1.10) | 52.86 (1.20) | 55.16 (1.22) | 50.27 (1.31) | 51.84 (1.11) | 53.70 (1.26) | 53.32 (1.12) | 54.73 (1.20) | No trend (0.1256) |
| Age groups (yr) | ||||||||||||||
| 18–34 | 30 (9.94) | 82 (13.62) | 76 (13.77) | 62 (11.90) | 50 (11.07) | 80 (13.56) | 45 (9.89) | 55 (11.00) | 90 (19.57) | 105 (16.15) | 50 (9.90) | 70 (10.53) | 55 (9.02) | No trend (0.1345) |
| 35–49 | 61 (19.82) | 180 (29.97) | 117 (21.38) | 111 (21.37) | 84 (18.46) | 145 (24.58) | 100 (21.98) | 90 (18.00) | 115 (25.00) | 120 (18.46) | 100 (19.80) | 185 (27.82) | 165 (27.05) | No trend (0.2379) |
| 50–64 | 164 (53.56) | 236 (39.30) | 270 (49.09) | 281 (54.15) | 276 (60.97) | 280 (47.46) | 255 (56.04) | 225 (45.00) | 170 (36.96) | 295 (45.38) | 260 (51.49) | 265 (39.85) | 200 (32.79) | Decrease (< 0.0001) |
| 65–79 | 46 (14.90) | 103 (17.12) | 87 (15.76) | 62 (11.86) | 38 (8.40) | 85 (14.41) | 55 (12.09) | 120 (24.00) | 75 (16.30) | 125 (19.23) | 85 (16.83) | 135 (20.30) | 190 (31.15) | Increase (< 0.0001) |
| ≥ 80 | < 11 (1.78) | 0 (0.00) | 0 (0.00) | < 11 (0.71) | < 11 (1.09) | 0 (0.00) | 0 (0.00) | < 11 (2.00) | < 11 (2.17) | < 11 (0.77) | < 11 (1.98) | < 11 (1.50) | 0 (0.00) | Increase (0.0157) |
| Gender | ||||||||||||||
| Male | 163 (53.30) | 278 (46.32) | 311 (56.61) | 328 (63.08) | 270 (59.48) | 325 (55.08) | 260 (57.14) | 235 (47.00) | 275 (59.78) | 380 (58.46) | 270 (53.47) | 370 (55.64) | 340 (55.74) | No trend (0.1383) |
| Female | 143 (46.70) | 322 (53.68) | 238 (43.39) | 192 (36.92) | 184 (40.52) | 265 (44.92) | 195 (42.86) | 265 (53.00) | 185 (40.22) | 270 (41.54) | 235 (46.53) | 295 (44.36) | 270 (44.26) | No trend (0.1383) |
| Race | ||||||||||||||
| White | 139 (59.81) | 387 (72.63) | 310 (66.45) | 322 (66.37) | 285 (71.89) | 395 (71.17) | 290 (65.91) | 375 (78.95) | 265 (61.63) | 390 (64.46) | 360 (75.00) | 385 (60.16) | 405 (66.94) | No trend (0.0517) |
| Black | 26 (11.00) | 48 (9.04) | 69 (14.68) | 99 (20.39) | 58 (14.49) | 35 (6.31) | 45 (10.23) | 40 (8.42) | 20 (4.65) | 90 (14.88) | 50 (10.42) | 60 (9.38) | 50 (8.26) | Decrease (0.0004) |
| Hispanic | 38 (16.49) | 63 (11.85) | 54 (11.58) | 43 (8.80) | 39 (9.75) | 65 (11.71) | 70 (15.91) | 35 (7.37) | 95 (22.09) | 80 (13.22) | 35 (7.29) | 135 (21.09) | 80 (13.22) | Increase (0.0009) |
| Asian | < 11 (4.27) | 20 (3.77) | 0 (0.00) | 11 (2.19) | < 11 (2.57) | 35 (6.31) | 20 (4.55) | 15 (3.16) | 20 (4.65) | 30 (4.96) | < 11 (2.08) | 25 (3.91) | 45 (7.44) | Increase (0.0002) |
| Other | 20 (8.42) | 14 (2.71) | 34 (7.28) | 11 (2.26) | < 11 (1.31) | 25 (4.50) | 15 (3.41) | < 11 (2.11) | 30 (6.98) | 15 (2.48) | 25 (5.21) | 35 (5.47) | 25 (4.13) | No trend (0.406) |
| CCI | ||||||||||||||
| CCI = 1 | 130 (42.71) | 232 (38.75) | 174 (31.68) | 147 (28.25) | 138 (30.35) | 185 (31.36) | 130 (28.57) | 155 (31.00) | 150 (32.61) | 160 (24.62) | 120 (23.76) | 160 (24.06) | 145 (23.77) | Decrease (< 0.0001) |
