S133 Etiology-Based Outcomes of Acute Pancreatitis: A Multi-Center Real-World Analysis From a Nationwide EMR Network

Introduction: Acute pancreatitis (AP) exhibits heterogeneity in presentation, complications, and outcomes depending on etiology. There are only limited large-scale comparative studies that exist evaluating outcomes across biliary, alcoholic, hypertriglyceridemia-induced, and idiopathic/other causes of AP. This study aims to compare outcomes based on different etiologies of AP to improve overall patient outcomes. Methods: We conducted a retrospective cohort analysis using the TriNetX U.S. Collaborative Network, comprising 67 healthcare organizations. Inclusion criteria included Adults (≥18 years) with AP who were stratified into 4 cohorts by etiology: biliary (n = 79,993), alcohol-induced (n = 55,880), hypertriglyceridemia-induced (n = 34,505), and idiopathic/other (n = 8,157). Outcomes were assessed 1 year post-index diagnosis and included Recurrence of pancreatitis, Chronic pancreatitis, Pancreatic pseudocyst/fluid collections, Exocrine pancreatic insufficiency, and One-year mortality. Results: After comparing different cohorts, outcomes varied significantly by etiology. Firstly, the recurrence of AP was highest in idiopathic/other (76.4%), followed by alcohol (54.4%), hypertriglyceridemia (48.5%), and lowest in biliary (59.0%) with Median time to recurrence; 14 days (idiopathic), 19 days (biliary), 85 days (alcohol), 284 days (hypertriglyceridemia). Secondly, Chronic pancreatitis was most frequent in idiopathic/other (18.0%) and alcohol (10.3%) groups compared to hypertriglyceridemia (8.7%) and biliary (4.7%). Furthermore, Pseudocyst/fluid collection was more common in idiopathic/other (18.9%) and alcohol (9.8%) than in biliary (6.2%) and hypertriglyceridemia (7.2%). However, exocrine pancreatic insufficiency was rare across all groups (≤0.3%). One-year mortality was seen highest in idiopathic/other (5.2%) and lowest in alcohol (3.9%). Mortality in the biliary and hypertriglyceridemia cohorts was 4.3% and 4.4%, respectively. Conclusion: This study indicates that the etiology of AP is a significant determinant of clinical outcomes. Idiopathic and alcohol-related AP are associated with higher recurrence and chronicity, while biliary and hypertriglyceridemia-related AP have relatively favorable survival profiles. Etiology-specific care pathways and preventive strategies may reduce morbidity and mortality in high-risk groups. Further studies are warranted to develop guidelines for cause-specific management of AP to overall improve patient outcomes.