Trends in Early and Late Mortality in Patients With Severe Acute Pancreatitis Admitted to ICUs: A Nationwide Cohort Study.
Journal
Critical care medicine
ISSN: 1530-0293
Titre abrégé: Crit Care Med
Pays: United States
ID NLM: 0355501
Informations de publication
Date de publication:
01 10 2022
01 10 2022
Historique:
pubmed:
26
7
2022
medline:
20
9
2022
entrez:
25
7
2022
Statut:
ppublish
Résumé
To investigate national mortality trends over a 12-year period for patients with severe acute pancreatitis (SAP) admitted to Dutch ICUs. Additionally, an assessment of outcome in SAP was undertaken to differentiate between early (< 14 d of ICU admission) and late (> 14 d of ICU admission) mortality. Data from the Dutch National Intensive Care Evaluation and health insurance companies' databases were extracted. Outcomes included 14-day, ICU, hospital, and 1-year mortality. Mortality before and after 2010 was compared using mixed logistic regression and mixed Cox proportional-hazards models. Sensitivity analyses, excluding early mortality, were performed to assess trends in late mortality. Not applicable. Consecutive adult patients with SAP admitted to all 81 Dutch ICUs between 2007 and 2018. Not applicable. Among 4,160 patients treated in 81 ICUs, 14-day mortality was 17%, ICU mortality 17%, hospital mortality 23%, and 1-year mortality 33%. After 2010 in-hospital mortality adjusted for age, sex, modified Marshall, and Acute Physiology and Chronic Health Evaluation III scores were lower (odds ratio [OR], 0.76; 95% CI, 0.61-0.94) than before 2010. There was no change in ICU and 1-year mortality. Sensitivity analyses excluding patients with early mortality demonstrated a decreased ICU mortality (OR, 0.45; 95% CI, 0.32-0.64), decreased in-hospital (OR, 0.48; 95% CI, 0.36-0.63), and decreased 1-year mortality (hazard ratio, 0.81; 95% CI, 0.68-0.96) after 2010 compared with 2007-2010. Over the 12-year period examined, mortality in patients with SAP admitted to Dutch ICUs did not change, although after 2010 late mortality decreased. Novel therapies should focus on preventing early mortality in SAP.
Identifiants
pubmed: 35876365
doi: 10.1097/CCM.0000000000005629
pii: 00003246-202210000-00010
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
1513-1521Informations de copyright
Copyright © 2022 by the Society of Critical Care Medicine and Wolters Kluwer Health, Inc. All Rights Reserved.
Déclaration de conflit d'intérêts
Drs. Termorshuizen’s and de Keizer’s institutions received funding from the National Intensive Care Evaluation Foundation. Dr. Termorshuizen’s institution received funding from the Rivierduinen Institute for Mental Health Care. Dr. de Keizer’s institution received funding from the Ministry of Health and Welfare. The remaining authors have disclosed that they do not have any potential conflicts of interest.
Références
Peery AF, Dellon ES, Lund J, et al.: Burden of gastrointestinal disease in the United States: 2012 update. Gastroenterology 2012; 143:1179–1187.e3
Banks PA, Bollen TL, Dervenis C, et al.; Acute Pancreatitis Classification Working Group: Classification of acute pancreatitis–2012: Revision of the Atlanta classification and definitions by international consensus. Gut 2013; 62:102–111
Bakker OJ, van Santvoort H, Besselink MG, et al.; Dutch Pancreatitis Study Group: Extrapancreatic necrosis without pancreatic parenchymal necrosis: A separate entity in necrotising pancreatitis? Gut 2013; 62:1475–1480
Schepers NJ, Bakker OJ, Besselink MG, et al.; Dutch Pancreatitis Study Group: Impact of characteristics of organ failure and infected necrosis on mortality in necrotising pancreatitis. Gut 2019; 68:1044–1051
Guidelines WGIAAP: IAP/APA evidence-based guidelines for the management of acute pancreatitis. Pancreatology 2013; 13(4 Suppl 2):e1–e15
van Dijk SM, Hallensleben NDL, van Santvoort HC, et al.; Dutch Pancreatitis Study Group: Acute pancreatitis: Recent advances through randomised trials. Gut 2017; 66:2024–2032
van Brunschot S, Hollemans RA, Bakker OJ, et al.: Minimally invasive and endoscopic versus open necrosectomy for necrotising pancreatitis: A pooled analysis of individual data for 1980 patients. Gut 2018; 67:697–706