| CCI = 2 | 48 (15.65) | 101 (16.81) | 106 (19.32) | 155 (29.77) | 61 (13.38) | 115 (19.49) | 115 (25.27) | 130 (26.00) | 90 (19.57) | 110 (16.92) | 75 (14.85) | 115 (17.29) | 85 (13.93) | Decrease (0.0036) |
| CCI ≥ 3 | 127 (41.64) | 267 (44.44) | 269 (49.01) | 218 (41.98) | 255 (56.27) | 290 (49.15) | 210 (46.15) | 215 (43.00) | 220 (47.83) | 380 (58.46) | 310 (61.39) | 390 (58.65) | 380 (62.30) | Increase (< 0.0001) |
| Hospital region | ||||||||||||||
| Northeast | 36 (11.70) | 209 (34.76) | 82 (14.99) | 61 (11.73) | 89 (19.75) | 100 (16.95) | 60 (13.19) | 35 (7.00) | 65 (14.13) | 95 (14.62) | 115 (22.77) | 115 (17.29) | 85 (13.93) | Decrease (< 0.0001) |
| Midwest | 64 (20.97) | 98 (16.26) | 213 (38.69) | 134 (25.71) | 144 (31.79) | 130 (22.03) | 125 (27.47) | 140 (28.00) | 130 (28.26) | 125 (19.23) | 130 (25.74) | 140 (21.05) | 130 (21.31) | Decrease (0.0063) |
| South | 105 (34.47) | 121 (20.22) | 119 (21.68) | 244 (47.04) | 169 (37.29) | 185 (31.36) | 180 (39.56) | 205 (41.00) | 170 (36.96) | 270 (41.54) | 145 (28.71) | 265 (39.85) | 230 (37.70) | Increase (< 0.0001) |
| West | 100 (32.86) | 173 (28.77) | 135 (24.64) | 81 (15.52) | 51 (11.18) | 175 (29.66) | 90 (19.78) | 120 (24.00) | 95 (20.65) | 160 (24.62) | 115 (22.77) | 145 (21.80) | 165 (27.05) | No trend (0.2338) |
| Hospital bed-size | ||||||||||||||
| Small | 43 (13.91) | 48 (7.97) | 23 (4.59) | 34 (6.64) | 23 (5.15) | 30 (5.08) | 60 (13.19) | 45 (9.00) | 65 (14.13) | 60 (9.23) | 40 (7.92) | 90 (13.53) | 85 (13.93) | Increase (< 0.0001) |
| Medium | 68 (22.16) | 93 (15.44) | 103 (20.26) | 91 (17.70) | 58 (13.10) | 120 (20.34) | 75 (16.48) | 135 (27.00) | 100 (21.74) | 120 (18.46) | 120 (23.76) | 195 (29.32) | 155 (25.41) | Increase (< 0.0001) |
| Large | 195 (63.93) | 459 (76.59) | 381 (75.16) | 389 (75.67) | 363 (81.75) | 440 (74.58) | 320 (70.33) | 320 (64.00) | 295 (64.13) | 470 (72.31) | 345 (68.32) | 380 (57.14) | 370 (60.66) | Decrease (< 0.0001) |
| Hospital location and teaching status | ||||||||||||||
| Rural | 18 (5.97) | 57 (9.51) | 20 (3.98) | 41 (7.98) | 35 (7.95) | 65 (11.02) | 30 (6.59) | 45 (9.00) | 35 (7.61) | 35 (5.38) | 15 (2.97) | 65 (9.77) | 25 (4.10) | Decrease (0.0238) |
| Urban nonteaching | 107 (35.14) | 145 (24.21) | 171 (33.68) | 156 (30.35) | 84 (18.89) | 190 (32.20) | 140 (30.77) | 70 (14.00) | 85 (18.48) | 125 (19.23) | 110 (21.78) | 110 (16.54) | 80 (13.11) | Decrease (< 0.0001) |
| Urban teaching | 180 (58.89) | 398 (66.28) | 316 (62.34) | 317 (61.67) | 325 (73.16) | 335 (56.78) | 285 (62.64) | 385 (77.00) | 340 (73.91) | 490 (75.38) | 380 (75.25) | 490 (73.68) | 505 (82.79) | Increase (< 0.0001) |
| Disposition | ||||||||||||||
| Discharge Home | 276 (90.47) | 473 (78.88) | 397 (72.25) | 359 (69.05) | 333 (73.51) | 440 (74.58) | 345 (75.82) | 395 (79.00) | 375 (81.52) | 525 (80.77) | 370 (73.27) | 490 (73.68) | 455 (74.59) | No trend (0.1111) |
