Atrial Fibrillation and Cardiovascular Comorbidity Burden as Predictors of In-Hospital Mortality in Acute Pancreatitis: A National Inpatient Sample Analysis of 1.9 Million Hospitalizations

Background Atrial fibrillation (AF) and cardiovascular (CV) comorbidities are prevalent in acute pancreatitis (AP) and may compromise hemodynamic tolerance of systemic inflammation. Their independent contributions to in-hospital mortality in AP have not been quantified nationally. Methods We analyzed discharge data from the National Inpatient Sample (NIS), Healthcare Cost and Utilization Project (HCUP), Agency for Healthcare Research and Quality (AHRQ), 2016–2022. Adult AP hospitalizations were identified by primary ICD-10-CM diagnosis. Twelve CV risk factors were examined. Survey-weighted logistic regression generated unadjusted, adjusted, and fully adjusted odds ratios (ORs) for in-hospital mortality. A cumulative risk factor count was constructed. Results Among 1,919,159 weighted AP hospitalizations, overall mortality was 0.59%. On full multivariable adjustment, cerebrovascular disease (OR 2.83, 95% CI 2.33–3.44), AF (2.10, 1.85–2.37), CKD (1.89, 1.68–2.12), MI (1.86, 1.56–2.23), and heart failure (1.79, 1.56–2.05) were the strongest independent CV-comorbidity predictors of in-hospital death. Weighted mortality rose progressively from 0.21% at zero to 3.03% at seven cumulative risk factors; per additional risk factor the crude OR was 1.47 (1.45–1.50, p<0.001). The dose-response gradient persisted after full adjustment, with integer-level adjusted ORs rising from 1.25 at one risk factor to 5.05 at seven, and a binary cutoff at three or more versus two or fewer risk factors carrying an adjusted OR of 2.01 (1.80–2.25, p<0.001). Conclusions Cerebrovascular disease, AF, CKD, MI, and heart failure independently predict in-hospital mortality in AP, with a robust adjusted dose-response by cumulative CV burden. These associative findings are hypothesis-generating; prospective studies are needed to determine whether structured cardiovascular risk assessment improves outcomes in this population.