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; 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

doi:10.1136/bmjopen-2016-011474

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

Research output: Contribution to journal › Article › peer-review

23 Citations (Scopus)

237 Downloads (Pure)

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 language	English
Article number	e011474
Pages (from-to)	1-15
Number of pages	15
Journal	BMJ Open
Volume	6
Issue number	6
DOIs	https://doi.org/10.1136/bmjopen-2016-011474
Publication status	Published - 15 Jun 2016

Keywords

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

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

Access to Document

10.1136/bmjopen-2016-011474Licence: CC BY-NC

Final Published Version
This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Final published version, 1.28 MBLicence: CC BY-NC

The Scottish eHealth Informatics Research Centre (E-HIRCs) (Joint with Universities of Aberdeen, Glasgow, Edinburgh, Strathclyde, St Andrews & Leicester and ISD)
Colhoun, H. (Investigator), Donnan, P. (Investigator), Guthrie, B. (Investigator), Jefferson, E. (Investigator), MacDonald, T. (Investigator), McCowan, C. (Investigator), Morris, A. (Investigator), Pearson, E. (Investigator), Sullivan, F. (Investigator) & Swedlow, J. (Investigator)
Medical Research Council
1/03/13 → 31/12/18
Project: Research

Donnan, Peter
- Population Health and Genomics - Professor (Teaching and Research) of Epidemiology and Biostatistics
Person: Academic

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. Article e011474. https://doi.org/10.1136/bmjopen-2016-011474

@article{bb8a5f0a321549269d87a2e28a8f73e2,

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

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.",

keywords = "Acute pancreatitis, severity strafification, critical care, organ failure, multiple organ dysfunction syndrome, national record linkage, safe haven",

author = "Mole, {Damian J.} and Usha Gungabissoon and Philip Johnston and Lynda Cochrane and Leanne Hopkins and Wyper, {Grant M. A.} and Christos Skouras and Chris Dibben and Frank Sullivan and Andrew Morris and Ward, {Hester J. T.} and Lawton, {Andrew M.} and Donnan, {Peter T.}",

year = "2016",

month = jun,

day = "15",

doi = "10.1136/bmjopen-2016-011474",

language = "English",

volume = "6",

pages = "1--15",

journal = "BMJ Open",

issn = "2044-6055",

publisher = "BMJ Publishing Group",

number = "6",

}

Mole, DJ, Gungabissoon, U, Johnston, P, Cochrane, L, Hopkins, L, Wyper, GMA, Skouras, C, Dibben, C, Sullivan, F, Morris, A, Ward, HJT, Lawton, AM & Donnan, PT 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, vol. 6, no. 6, e011474, pp. 1-15. https://doi.org/10.1136/bmjopen-2016-011474

Identifying risk factors for progression to critical care admission and death among individuals with acute pancreatitis: a record linkage analysis of Scottish healthcare databases. / Mole, Damian J. (Lead / Corresponding author); Gungabissoon, Usha; Johnston, Philip et al.
In: BMJ Open, Vol. 6, No. 6, e011474, 15.06.2016, p. 1-15.

Research output: Contribution to journal › Article › peer-review

TY - JOUR

T1 - Identifying risk factors for progression to critical care admission and death among individuals with acute pancreatitis

T2 - a record linkage analysis of Scottish healthcare databases

AU - Mole, Damian J.

AU - Gungabissoon, Usha

AU - Johnston, Philip

AU - Cochrane, Lynda

AU - Hopkins, Leanne

AU - Wyper, Grant M. A.

AU - Skouras, Christos

AU - Dibben, Chris

AU - Sullivan, Frank

AU - Morris, Andrew

AU - Ward, Hester J. T.

AU - Lawton, Andrew M.

AU - Donnan, Peter T.

PY - 2016/6/15

Y1 - 2016/6/15

N2 - 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.

AB - 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.

KW - Acute pancreatitis

KW - severity strafification

KW - critical care

KW - organ failure

KW - multiple organ dysfunction syndrome

KW - national record linkage

KW - safe haven

U2 - 10.1136/bmjopen-2016-011474

DO - 10.1136/bmjopen-2016-011474

M3 - Article

SN - 2044-6055

VL - 6

SP - 1

EP - 15

JO - BMJ Open

JF - BMJ Open

IS - 6

M1 - e011474

ER -

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

Abstract

Keywords

UN SDGs

Access to Document

Fingerprint

Projects

The Scottish eHealth Informatics Research Centre (E-HIRCs) (Joint with Universities of Aberdeen, Glasgow, Edinburgh, Strathclyde, St Andrews & Leicester and ISD)

Profiles

Donnan, Peter

Cite this