| Transfer to short-term hospital | < 11 (3.06) | 46 (7.74) | 37 (6.72) | 68 (13.01) | 35 (7.81) | 50 (8.47) | 25 (5.49) | 35 (7.00) | 40 (8.70) | 30 (4.62) | 60 (11.88) | 30 (4.51) | 35 (5.74) | No trend (0.0657) |
| Transfer to another facility (Includes SNF and ICF) | < 11 (3.25) | 20 (3.28) | 34 (6.11) | 26 (5.09) | 13 (2.97) | 25 (4.24) | < 11 (2.20) | < 11 (1.00) | 10 (2.17) | 45 (6.92) | < 11 (0.99) | 70 (10.53) | 15 (2.46) | No trend (0.0532) |
| Home health care | < 11 (3.22) | 30 (5.07) | 51 (9.32) | 62 (11.87) | 42 (9.25) | 60 (10.17) | 60 (13.19) | 50 (10.00) | 30 (6.52) | 45 (6.92) | 55 (10.89) | 55 (8.27) | 60 (9.84) | Increase (0.0426) |
| Discharge against medical advice | 0 (0.00) | 25 (4.16) | 11 (2.00) | < 11 (0.98%) | < 11 (1.11) | < 11 (1.69) | 15 (3.30) | <11 (2.00) | < 11 (1.09) | 0 (0.00) | < 11 (0.99) | 20 (3.01) | 25 (4.10) | No trend (0.1735) |
Table 2 Trends of outcomes for liver transplant hospitalizations with acute pancreatitis in the United States from 2007–2019, n (%)
| Outcomes | Years | Trend (P value) | ||||||||||||
| 2007 | 2008 | 2009 | 2010 | 2011 | 2012 | 2013 | 2014 | 2015 | 2016 | 2017 | 2018 | 2019 | ||
| Inpatient mortality | 0 (0.00) | < 11 (0.87) | 20 (3.60) | 0 (0.00) | 24 (5.35) | < 11 (0.85) | 0 (0.00) | < 11 (1.00) | 0 (0.00) | < 11 (0.77) | < 11 (1.98) | 0 (0.00) | 20 (3.28) | No trend (0.3879) |
| Length of stay (d) | 5.62 | 5.44 | 7.09 | 6.02 | 7.85 | 5.40 | 8.53 | 4.53 | 4.86 | 7.33 | 6.62 | 6.23 | 4.55 | No trend (0.6905) |
| Total healthcare charge ($) | 36413 | 53418 | 50432 | 53115 | 68247 | 42107 | 95774 | 41613 | 42319 | 79746 | 80479 | 65054 | 56011 | No trend (0.1946) |
| Complications | ||||||||||||||
| Pancreatic psuedocyst | < 11 (3.41) | 35 (5.88) | 34 (6.13) | 26 (5.06) | 14 (3.01) | < 11 (1.69) | 20 (4.40) | < 11 (2.00) | < 11 (1.09) | 20 (3.08) | 0 (0.00) | 50 (7.52) | 30 (4.92) | No trend (0.1273) |
| Abdominal abscess | 0 (0.00) | 0 (0.00) | 0 (0.00) | 11 (2.07) | < 11 (1.00) | 0 (0.00) | < 11 (1.10) | < 11 (1.00) | 0 (0.00) | < 11 (0.77) | 0 (0.00) | 20 (3.01) | < 11 (0.82) | Increase (0.0006) |
| Sepsis | < 11 (1.25) | 41 (6.91) | 46 (8.37) | 30 (5.69) | 32 (7.15) | 20 (3.39) | 35 (7.69) | 30 (6.00) | 40 (8.70) | 60 (9.23) | 55 (10.89) | 70 (10.53) | 110 (18.03) | Increase (< 0.0001) |
| Acute renal failure | 52 (17.13) | 121 (20.10) | 149 (27.09) | 123 (23.74) | 143 (31.62) | 160 (27.12) | 130 (28.57) | 145 (29.00) | 155 (33.70) | 205 (31.54) | 180 (35.64) | 245 (36.84) | 210 (34.43) | Increase (< 0.0001) |
| Acute respiratory failure | < 11 (1.44) | 37 (6.10) | 21 (3.79) | 21 (4.06) | 28 (6.28) | 0 (0.00) | 15 (3.30) | < 11 (2.00) | 25 (5.43) | 55 (8.46) | 20 (3.96) | 40 (6.02) | 40 (6.56) | Increase (0.0002) |
| Need for blood transfusion | 19 (6.09) | 72 (12.03) | 33 (6.10) | 40 (7.61) | 91 (20.09) | 95 (16.10) | 45 (9.89) | 35 (7.00) | 30 (6.52) | 20 (3.08) | 20 (3.96) | 25 (3.76) | 0 (0.00) | Decrease (< 0.0001) |
