Identifying risk factors for progression to critical care admission and death among individuals with acute pancreatitis: a record linkage analysis of Scottish healthcare databases.
Acute pancreatitis (AP) can initiate systemic complications that require support in critical care (CC). Our objective was to use the unified national health record to define the epidemiology of AP in Scotland, with a specific focus on deterministic and prognostic factors for CC admission in AP.



Health boards in Scotland (n=4).



We included all individuals in a retrospective observational cohort with at least one episode of AP (ICD10 code K85) occurring in Scotland from 1 April 2009 to 31 March 2012. 3340 individuals were coded as AP.



Data from 16 sources, spanning general practice, community prescribing, Accident and Emergency attendances, hospital in-patient, CC and mortality registries, were linked by a unique patient identifier in a national safe haven. Logistic regression and gamma models were used to define independent predictive factors for severe AP (sAP) requiring CC admission or leading to death.



2053 individuals (61.5% (95% CI 59.8% to 63.2%)) met the definition for true AP (tAP). 368 patients (17.9% of tAP (95% CI 16.2% to 19.6%)) were admitted to CC. Predictors of sAP were pre-existing angina or hypertension, hypocalcaemia and age 30-39 years, if type 2 diabetes mellitus was present. The risk of sAP was lower in patients with multiple previous episodes of AP. In-hospital mortality in tAP was 5.0% (95% CI 4.1% to 5.9%) overall and 21.7% (95% CI 19.9% to 23.5%) in those with tAP necessitating CC admission.



National record-linkage analysis of routinely collected data constitutes a powerful resource to model CC admission and prognosticate death during AP. Mortality in patients with AP who require CC admission remains high.
MRC Centre for Inflammation Research, Queen's Medical Research Institute, University of Edinburgh, Edinburgh, UK Clinical Surgery, University of Edinburgh, Edinburgh, UK.
Damian J
DJ
Mole
Healthcare Information Factory, Observational Data Analytics Group, Worldwide Epidemiology, GSK, Uxbridge, UK.
Usha
U
Gungabissoon
eDRIS, NHS National Services Scotland, Edinburgh, UK.
Philip
P
Johnston
Clinical Statistics Consultants, Dundee, UK.
Lynda
L
Cochrane
eDRIS, NHS National Services Scotland, Edinburgh, UK.
Leanne
L
Hopkins
eDRIS, NHS National Services Scotland, Edinburgh, UK.
Grant M A
GM
Wyper
Clinical Surgery, University of Edinburgh, Edinburgh, UK.
Christos
C
Skouras
Farr Institute, Edinburgh, UK.
Chris
C
Dibben
Department of Family and Community Medicine, North York General Hospital, University of Toronto, Toronto, Ontario, Canada.
Frank
F
Sullivan
Farr Institute, Edinburgh, UK.
Andrew
A
Morris
eDRIS, NHS National Services Scotland, Edinburgh, UK.
Hester J T
HJ
Ward
Healthcare Information Factory, Observational Data Analytics Group, Worldwide Epidemiology, GSK, Uxbridge, UK.
Andrew M
AM
Lawton
Dundee Epidemiology and Biostatistics Unit (DEBU), Division of Population Health Sciences, Medical Research Institute, University of Dundee, Dundee, UK.
Peter T
PT
Donnan
D000208:Acute Disease; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003422:Critical Care / Q000706:statistics & numerical data; D016208:Databases, Factual; D003924:Diabetes Mellitus, Type 2 / Q000150:complications; D018450:Disease Progression; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D016015:Logistic Models; D008297:Male; D008499:Medical Records; D008875:Middle Aged; D010195:Pancreatitis / Q000401:mortality*; D010343:Patient Admission / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D012606:Scotland / Q000453:epidemiology
acute pancreatitis; critical care; multiple organ dysfunction syndrome; organ failure; record linkage analysis; safe haven