Assessing the impact of hypercalcemia of malignancy on clinical outcomes in cancer patients admitted with acute pancreatitis.
Authors: Deenadayalan Vaishali , Kumi Dennis Danso , Shah Mihir , Turk Ekrem , Obeidat Khaldun , Vakil Jay , Weir Catherine , Rodriguez Alarcon Pierre Alexander , Gupta Shweta 
Published: June 2022

e24049

Background: Hypercalcemia of malignancy is a well-recognized complication in cancer. Hypercalcemia itself is one of the etiologies of acute pancreatitis. Empiric data on how presence of both these entities affect hospitalization outcomes in cancer patients is lacking. We studied 5 common cancers - Lung cancer, multiple myeloma, diffuse large B-cell lymphoma, renal cell cancer and head & neck cancers with known hypercalcemia of malignancy and studied the outcomes if they developed acute pancreatitis versus not. Methods: Healthcare Cost and Utilization Project National Inpatient Sample (HCUP-NIS) 2016 – 2018 was queried to identify adult patients with known hypercalcemia of malignancy and any of the 5 cancers stated above. From this cohort we identified patients admitted with a principal diagnosis of acute pancreatitis. The frequency of various etiologies of acute pancreatitis in the defined population was assessed. Primary outcomes assessed were mortality, length of stay (LOS), and total hospitalization charges (THC). Secondary outcomes included diagnosis of septic shock, acute kidney injury (AKI), and acute respiratory failure (ARF). Statistics were performed using multivariate linear and logistic regression. Results: There were a total of 44,030 adult patient hospitalizations with history of hypercalcemia of malignancy and one of the 5 cancers of which 4,195 hospitalizations were for acute pancreatitis. The most common etiology for acute pancreatitis was idiopathic (69.4%), followed by biliary pancreatitis (15.7%), alcohol-associated pancreatitis (7.75%) and drug-induced pancreatitis (7.15%). The incidence of acute pancreatitis was higher in the hypercalcemia of malignancy group than those without (0.36% vs 0.28%). Hypercalcemia of malignancy group had significantly increased odds of mortality during admission for acute pancreatitis (15.63% vs 3.48%, aOR: 3.48, p = 0.043) and significantly higher THC ($122,184 vs $49,223, adjusted difference of $69,974.59, p = 0.049). There was a trend towards an increased LOS among patients with hypercalcemia of malignancy (10.7 vs 5.5 days), but it was not statistically significant (p = 0.069). Hypercalcemia of malignancy was also associated with an increased odds of AKI, 53.13% vs 16.85% (aOR: 6.15, p < 0.001). Other outcomes of septic shock and ARF were similar between groups. Conclusions: Despite the high prevalence of hypercalcemia of malignancy in certain at-risk cancer groups, the most common etiology of acute pancreatitis is idiopathic. The history of hypercalcemia of malignancy in cancer patients with acute pancreatitis was associated with a 3-fold increased odds of death, higher odds of AKI and a significant increase in THC. Cancer patients with history of hypercalcemia presenting with acute pancreatitis may need more aggressive management to prevent worse outcomes than patients without history of hypercalcemia.