| Portal vein thrombosis | 0 (0.00) | < 11 (1.69) | < 11 (0.86) | 0 (0.00) | 0 (0.00) | 0 (0.00) | < 11 (1.10) | < 11 (2.00) | < 11 (1.09) | 15 (2.31) | 15 (2.97) | 15 (2.26) | 25 (4.10) | Increase (< 0.0001) |
| Venous thromboembolism | < 11 (1.82) | < 11 (0.85) | 35 (6.29) | 16 (3.02) | < 11 (1.00) | < 11 (1.69) | < 11 (1.10) | < 11 (1.00) | < 11 (2.17) | 25 (3.85) | 25 (4.95%) | 50 (7.52) | 45 (7.38) | Increase (< 0.0001) |
Table 3 Comparative analysis of hospitalization characteristics for liver and non-liver transplant hospitalizations with acute pancreatitis in the United States from 2007–2019, n (%)
| Outcomes | Liver transplant hospitalizations with acute pancreatitis | Non-liver transplant hospitalizations with acute pancreatitis | P value |
| Total number of hospitalizations | 6863 | 5649980 | |
| Mean age ± standard error (yr) | 53.50 (0.04) | 52.55 (0.39) | 0.017 |
| Age group (yr) | < 0.0001 | ||
| 18–34 | 12.38 | 16.20 | |
| 35–49 | 22.91 | 26.36 | |
| 50–64 | 46.29 | 29.97 | |
| 65–79 | 17.55 | 18.43 | |
| ≥ 80 | 0.86 | 9.03 | |
| Gender | 0.0046 | ||
| Male | 55.43 | 51.13 | |
| Female | 44.57 | 48.87 | |
| Race | ≤ 0.0001 | ||
| White | 67.91 | 64.57 | |
| Black | 10.85 | 16.11 | |
| Hispanic | 13.11 | 13.12 | |
| Asian | 3.95 | 2.30 | |
| Other | 4.16 | 3.90 | |
| Charlson comorbidity index | < 0.0001 | ||
| CCI = 1 | 29.53 | 28.27 | |
| CCI = 2 | 19.02 | 13.65 | |
| CCI ≥ 3 | 51.46 | 19.76 | |
| Hospital region | 0.0753 | ||
| Northeast | 16.71 | 16.45 | |
| Midwest | 24.80 | 22.02 | |
| South | 35.10 | 40.16 | |
| West | 23.38 | 21.37 | |
| Hospital bed-size | < 0.0001 | ||
| Small | 9.49 | 17.96 | |
| Medium | 21.04 | 28.13 | |
| Large | 69.47 | 53.91 | |
| Hospital location and teaching status | < 0.0001 | ||
| Rural | 7.15 | 12.46 | |
| Urban nonteaching | 23.12 | 36.23 | |
| Urban teaching | 69.73 | 51.32 | |
| Disposition | < 0.0001 | ||
| Routine (Home) | 76.26 | 77.39 | |
| Transfer to short-term hospital | 7.30 | 3.10 | |
| Transfer to another type of facility (Includes SNF and ICF) | 4.20 | 7.64 | |
| Home health care | 8.89 | 6.69 | |
| Discharge against medical advice | 1.98 | 3.00 |
Table 4 Comparative analysis of clinical outcomes for liver and non-liver transplant hospitalizations with acute pancreatitis in the United States from 2007–2019, n (%)
| Outcomes | Liver transplant hospitalizations with acute pancreatitis | Non-liver transplant hospitalizations with acute pancreatitis | P value |
| Inpatient mortality | 1.37 | 2.16 | 0.0479 |
| Gender-specific inpatient mortality | |||
| Male | 1.43 | 2.34 | 0.1107 |
| Female | 1.31 | 1.97 | 0.2396 |
| Race specific inpatient mortality | |||
| White | 1.48 | 2.23 | 0.1403 |
| Black | 1.45 | 2.00 | 0.6469 |
| Hispanic | 0.00 | 1.60 | --- |
| Asian | 1.99 | 3.20 | 0.6289 |
| Others | 4.01 | 2.23 | 0.3868 |
