Aging and Comorbidities in Acute Pancreatitis II.: A Cohort-Analysis of 1203 Prospectively Collected Cases

Szakács, Zsolt; Gede, Noémi; Pécsi, Dániel; Izbéki, Ferenc; Papp, Mária; Kovács, György; Fehér, Eszter; Dobszai, Dalma; Kui, Balázs; Korbonits, M; Kónya, Klára; Szabó, Imre; Török, Imola; Gajdán, László; Takács, Tamás; Patrícia, Silvia; Gódi, Szilárd; Varga, Márta; Hamvas, József; Vincze, Áron; Szentesi, Andrea; Párniczky, Andrea

doi:10.3389/fphys.2018.01776

Cited by 38 publications

(28 citation statements)

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“…However, after adjusting for comorbid disease, only the very extreme age (>85 years old) was associated with 30-day in-patient mortality and persistent organ failure in a recent prospective, multicenter study (Mounzer et al, 2012). Our results are in line with a recent cohort analysis that found that elderly patients had a significantly higher risk of developing systemic complications, while high mortality in this group is due to the effect of severe comorbidities (Szakacs et al, 2018).…”

Section: Discussionsupporting

confidence: 92%

Multiple Hits in Acute Pancreatitis: Components of Metabolic Syndrome Synergize Each Other’s Deteriorating Effects

et al. 2019

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IntroductionThe incidence of acute pancreatitis (AP) and the prevalence of metabolic syndrome (MetS) are growing worldwide. Several studies have confirmed that obesity (OB), hyperlipidemia (HL), or diabetes mellitus (DM) can increase severity, mortality, and complications in AP. However, there is no comprehensive information on the independent or joint effect of MetS components on the outcome of AP. Our aims were (1) to understand whether the components of MetS have an independent effect on the outcome of AP and (2) to examine the joint effect of their combinations.MethodsFrom 2012 to 2017, 1435 AP cases from 28 centers were included in the prospective AP Registry. Patient groups were formed retrospectively based on the presence of OB, HL, DM, and hypertension (HT). The primary endpoints were mortality, severity, complications of AP, and length of hospital stay. Odds ratio (OR) with 95% confidence intervals (CIs) were calculated.Results1257 patients (55.7 ± 17.0 years) were included in the analysis. The presence of OB was an independent predictive factor for renal failure [OR: 2.98 (CI: 1.33–6.66)] and obese patients spent a longer time in hospital compared to non-obese patients (12.1 vs. 10.4 days, p = 0.008). HT increased the risk of severe AP [OR: 3.41 (CI: 1.39–8.37)], renal failure [OR: 7.46 (CI: 1.61–34.49)], and the length of hospitalization (11.8 vs. 10.5 days, p = 0.020). HL increased the risk of local complications [OR: 1.51 (CI: 1.10–2.07)], renal failure [OR: 6.4 (CI: 1.93–21.17)], and the incidence of newly diagnosed DM [OR: 2.55 (CI: 1.26–5.19)]. No relation was found between the presence of DM and the outcome of AP. 906 cases (mean age ± SD: 56.9 ± 16.7 years) had data on all four components of MetS available. The presence of two, three, or four MetS factors increased the incidence of an unfavorable outcome compared to patients with no MetS factors.ConclusionOB, HT, and HL are independent risk factors for a number of complications. HT is an independent risk factor for severity as well. Components of MetS strongly synergize each other’s detrimental effect. It is important to search for and follow up on the components of MetS in AP.

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Section: Discussionsupporting

confidence: 92%

Multiple Hits in Acute Pancreatitis: Components of Metabolic Syndrome Synergize Each Other’s Deteriorating Effects

et al. 2019

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“…Not surprisingly, a higher disease-related mortality could be evidenced in these compared to younger patients ( 16 ). In contrast, it is the middle-aged adults who were reported to have the highest risk for aggravated disease, which is in concordance with the mean age of 52 years in our analysis ( 17 ). Furthermore, evidence is emerging that preexisting comorbidities rather than age per se seem to trigger adverse outcomes.…”

