Impact of Prediabetes on In-Hospital Mortality and Clinical Outcomes in Acute Pancreatitis: Insights from a Nationwide Inpatient Sample

<b>Background/Objectives</b>: Prediabetes is characterized by insulin resistance and systemic inflammation, which may increase susceptibility to acute pancreatitis (AP). However, limited data exist on how prediabetes influences in-hospital outcomes in AP patients. This study aimed to evaluate the prevalence and clinical outcomes of hospitalized AP patients with prediabetes using the National Inpatient Sample (NIS) database. <b>Methods</b>: We conducted a retrospective cohort study using NIS data from 2016 to 2018, identifying adult patients hospitalized with a primary diagnosis of AP. Patients were stratified based on the presence or absence of prediabetes; those with type 1 or 2 diabetes were excluded. The primary outcome is the association of prediabetes with developing acute pancreatitis and its influence on in-hospital mortality, length of stay, and total hospital cost. <b>Results</b>: Among 193,617 patients hospitalized with AP, 1639 had prediabetes. No statistically significant difference was found in in-hospital mortality, length of stay, or hospitalization costs between patients with or without prediabetes. The in-hospital mortality was 1.22% in prediabetic patients versus 2.01% in non-prediabetic patients (<i>p</i> = 0.0225). The length of stay was shorter in prediabetic patients (4.93 vs. 5.37 days, <i>p</i> = 0.0021), and hospitalization costs were similar (USD55,351.56 vs. USD57,106.83, <i>p</i> = 0.195). Furthermore, prediabetes was not an independent predictor of mortality (OR 0.50, 95% CI 0.31-0.82, <i>p</i> = 0.0063). Significant predictors of mortality included acute kidney injury (OR 12.98, 95% CI 11.96-14.09, <i>p</i> < 0.001) and severe sepsis with shock (OR 5.89, 95% CI 5.27-6.59, <i>p</i> < 0.001). <b>Conclusions</b>: Prediabetes was not associated with an increased in-hospital mortality in AP patients. However, complications such as AKI and septic shock significantly predicted mortality, underscoring the importance of early recognition and management.