Acute venous thromboembolism in acute pancreatitis based on the severity: a retrospective cohort study

Abstract Objective: Acute pancreatitis (AP) results in systemic inflammatory responses and activates coagulation pathways. We intend to investigate the risk and hospital outcomes of acute venous thromboembolisms (VTE) in patients with AP. Methods: We retrospectively analyzed patients with AP from 2016 to 2019 using the National Inpatient Sample database. Primary outcome was the effect of VTE on the length of stay, inpatient costs, and mortality. Hierarchical multivariate logistic regression models were built using univariate screens. Results: The study included 909,354 weighted discharges with AP. 2.1% of cases had an acute VTE. The length of stay was 5.9 days longer in the hospital of AP patients with VTE compared to AP with no VTE (P < 0.001). Total hospital charge per patient was $71,914 in patients with VTE compared to AP with no VTE (P < 0.001). Mortality was higher in AP patients with VTE compared to AP with no VTE (adjusted odds ratio [AOR] 4.2, 95% confidence interval [CI]: 3.4–5.3, P < 0.001). AP was associated with an increased VTE risk during inpatient stay (AOR 1.06, 95% CI 1.04–1.1, P < 0.001) There was an increased association of lower and upper extremity deep venous thrombosis with AP without necrosis (AOR 6.9, 95% CI 6.4–7.4, P < 0.001) and AP with infected necrosis (AOR 12.2, 95% CI 10.6–14.1, P < 0.001) but not in AP without necrosis (AOR 0.77, 95% CI 0.74–0.81, P < 0.001). Conclusion: VTE in AP increases length of stay and inpatient costs. The prognosis is poor in such patients, with increased inpatient mortality compared to no VTE. AP with necrosis can increase chances of all VTE subtypes; however, AP without necrosis does not increase upper and lower extremity VTE risk.