Detailed Characteristics of Post-discharge Mortality in Acute Pancreatitis.

Humans Pancreatitis / epidemiology Patient Discharge Acute Disease Aftercare Cachexia Retrospective Studies
Acute Pancreatitis Cardiac Failure Post-discharge Mortality Pseudocyst

Journal

Gastroenterology
ISSN: 1528-0012
Titre abrégé: Gastroenterology
Pays: United States
ID NLM: 0374630

Informations de publication

Date de publication:
09 2023
Historique:
received: 07 10 2022
revised: 25 04 2023
accepted: 12 05 2023
medline: 22 8 2023
pubmed: 30 5 2023
entrez: 29 5 2023
Statut: ppublish

Résumé

The in-hospital survival of patients suffering from acute pancreatitis (AP) is 95% to 98%. However, there is growing evidence that patients discharged after AP may be at risk of serious morbidity and mortality. Here, we aimed to investigate the risk, causes, and predictors of the most severe consequence of the post-AP period: mortality. A total of 2613 well-characterized patients from 25 centers were included and followed by the Hungarian Pancreatic Study Group between 2012 and 2021. A general and a hospital-based population was used as the control group. After an AP episode, patients have an approximately threefold higher incidence rate of mortality than the general population (0.0404 vs 0.0130 person-years). First-year mortality after discharge was almost double than in-hospital mortality (5.5% vs 3.5%), with 3.0% occurring in the first 90-day period. Age, comorbidities, and severity were the most significant independent risk factors for death following AP. Furthermore, multivariate analysis identified creatinine, glucose, and pleural fluid on admission as independent risk factors associated with post-discharge mortality. In the first 90-day period, cardiac failure and AP-related sepsis were among the main causes of death following discharge, and cancer-related cachexia and non-AP-related infection were the key causes in the later phase. Almost as many patients in our cohort died in the first 90-day period after discharge as during their hospital stay. Evaluation of cardiovascular status, follow-up of local complications, and cachexia-preventing oncological care should be an essential part of post-AP patient care. Future study protocols in AP must include at least a 90-day follow-up period after discharge.

Sections du résumé

BACKGROUND & AIMS
The in-hospital survival of patients suffering from acute pancreatitis (AP) is 95% to 98%. However, there is growing evidence that patients discharged after AP may be at risk of serious morbidity and mortality. Here, we aimed to investigate the risk, causes, and predictors of the most severe consequence of the post-AP period: mortality.
METHODS
A total of 2613 well-characterized patients from 25 centers were included and followed by the Hungarian Pancreatic Study Group between 2012 and 2021. A general and a hospital-based population was used as the control group.
RESULTS
After an AP episode, patients have an approximately threefold higher incidence rate of mortality than the general population (0.0404 vs 0.0130 person-years). First-year mortality after discharge was almost double than in-hospital mortality (5.5% vs 3.5%), with 3.0% occurring in the first 90-day period. Age, comorbidities, and severity were the most significant independent risk factors for death following AP. Furthermore, multivariate analysis identified creatinine, glucose, and pleural fluid on admission as independent risk factors associated with post-discharge mortality. In the first 90-day period, cardiac failure and AP-related sepsis were among the main causes of death following discharge, and cancer-related cachexia and non-AP-related infection were the key causes in the later phase.
CONCLUSION
Almost as many patients in our cohort died in the first 90-day period after discharge as during their hospital stay. Evaluation of cardiovascular status, follow-up of local complications, and cachexia-preventing oncological care should be an essential part of post-AP patient care. Future study protocols in AP must include at least a 90-day follow-up period after discharge.

Identifiants

DOI: 10.1053/j.gastro.2023.05.028 PMID: 37247642
pubmed: 37247642
pii: S0016-5085(23)00801-6
doi: 10.1053/j.gastro.2023.05.028
pii:
doi:

