Introduction Hypertriglyceridemia (HTG)-induced pancreatitis is the third most common cause of acute pancreatitis after gallstone disease and alcohol. We analyzed data from the National (Nationwide) Inpatient Sample (NIS) with the aim of evaluating the outcomes of patients with HTG-induced pancreatitis when compared to those with biliary-induced pancreatitis. Methods The NIS database was sourced for data involving adult hospitalizations for HTG-induced pancreatitis in the United States between January 1, 2016 and December 31, 2017. The main outcome was mortality in patients with biliary pancreatitis vs HTG pancreatitis. Secondary outcomes were the incidence of sepsis, septic shock, non-ST-elevation myocardial infarction (NSTEMI), blood transfusion requirements, acute kidney failure, acute respiratory distress syndrome (ARDS), and length of hospital stay. Results A total of 575,230 patients were admitted with a diagnosis of acute pancreatitis, 18.2% of which were classified as having HTG pancreatitis. The in-hospital mortality for pancreatitis was 0.59%. Patients with HTG pancreatitis had lower odds of in-hospital mortality (adjusted odds ratio [aOR]: 0.74, 95% CI 0.582-0.934, p=0.012) compared to those with biliary pancreatitis. Patients with HTG pancreatitis had less odds of developing comorbid sepsis (aOR: 0.52, 95% CI 0.441-0.612, p<0.001), septic shock (aOR: 0.64, 95% CI 0.482-0.851, p<0.001), and NSTEMI (aOR: 0.70, 95% CI 0.535-0.926, p<0.001) and had less odds of requiring transfusion of blood products (aOR: 0.57, 95% CI 0.478-0.678, p<0.001) when compared to those with biliary pancreatitis. Patients with HTG pancreatitis also had a lower average length of hospital stay and lower total hospital charges compared to those with biliary pancreatitis. There was no statistical difference, however, in acute kidney failure and ARDS between the two groups.

e17055 Background: Primary mediastinal germ cell malignancies (PMGCM) account for up to 5% of all germ cell tumors. Different clinical and epidemiological factors have been known to have important prognostic implications as they contribute to a wide range of long term survival in individuals with PMGCM. Methods: We obtained data from the Surveillance, Epidemiology and End Results (SEER) database from years 1975-2016 to include cases with confirmed primary mediastinal germ cell tumors. After complete gathering of selected data, a total of 1,328 number of cohorts were obtained which were stratified by age, sex, race, type of malignancy, size of primary tumor, site, grade etc. and were analyzed by Cox regression using proportional hazard model. Kaplan Meier curves were also obtained to visualize all cause survival and stratified survival according to the types of malignancy. Results: In our study, we found the incidence of PMGCM to be 0.18 per 1,000 people with malignant cancer with a median age at diagnosis of 28 years, the age range being 21-50 years. 92.9% patients were males and 7.1% were females with more common occurrence in White patients (54.5%). Most common type of PMGCM was found to be Seminoma (23.4%) and 56.32% were poorly differentiated (Grade III), excluding unknown cases. About half (52%) of all was found to arise from the anterior mediastinum. 36% of all cases died from primary cancer. 42.7% underwent surgery, however there was no data for chemotherapy or radiotherapy. Mean survival time among all PMGCM was 37.5 months (p <0.05). A significant negative correlation was observed between survival time & age at diagnosis with Rp of 0.12 (p < 0.001). On survival analysis, age was a significant factor for decreased survival time with patients more than 50 years having a HR of 2 (p<0.001). Similarly, choriocarcinoma was associated with decreased survival time with HR 1.71 (p=0.03). Germinoma and seminoma were found to have higher survival time (HR 0.65 & 0.18; p=0.03 and <0.001 respectively). Patients with grade IV PMGCM had significantly lower survival time (HR 1.74, p<0.001). Patients who had undergone surgery had a better survival time compared to those who didn’t get surgery. There was no significant association of sex, race, tumor size or site with the survival time. Conclusions: Our study concludes that among PMGCM, seminomatous tumors have a favorable prognosis compared to non-seminomatous tumors with higher survival time. Age was found to be a significant contributing factor with ages over 50 having lower survival time. Surgical intervention was found to be associated with increased survival time, although it is important to recognize the lack of chemo-radiotherapeutics data.

Introduction: Obesity is a significant independent risk factor for the development of liver disease. There is some available data suggesting worse outcomes of alcoholic hepatitis (AH) in obese patients however, national sample data supporting these findings are scarce. The aim of our study was to study the severity of AH in patients with concurrent obesity thus we analyzed data from the national inpatient sample. Methods: We queried the National Inpatient Sample (NIS) 2016 and 2017 database. The NIS was searched for hospitalization of adult patients with alcoholic hepatitis as a principal diagnosis with and without Obesity (BMI = 30 and above) as a secondary diagnosis using ICD-10 codes. The primary outcome was inpatient mortality while the secondary outcomes were severe sepsis with shock, hospital length of stay (LOS), NSTEMI, hepatorenal syndrome (HRS) and bleeding esophageal varices (BEV) development. STATA software was used for analysis. Multivariate logistic and linear regression analysis was used accordingly to adjust for confounders. Results: There were over 71 million discharges in the combined 2016 and 2017 NIS database. Out of 32,584 adult AH hospitalizations, 3,720 (11.4%) had a concomitant diagnosis of obesity. There were no differences between mean age, sex and race in both groups of patients. Patients with AH and concurrent obesity had no significant difference in inpatient mortality (aOR= 0.74, P = 0.272, CI = 0.438 -1.261) however, they were found to have higher odds of developing HRS (aOR = 1.54, P= 0.020, CI= 1.069 -2.209) and lower odds of developing BEV(aOR 0.22, P= 0.008, CI= 0.070 -0.670). Patients with AH and concurrent obesity were also found to have similar odds of developing NSTEMI (aOR = 2.29, P= 0.180, CI= 0.680 - 7.762), severe sepsis with shock (aOR = 0.97%, P= 0.945, CI= 0.486 -1.954) and a 0.5 day mean increase in LOS (P =0.045, CI = 0.011 - 0.987) when compared to those without obesity. Conclusion: In conclusion, patients with obesity admitted with AH have higher odds of developing HRS, lower odds of developing BEV and no statistically significant difference in mortality, development of NSTEMI and severe sepsis with septic shock. It is important to identify these patients at higher risk and provide better surveillance to prevent the development of HRS.