van Santvoort HC, Besselink MG, Bakker OJ, et al.; Dutch Pancreatitis Study Group: A step-up approach or open necrosectomy for necrotizing pancreatitis. N Engl J Med 2010; 362:1491–1502
Bakker OJ, van Santvoort HC, van Brunschot S, et al.; Dutch Pancreatitis Study Group: Endoscopic transgastric vs surgical necrosectomy for infected necrotizing pancreatitis: A randomized trial. JAMA 2012; 307:1053–1061
Bakker OJ, van Brunschot S, van Santvoort HC, et al.; Dutch Pancreatitis Study Group: Early versus on-demand nasoenteric tube feeding in acute pancreatitis. N Engl J Med 2014; 371:1983–1993
van Brunschot S, van Grinsven J, van Santvoort HC, et al.; Dutch Pancreatitis Study Group: Endoscopic or surgical step-up approach for infected necrotising pancreatitis: A multicentre randomised trial. Lancet 2018; 391:51–58
Besselink MG, van Santvoort HC, Buskens E, et al.; Dutch Acute Pancreatitis Study Group: Probiotic prophylaxis in predicted severe acute pancreatitis: A randomised, double-blind, placebo-controlled trial. Lancet 2008; 371:651–659
Boxhoorn L, van Dijk SM, van Grinsven J, et al.; Dutch Pancreatitis Study Group: Immediate versus postponed intervention for infected necrotizing pancreatitis. N Engl J Med 2021; 385:1372–1381
von Elm E, Altman DG, Egger M, et al.; STROBE Initiative: Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: Guidelines for reporting observational studies. BMJ 2007; 335:806–808
van de Klundert N, Holman R, Dongelmans DA, et al.: Data resource profile: The Dutch National Intensive Care Evaluation (NICE) registry of admissions to adult intensive care units. Int J Epidemiol 2015; 44:1850h–50h
Zimmerman JE, Kramer AA, McNair DS, et al.: Acute Physiology and Chronic Health Evaluation (APACHE) IV: Hospital mortality assessment for today’s critically ill patients. Crit Care Med 2006; 34:1297–1310
Knaus WA, Wagner DP, Draper EA, et al.: The APACHE III prognostic system. Risk prediction of hospital mortality for critically ill hospitalized adults. Chest 1991; 100:1619–1636
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
van Grinsven J, van Dijk SM, Dijkgraaf MG, et al.; Dutch Pancreatitis Study Group: Postponed or immediate drainage of infected necrotizing pancreatitis (POINTER trial): Study protocol for a randomized controlled trial. Trials 2019; 20:239
van Grinsven J, van Brunschot S, van Santvoort HC; Dutch Pancreatitis Study Group: The value of a 24/7 online nationwide multidisciplinary expert panel for acute necrotizing pancreatitis. Gastroenterology 2017; 152:685–688.e6
Xiao AY, Tan ML, Wu LM, et al.: Global incidence and mortality of pancreatic diseases: A systematic review, meta-analysis, and meta-regression of population-based cohort studies. Lancet Gastroenterol Hepatol 2016; 1:45–55
Ventre C, Nowell S, Graham C, et al.: Survival and new-onset morbidity after critical care admission for acute pancreatitis in Scotland: A national electronic healthcare record linkage cohort study. BMJ Open 2018; 8:e023853
Granger J, Remick D: Acute pancreatitis: Models, markers, and mediators. Shock 2005; 24(Suppl 1):45–51
Spanier B, Bruno MJ, Dijkgraaf MG: Incidence and mortality of acute and chronic pancreatitis in the Netherlands: A nationwide record-linked cohort study for the years 1995-2005. World J Gastroenterol 2013; 19:3018–3026
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
Huang Z, Ma X, Jia X, et al.: Prevention of severe acute pancreatitis with cyclooxygenase-2 inhibitors: A randomized controlled clinical trial. Am J Gastroenterol 2020; 115:473–480
Al-Leswas D, Eltweri AM, Chung WY, et al.: Intravenous omega-3 fatty acids are associated with better clinical outcome and less inflammation in patients with predicted severe acute pancreatitis: A randomised double blind controlled trial. Clin Nutr 2020; 39:2711–2719
Wolbrink DRJ, Grundsell JR, Witteman B, et al.; Dutch Pancreatitis Study Group: Are omega-3 fatty acids safe and effective in acute pancreatitis or sepsis? A systematic review and meta-analysis. Clin Nutr 2020; 39:2686–2694