Unveiling Racial Discrepancies in the Outcomes of Portal Vein Thrombosis Associated With Pancreatic Cancer in the United States

Introduction: Portal vein thrombosis (PVT) is a negative prognostic factor in patients with Pancreatic Cancer (PC). Our study is the first to compare the baseline characteristics, hospital utilization, and outcomes associated with PVT in PC patients across different racial groups within the United States (US). Methods: This is a retrospective longitudinal study of patients with a primary PC diagnosis. We retrieved data from the National Inpatient Sample (NIS) databases from 2016 to 2020 using ICD-10-CM codes. The baseline characteristics of patients were compared using a T-test and Chi-Square. Multivariate regression analysis was applied to estimate the outcomes (length of hospital stay (LOS) and total hospital charges (THC), mortality, and morbidity) while adjusting for confounders. The P-value was set at P< 0.05 for statistical significance. Results: Among a total of 361,440 adults identified with PC, 4% (N=13,820) had PVT. Whites had the highest rate of PVT among all races (P=0.001). Asians or Pacific Islander patients had a significant increase in total healthcare costs (P=0.006) and Black patients had a higher (3+) Charlson Comorbidity Index (P=0.00) as compared to Whites. Black patients had a higher mean length of stay (5.32 days, P=0.00) though also lower rates of portal hypertension (10.4%, P=0.03) as compared to White patients. Asian patients had the highest rates of ascites (47.4%, P=0.07) and were found to have the highest rate of cardiac arrest (aOR 7.5, P=0.01) followed by Black patients (aOR 4.5 P=0.02). There were no significant differences found in terms of acute liver failure, intestinal infarction, inferior vena cava thrombosis, acute respiratory failure, renal impairment or mortality among all race cohorts (Table 1). Conclusion: This study demonstrates Asian, Hispanic, and Black patients were disproportionately affected by PVT and its complications in the setting of PC when compared to White patients. While Asian patients had the highest rate of cardiac arrest, Black patients had the longest LOS. This discrepancy may be due in part to Black patients having the highest Charlson Score across races indicating later progression of disease. Additionally, there may be inherent systemic and provider biases or delayed recognition of symptoms of PVT and its complications across different racial groups. Large-scale studies with additional confounders are needed to evaluate better the factors leading to these findings. Table 1. - Baseline Characteristics of Patients and Associated Outcomes WhitesN (%) BlacksN (%) HispanicsN (%) Asians or Pacific IslanderN (%) Native AmericanN (%) P-value Baseline characteristics Pancreatic carcinoma361,440 251,880 (0.3) 48,845 (0.2) 28,045 (0.2) 11,730 (0.3) 1,375 (0.1) 0.001 Portal vein thrombosis13,820 9390 1585 1260 685 65 0.001 Mean age (years) 65 62.4 62.6 64.5 63.8 0.001 Female 4,525 (48) 810 (51) 590 (46.8) 405 (59) 15 (23) 0.11 Charlson score: 3 or more 8,455 (90) 1,500 (94.5) 1,155 (91.6) 635 (92.7) 55 (84.6) 0.000 Total healthcare charges (USD) 56,159 56,403 63,836 67,249 50,325 0.00 Mean length of stay (days) 4.74 5.32 4.54 4.72 4.93 0.00 Outcomes Mortality 2,428,145 (2.5) 479,565 (2.1) 313,190 (1.9) 105,845 (2.6) 23,965 (2.5) 0.000 Cardiac arrest 80 (0.8) 40 (2.5) 15 (1.1) 20 (2.9) 0 (0) 0.05 Inferior vena cava thrombosis 100 (1) 15 (1) 25 (2) 15 (2.19) 0 (0) 0.03 Portal hypertension 1,445 (15.4) 165 (10.4) 195 (15.4) 155 (22.6) 5 (7.69) 0.03 Esophageal varices with bleeding 90 (0.96) 15 (0.95) 10 (0.79) 10 (1.46) 0 (0) 0.99 Esophageal varices without bleeding 420 (4.47) 55 (3.47) 60 (4.76) 40 (5.84) 25 (0) 0.87 Acute liver failure 575 (6.1) 100 (6.3) 125 (9.9) 35 (5.1) 5 (7.6) 0.1 Ascities 3,900 (41.5) 585 (36.9) 500 (39.6) 325 (47.4)) 20 (30.7 0.07 Intestinal infarct 430 (4.58) 75 (4.73) 60 (4.76) 35 (5.11) 10 (15.3) 0.58 Acute respiratory failure 880 (9.3) 180 (11.3) 85 (6.75) 55 (8) 10 (15.3) 0.48 Gastric varices 190 (2) 20 (1.26) 5 (0.4) 0 (0) 0 (0) 0.28 Acute kidney injury 1,920 (20.4) 420 (26.5) 260 (20.6) 155 (22.6) 15 (23) 0.12 Pulmonary embolism 530 (5.6) 95 (5.9) 80 (6.3) 25 (3.6) 0 (0) 0.80 Sepsis 1,315 (14) 195 (12.3) 185 (14.6) 135 (19.7) 20 (30.7) 0.08 Septic shock 800 (8.52) 150 (9.46) 105 (8.33) 90 (13) 10 (15.3) 0.48