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Background/Aims <p>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.</p> Methods <p>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.</p> Results <p>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 &lt; 0.001) and morbidity (71.8% vs 35.7%, P &lt; 0.001). They also had longer LOS (8.5 vs 5.3&#xa0;days, P &lt; 0.001) and higher charges ($122,635 vs $81,984, P &lt; 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).</p> Conclusions <p>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.</p>

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

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年5月31日

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  • Zachary D. Leslie,
  • Khalid Ahmed,
  • Yasmin Ali,
  • Eric S. Wise,
  • Nabeel Azeem,
  • Martin Freeman,
  • Stuart K. Amateau,
  • Ahmed Dirweesh

摘要

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.