Analysis of Treatment-Related Factors Affecting Mortality in Patients with Severe Necrotizing Acute Pancreatitis

Abstract

The aim of the paper was to determine the factors related to the initial therapy that may contribute to death from severe necrotizing acute pancreatitis and to analyze their clinical importance as well as possible additive effects.A retrospective case-control study included all adult patients treated for severe necrotizing acute pancreatitis in the Clinical Center of Kragujevac, Serbia, during the five-year period (2006-2010.). The cases (n = 41) were patients who died, while the controls (n = 69) were participants who survived. In order to estimate the relationship between potential risk factors and observed outcome, crude and adjusted odds ratios (OR) with 95 % confidence intervals (CI) were calculated in logistic regression models.Significant association with observed outcome was shown for the use of gelatin and/or hydroxyethyl starch (adjusted OR 12.555; 95 % CI 1.150-137.005), use of albumin (adjusted OR 27.973; 95 % CI 1.741-449.373), use of octreotide (adjusted OR 16.069; 95 % CI 1.072-240.821) and avoiding of enteral feeding (adjusted OR 3.933; 95 % CI 1.118-13.829), while the use of nonsteroidal anti-inflammatory drugs had protective role (adjusted OR 0.057; 95 % CI 0.004-0.805).The risk of death in patients with predicted severe necrotizing acute pancreatitis could be reduced with avoidance of treatment with colloid solutions, albumin and octreotide, as well as with an early introduction of oral/enteral nutrition and use of nonsteroidal anti-inflammatory drugs. O r i g i n a l a r t i c l e I NT ROD U CT I ONSevere necrotizing acute pancreatitis is a multisystem disorder, characterized by pancreatic and/or peripancreatic tissue necrosis and widespread inflammatory response leading to single or multiple organ dysfunction which does not resolve within the first 48 hours (the so-called persistent organ failure according to revised Atlanta criteria 2012) (1). It occurs in about 15-20 % of all cases of acute pancreatitis (AP) and is considered the most serious disease course due to high complications and death rates despite recent diagnostic and therapeutic advancements; the mortality may be particularly high if necrotic areas become infected, exceeding 50 % when infection and persistent organ failure develop during the first week of the illness (1-4).In the light of these facts, taking also into account variable and unpredictable course of AP, current recommendations emphasize appropriate early management based on careful initial risk assessment in all patients presenting with AP on admission to hospital (1, 4). Dealing with this issue, previous studies have identified numerous factors that are only associated with or may contribute to the development of severe disease and increased mortality rate in patients with AP. Many of them are well-documented, such as older age, obesity, idiopathic AP, important comorbidities, as well as certain clinical, laboratory and radiologic parameters of disease severity on initial evaluation (signs of systemic inflammatory response syndrome, hypotension, altered mental sta...