Kojo-Frimpong B. Awuah, MD1, Komlan E.B. Guedze, MD2, Mutabi Erasmus, MD1, Onwuzo Somotochukwu, MD1, Tyrell Daniel, MD3, Chidera Onwuzo, MD4, Rashid Abdel-Razeq, MD5 1Allegheny Health Network, Pittsburgh, PA; 2Franciscan Alliance, Olympia Fields, IL; 3Sentara Northern Virginia Medical Center, Woodbridge, VA; 4State University of New York Upstate Medical University, Syracuse, NY; 5Cleveland Clinic Foundation, Cleveland, OH Introduction: Cardiorenal syndrome, defined by the interconnected dysfunction of cardiac and renal systems, is a critical complication of acute pancreatitis (AP) associated with significant morbidity and mortality. Cirrhosis, characterized by hemodynamic instability and systemic inflammation, may exacerbate these outcomes. However, the specific contribution of cirrhosis to the severity and incidence of cardiorenal syndrome in AP patients remains poorly understood. This study investigates the impact of cirrhosis on cardiac and renal complications in AP, emphasizing the need for tailored therapeutic strategies. Methods: We conducted a retrospective cohort analysis using the TriNetX database, examining 26,160 patients with AP and cirrhosis compared with 26,160 non-cirrhotic AP patients. Primary outcomes included the one-year incidence of heart failure (HF), acute kidney injury (AKI), and their combined occurrence as an indicator of cardiorenal syndrome. Propensity score matching was utilized to minimize baseline differences. Risk associations were quantified using hazard ratios (HR) with 95% confidence intervals (CI). Results: Cirrhotic AP patients had significantly higher rates of HF (4.8% vs. 3.3%; HR: 1.45; CI: 1.32–1.61; p< 0.001) and AKI (27.9% vs. 15.9%; HR: 1.76; CI: 1.70–1.82; p< 0.001) compared to non-cirrhotic patients. The co-occurrence of HF and AKI, characteristic of cardiorenal syndrome, was more prevalent in cirrhotic patients (8.2% vs. 4.5%; HR: 1.83; CI: 1.65–2.03; p< 0.001). These results align with prior findings highlighting the role of cirrhosis in amplifying systemic inflammation and organ dysfunction in AP. Discussion: Cirrhosis significantly increases the risk of cardiorenal syndrome in AP patients, underscoring the need for early identification and integrated management of cardiac and renal complications. Interventions targeting hemodynamic stabilization and inflammation modulation may improve outcomes in this high-risk population. Further research is warranted to elucidate the underlying mechanisms and refine therapeutic strategies.
Figure: Table 1: Baseline characteristics of patients with acute pancreatitis (AP) stratified into two cohorts:
Cohort 1 includes AP patients with cirrhosis, and Cohort 2 includes AP patients without cirrhosis. Demographic variables, comorbid conditions, and diagnoses were compared to highlight differences between the groups. Before propensity score matching, significant imbalances were observed, with cirrhotic patients showing higher rates of alcohol abuse, chronic kidney disease, and nicotine dependence. After matching, standard differences were markedly reduced, ensuring comparability between cohorts and enabling robust analysis of the impact of cirrhosis on 1-year outcomes in AP.
Figure: Figure 1: Forest Plot of Cardiovascular and Renal Outcomes in Cirrhotic vs. Non-Cirrhotic Patients
This forest plot depicts the hazard ratios (HR) and 95% confidence intervals (CI) for three outcomes in cirrhotic compared to non-cirrhotic patients. Cardiorenal syndrome shows the highest risk, followed by acute kidney injury and heart failure, with all outcomes having hazard ratios significantly greater than 1. The dashed vertical line at HR = 1 represents no effect. The plot highlights the increased risk of these complications in cirrhotic patients.
Disclosures: Kojo-Frimpong B. Awuah indicated no relevant financial relationships. Komlan Guedze indicated no relevant financial relationships. Mutabi Erasmus indicated no relevant financial relationships. Onwuzo Somotochukwu indicated no relevant financial relationships. Tyrell Daniel indicated no relevant financial relationships. Chidera Onwuzo indicated no relevant financial relationships. Rashid Abdel-Razeq indicated no relevant financial relationships.
Kojo-Frimpong B. Awuah, MD1, Komlan E.B. Guedze, MD2, Mutabi Erasmus, MD1, Onwuzo Somotochukwu, MD1, Tyrell Daniel, MD3, Chidera Onwuzo, MD4, Rashid Abdel-Razeq, MD5. P2188 - Cirrhosis Exacerbates Multi-System Complications in Acute Pancreatitis: An Insight Into Cardiorenal Syndrome, ACG 2025 Annual Scientific Meeting Abstracts. Phoenix, AZ: American College of Gastroenterology.
