Undernutrition and Obesity Are Associated with Adverse Clinical Outcomes in Hospitalized Children and Adolescents with Acute Pancreatitis
Abstract
:1. Introduction
2. Materials and Methods
2.1. Variables and Outcomes
2.2. Statistical Analysis
3. Results
4. Discussion
5. Limitations
6. Conclusions
Supplementary Materials
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
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Parameters | Control | Undernutrition | Obesity | p Value |
---|---|---|---|---|
Group | Group | Group | ||
n = 34,660 | n = 782 | n = 4363 | ||
Demographics | ||||
Age in years (Mean ± SD) | 15.1 ± 4.8 | 13.9 ± 5.9 | 16.3 ± 3.3 | <0.001 |
Gender | - | - | - | <0.001 |
Male | 14,350 (41.9%) | 354 (45.3%) | 1363 (31.3%) | |
Female | 19,867 (58.9%) | 428 (54.7%) | 2992 (68.7%) | |
Race | - | - | - | <0.001 |
Caucasian | 15,402 (44.4%) | 337 (43.1%) | 1545 (35.4%) | |
African American | 3460 (10%) | 106 (13.6%) | 456 (10.4%) | |
Hispanic | 7674 (22.1%) | 156 (19.9%) | 1575 (36.1%) | |
Others | 8123 (23.4%) | 183 (23.4%) | 788 (18.1%) | |
Insurance | - | - | - | <0.001 |
Public | 13,953 (40.3%) | 336 (43%) | 2278 (52.2%) | |
Private | 15,837 (45.7%) | 330 (42.3%) | 1474 (33.8%) | |
Self-pay/Other/Uninsured | 4870 (14.1%) | 115 (14.7%) | 611 (14%) | |
Location/Teaching Status | - | - | - | <0.001 |
Rural | 3922 (11.6%) | 36 (4.8%) | 345 (8.1%) | |
Urban Non-Teaching | 10,482 (31.1%) | 171 (22.8%) | 1419 (33.1%) | |
Urban Teaching | 19,329 (57.3%) | 544 (72.4%) | 2518 (58.8%) | |
Hospitalization | - | - | - | <0.01 |
Elective | 2250 (6.5%) | 55 (7.1%) | 228 (5.2%) | |
Non-Elective | 32,288 (93.5%) | 724 (92.9%) | 4123 (94.8%) | |
Etiologic and Comorbid Conditions | ||||
Acute cholangitis | 223 (0.6%) | 17 (2.2%) | 37 (0.8%) | <0.001 |
Cholelithiasis | 7788 (22.5%) | 98 (12.5%) | 1908 (43.7%) | <0.001 |
Other Biliary Diseases | 1088 (3.1%) | 46 (5.9%) | 163 (3.7%) | <0.001 |
Hypertriglyceridemia | 737 (2.1%) | 31 (4%) | 369 (8.5%) | <0.001 |
Hypercalcemia | 111 (0.3%) | 10(1.2%) | 10 (0.2%) | <0.001 |
Abdominal trauma | 122 (0.4%) | ≤10 | ≤10 | <0.001 |
Anomalies of pancreas | 202 (0.6%) | ≤10 | ≤10 | <0.001 |
Diabetic ketoacidosis | 704 (2%) | 20 (2.6%) | 121 (2.8%) | 0.004 |
Systemic Lupus Erythematosus | 181 (0.5%) | 14 (1.8%) | 12 (0.3%) | <0.001 |
Cystic Fibrosis | 295 (0.9%) | 14 (1.8%) | ≤10 | <0.001 |
Inflammatory Bowel Disease | 815 (2.4%) | 29 (3.7%) | 18 (0.4%) | <0.001 |
Malignancies | 872 (2.5%) | 60 (7.7%) | 25 (0.6%) | <0.001 |
Solid Organ Transplant | 217 (0.6%) | 11 (1.4%) | ≤10 | <0.001 |
Alcohol Related | 1846 (5.3%) | 34 (4.4%) | 120 (2.8%) | <0.001 |
Parameters | Control | Undernutrition | Obesity | p Value |
---|---|---|---|---|
Group | Group | Group | ||
n = 34,660 | n = 782 | n = 4363 | ||
Outcomes | ||||
