Int J Cardiol Cardiovasc Risk Prev. 2026 Jun 18;30:200662. doi: 10.1016/j.ijcrp.2026.200662. eCollection 2026 Sep.
ABSTRACT
BACKGROUND: Atrial fibrillation (AF) and cardiovascular (CV) comorbidities are prevalent in acute pancreatitis (AP) and may compromise hemodynamic tolerance of systemic inflammation. Their independent contributions to in-hospital mortality in AP have not been quantified nationally.
METHODS: We analyzed discharge data from the National Inpatient Sample (NIS), Healthcare Cost and Utilization Project (HCUP), Agency for Healthcare Research and Quality (AHRQ), 2016-2022. Adult AP hospitalizations were identified by primary ICD-10-CM diagnosis. Twelve CV risk factors were examined. Survey-weighted logistic regression generated unadjusted, adjusted, and fully adjusted odds ratios (ORs) for in-hospital mortality. A cumulative risk factor count was constructed.
RESULTS: Among 1,919,159 weighted AP hospitalizations, overall mortality was 0.59%. On full multivariable adjustment, cerebrovascular disease (OR 2.83, 95% CI 2.33-3.44), AF (2.10, 1.85-2.37), CKD (1.89, 1.68-2.12), MI (1.86, 1.56-2.23), and heart failure (1.79, 1.56-2.05) were the strongest independent CV-comorbidity predictors of in-hospital death. Weighted mortality rose progressively from 0.21% at zero to 3.03% at seven cumulative risk factors; per additional risk factor the crude OR was 1.47 (1.45-1.50, p < 0.001). The dose-response gradient persisted after full adjustment, with integer-level adjusted ORs rising from 1.25 at one risk factor to 5.05 at seven, and a binary cutoff at three or more versus two or fewer risk factors carrying an adjusted OR of 2.01 (1.80-2.25, p < 0.001).
CONCLUSIONS: Cerebrovascular disease, AF, CKD, MI, and heart failure independently predict in-hospital mortality in AP, with a robust adjusted dose-response by cumulative CV burden. These associative findings are hypothesis-generating; prospective studies are needed to determine whether structured cardiovascular risk assessment improves outcomes in this population.
PMID:42382912 | PMC:PMC13316218 | DOI:10.1016/j.ijcrp.2026.200662