Identifying risk factors for progression to critical care admission and death among individuals with acute pancreatitis: a record linkage analysis of Scottish healthcare databases

Damian J. Mole (Lead / Corresponding author), Usha Gungabissoon, Philip Johnston, Lynda Cochrane, Leanne Hopkins, Grant M. A. Wyper, Christos Skouras, Chris Dibben, Frank Sullivan, Andrew Morris, Hester J. T. Ward, Andrew M. Lawton, Peter T. Donnan

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    Abstract

    Objectives: Acute pancreatitis (AP) can initiate systemic complications that require support in critical care (CC). Our objective was to utilize the unified national health record to define the epidemiology of AP in Scotland, with a specific focus on deterministic and prognostic factors for CC admission in AP. Setting: Health boards in Scotland (n=4). Participants: We included all individuals in a retrospective observational cohort with at least one episode of AP (ICD10 code K85) occurring in Scotland from 1st April 2009 to 31st March 2012. 3340 individuals were coded as AP. Methods: Data from sixteen sources, spanning general practice, community prescribing, A&E, hospital in-patient, critical care, and mortality registries were linked by a unique patient identifier in a national safe haven. Logistic regression and gamma models were used to define independent predictive factors for severe AP (sAP) requiring CC admission or leading to death. Results: 2053 individuals (61.5% (95%CI 59.8, 63.2%)) met the definition for true AP (tAP). 368 patients (17.9% of tAP (95%CI 16.2, 19.6%)) were admitted to CC. Predictors of sAP were: pre-existing angina or hypertension, hypocalcaemia, and age 30-39 years, if type 2 diabetes mellitus was present. The risk of sAP was lower in patients with multiple previous episodes of AP. In-hospital mortality in tAP was 5.0% (95%CI 4.1, 5.9%) overall, and 21.7% (95%CI 19.9, 23.5%) in those with tAP necessitating CC admission. Conclusion: National record-linkage analysis of routinely collected data constitutes a powerful resource to model CC admission and prognosticate death during AP. Mortality in patients with AP who require CC admission remains high.
    Original languageEnglish
    Article numbere011474
    Pages (from-to)1-15
    Number of pages15
    JournalBMJ Open
    Volume6
    Issue number6
    DOIs
    Publication statusPublished - 15 Jun 2016

    Keywords

    • Acute pancreatitis
    • severity strafification
    • critical care
    • organ failure
    • multiple organ dysfunction syndrome
    • national record linkage
    • safe haven

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    Cite this

    Mole, D. J., Gungabissoon, U., Johnston, P., Cochrane, L., Hopkins, L., Wyper, G. M. A., Skouras, C., Dibben, C., Sullivan, F., Morris, A., Ward, H. J. T., Lawton, A. M., & Donnan, P. T. (2016). Identifying risk factors for progression to critical care admission and death among individuals with acute pancreatitis: a record linkage analysis of Scottish healthcare databases. BMJ Open, 6(6), 1-15. [e011474]. https://doi.org/10.1136/bmjopen-2016-011474