Impact of Different Patterns of Organ Failure on Mortality in Acute Necrotizing Pancreatitis.
Adult
Female
Hospitalization
/ statistics & numerical data
Humans
Male
Middle Aged
Multiple Organ Failure
/ complications
Necrosis
Pancreatitis, Acute Necrotizing
/ complications
Patient Readmission
/ statistics & numerical data
Proportional Hazards Models
Prospective Studies
Retrospective Studies
Risk Factors
Survival Analysis
Survival Rate
Journal
Pancreas
ISSN: 1536-4828
Titre abrégé: Pancreas
Pays: United States
ID NLM: 8608542
Informations de publication
Date de publication:
01 08 2021
01 08 2021
Historique:
pubmed:
12
10
2021
medline:
22
3
2022
entrez:
11
10
2021
Statut:
ppublish
Résumé
Organ failure (OF) and infected necrosis (IN) are the most important predictors of mortality in necrotizing acute pancreatitis (AP). We studied the relationship between timing (onset and duration) and patterns of OF with mortality and the impact of IN on mortality. Consecutive patients with necrotizing AP between January 2017 and February 2020 were analyzed retrospectively for OF and its impact on outcome. Organ failure was divided as single OF, simultaneous multiple OF (SiMOF) and sequential multiple OF (SeMOF). Mortality was compared for timing of onset, total duration and patterns of OF. Among 300 patients with necrotizing AP, 174 (58%) had OF. Mortality was not associated with onset of OF (P = 0.683) but with duration of OF (P = 0.006). Mortalities for single OF, SiMOF, and SeMOF were 11.8%, 30.4%, and 69.2% respectively (P < 0.001). On Cox proportional hazard analysis, adjusted hazard ratio of risk of mortality for OF with IN versus IN, SiMOF versus single OF and SeMOF versus single OF was 3.183, 2.878, and 8.956, respectively (P = 0.023, <0.030, and <0.001, respectively). Duration of OF was associated with increased mortality and SeMOF had worse outcome than single OF and SiMOF.
Identifiants
pubmed: 34629457
doi: 10.1097/MPA.0000000000001880
pii: 00006676-202108000-00019
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
1030-1036Informations de copyright
Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.
Déclaration de conflit d'intérêts
The authors declare no conflict of interest.
Références
Garg PK, Singh VP. Organ failure due to systemic injury in acute pancreatitis. Gastroenterology . 2019;156:2008–2023.
Schepers NJ, Bakker OJ, Besselink MG, et al. Impact of characteristics of organ failure and infected necrosis on mortality in necrotising pancreatitis. Gut . 2019;68:1044–1051.
Banks PA, Bollen TL, Dervenis C, et al. Classification of acute pancreatitis—2012: revision of the Atlanta classification and definitions by international consensus. Gut . 2013;62:102–111.
Padhan RK, Jain S, Agarwal S, et al. Primary and secondary organ failures cause mortality differentially in acute pancreatitis and should be distinguished. Pancreas . 2018;47:302–307.
Petrov MS, Shanbhag S, Chakraborty M, et al. Organ failure and infection of pancreatic necrosis as determinants of mortality in patients with acute pancreatitis. Gastroenterology . 2010;139:813–820.
Thandassery RB, Yadav TD, Dutta U, et al. Dynamic nature of organ failure in severe acute pancreatitis: the impact of persistent and deteriorating organ failure. HPB (Oxford) . 2013;15:523–528.
Besselink MG, van Santvoort HC, Boermeester MA, et al. Timing and impact of infections in acute pancreatitis. Br J Surg . 2009;96:267–273.
Werge M, Novovic S, Schmidt PN, et al. Infection increases mortality in necrotizing pancreatitis: a systematic review and meta-analysis. Pancreatology . 2016;16:698–707.
Wig JD, Bharathy KG, Kochhar R, et al. Correlates of organ failure in severe acute pancreatitis. JOP . 2009;10:271–275.
Isenmann R, Rau B, Beger HG. Early severe acute pancreatitis: characteristics of a new subgroup. Pancreas . 2001;22:274–278.
Sharma M, Banerjee D, Garg PK. Characterization of newer subgroups of fulminant and subfulminant pancreatitis associated with a high early mortality. Am J Gastroenterol . 2007;102:2688–2695.
Shi N, Liu T, de la Iglesia-Garcia D, et al. Duration of organ failure impacts mortality in acute pancreatitis. Gut . 2020;69:604–605.
