S295 Unmasking the Impact of Alcohol Withdrawal in Acute Pancreatitis

Introduction: Alcohol use is an established and major cause of acute pancreatitis. However, there was a hypothesis that acute pancreatitis might be a manifestation of alcohol withdrawal, in long term alcohol users with sudden cessation. Withdrawal may exacerbate inflammation via disrupted calcium signaling, oxidative stress, and impaired autophagy triggering episodes of acute pancreatitis and ongoing inflammation could lead to worse. In this study, we tried to explore the effects of alcohol withdrawal on outcomes of acute pancreatitis. Methods: We conducted a retrospective cohort study using the National Inpatient Sample database (2018 to 2022). Patients ≥18 years with a principal AAP diagnosis were identified by ICD-10 codes and stratified by presence of alcohol withdrawal during the admission. The primary outcome was in-hospital mortality; secondary outcomes included resource use and AAP complications. Categorical variables were compared with chi-square tests, continuous variables with t-tests. Multivariable logistic and linear regressions adjusted for demographics, hospital characteristics, and comorbidities. Results: Among 498,680 AAP hospitalizations, 27.9% involved alcohol withdrawal. The majority of patients were men in both groups (72% with withdrawal vs 67% without). Demographic characteristics were comparable between the 2 cohorts. The in-hospital mortality rate was slightly higher with withdrawal (1.5%) compared to without (1.1%); however, this difference was not statistically significant after multivariable adjustment (odds ratio 1.13; P > 0.05). Alcohol withdrawal was significantly associated with increased odds of sepsis, septic shock, acute renal failure, acute respiratory distress syndrome and the need for mechanical ventilation. Additionally, alcohol withdrawal correlated with increased resource utilization, evidenced by a prolonged hospital stay of 2.17 days and an average increase in hospital charges of $24,362. Conclusion: Our study shows that alcohol withdrawal during AAP hospitalizations is associated with heightened mortality and morbidity burden. While chronic alcohol intake is generally considered a proinflammatory state, sudden cessation could exacerbate the inflammation, lead to autophagy and release of pancreatic enzymes leading to AAP. These findings underscore the importance of early identification and management of alcohol withdrawal. Implementing standardized screening protocols and withdrawal management regimens may help mitigate adverse outcomes.