S143 Procedural Trends and In-Hospital Outcomes of Biliary Acute Pancreatitis in HIV-Positive Patients: A National Inpatient Sample Analysis

Introduction: Growing evidence suggests that HIV infection may influence the presentation of acute pancreatitis (AP), but nationally representative data on biliary AP outcomes remain limited. Using the National Inpatient Sample, this study aims to assess in-hospital outcomes, including mortality, complications, procedural rates, length of stay, and hospital charges among HIV-positive adults admitted with biliary AP. Methods: We conducted a retrospective cohort study using the 2019 to 2022 National Inpatient Sample. Adults with a principal diagnosis of biliary AP and comorbid HIV were identified using ICD-10-CM codes. The primary outcome was in-hospital mortality. Secondary outcomes included complications, endoscopic retrograde cholangiopancreatography (ERCP) and cholecystectomy rates, length of stay, and hospital charges. Multivariable regression adjusted for demographics, comorbidities, hospital, and socioeconomic factors. Results: Among 176,734 adult biliary AP admissions, 677 had HIV (0.38%). Compared to HIV-negative patients, those with HIV were younger, more likely to be men and Black, and had a higher burden of comorbidities. There was no significant difference in in-hospital mortality, necrotizing AP, AKI, or shock between HIV-positive and HIV-negative patients. However, HIV-positive patients had higher odds of respiratory failure (OR = 2.08, 95% CI: 1.04–4.16, P = 0.039). HIV-positive patients had higher odds of undergoing ERCP (OR = 1.56, P = 0.040) but lower odds of same-admission cholecystectomy (OR = 0.62, P = 0.016). HIV-positive patients had a longer hospital stay (7.39 vs 4.82 days) and higher total hospitalization charges ($97,453 vs $67,822), though the differences in length of stay and charges were not statistically significant after adjustment. Conclusion: Our study demonstrates that HIV-positive patients admitted with biliary AP are at increased risk for severe complications, particularly respiratory failure. They also had significantly higher need for ERCP interventions. Notably, we observed a lower rate of same-admission cholecystectomy among HIV-positive patients. These findings underscore the need for heightened clinical vigilance and individualized management strategies in this population.