High-Risk Comorbidities Drive Adverse Inpatient Outcomes After ERCP: A National Analysis and Predictive Model

BACKGROUND/AIMS: Patients undergoing ERCP with chronic kidney disease (CKD), congestive heart failure (CHF), or liver cirrhosis (LC) often experience worse outcomes. It is unclear whether these are driven by procedure-related events or underlying comorbidity. METHODS: We analyzed the National Inpatient Sample to identify adult ERCP cases. High-risk comorbidities were defined as CKD, CHF, or LC. Primary outcomes were inpatient mortality and morbidity. RESULTS: Among 1, 171, 973 ERCP admissions, 267, 739 (22. 8%) were high-risk. Compared with lower-risk patients, high-risk patients had higher inpatient mortality (3. 8% vs 0. 8%, P < 0. 001) and morbidity (71. 8% vs 35. 7%, P < 0. 001). They also had longer LOS (8. 5 vs 5. 3 days, P < 0. 001) and higher charges (122, 635 vs 81, 984, P < 0. 001). In adjusted models, high-risk comorbidities independently predicted mortality (OR 3. 80, 95% CI 3. 66-3. 94) and morbidity (OR 3. 22, 95% CI 3. 18-3. 26). LC was the strongest predictor of mortality (OR 4. 53), while CHF was most associated with morbidity (OR 2. 84). Predictive models showed good discrimination (AUC 0. 76 for mortality; 0. 73 for morbidity). CONCLUSIONS: High-risk comorbidities are present in nearly one-quarter of ERCP admissions and strongly predict worse inpatient outcomes. Most adverse events are likely driven by underlying illness rather than ERCP-specific complications. Our validated predictive models may inform counseling, triage, and peri-procedural management.