Section: Discussionsupporting

confidence: 91%

Open Abdomen Treatment in Acute Pancreatitis

et al. 2021

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Background: Severe acute pancreatitis (SAP) is a heterogeneous and life-threatening disease. While recent guidelines recommend a stepwise approach starting with non-surgical techniques, emergency laparotomy remains inevitable in certain situations. Open abdomen treatment (OAT) may follow, potentially resulting in additional risks for severe morbidity. Causative factors and clinical impact of OAT in SAP are poorly understood and therefore issue of the present study.Materials and Methods: A retrospective analysis of patients admitted to the Department of General, Visceral, Thoracic and Vascular Surgery at University of Bonn suffering from acute pancreatitis (ICD K.85) between 2005 and 2020 was performed. Medical records were screened for demographic, clinical and outcome parameters. Patients who received primary fascial closure (PFC) were compared to those patients requiring OAT. SAP-specific scores were calculated, and data statistically analyzed (P = 0.05).Results: Among 430 patients included, 54 patients (13%) had to undergo emergency laparotomy for SAP. Patients were dominantly male (72%) with a median age of 51 years. Indications for surgery were infected necrosis (40%), suspected bowel perforation (7%), abdominal compartment syndrome (5%), and acute intra-abdominal hemorrhage (3%). While 22 patients (40%) had PFC within initial surgery, 33 patients (60%) required OAT including a median of 12 subsequent operations (SD: 6, range: 1–24). Compared to patients with PFC, patients in the OAT group had significantly fewer biliary SAP (P = 0.031), higher preoperative leukocyte counts (P = 0.017), higher rates of colon resections (P = 0.048), prolonged ICU stays (P = 0.0001), and higher morbidity according to Clavien–Dindo Classification (P = 0.002). Additionally, BISAP score correlated positively with the number of days spent at ICU and morbidity (P = 0.001 and P = 0.000002). Both groups had equal mortality rates.Discussion: Our data suggest that preoperative factors in surgically treated SAP may indicate the need for OAT. The procedure itself appears safe with equal hospitalization days and mortality rates compared to patients with PFC. However, OAT may significantly increase morbidity through longer ICU stays and more bowel resections. Thus, minimally invasive options should be promoted for an uncomplicated and rapid recovery in this severe disease. Emergency laparotomy will remain ultima ratio in SAP while patient selection seems to be crucial for improved clinical outcomes.

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“…However, in order to prove the influence of comorbidity on survivals, we wanted to extend our study with comparing comorbidities at different age categories. Since the articles in this study did not contain sufficient amount of information on comorbidities we have performed a large multinational cohort analysis on a prospective high quality database (Szakács et al, 2018). The analysis of a total of 1,203 patients showed that severe comorbidities (CCI≥3) predict mortality (OR = 4.48; CI: 1.57–12.80) much better than age, suggesting that comorbidity is an important additional predictor for mortality.…”

Section: Discussionmentioning

confidence: 99%

Aging and Comorbidities in Acute Pancreatitis I: A Meta-Analysis and Systematic Review Based on 194,702 Patients

et al. 2019

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Background: Acute pancreatitis (AP) is one of the most common cause of hospitalization among gastrointestinal diseases worldwide. Although most of the cases are mild, approximately 10–20% of patients develop a severe course of disease with higher mortality rate. Scoring systems consider age as a risk factor of mortality and severity (BISAP; >60 years, JPN>70 years, RANSON; >55 years, APACHE II >45 years). If there is a correlation between aging and the clinical features of AP, how does age influence mortality and severity? Aim: This study aimed to systematically review the effects of aging on AP. Methods: A comprehensive systematic literature search was conducted in the Embase, Cochrane, and Pubmed databases. A meta-analysis was performed using the preferred reporting items for systematic review and meta-analysis statement (PRISMA). A total of 1,100 articles were found. After removing duplicates and articles containing insufficient or irrelevant data, 33 publications involving 194,702 AP patients were analyzed. Seven age categories were determined and several mathematical models, including conventional mathematical methods (linear regression), meta-analyses (random effect model and heterogeneity tests), meta-regression, funnel plot and Egger's test for publication bias were performed. Quality assessment was conducted using the modified Newcastle–Ottawa scale. The meta-analysis was registered in the PROSPERO database (CRD42017079253). Results: Aging greatly influences the outcome of AP. There was a low severe AP incidence in patients under 30 (1.6%); however, the incidence of severe AP showed a continuous, linear increase between 20 and 70 (0.193%/year) of up to 9.6%. The mortality rate was 0.9% in patients under 20 and demonstrated a continuous linear elevation until 59, however from this age the mortality rate started elevating with 9 times higher rate until the age of 70. The mortality rate between 20 and 59 grew 0.086%/year and 0.765%/year between 59 and 70. Overall, patients above 70 had a 19 times higher mortality rate than patients under 20. The mortality rate rising with age was confirmed by meta-regression (coefficient: 0.037 CI: 0.006–0.068, p = 0.022; adjusted r 2 : 13.8%), and severity also (coefficient: 0.035 CI: 0.019–0.052, p < 0.001; adjusted r 2 : 31.6%). Conclusion: Our analysis shows a likelihood of severe pancreatitis, as well as, pancreatitis-associated mortality is more common with advanced age. Importantly, the rapid elevation of mortality above the age of 59 suggests the involvement of additional deteriorating factors such as co-morbidity in elderly.

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Aging and Comorbidities in Acute Pancreatitis II.: A Cohort-Analysis of 1203 Prospectively Collected Cases

Cited by 38 publications

References 33 publications

Multiple Hits in Acute Pancreatitis: Components of Metabolic Syndrome Synergize Each Other’s Deteriorating Effects

Multiple Hits in Acute Pancreatitis: Components of Metabolic Syndrome Synergize Each Other’s Deteriorating Effects

Open Abdomen Treatment in Acute Pancreatitis

Aging and Comorbidities in Acute Pancreatitis I: A Meta-Analysis and Systematic Review Based on 194,702 Patients

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