Introduction: Obesity is reportedly associated with worse outcome in patients with acute pancreatitis (AP). However, AP has varying etiologies. Hypertriglyceridemia induced acute pancreatitis (HTGP) has sociodemographic variations compared to AP from biliary stones or alcohol. This study aimed to determine the impact of obesity on outcomes of patients with HTGP. Methods: This was a retrospective cohort study of the combined Nationwide Inpatient Sample database for 2016 and 2017. Hospital discharges of patients 18 years and over with HTGP were included. This cohort was divided based on presence of comorbid obesity into three groups- patients without obesity, mild-moderate obesity (MMO) (BMI: 30.0 - 39.9) and morbid obesity (MO) (BMI &gt;=40.0). Primary outcome was inpatient mortality. Secondary outcomes included length of hospital stay (LOS), total hospital charges (THC), discharge diagnoses of hypocalcemia, sepsis, septic shock, acute renal failure (AKI) and acute respiratory failure (ARF). Multivariate regression analysis was used to adjust for patients’ sociodemographic factors, Charlson comorbidity index as well as hospital characteristics as confounders. Results: A total of 104,465 hospitalizations were principally for HTGP, accounting for 18.2% of patients with acute pancreatitis during the study period. Of the patients with HTGP, 13.7% and 10.9% of these patients classified as having MMO and MO respectively. Patients with obesity were significantly younger than patients without obesity. In patients with MO, there was higher odds of mortality (aOR=1.83, 95% CI: 1.090 – 3.083, p=0.022), while there was no difference in mortality in patients with MMO (aOR 1.09 95% CI: 0.609 – 1.940, p=0.777), both compared with patients without obesity. Patients with MO had increased mean LOS of 0.5 days (95% CI: 0.3 – 0.7, p&lt;0.001) as well as increased THC of $3977 (95% CI: 1467 – 6487, p=0.002) compared to those without obesity. There was no difference in mortality, THC and LOS in patients with MMO. Morbidly obese patients also had increased odds of septic shock (aOR=2.27, 95% CI: 1.297 – 3.972, p=0.007), AKI (aOR=1.28, 95% CI: 1.120 – 1.459, p&lt;0.001), and ARF (aOR=1.94, 95% CI: 1.491 – 2.524, p&lt;0.001). Conclusion: Morbid obesity is associated with higher mortality and poor outcomes in patient with hypertriglyceridemia induced pancreatitis.

Introduction: Morbid obesity (MO) is associated with increased mortality in various conditions including acute pancreatitis. Interventions are challenging in patients with MO due to higher prevalence of comorbidities that may affect airway and cardiopulmonary management. Biliary acute pancreatitis (BAP) is the most common etiology for acute pancreatitis in the US. Population-based studies on the effect of obesity on biliary acute pancreatitis are lacking. This study aimed to assess the impact of MO on outcomes of patients with BAP. Methods: Data was obtained from the Nationwide Inpatient Sample database for 2016 and 2017. Hospital discharges of patients 18 years and over with a principal diagnosis of BAP were included. This cohort was divided based on BMI into nonobese patients (BMI &lt;30) and morbidly obese (MO) patients (BMI &gt;/=40.0). Patients with BMI between 30.0–39.9 were excluded. Primary outcome was inpatient mortality. Secondary outcomes included rate of endoscopic procedures, length of hospital stay (LOS), total hospital charges (THC), discharge diagnoses of hypocalcemia, septic shock, acute renal failure (AKI) and acute respiratory failure (ARF). Multivariate regression analysis was used to adjust for patients’ sociodemographic factors, Charlson comorbidity index as well as hospital characteristics as confounders. Results: A total of 128995 hospitalizations were principally for BAP, with 75.7% and 12.0% of these patients classified as nonobese and MO respectively. There was a significantly higher proportion of females (66.1 vs 54.5%, p&lt;0.001) and lower mean age (50.1 vs 58.7 years, p&lt;0.001) in patients with MO. There was no significant difference in adjusted odds of mortality (aOR=1.34, 95% CI: 0.88 - 2.03, p=0.174), or rate of endoscopy (aOR 1.00 95% CI: 0.91 - 1.11, p=0.958), in MO compared with patients who were nonobese. However, MO patients had increased mean LOS of 0.8 days (95% CI: 0.5 - 1.0, p&lt;0.001), increased mean THC of $10760 (95% CI: 7077 - 14442, p&lt;0.001), increased odds of hypocalcemia (aOR=1.60, 95% CI: 1.22 - 2.09, p=0.001), septic shock (aOR=2.13, 95% CI: 1.39 - 3.25, p&lt;0.001), and AKI (aOR=1.48, 95% CI: 1.30 - 1.68, p&lt;0.001). Conclusion: Even though we did not find any significative difference in mortality, patients with MO appear to have and increased LOS and THC, as well as more complications like septic shock, AKI, and hypocalcemia. This calls for a greater recognition of this association for further research studies and to recognize this potential association during clinical practice.