Impact of Prediabetes on In-Hospital Mortality and Clinical Outcomes in Acute Pancreatitis: Insights from a Nationwide Inpatient Sample

Background/Objectives: Prediabetes is characterized by insulin resistance and systemic inflammation, which may increase susceptibility to acute pancreatitis (AP). However, limited data exist on how prediabetes influences in-hospital outcomes in AP patients. This study aimed to evaluate the prevalence and clinical outcomes of hospitalized AP patients with prediabetes using the National Inpatient Sample (NIS) data-base. Methods: We conducted a retrospective cohort study using NIS data from 2016 to 2018, identifying adult patients hospitalized with a primary diagnosis of AP. Patients were stratified based on the presence or absence of prediabetes; those with type 1 or type 2 diabetes were excluded. The primary outcome is the association of prediabetes in developing acute pancreatitis and its influence on in-hospital mortality, length of stay, total hospital cost. Results: Among 193,617 patients hospitalized with AP, 1,639 had prediabetes. In-hospital mortality was 1.22% in prediabetic patients versus 2.01% in non-prediabetic patients (p = 0.0225), though this was not statistically significant. LOS was shorter in prediabetic patients (4.93 vs. 5.37 days, p = 0.0021), and hospitalization costs were similar ($55,351.56 vs. $57,106.83, p = 0.195). Prediabetes was not an independent predictor of mortality (OR 0.50, 95% CI 0.31–0.82, p = 0.0063). Significant predictors of mortality included acute kidney injury (AKI) (OR 12.98, 95% CI 11.96–14.09, p < 0.001) and severe sepsis with shock (OR 5.89, 95% CI 5.27–6.59, p < 0.001). Conclusions: Prediabetes was not associated with increased in-hospital mortality in AP patients. However, complications such as AKI and septic shock significantly predicted mortality, underscoring the importance of early recognition and management.