S126 Acute Kidney Injury Predicts Poor Outcomes in Acute Pancreatitis Regardless of Baseline Renal Function

Introduction: Acute kidney injury (AKI) is an established independent risk factor for mortality and major complications in hospitalized and critically ill patients, including those with acute pancreatitis (AP). The impact of underlying chronic kidney disease (CKD) on patients with AP presenting with AKI remains unclear, with some studies suggesting a possible protective benefit from underlying CKD. Here we aim to evaluate the association between AKI and CKD on outcomes for AP. Methods: This retrospective cohort study selected veterans hospitalized with AP between 2011 and 2017 and classified patients by baseline CKD and admission AKI. AKI was classified with KDIGO criteria. Baseline CKD was defined by an estimated GFR of <60 mL/min/1.73 m2 within 6 months prior to admission. Primary outcomes included 30-day mortality and a composite of major complications. Multivariable logistic regression was used to calculate adjusted odds ratios (aORs), and the interaction between AKI and CKD was formally tested. Adjustment variables included demographic and relevant clinical characteristics. Results: 16,321 patients were included in the final analysis. Mean age was 62.2 years. Patients were predominantly White (71.5%) and men (93.9%), and 3,359 (20.6%) had baseline CKD as defined. On admission, 2,634 (16.1%) had AKI. A total of 663 (4.1%) patients died within 30 days, and 3,342 (20.5%) suffered a major complication. Both AKI and CKD were associated with increased rates of mortality and major complication. After adjustment for confounding variables, AKI on admission was associated with increased risk of mortality [aOR (95% confidence interval) 1.71 (1.36, 2.15)] and major complication [aOR 1.99 (95% CI 1.63, 2.43). We found no significant interaction between admission AKI and underlying CKD on either mortality (P = .13) or major complication (P = .96). Notably, patients with AKI received greater fluid volumes (mean 24.7 vs 19.0 mL/kg) and were twice as likely to undergo large-volume resuscitation (P < .001). Rates of enteral nutrition were similar between groups. Conclusion: In this study of patients hospitalized with AP, AKI was a strong and independent predictor of 30-day mortality and major complications, regardless of baseline renal function. Aggressive fluid resuscitation and failure to implement early enteral nutrition may be drivers of poor outcomes in this population and warrant further study.