| Age group specific inpatient mortality | |||
| 18-34 | 0.60 | 0.64 | 0.9583 |
| 35-49 | 0.90 | 1.04 | 0.7855 |
| 50-64 | 1.12 | 2.08 | 0.0921 |
| 65-79 | 3.26 | 3.60 | 0.7784 |
| ≥ 80 | 0.00 | 5.46 | --- |
| Length of stay (d) | 6.14 | 5.80 | 0.3189 |
| Total healthcare charge ($) | 59596 | 50466 | 0.0429 |
| Complications (out of total hospitalizations) | |||
| Pancreatic psuedocyst | 3.85 | 5.46 | 0.0259 |
| Abdominal abscess | 0.81 | 0.53 | 0.1925 |
| Sepsis | 8.35 | 8.78 | 0.5834 |
| Acute renal failure | 29.41 | 14.91 | < 0.0001 |
| Acute respiratory failure | 4.61 | 5.67 | 0.1018 |
| Cholangiocarcinoma | 0.21 | 0.11 | 0.2545 |
| Need for blood transfusion | 7.65 | 4.75 | < 0.0001 |
| Portal vein thrombosis | 1.53 | 0.64 | < 0.0001 |
| Venous thromboembolism | 3.50 | 2.19 | 0.0011 |
Table 5 Predictors of inpatient mortality for liver transplant hospitalizations with acute pancreatitis in the United States from 2007–2019
| Variable | Adjusted hazard ratio | 95%CI | P value |
| Gender | |||
| Male | Reference | ||
| Female | 0.596 | (0.150, 2.365) | 0.461 |
| Race | |||
| White | Reference | ||
| Black | 0.306 | (0.017, 5.368) | 0.418 |
| Hispanic | < 0.001 | (< 0.001, < 0.001) | < 0.0001 |
| Asian | 0.042 | (< 0.001, 14.916) | 0.289 |
| Other | 0.064 | (< 0.001, 10.989) | 0.295 |
| Charlson comorbidity index | 1.678 | (1.055, 2.668) | 0.029 |
| Hospital region | |||
| Northeast | Reference | ||
| Midwest | 1.574 | (0.148, 16.692) | 0.706 |
| South | 1.435 | (0.230, 8.955) | 0.699 |
| West | 1.723 | (0.423, 7.014) | 0.447 |
| Hospital bed size | |||
| Small | Reference | ||
| Medium | 1.427 | (0.093, 21.893) | 0.798 |
| Large | 1.974 | (0.093, 42.139) | 0.663 |
| Hospital location and teaching status | |||
| Rural | Reference | ||
| Urban nonteaching | < 0.001 | (< 0.001, 0.048) | 0.003 |
| Urban teaching | 0.551 | (0.053, 5.689) | 0.617 |
| Complications (reference = Without the complication) | |||
| Pancreatic psuedocyst | 14.158 | (1.642, 122.094) | 0.016 |
| Abdominal abscess | < 0.001 | (< 0.001, < 0.001) | < 0.0001 |
| Sepsis | 13.960 | (2.163, 90.093) | 0.006 |
| Acute renal failure | 2.684 | (1.109, 6.494) | 0.029 |
| Acute respiratory failure | 24.758 | (1.063, 576.522) | 0.046 |
| Need for blood transfusion | 150.340 | (17.049, 1325.754) | < 0.0001 |
| Portal vein thrombosis | < 0.001 | (< 0.001, < 0.001) | < 0.0001 |
| Venous thromboembolism | 75.422 | (1.637, 3475.134) | 0.027 |
- Citation: Dahiya DS, Jahagirdar V, Chandan S, Gangwani MK, Merza N, Ali H, Deliwala S, Aziz M, Ramai D, Pinnam BSM, Bapaye J, Cheng CI, Inamdar S, Sharma NR, Al-Haddad M. Acute pancreatitis in liver transplant hospitalizations: Identifying national trends, clinical outcomes and healthcare burden in the United States. World J Hepatol 2023; 15(6): 797-812
- URL: https://www.wjgnet.com/1948-5182/full/v15/i6/797.htm
- DOI: https://dx.doi.org/10.4254/wjh.v15.i6.797