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 status was 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 status 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.