Marshall JC, Cook DJ, Christou NV, et al. Multiple organ dysfunction score: a reliable descriptor of a complex clinical outcome. Crit Care Med . 1995;23:1638–1652.
Vincent JL, de Mendonça A, Cantraine F, et al. Use of the SOFA score to assess the incidence of organ dysfunction/failure in intensive care units: results of a multicenter, prospective study. Working group on “sepsis-related problems” of the European Society of Intensive Care Medicine. Crit Care Med . 1998;26:1793–1800.
Tenner S, Baillie J, DeWitt J, et al. American College of Gastroenterology guideline: management of acute pancreatitis. Am J Gastroenterol . 2013;108:1400–1415; 1416.
Párniczky A, Lantos T, Tóth EM, et al. Antibiotic therapy in acute pancreatitis: from global overuse to evidence based recommendations. Pancreatology . 2019;19:488–499.
van Santvoort HC, Besselink MG, Bakker OJ, et al. A step-up approach or open necrosectomy for necrotizing pancreatitis. N Engl J Med . 2010;362:1491–1502.
Trikudanathan G, Wolbrink DRJ, van Santvoort HC, et al. Current concepts in severe acute and necrotizing pancreatitis: an evidence-based approach. Gastroenterology . 2019;156:1994–2007.e3.
Leppäniemi A, Tolonen M, Tarasconi A, et al. 2019 WSES guidelines for the management of severe acute pancreatitis. World J Emerg Surg . 2019;14:27.
Kamal A, Sinha A, Hutfless S, et al. Hospital admission volume does not impact the in-hospital mortality of acute pancreatitis. HPB (Oxford) . 2017;19:21–28.
Hamada S, Masamune A, Kikuta K, et al. Nationwide epidemiological survey of acute pancreatitis in Japan. Pancreas . 2014;43:1244–1248.
Shen HN, Lu CL. Incidence, resource use, and outcome of acute pancreatitis with/without intensive care: a nationwide population-based study in Taiwan. Pancreas . 2011;40:10–15.
Le Mée J, Paye F, Sauvanet A, et al. Incidence and reversibility of organ failure in the course of sterile or infected necrotizing pancreatitis. Arch Surg . 2001;136:1386–1390.
Lytras D, Manes K, Triantopoulou C, et al. Persistent early organ failure: defining the high-risk group of patients with severe acute pancreatitis? Pancreas . 2008;36:249–254.
Choi JH, Kim MH, Cho DH, et al. Revised Atlanta classification and determinant-based classification: which one better at stratifying outcomes of patients with acute pancreatitis? Pancreatology . 2017;17:194–200.
Trivedi V, Bleeker H, Kantor N, et al. Survival, quality of life, and functional status following prolonged ICU stay in cardiac surgical patients: a systematic review. Crit Care Med . 2019;47:e52–e63.
Moitra VK, Guerra C, Linde-Zwirble WT, et al. Relationship between ICU length of stay and long-term mortality for elderly ICU survivors. Crit Care Med . 2016;44:655–662.
van Santvoort HC, Bakker OJ, Bollen TL, et al. A conservative and minimally invasive approach to necrotizing pancreatitis improves outcome. Gastroenterology . 2011;141:1254–1263.
Guo Q, Li A, Xia Q, et al. The role of organ failure and infection in necrotizing pancreatitis: a prospective study. Ann Surg . 2014;259:1201–1207.
Kadiyala V, Suleiman SL, McNabb-Baltar J, 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.
Pavlidis P, Crichton S, Lemmich Smith J, et al. Improved outcome of severe acute pancreatitis in the intensive care unit. Crit Care Res Pract . 2013;2013:897107.
Zubia-Olaskoaga F, Maraví-Poma E, Urreta-Barallobre I, et al. Comparison between revised Atlanta Classification and determinant-based classification for acute pancreatitis in intensive care medicine. Why do not use a modified determinant-based classification? Crit Care Med . 2016;44:910–917.
Lee PJ, Bhatt A, Lopez R, et al. Thirty-day readmission predicts 1-year mortality in acute pancreatitis. Pancreas . 2016;45:561–564.
Garg SK, Campbell JP, Anugwom C, et al. Incidence and predictors of readmissions in acute pancreatitis: a nationwide analysis. Pancreas . 2018;47:46–54.