Analysis of Factors Influencing Survival

Abstract

Of patients with acute pancreatitis (AP), there remains a group who suffer life-threatening complications despite current modes of therapy. To identify factors which distinguish this group from the entire patient population, a retrospectiva analysis of 519 cases of AP occurring over a 5-year period was undertaken. Thirty-one per cent of these patients had a history of alcoholism and 47% had a history of biliary disease. The overall mortality was 12.9%. Of symptoms and signs recorded at the time of admission, hypotension, tachycardia, fever, abdominal mass, and abnormal examination of the lung fields correlated positively with increased mortality. Seven features of the initial laboratory examination correlated with increased mortality. Shock, massive colloid requirement, hypocalcemia, renal failure, and respiratory failure requiring endotracheal intubation were complications associated with the poorest prognosis. Among patients in this series with three or more of these clinical characteristics, maximal nonoperative treatment yielded a survival rate of 29%, compared to the 64% survival rate for a group of patients treated operatively with cholecystostomy, gastrostomy, feeding jejunostomy, and sump drainage of the lesser sac and retroperitoneum.

Acute Pancreatitis: Experience in a University Hospital in Riyadh, Saudi Arabia

“…Serious complications occur in 20 to 30% of the cases, with death in 8 to 20% , [4][5][6] This five-year retrospective study of all the admissions for AP to the University Hospitals in Riyadh (> 600 beds) shows that AP is not a common clinical entity in Saudi Arabia, forming a small proportion of the total number of annual hospital admissions. This finding should be representative of the incidence in major hospitals in the Kingdom, as the University Hospitals adopted an open-access policy during the study period and were accepting both Saudi nationals and expatriates with acute medical problems.…”

“…The fourth patient had hyperlipidemia-associated acute relapsing pancreatitis and at recurrence had an amylase value of 1.23 μkat/L in grossly lipemic serum. According to the modified Glasgow scoring criteria, 22 (21%) of the 104 attacks of AP were severe, with a mean score of 4 out of a possible 8 (range, [3][4][5][6].…”

“…Serious complications of AP supervene in 20 to 30% of cases, with death in 8 to 20% , [4][5][6] The early differentiation of patients with mild and severe disease is important if prompt intensive management is to benefit those with severe disease. The criteria introduced by Ranson and modified by Imerie are now generally accepted as providing the best assessment of severity in AP.…”

A Patient with Severe Pancreatitis Successfully Treated by Continuous Peritoneal Dialysis

“…As Jacobs et al 4) showed that the mortality rate was 71% without operation but was 36% with operation, the time of surgery is an important prognostic factor in this disease. Prompt decision must be made whether conservative therapy is sufficient, peritoneal perfusion should be decided, or surgical treatment is necessary.…”

The Role of Ercp in the Management of Gallstone-Associated Acute Pancreatitis: A Prospective Study of 64 Patients at Riyadh Central Hospital

“…AP is associated with serious complications in 20% to 30% of cases and death in 8% to 20%. This high rate of morbidity and mortality usually occurs among the "severe" form of the disease [6][7][8]. Apart from the early recognition of such "severe" cases using recently accepted Ranson and Imrie criteria and thus providing early identification and management of any serious complications, little progress has been achieved in improving the outcome of AP despite intensive worldwide research over the last several decades [9].…”