COMORBIDITY BURDEN AND OUTCOMES OF ENDOSCOPIC ULTRASOUND-GUIDED TREATMENT OF PANCREATIC FLUID COLLECTIONS: MULTICENTER STUDY WITH NATIONWIDE DATA-BASED VALIDATION

Abstract

Objectives: The appropriate holistic management is mandatory for successful endoscopic ultrasound (EUS)-guided treatment of pancreatic fluid collections (PFCs). However, comorbidity status has not been fully examined in relation to clinical outcomes of this treatment.

Methods: Using a multi-institutional cohort of 406 patients receiving EUS-guided treatment of PFCs in 2010-2020, we examined the associations of Charlson Comorbidity Index (CCI) with in-hospital mortality and other clinical outcomes. Multivariable logistic regression analysis was conducted with adjustment for potential confounders. The findings were validated using a Japanese nationwide inpatient database including 4053 patients treated at 486 hospitals in 2010-2020.

Results: In the clinical multi-institutional cohort, CCI was positively associated with the risk of in-hospital mortality (P _trend＜0.001). Compared to patients with CCI=0, patients with CCI of 1-2, 3-5, and≥6 had adjusted odds ratios (95% confidence intervals) of 0.76 (0.22-2.54), 5.39 (1.74-16.7), and 8.77 (2.36-32.6), respectively. In the nationwide validation cohort, a similar positive association was observed; the corresponding odds ratios (95% confidence interval) were 1.21 (0.90-1.64), 1.52 (0.92-2.49), and 4.84 (2.63-8.88), respectively (P _trend＜0.001). The association of higher CCI with longer length of stay was observed in the nationwide cohort (P _trend＜0.001), but not in the clinical cohort (P _trend=0.18). CCI was not associated with the risk of procedure-related adverse events.

Conclusions: Higher levels of CCI were associated with a higher risk of in-hospital mortality among patients receiving EUS-guided treatment of PFCs, suggesting the potential of CCI in stratifying the periprocedural mortality risk.

Trial registration: The research based on the clinical data from the WONDERFUL cohort was registered with UMIN-CTR (registration number UMIN000044130).