Acute pancreatitis and the influence of socioeconomic deprivation

Ellis, Matthew; French, Jeremy; Charnley, Richard

doi:10.1002/bjs.6414

Cited by 45 publications

(40 citation statements)

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“…These data confirm a disproportionately high incidence of AP in the most multiply deprived quintiles of areas, in keeping with previous observations by us and others,25 and that CC admission during an episode of AP has a high (21.7%) mortality compared to that of the overall cohort (5.0%). Patients who require CC admission do so early in the disease course (at a median of 1 day after admission) and experience a median total of 6 days CC support per episode of AP.…”

Section: Discussionsupporting

confidence: 92%

Identifying risk factors for progression to critical care admission and death among individuals with acute pancreatitis: a record linkage analysis of Scottish healthcare databases

et al. 2016

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ObjectivesAcute pancreatitis (AP) can initiate systemic complications that require support in critical care (CC). Our objective was to use the unified national health record to define the epidemiology of AP in Scotland, with a specific focus on deterministic and prognostic factors for CC admission in AP.SettingHealth boards in Scotland (n=4).ParticipantsWe included all individuals in a retrospective observational cohort with at least one episode of AP (ICD10 code K85) occurring in Scotland from 1 April 2009 to 31 March 2012. 3340 individuals were coded as AP.MethodsData from 16 sources, spanning general practice, community prescribing, Accident and Emergency attendances, hospital in-patient, CC and mortality registries, were linked by a unique patient identifier in a national safe haven. Logistic regression and gamma models were used to define independent predictive factors for severe AP (sAP) requiring CC admission or leading to death.Results2053 individuals (61.5% (95% CI 59.8% to 63.2%)) met the definition for true AP (tAP). 368 patients (17.9% of tAP (95% CI 16.2% to 19.6%)) were admitted to CC. Predictors of sAP were pre-existing angina or hypertension, hypocalcaemia and age 30–39 years, if type 2 diabetes mellitus was present. The risk of sAP was lower in patients with multiple previous episodes of AP. In-hospital mortality in tAP was 5.0% (95% CI 4.1% to 5.9%) overall and 21.7% (95% CI 19.9% to 23.5%) in those with tAP necessitating CC admission.ConclusionsNational record-linkage analysis of routinely collected data constitutes a powerful resource to model CC admission and prognosticate death during AP. Mortality in patients with AP who require CC admission remains high.

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Section: Discussionsupporting

confidence: 92%

Identifying risk factors for progression to critical care admission and death among individuals with acute pancreatitis: a record linkage analysis of Scottish healthcare databases

et al. 2016

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“…The incidence has been shown to be as high as 56.5 per 100 000 in a recent study1 and seems to be increasing 2. Most pancreatitis is mild and self-limiting but approximately 20% of cases are severe where mortality can approach 40% with infected necrosis 3…”

Section: Introductionmentioning

confidence: 99%

Impact of a care pathway in acute pancreatitis

McCallum

Hicks²,

Seymour³

2011

Postgraduate Medical Journal

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Background Previous studies have shown that accurate process of care predicts quality of care. Few examples currently exist for process of care for the acute surgical patient. A recent region wide audit had identified good outcomes for patients with acute pancreatitis at our institution but aspects of care that could be improved. Methods For this re-audit, a simple written care pathway for the management of those presenting with acute pancreatitis was introduced in our institution from February to July 2009. The audit standards were set against the British Society of Gastroenterology (BSG) guidelines for management of acute pancreatitis and were compared with the previous region wide audit. Results Marked improvements were noted in the rates of abdominal imaging achieved within 24 h of diagnosis (35.2% vs 47.7%), severity stratification within 48 h of diagnosis (28.7% vs 75%), critical care admission for those classified as severe (39.3% vs 63.6%) and definitive treatment during index admission (22.2% vs 38.5%). Survival rates were 100% for this audit cycle and 95% for all patients within the region wide audit. Despite these improvements, care still does not reach the standards set out by BSG. Conclusion Predefined processes of care may help to recognise those developing or likely to develop severe pancreatitis, ensure accurate documentation of severity, expedite critical care review and/or admission, and help to encourage the timely management of those with a treatable underlying cause of their pancreatitis.

