Impact of characteristics of organ failure and infected necrosis on mortality in necrotising pancreatitis

Schepers, Nicolien J.; Bakker, Olaf J.; Besselink, Marc G.; Ali, Usama Ahmed; Bollen, Thomas L.; Gooszen, Hein G.; Santvoort, Hjalmar C. van; Bruno, Marco J.

doi:10.1136/gutjnl-2017-314657

Cited by 312 publications

(299 citation statements)

References 37 publications

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“…The proper classification of these collections is important because not every collection needs an intervention (an acute fluid collection or pseudocyst during oedematous pancreatitis), and when an intervention is needed (an acute necrotic collection or walled-off necrosis during necrotizing pancreatitis) the timing and (surgical) interventions are preferably delayed until walledoff necrosis has developed [7,8]. Organ failure develops in 38% of the severe acute pancreatitis cases in the first week after admission and lasts for a median of 1 week [9]. Of patients with organ failure, about 92% will develop respiratory failure, followed by cardiovascular failure in 82% and renal failure in 44%, resulting in admission to an intensive care unit (ICU) [9].…”

Section: Introductionmentioning

confidence: 99%

“…Organ failure develops in 38% of the severe acute pancreatitis cases in the first week after admission and lasts for a median of 1 week [9]. Of patients with organ failure, about 92% will develop respiratory failure, followed by cardiovascular failure in 82% and renal failure in 44%, resulting in admission to an intensive care unit (ICU) [9]. Mortality due to early (persisting) organ failure is high in this group (42% within 1 week) [9].…”

Section: Introductionmentioning

confidence: 99%

“…Of patients with organ failure, about 92% will develop respiratory failure, followed by cardiovascular failure in 82% and renal failure in 44%, resulting in admission to an intensive care unit (ICU) [9]. Mortality due to early (persisting) organ failure is high in this group (42% within 1 week) [9]. Secondary infection of the (peri)pancreatic necrosis develops in 27% of patients within 2 weeks and can cause further deterioration with ongoing or new onset of organ failure, with a mortality rate of 40% [10,11].…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Management of infected pancreatic necrosis in the intensive care unit: a narrative review

Wolbrink

Kolwijck

Oever

et al. 2020

Clinical Microbiology and Infection

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Management of infected pancreatic necrosis in the intensive care unit: a narrative review

Wolbrink

Kolwijck

Oever

et al. 2020

Clinical Microbiology and Infection

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“…Coagulation system could be activated by systemic inflammatory cascade reaction, thus induces microcirculation disturbance and aggravating pancreatic tissue injury . Moreover, systemic microcirculation disturbance can induce the development of multiple organ failure (MOF), increasing the mortality of necrotizing pancreatitis up to 43% . Therefore, coagulation system activation plays an important role in the pathogenesis of SAP, and coagulation dysfunction is a deteriorating factor in the prognosis of SAP.…”

Section: Introductionmentioning

confidence: 99%

The efficacy of low molecular weight heparin in severe acute pancreatitis: A systematic review and meta‐analysis of randomized controlled trials

Qiu

Tang

et al. 2019

J of Digest Diseases

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Objective The effects of low molecular weight heparin (LMWH) on severe acute pancreatitis (SAP) have been controversial. We aimed to evaluate the efficacy of LMWH on prognosis of SAP by systematic review and meta‐analysis. Methods We searched relevant studies published up to March 2019 in five databases (MEDLINE/PubMed, EMBASE, the Cochrane Central Register of Controlled Trials in Cochrane Library, China National Knowledge Infrastructure, and the Chinese Journal of Science and Technology of VIP database). Results Sixteen randomized controlled trials with 1625 patients were included in the final analysis. Most studies were from China. In analysis of laboratory parameters and clinical scores, SAP patients receiving LMWH treatment had lower white blood cell counts, C‐reactive protein level, Acute Physiology and Chronic Health Evaluation II score, and computed tomography severity index. In clinical outcomes, SAP patients who received LMWH treatment had shorter hospital stay (pooled mean difference [95% confidence interval; CI] −8.79 [−11.18, −6.40], P < .01), lower mortality (pooled risk ratio [RR] [95% CI] 0.33 [0.24‐0.44], P < .01), lower incidences of multiple organ failure (pooled RR [95% CI] 0.34 [0.23‐0.52], P < .01), pancreatic pseudocyst (pooled RR [95% CI] 0.49 [0.27‐0.90], P = .02), and operation rate (pooled RR [95% CI] 0.39 [0.31‐0.50], P < .01). Conclusions LMWH could improve the prognosis of SAP, and has a potential role in reducing hospital stay, mortality, incidences of multiple organ failure, pancreatic pseudocyst, and operation rate.

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“…The overall mortality of AP is < 5%, but it can be as high as 50% in patients with severe AP or infected necrosis [5, 6]. Interestingly, novel retrospective data on a large cohort of patients with infected pancreatic necrosis indicate that mortality does not correlate with onset (early versus late) and duration of organ failure, nor does the combination of infected pancreatic necrosis with organ failure result in higher mortality [7]. …”

Section: Introductionmentioning

confidence: 99%

Risk Stratification and Early Conservative Treatment of Acute Pancreatitis

2019

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Background: Acute pancreatitis (AP) is a potentially life-threatening common gastrointestinal disorder with increasing incidence around the globe. Although the majority of cases will take an uneventful, mild course, a fraction of patients is at risk of moderately severe or severe pancreatitis which is burdened with substantial morbidity and mortality. Early identification of patients at risk of a severe disease course and an adopted treatment strategy are crucial to avoid adverse outcomes. Summary: In this review we summarize the most recent concepts of severity grading in patients diagnosed with AP by adopting recommendations of current guidelines and discussing them in the context of the available literature. The severity of AP depends on the presence of local and/or systemic complications and organ failure. To predict the severity early in the disease course, host-specific factors (age, comorbidities, body mass index), clinical risk factors (biochemical and physiological parameters and scoring systems), as well as the response to initial therapy need to be considered and revisited in the short term. Depending on the individual risk and comorbidity the initial treatment can be guided, which will be discussed in the second part of this review. Key Message: Predicting the severity of AP and adapting the individual treatment strategy requires multidimensional risk assessment and close observation during the early phase of AP development.

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Impact of characteristics of organ failure and infected necrosis on mortality in necrotising pancreatitis

Cited by 312 publications

References 37 publications

Management of infected pancreatic necrosis in the intensive care unit: a narrative review

Management of infected pancreatic necrosis in the intensive care unit: a narrative review

The efficacy of low molecular weight heparin in severe acute pancreatitis: A systematic review and meta‐analysis of randomized controlled trials

Risk Stratification and Early Conservative Treatment of Acute Pancreatitis

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