Severe acute pancreatitis | 1219 (3.5%) | 123 (15.7%) | 254 (5.8%) | <0.001 |
Length of stay (Mean ± SE) in days | 4.8 ± 0.02 | 14.1 ± 0.73 | 5.4 ± 0.09 | <0.001 |
Total hospital costs (Mean ± SE in USD) | 9327 ± 107 | 34,089 ± 3339 | 11,827 ± 295 | <0.001 |
Mortality | 55 (0.2%) | ≤10 | ≤10 | 0.97 |
AKI | 465 (1.3%) | 62 (7.9%) | 79 (1.8%) | <0.001 |
Respiratory Failure | 729 (2.1%) | 75 (9.6%) | 178 (4.1%) | <0.001 |
Invasive Mechanical Ventilation | 339 (1%) | 30 (3.8%) | 56 (1.3%) | <0.001 |
SIRS with organ dysfunction | 23 (0.1%) | ≤10 | 10 (0.2%) | 0.002 |
Use of Vasopressors | 18 (0.1%) | ≤10 | ≤10 | <0.001 |
CVC placement | 1959 (5.7%) | 198 (25.3%) | 245 (5.6%) | <0.001 |
Parenteral Nutrition | 1967 (5.7%) | 241 (30.9%) | 243 (5.6%) | <0.001 |
Sepsis | 341 (1%) | 62 (7.9%) | 54 (1.2%) | <0.001 |
PE/DVT | 46 (0.2%) | 15 (1.9%) | 23 (0.5%) | <0.001 |
Pseudocyst | 953 (2.7%) | 91 (11.7%) | 199 (4.6%) | <0.001 |
Cholecystectomy | 4773 (13.8%) | 52 (6.6%) | 1063 (24.4%) | <0.001 |
Any ERCP | 2521 (7.3%) | 55 (7%) | 472 (10.8%) | <0.001 |
Percutaneous/Open Biliary Procedures | 151 (0.5%) | ≤10 | ≤10 | 0.08 |
Pancreatectomy | 144 (0.4%) | 19 (2.4%) | 27 (0.6%) | <0.001 |
Outcomes | Odds ratio | 95% CI | p value |
---|---|---|---|
Severe acute pancreatitis * | |||
Control group | Reference | - | - |
Undernutrition group vs. Control group | 2.55 | 2.03 to 3.20 | <0.001 |
Obesity group vs. Control group | 1.62 | 1.39 to 1.89 | <0.001 |
Average Difference | 95% CI | p value | |
Length of stay (in days) ** | |||
Control group | Reference | ||
Undernutrition group vs. Control group | 6.12 | 5.67 to 6.57 | <0.001 |
Obesity group vs. Control group | 0.53 | 0.32 to 0.73 | <0.001 |
Total hospitalization costs (in USD) ** | |||
Control group | Reference | - | - |
Undernutrition group vs. Control group | 15,919 | 14,317 to 17,520 | <0.001 |
Obesity group vs. Control group | 1952 | 1237 to 2667 | <0.001 |
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Thavamani, A.; Umapathi, K.K.; Sferra, T.J.; Sankararaman, S. Undernutrition and Obesity Are Associated with Adverse Clinical Outcomes in Hospitalized Children and Adolescents with Acute Pancreatitis. Nutrients 2021, 13, 43. https://doi.org/10.3390/nu13010043
Thavamani A, Umapathi KK, Sferra TJ, Sankararaman S. Undernutrition and Obesity Are Associated with Adverse Clinical Outcomes in Hospitalized Children and Adolescents with Acute Pancreatitis. Nutrients. 2021; 13(1):43. https://doi.org/10.3390/nu13010043
Chicago/Turabian StyleThavamani, Aravind, Krishna Kishore Umapathi, Thomas J. Sferra, and Senthilkumar Sankararaman. 2021. "Undernutrition and Obesity Are Associated with Adverse Clinical Outcomes in Hospitalized Children and Adolescents with Acute Pancreatitis" Nutrients 13, no. 1: 43. https://doi.org/10.3390/nu13010043