Types de publication

Journal Article Research Support, Non-U.S. Gov't

Langues

eng

Sous-ensembles de citation

IM

Pagination

682-695

Investigateurs

Péter Jenő Hegyi (PJ)
Andrea Párniczky (A)
Mária Földi (M)
Klementina Ocskay (K)
Márk Félix Juhász (MF)
Marcell Imrei (M)
Szabolcs Kiss (S)
Alexandra Mikó (A)
Szilárd Gódi (S)
Judit Bajor (J)
Roland Hágendorn (R)
Patrícia Sarlós (P)
Imre Szabó (I)
József Czimmer (J)
Nándor Faluhelyi (N)
Péter Kanizsai (P)
Attila Miseta (A)
Tamás Nagy (T)
László Gajdán (L)
Adrienn Halász (A)
Balázs Németh (B)
Balázs Kui (B)
Dóra Illés (D)
Tamás Takács (T)
László Tiszlavicz (L)
Orsolya Oláh-Németh (O)
Bence Radics (B)
Zsuzsanna Vitális (Z)
József Hamvas (J)
Márta Varga (M)
Barnabás Bod (B)
János Novák (J)
Pál Maurovich-Horváth (P)
Attila Doros (A)
Pál Ákos Deák (PÁ)
Csaba Varga (C)
Szabolcs Gaál (S)
László Zubek (L)
János Gál (J)
Zsolt Molnár (Z)
Tamás Tornai (T)
Balázs Lázár (B)
Tamás Hussein (T)
Bea Kovács (B)
Anna Németh (A)
Dorottya Tarján (D)
Mónika Lipp (M)
Orsolya Urbán (O)
Simon Tóth (S)
Dániel Söti (D)
Dávid Becker (D)

Informations de copyright

Copyright © 2023 The Authors. Published by Elsevier Inc. All rights reserved.

Auteurs

Dóra Czapári (D)

Institute for Translational Medicine, Medical School, University of Pécs, Pécs, Hungary; Center for Translational Medicine, Semmelweis University, Budapest, Hungary.

Alex Váradi (A)

Institute for Translational Medicine, Medical School, University of Pécs, Pécs, Hungary; Department of Metagenomics, University of Debrecen, Debrecen, Hungary; Department of Laboratory Medicine, University of Pécs, Pécs, Hungary.

Nelli Farkas (N)

Institute for Translational Medicine, Medical School, University of Pécs, Pécs, Hungary; Institute of Bioanalysis, Medical School, University of Pécs, Pécs, Hungary.

Gergely Nyári (G)

Department of Pathology, University of Szeged, Szeged, Hungary.

Katalin Márta (K)

Center for Translational Medicine, Semmelweis University, Budapest, Hungary; Institute of Pancreatic Diseases, Semmelweis University, Budapest, Hungary.

Szilárd Váncsa (S)

Institute for Translational Medicine, Medical School, University of Pécs, Pécs, Hungary; Center for Translational Medicine, Semmelweis University, Budapest, Hungary; Institute of Pancreatic Diseases, Semmelweis University, Budapest, Hungary.

Rita Nagy (R)

Institute for Translational Medicine, Medical School, University of Pécs, Pécs, Hungary; Center for Translational Medicine, Semmelweis University, Budapest, Hungary; Heim Pál National Pediatric Institute, Budapest, Hungary.

Brigitta Teutsch (B)

Institute for Translational Medicine, Medical School, University of Pécs, Pécs, Hungary; Center for Translational Medicine, Semmelweis University, Budapest, Hungary.

Stefania Bunduc (S)

Center for Translational Medicine, Semmelweis University, Budapest, Hungary; Institute of Pancreatic Diseases, Semmelweis University, Budapest, Hungary; Carol Davila University of Medicine and Pharmacy, Bucharest, Romania; Fundeni Clinical Institute, Bucharest, Romania.

Bálint Erőss (B)

Institute for Translational Medicine, Medical School, University of Pécs, Pécs, Hungary; Center for Translational Medicine, Semmelweis University, Budapest, Hungary; Institute of Pancreatic Diseases, Semmelweis University, Budapest, Hungary.

László Czakó (L)

Department of Medicine, University of Szeged, Szeged, Hungary.

Áron Vincze (Á)

Department of Gastroenterology, First Department of Medicine, Medical School, University of Pécs, Pécs, Hungary.

Ferenc Izbéki (F)

Szent György Teaching Hospital of County Fejér, Székesfehérvár, Hungary.

Mária Papp (M)

Department of Gastroenterology, Institute of Internal Medicine, Faculty of Medicine, University of Debrecen, Debrecen, Hungary.

Béla Merkely (B)

Heart and Vascular Center, Semmelweis University, Budapest, Hungary.

Andrea Szentesi (A)

Institute for Translational Medicine, Medical School, University of Pécs, Pécs, Hungary.

Péter Hegyi (P)

Institute for Translational Medicine, Medical School, University of Pécs, Pécs, Hungary; Center for Translational Medicine, Semmelweis University, Budapest, Hungary; Institute of Pancreatic Diseases, Semmelweis University, Budapest, Hungary; Translational Pancreatology Research Group, Interdisciplinary Center of Excellence for Research Development and Innovation, University of Szeged, Szeged, Hungary. Electronic address: hegyi2009@gmail.com.

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questionsmedicales.fr › Maladies de l'appareil digestif › Maladies du pancréas › Pancréatite › Detailed Characteristics of Post-discharge...
questionsmedicales.fr › Administration des services de santé › Gestion des soins aux patients › Services de santé polyvalents › Soins de santé primaires › Continuité des soins › Sortie du patient › Detailed Characteristics of Post-discharge...
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