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“…Общая летальность при остром панкреатите на про-тяжении последних 10 лет находится на одном уровне и варьирует в зависимости от удельного веса деструктивных форм заболевания в преде-лах 3-6%, а при распространенном панкреоне-крозе по-прежнему достигает 20-45% [2,3,4].…”

Section: Introductionunclassified

Multivariate analysis of factors associated with immediate causes of death in severe acute pancreatitis

Куделич¹,

Kondratenko²,

Yudina³

et al. 2014

Novosti Khirurgii

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Цель. Выявить наиболее значимые непосредственные причины смерти при тяжелом остром панкре-атите и определить наиболее значимые патоморфологические изменения в жизненно важных органах для целенаправленной разработки способов их защиты.Материал и методы. Безвыборочным методом произведен анализ патологоанатомических исследований умерших (n=225) в связи с тяжелым острым (и/или обострением хронического) панкреатитом. Корреляционному анализу подвергнут возраст умерших и период от начала заболевания до наступления летального исхода.Результаты. Синдром полиорганной недостаточности (СПОН) при тяжелом остром панкреатите в большинстве наблюдений (165 умерших -73,3%) явился непосредственной причиной смерти. Интоксикация, как вторая по частоте непосредственная причина летального исхода отмечена у 27 умерших (12%). В разных возрастных группах непосредственные причины смерти достоверно отличались (χ 2 =22,8; р=0,043), однако корреляционной связи между ними не было (Spearmаn r=-0,017; р=0,795).При анализе структурных изменений жизненно важных органов выявлено, что у умерших обеих возрастных групп патоморфологически значимые поражения легких при тяжелом остром панкреатите наблюдались наиболее часто (83,1% случаев), вторым по частоте поражения являлась ткань головного мозга (70,2%), затем почечная паренхима (69,3%), миокард (67,1%) и печень (54,2%). Выявлены достоверные различия и корреляционная зависимость частоты поражения сердечно-сосудистой (χ 2 =8,35; р=0,004/ r=0,193; р=0,004) и печеночной (χ 2 =7,1; р=0,008 / r = -0,178; р=0,009) систем у умерших разных возрастных групп.Заключение. СПОН вследствие эндогенной интоксикации при тяжелом остром панкреатите является основной непосредственной причиной смерти (73,3%) независимо от возраста и срока от начала заболевания до летального исхода. Генерализованные расстройства микроциркуляции, являющиеся причиной тканевой гипоксии, раскрывают смысл и рациональность компенсации энергодефицита клеток и предупреждения СПОН путем применения средств, обеспечивающих независимый от гипоксии II-й комплекс дыхательной цепи. Ключевые слова: тяжелый острый панкреатит, непосредственная причина смерти, эндогенная инток-сикация, синдром полиорганной недостаточностиObjectives. To reveal the most significant immediate causes of death at severe acute pancreatitis and determine the most important pathological changes in vital organs to develop the targeted method of protection.Methods. A randomized analysis of pathoanatomical studies of deceased patients (n = 225) due to severe acute (and/or exacerbation of chronic) pancreatitis has been performed. Correlation analysis is used to determine the age and the period from the disease onset to lethal outcome.Results. In the most cases the multiple organ dysfunction syndrome (MODS) in severe acute pancreatitis led to the immediate death in 165 cases (73,3%). Intoxication as the second most common cause of death was revealed in 27 cases (12%). In different age groups the immediate causes of death have been differed reliably (χ 2 =22,8; р=0,043) without any correl...

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Acute pancreatitis and the influence of socioeconomic deprivation

Abstract: The incidence of AP based on a highly sensitive method of case identification was higher than previously reported. A clear relationship was found between socioeconomic deprivation and incidence of AP, which was largely explained by a higher incidence of alcoholic aetiology.

Cited by 45 publications

References 32 publications

Identifying risk factors for progression to critical care admission and death among individuals with acute pancreatitis: a record linkage analysis of Scottish healthcare databases

Identifying risk factors for progression to critical care admission and death among individuals with acute pancreatitis: a record linkage analysis of Scottish healthcare databases

Impact of a care pathway in acute pancreatitis

Multivariate analysis of factors associated with immediate causes of death in severe acute pancreatitis

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