Poplar Bluff Regional Medical Center LLC

Metabolic dysfunction-associated steatotic liver disease (MASLD) is a key contributor to the severity and outcomes of acute pancreatitis (AP). This study compares the clinical outcomes of AP in patients with lean versus non-lean MASLD.

We identified adult patients hospitalized with AP and a secondary diagnosis of MASLD from the National Inpatient Sample (NIS 2016-2020). Outcomes, including mortality, organ failures, and healthcare utilization, were analyzed using logistic and linear regression models, adjusting for demographic, clinical, and hospital factors.

We included 34,388 hospitalized patients with AP and MASLD, of whom 14,443 (42.0%) were non-lean. Annual admissions increased sharply in lean MASLD patients (5339 in 2016 to 8247 in 2020) compared to non-lean MASLD (2273 to 3635). Non-lean MASLD patients experienced higher inflation-adjusted hospital charges ($5,324.01; 95% CI $3,273.42-$7,374.61, P < 0.01), a longer length of stay ((adjusted increase 0.25 days; 95% CI 0.12-0.39, P < 0.05), increased odds of respiratory failure (aOR 4.60; 95% CI 2.24-9.46, P < 0.01), sepsis (aOR 1.11; 95% CI 1.00-1.23, P = 0.04), cholecystectomy (aOR 2.05; 95% CI 1.92-2.19, P < 0.01), and ERCP (aOR of 1.42 95% CI 1.11-1.82, P = 0.01). Mortality did not differ significantly. (aOR 0.90; 95% CI 0.69-1.17, P = 0.43).

Our study suggests that lean MASLD patients with AP may experience a higher rate of hospital admissions and distinct clinical profiles, including a similar mortality risk compared to non-lean MASLD patients, indicating a complex relationship between AP outcomes and MASLD beyond BMI.

Hodgkin's lymphoma is a malignancy of the lymphatic system that can rarely present with advanced-stage features such as spinal cord involvement and hypercalcemia. We present the case of a 63-year-old Caucasian male with advanced Hodgkin's lymphoma, presenting with hypercalcemia and symptoms resembling normal pressure hydrocephalus. The patient exhibited gait impairment, altered mental status, and urinary incontinence, forming the classic triad seen in normal pressure hydrocephalus. Laboratory findings revealed leukocytosis, anemia, hypercalcemia, and acute kidney injury. Imaging showed extensive lymphadenopathy, a right adrenal mass, and bone marrow abnormalities suggestive of disseminated malignancy, leading to the decision not to biopsy the adrenal mass due to the strong suspicion of widespread metastatic disease. A biopsy of a mediastinal lymph node confirmed the diagnosis of Hodgkin's lymphoma, with hypercalcemia attributed to paraneoplastic syndrome. The patient's treatment included managing hypercalcemia and administering chemotherapy with adriamycin, bleomycin, vinblastine, and dacarbazine. This case highlights the importance of considering Hodgkin's lymphoma in patients with atypical presentations and the need for comprehensive diagnostic evaluation, including imaging and laboratory tests. While hypercalcemia in Hodgkin's lymphoma is associated with a poor prognosis, newer therapies like brentuximab vedotin offer promising treatment options for frail patients.