Acute inflammation induced coagulopathy (AIIC) is a/w an increase in mortality in patients with acute pancreatitis

Rohit Rasane; Christina X Zhang; Qiao Zhang; Jose Aldana; Ricardo Fonseca; Javier Rincon; Kelly Marie Bochicchio; Obeid Ilahi; Grant Bochicchio

Acute pancreatitis (AP) is a life-threatening disease associated with significant inflammation and potential infection. Most deaths in acute pancreatitis result from sepsis and multiorgan failure. To our knowledge, there is a paucity of data evaluating the impact of acute inflammation induced coagulopathy (AIIC) in this patient population.

We hypothesize that AIIC (the combination of admission platelet count ≤1,500,000/mcL and INR > 1.4) are a predictor of worse outcome in acute pancreatitis.

Acute and Critical Care Surgery (ACCS) registry spanning years 2008 to 2018 was retrospectively analyzed for patients with AP. Demographics, laboratory values and outcomes were collected. Patients were divided into 2 cohorts based on the presence or absence of the diagnosis of AIIC on admission. The primary outcome of the study was AP related mortality and its correlation with AIIC. We also evaluated whether acute platelet drop was associated with a greater mortality in the first 48 hours in patients with AIIC. Daily optimal cut-off value for percentage drop in platelets was calculated by using the receiver operating characteristic (ROC) curve analysis. Student’s T-test was used for continuous variables and Chi-square test was used for categorical variables.

Total 406 patients were diagnosed with AP. The mean age of AP patients was 53.0±17.2 yearsTwenty (4.9%) patients met our criteria for AIIC on admission. AP patients with AIIC had a higher Charlson comorbidity index (4.9±2.6 vs 3.2±2.9 p=0.006), significantly lower platelet count (143.9±71.7 vs 285.0±142.6 p<0.0001) and higher INR (1.8±0.3 vs 1.7±1.1 p=0.0002) on admission.  These patients also had longer hospital (20.1±16.5 vs 11.9±16.2 p=0.044) and ICU days (11.3±13.0 vs 4.0±11.9 p=0.023), as well as mortality (40% vs 4.2% p<0.0001). When comparing the daily platelet percentage drop from baseline, the platelet percentage drop on day 2 was most significant (0.22 ± 0.21 vs 0.11 ± 0.18, p= 0.013). When controlling for age and Charlson comorbidity index, INR ≥ 1.4 (OR 7.9, 2.8 to 22.9, p= 0.0001) and platelet percentage drop (OR 12.9, 1.1 to 156.5, p= 0.045) on day 2 were significant predictors of mortality.

AIIC was associated with worse outcomes in AP patients.  In addition, a platelet decrease of 30% on day 2 was most predictive of mortality. This cohort may benefit from early thrombomodulin therapy.