Impact of Clinical, Laboratory and Fluid Therapy Variables on Hospital Length of Stay for Children with Acute Pancreatitis

Abstract

Purpose: There have been many efforts to develop generalizable severity markers in children with acute pancreatitis (AP). Expert opinion panels have developed consensus guidelines on management but it is unclear if these are sufficient or valid. Our study aims to assess the effect of clinical and laboratory variables, in addition to treatment modality on hospital length of stay (LOS) as a proxy variable for severity in pediatric patients admitted with AP. Methods: We conducted a retrospective chart review of patients between ages of 0-18 years, who were admitted with AP at 2 institutions between 2013-2018, John R. Oishei Children's Hospital (Buffalo, NY, USA) and Medical University of South Carolina Children's Hospital (Charleston, SC, USA). We constructed three linear regression models to analyze the effect of clinical signs of organ dysfunction, laboratory markers and fluid intake on hospital LOS. Results: Ninety-two patients were included in the study. The mean age was 12 years (range, 7.6-17.4 years), 55% were females, and median LOS was 3 days. The most frequent cause of AP was idiopathic. Our study showed that elevated blood urea nitrogen (BUN) on admission (p<0.005), tachycardia that lasted for ≥48 hours (p<0.001) and need for fluid resuscitation were associated with increase LOS. Total daily fluid intake above maintenance did not have a significant effect on the primary outcome (p=0.49). Conclusion: Elevated serum BUN on admission, persistent tachycardia and need for fluid resuscitation were associated with increase LOS in pediatric AP. Daily total fluid intake above recommended maintenance did not reduce LOS.

Mean Corpuscular Hemoglobin Predicts Length of Hospital Stay Independent of Severity Classification in Acute Pancreatitis Patients: a Retrospective Study

“…Long hospital stay is associated with high hospital occupancy, increased costs, and adverse patient outcomes, such as persistent organ failure [10][11][12] . The previous studies showed that low MCH level is one of the earliest and sensitive indicators of iron de ciency in different populations [13][14][15] , suggesting that MCH positively correlated with iron level.…”

Commentary—Update on disorders of the gastrointestinal tract in children, part II

“…Fluid intake above recommended maintenance did not reduce length of stay. 4 The article highlights the common etiologies of acute pancreatitis and Table 1 provides a comprehensive list. Pancreatitis may also be part of COVID-19.…”