Identifying risk factors for progression to critical careadmission and death among individuals with acute pancreatitis: a record linkage analysis of Scottish healthcare databases

Objectives Acute pancreatitis (AP) can initiate systemic complications that require support in critical care (CC). Our objective was to utilize the unified national health record to define the epidemiology of AP in Scotland, with a specific focus on deterministic and prognostic factors for CC admission in AP. Setting Health boards in Scotland (n=4). Participants We included all individuals in a retrospective observational cohort with at least one episode of AP (ICD10 code K85) occurring in Scotland from 1st April 2009 to 31st March 2012. 3340 individuals were coded as AP. Methods Data from sixteen sources, spanning general practice, community prescribing, A&E, hospital in-patient, critical care, and mortality registries were linked by a unique patient identifier in a national safe haven. Logistic regression and gamma models were used to define independent predictive factors for severe AP (sAP) requiring CC admission or leading to death. Results 2053 individuals (61.5% (95%CI 59.8, 63.2%)) met the definition for true AP (tAP). 368 patients (17.9% of tAP (95%CI 16.2, 19.6%)) were admitted to CC. Predictors of sAP were: pre-existing angina or hypertension, hypocalcaemia, and age 30-39 years, if type 2 diabetes mellitus was present. The risk of sAP was lower in patients with multiple previous episodes of AP. In-hospital mortality in tAP was 5.0% (95%CI 4.1, 5.9%) overall, and 21.7% (95%CI 19.9, 23.5%) in those with tAP necessitating CC admission. Conclusion National record-linkage analysis of routinely collected data constitutes a powerful resource to model CC admission and prognosticate death during AP. Mortality in patients with AP who require CC admission remains high.