The effect of gastrointestinal bleeding on outcomes of patients with acute pancreatitis: A national population-based study

Objectives: To investigate the adverse effect of gastrointestinal bleeding (GIB) in patients with acute pancreatitis (AP), accounting for the status of organ failure (OF). Methods: We analyzed 107,349 patients with first-attack AP from the Taiwan National Health Insurance Research Database between 2000 and 2009. Patients were categorized into four groups according to the status of GIB and OF, the effect of which was assessed using multivariable analyses with generalized estimating equations models. Primary outcomes were 14-day and hospital mortality. Secondary outcomes were septic complication and prolonged hospital stay (>18 days). Results: The covariate-adjusted odds ratio for 14-day mortality, hospital mortality, septic complication, and prolonged stay all significantly increased at 4.63 (95% confidence interval [CI] 3.80e5.63), 4.22 (95% CI 3.66e4.87), 3.52 (95% CI 3.03e4.08), and 1.27 (95% CI 1.20e1.35), respectively for the patients with OF only (n = 88,561). The corresponding figures for the patients with GIB only (n = 5184) were lower but still significant at 1.44 (95% CI 1.09e1.91), 1.42 (95% CI 1.15e1.75), 1.54 (95% CI 1.19e2.00), and 1.38 (95% CI 1.28e1.48). The co-existence of GIB in patients with OF (n = 1663) showed little additional risk of all adverse outcomes. Results of sensitivity analyses (enrolling only patients with principal diagnosis of AP) showed similar findings except that septic complication was not seen for GIB only. Conclusions: OF poses greater adverse effects than GIB on outcomes of AP patients. Nevertheless, GIB still modestly increased the risks of prolonged stay and death in AP patients without OF.