Factors associated with length of hospital stay in patients with non-biliary acute pancreatitis

Aims: This study aimed to investigate the factors associated with prolonged hospital stays in patients diagnosed with non-biliary acute pancreatitis. Methods: The medical records of 76 patients diagnosed with non-biliary acute pancreatitis at the Internal Medicine Clinic, Afyonkarahisar University of Health Sciences Hospital, between January 1, 2020, and December 31, 2023, were retrospectively analyzed. The diagnosis of acute pancreatitis was based on the presence of two of the following three criteria: (i) Sudden-onset, severe, upper abdominal pain characteristic of acute pancreatitis that may radiate to the back, (ii) A significant increase in serum lipase or amylase levels (three times the upper limit of normal), and (iii) Radiological findings consistent with acute pancreatitis. Biliary pancreatitis was excluded based on the absence of stones on ultrasound and/or MRCP and the normal appearance of the common bile duct. Therefore, in our study, hospital stays of 8 days or longer were defined as prolonged hospital stays. Patients were divided into two groups based on their length of hospital stay. Those who stayed in the hospital for 8 days or longer were included in the long-stay group, while those who stayed for less than 8 days were included in the short-stay group. The following data were recorded: age, sex, history of diabetes mellitus, hypertension, and coronary artery disease, alcohol use, and use of angiotensin-converting enzyme inhibitors/ARBs, calcium channel blockers dipeptidyl peptidase-4 inhibitors, and diuretics. In addition, patients’ Bedside Index for Severity in Acute Pancreatitis (BISAP) score and Ranson score at admission (0-h) and at 48-h were evaluated. Laboratory findings included white blood cell count, neutrophil and lymphocyte counts, neutrophil-to-lymphocyte ratio, hemoglobin, hematocrit, C-reactive protein, albumin, and triglyceride levels. Variables with p-values less than 0.2 were included in the binary logistic regression analysis. Due to multicollinearity with the BISAP and Ranson scores, the age and white blood cell count variables were not included in the multivariate analysis model. p<0.05 was considered statistically significant. Results: In this retrospective study, 76 patients were evaluated; 63.2% of the patients were male, and the mean age was 53.6 years. 35.5% of the participants were aged >65 years. The mean length of hospital stay was 6.62±2.53 days, and 32.9% of the patients were hospitalized for 8 days or longer. Comorbidities were present in 53.9% of the patients, with diabetes mellitus, hypertension, and coronary artery disease being the most common. No significant association was found between laboratory parameters and prolonged hospital stay (all p>0.05). No significant differences were observed between groups regarding sex, comorbidities, medication use, and alcohol consumption (all p>0.05). Age >65 years was found to be significantly associated with prolonged hospital stay (p=0.018). In univariate analysis, age >65 years (p=0.011; OR: 3.72; 95% CI: 1.355-10.215) and white blood cell count (p=0.049; OR: 1.11; 95% CI: 1.0-1.247) were found to be associated with prolonged hospital stay. However, due to multicollinearity, age and white blood cell count were excluded from the multivariate model. BISAP and 48-h Ranson scores were higher in the long-stay group (p<0.001 and p=0.01, respectively). In regression analyses, a significant association was found between the BISAP score and prolonged hospital stay in both univariate (p<0.001; OR: 4.13; 95% CI: 1.985-8.616) and multivariate analyses (p=0.007; OR: 3.45; 95% CI: 1.4-8.51). In contrast, no significant association was found between the 0-h Ranson score and prolonged hospital stay (univariate p=0.142; multivariate p=0.493). The 48-h Ranson score was found to be significant in univariate analysis (p=0.002; OR: 3.22; 95% CI: 1.514-6.881), but lost its significance in the multivariate analysis (p=0.064; OR: 2.34; 95% CI: 0.951-5.793). Conclusion: In conclusion, a higher BISAP score was independently associated with prolonged hospital stay in patients with non-biliary acute pancreatitis.