Clinical Outcomes of Acute Pancreatitis in Patients with Cirrhosis According to Liver Disease Severity Scores.
Acute pancreatitis
Cirrhosis outcomes
Liver cirrhosis pancreatitis
Severe pancreatitis
Journal
Digestive diseases and sciences
ISSN: 1573-2568
Titre abrégé: Dig Dis Sci
Pays: United States
ID NLM: 7902782
Informations de publication
Date de publication:
08 2021
08 2021
Historique:
received:
01
10
2019
accepted:
21
08
2020
pubmed:
7
9
2020
medline:
23
9
2021
entrez:
6
9
2020
Statut:
ppublish
Résumé
Literature on acute pancreatitis (AP) outcomes in patients with cirrhosis is limited. We aim to investigate the mortality and morbidity of AP in patients with cirrhosis. We conducted a retrospective cohort study, and propensity score matching was done to match cirrhotic with non-cirrhotic patients on a 1:2 basis. Outcomes included inpatient mortality, organs failure, systemic inflammatory response syndrome, and length of hospital stay. We performed subgroup analysis of cirrhotics according to Child-Pugh and MELD scores. Multivariable logistic regression models were tested. From 819 AP patients, cirrhosis prevalence was 4.9% (40). There was no significant difference between cirrhotics and non-cirrhotics for inpatient mortality (7.5% vs. 1.3%, p = 0.1), severe AP (17.5% vs. 7.5%), shock (7.9% vs. 3%), respiratory failure (10% vs. 3.8%), need for intensive care unit (15% vs. 6.3%), systemic inflammatory response syndrome (SIRS) on admission (22.5% vs. 32.5%), and SIRS on day 2 (25% vs. 15%). Cirrhotics had similar rates of pancreatic necrosis, ileus, BISAP score, Marshall score, admission hematocrit, BUN, and hospital length of stay. Finally, cirrhotics who had severe AP, required ICU, and/or die in-hospital appeared to have more severe liver diseases (Child-C, higher MELD score > 17) and had lower AP severity scores (BISAP < 3, Marshall scores < 2). In our study, cirrhotics hospitalized with AP had similar morbidity and mortality when compared to non-cirrhotics.
Sections du résumé
BACKGROUND
Literature on acute pancreatitis (AP) outcomes in patients with cirrhosis is limited. We aim to investigate the mortality and morbidity of AP in patients with cirrhosis.
METHODS
We conducted a retrospective cohort study, and propensity score matching was done to match cirrhotic with non-cirrhotic patients on a 1:2 basis. Outcomes included inpatient mortality, organs failure, systemic inflammatory response syndrome, and length of hospital stay. We performed subgroup analysis of cirrhotics according to Child-Pugh and MELD scores. Multivariable logistic regression models were tested.
RESULTS
From 819 AP patients, cirrhosis prevalence was 4.9% (40). There was no significant difference between cirrhotics and non-cirrhotics for inpatient mortality (7.5% vs. 1.3%, p = 0.1), severe AP (17.5% vs. 7.5%), shock (7.9% vs. 3%), respiratory failure (10% vs. 3.8%), need for intensive care unit (15% vs. 6.3%), systemic inflammatory response syndrome (SIRS) on admission (22.5% vs. 32.5%), and SIRS on day 2 (25% vs. 15%). Cirrhotics had similar rates of pancreatic necrosis, ileus, BISAP score, Marshall score, admission hematocrit, BUN, and hospital length of stay. Finally, cirrhotics who had severe AP, required ICU, and/or die in-hospital appeared to have more severe liver diseases (Child-C, higher MELD score > 17) and had lower AP severity scores (BISAP < 3, Marshall scores < 2).
CONCLUSION
In our study, cirrhotics hospitalized with AP had similar morbidity and mortality when compared to non-cirrhotics.
Identifiants
pubmed: 32892261
doi: 10.1007/s10620-020-06575-x
pii: 10.1007/s10620-020-06575-x
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
2795-2804Informations de copyright
© 2020. Springer Science+Business Media, LLC, part of Springer Nature.
Références
Krishna SG, et al. The changing epidemiology of acute pancreatitis hospitalizations: a decade of trends and the impact of chronic pancreatitis. Pancreas. 2017;46:482–488.
doi: 10.1097/MPA.0000000000000783
Peery AF, et al. Burden of gastrointestinal disease in the United States: 2012 update. Gastroenterology. 2012;143:1179–1187.
doi: 10.1053/j.gastro.2012.08.002
Marcellin P, Kutala BK. Liver diseases: A major, neglected global public health problem requiring urgent actions and large-scale screening. Liver Int. 2018;38:2–6.
doi: 10.1111/liv.13682
Banks PA, et al. Classification of acute pancreatitis–2012: revision of the Atlanta classification and definitions by international consensus. Gut. 2013;62:102–111.
doi: 10.1136/gutjnl-2012-302779
Kadiyala V, et al. The Atlanta Classification, Revised Atlanta Classification, and Determinant-Based Classification of Acute Pancreatitis: Which Is Best at Stratifying Outcomes? Pancreas. 2016;45:510–515.
doi: 10.1097/MPA.0000000000000477
Gardner TB, et al. Fluid resuscitation in acute pancreatitis. Clin Gastroenterol Hepatol. 2008;6:1070–1076.
doi: 10.1016/j.cgh.2008.05.005
Singh VK, et al. Early systemic inflammatory response syndrome is associated with severe acute pancreatitis. Clin Gastroenterol Hepatol. 2009;7:1247–1251.
doi: 10.1016/j.cgh.2009.08.012
Mofidi R, et al. Association between early systemic inflammatory response, severity of multiorgan dysfunction and death in acute pancreatitis. Br J Surg. 2006;93:738–744.
doi: 10.1002/bjs.5290
John BJ, et al. Persistent systemic inflammatory response syndrome predicts the need for tertiary care in acute pancreatitis. Acta Gastroenterol Belg. 2017;80:377–380.
pubmed: 29560666
Wu CC, et al. Incidence and factors predictive of acute renal failure in patients with advanced liver cirrhosis. Clin Nephrol. 2006;65:28–33.
doi: 10.5414/CNP65028
Bucsics T, Krones E. Renal dysfunction in cirrhosis: acute kidney injury and the hepatorenal syndrome. Gastroenterol Rep (Oxf). 2017;5:127–137.
doi: 10.1093/gastro/gox009
Ibrahim M, Mostafa I, Deviere J. New developments in managing variceal bleeding. Gastroenterology. 2018;154:1964–1969.
doi: 10.1053/j.gastro.2018.02.023
Noor MT, Manoria P. Immune dysfunction in cirrhosis. J Clin Transl Hepatol. 2017;5:50–58.
pubmed: 28507927
pmcid: 5411357
Lankisch PG, Apte M, Banks PA. Acute pancreatitis. Lancet. 2015;386:85–96.
doi: 10.1016/S0140-6736(14)60649-8