Incidence, Mortality, and Long-Term Survival in Patients With Acute Pancreatitis Admitted to Intensive Care: A Nationwide Cohort Study.

Abstract

Characteristics and outcomes of patients with acute pancreatitis (AP) admitted to intensive care units (ICUs) are not well described in complete population-based national cohorts. Thus, we aimed to investigate the incidence over time and predictors of short- and long-term survival of AP treated in ICUs in a national cohort. Nationwide observational cohort study in a universal healthcare system. Adult patients with AP admitted to Norwegian ICUs from 2016 to 2021 were identified using coded data from the Norwegian Intensive Care and Pandemic Registry and the Norwegian Patient Registry. Logistic regression was used to identify predictors of 90-day mortality. Overall survival was analyzed using Cox regression, and post-discharge survival was assessed for conditional relative survival. A total of 1183 patients were identified, with a median age of 64.8 years (interquartile range [IQR] 52.0-75.3) and 60.4% men. The average annual incidence was 3.8 per 100,000 inhabitants and increased significantly (p_trend = 0.048) during the study period. In-hospital mortality was 20.5% (n = 243), 90-day mortality 22.8% (n = 270), and the overall 1-year cumulative mortality was 28.0% (n = 331). Independent predictors of 90-day mortality included age (OR 1.05; 95% CI 1.04-1.07), SAPS II score (OR 1.06; 95% CI 1.05-1.07), Charlson Comorbidity Index (CCI) score (OR 1.2; 95% CI 1.10-1.31), and pancreatitis etiology. In the multivariable survival analysis of hospital survivors, age (HR 1.05; 95% CI 1.04-1.07), SAPS II (HR 1.01; 95% CI 1.00-1.02), and CCI (HR 1.29; 95% CI 1.21-1.38) were associated with increased risk of death, whereas biliary etiology (HR 0.48; 95% CI 0.30-0.78) and longer ICU length of stay (HR 0.98; 95% CI 0.97-1.00) were associated with a reduced risk of death. No association was found between advanced organ support and the risk of death after discharge from the hospital. Compared to an age- and gender-matched population, long-term survival of patients discharged alive was approximately 90%. Admissions to the ICU for AP seem to increase in a national cohort, and 90-day mortality occurred in almost every 1 of 4 patients. Patients with ICU-treated AP discharged alive from the hospital have good long-term survival, although with reduced longevity compared to the age- and gender-adjusted general population. This registry-based nationwide study assesses the incidence and short- and long-term outcomes of AP in Norwegian ICUs over a 6-year period. The incidence of intensive care-treated pancreatitis seems to be increasing over this time period. Long-term outcome for the hospital survivors is good, almost at the level of the general population.