S142 Drug-Induced Acute Pancreatitis Has a More Favorable Course Than Biliary Acute Pancreatitis: Findings From Analysis of the National Inpatient Sample

Introduction: Acute pancreatitis (AP) is the third leading cause of gastrointestinal hospitalization in the U.S., with drug-induced AP (DIAP) representing a rare (0.1–2%) but clinically important subset, often diagnosed by exclusion. Delayed recognition may lead to recurrent injury and suboptimal care. Large-scale national studies on DIAP are limited. This study examines the characteristics, disparities, and outcomes of DIAP admissions compared to biliary AP. Methods: We conducted a retrospective cohort study using the 2019 to 2022 National Inpatient Sample. Adult admissions with a primary diagnosis of AP were identified by ICD-10-CM codes, with DIAP and biliary AP defined accordingly. We excluded chronic pancreatitis and records with missing data. The primary outcome was to compare demographics, characteristics, and disparities between DIAP and biliary AP, with the latter serving as the reference standard for AP. Secondary outcomes included mortality, complications, length of stay, and hospital charges. Multivariable regression adjusted for demographics, comorbidities, hospital, and socioeconomic factors. Results: Among 1,030,954 adult AP admissions, 15,869 were DIAP cases. Compared to biliary AP, DIAP patients were less likely Hispanic, and had higher rates of diabetes, hyperlipidemia, and greater comorbidity burden. In multivariable adjusted analyses, DIAP was associated with lower in-hospital mortality (adjusted odds ratio [aOR] 0.58, P = 0.049). DIAP had lower odds of necrotizing AP (aOR 0.69, P = 0.001), respiratory failure (aOR 0.74, P = 0.004), and shock (aOR 0.60, P = 0.024), but higher odds of paralytic ileus (aOR 2.05, P = 0.036). No difference was seen in AKI. DIAP was associated with shorter stays and lower charges. Conclusion: In this large national inpatient cohort, DIAP accounted for 1.5% of AP admissions and was more common in non-Hispanic patients and those with greater comorbidities compared to biliary AP. Despite the higher comorbidity burden, DIAP admissions had lower mortality and significantly fewer complications, with shorter hospital stays and significantly reduced charges, suggesting a more favorable overall course than biliary AP. These findings may help clinicians identify distinct features of DIAP, monitor for specific complications, and influence clinical course and management. Ultimately, early identification of DIAP as the etiology is crucial to prevent repeated pancreatic injury and further morbidity and mortality.