Mortality from Acute Pancreatitis: Late Septic Deaths Can Be Avoided But Some Early Deaths Still Occur

Lowham, Anthony; Lavelle, Janet; Leese, T

doi:10.1385/ijgc:25:2:103

Cited by 48 publications

(15 citation statements)

References 10 publications

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“…Early mortality has been variously defined as death within 1 week [2-4] or 2 weeks [1,9], five studies having mentioned the exact time of death. With the exception of smaller studies [1,3], we -like others -show that about half of the patients die from acute pancreatitis early and half late, with the first half dying from multiple organ failure and the second from septic complications. This agrees with a postmortem study showing that 60% of the patients died within one week because of multiple organ failure and 40% of infections later [17].…”

Section: Discussionmentioning

confidence: 56%

Fatal Outcome in Acute Pancreatitis: Its Occurrence and Early Prediction

et al. 2001

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Section: Discussionmentioning

confidence: 56%

Fatal Outcome in Acute Pancreatitis: Its Occurrence and Early Prediction

et al. 2001

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“…[2][3][4][5][6][7] The reported case-fatality rate ranges between 2 and 9% depending on the exact case definition, with approximately half of the deaths occurring very early within 2 weeks of hospitalization, with the majority manifesting multiple organ system failures. [8][9][10][11][12] After this early phase, most studies suggest that sepsis and other complications are the principal causes of late deaths. 12,13 Most studies of patients with pancreatitis have been observational in nature, usually case series of patients hospitalized at large university medical centers.…”

Section: Introductionmentioning

confidence: 99%

Co-morbidity is a Strong Predictor of Early Death and Multi-organ System Failure among Patients with Acute Pancreatitis

Frey

Zhou

Harvey

et al. 2007

Journal of Gastrointestinal Surgery

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A small but significant percentage of patients with acute pancreatitis die within 2 weeks of hospitalization, usually with multiorgan system failure. To determine the effect of chronic medical comorbidities on early death, we conducted a retrospective analysis of all patients who were hospitalized in California with first-time pancreatitis between 1992 and 2002. Among 84,713 patients, 1514 (1.8%) died within 2 weeks. In a risk-adjusted multivariate model, the strongest predictors of early death were age 65 to 75 years (OR = 2.6, 95% CI: 2.2-3.1 versus <55 years), age over 75 years (OR = 5.2, 95% CI: 4.4-6.1), and the presence of either two chronic comorbid conditions (OR = 3.5, CI: 2.7-4.6) or three or more comorbidities (OR = 7.4, 95% CI: 5.7-9.5). Among the 14,280 patients younger than 55 years who had no chronic comorbid conditions, only 14 (0.1%) died in the first 14 days compared to 701 (5.9%) of 24,852 patients 64 years or older who had three or more comorbidities (RR = 29, 95% CI: 17-50). Comorbid conditions associated with early death included recent cancer, heart failure, renal disease, and liver disease. We conclude that advancing age and the number of chronic comorbid conditions are very strong predictors of early death among patients with acute pancreatitis.

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“…Some early deaths may still occur because of severe remote multiorgan injury [38]. In AP, immune cells are the main triggers of the acute systemic inflammatory response that determines disease severity.…”

Section: Discussionmentioning

confidence: 99%

TNF-α Regulated MAdCAM-1 Expression in Pancreatic Microvessel Endothelium: A Possible Role for MAdCAM-1 in Pancreatitis?

Ando¹,

Jordan²,

Wang³

et al. 2008

TOGASJ

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Abstract:The Mucosal Addressin Cell Adhesion Molecule-1 (MAdCAM-1) is associated with active inflammatory bowel disease; however MAdCAM-1 expression in the pancreas has not been previously documented. This study investigated MAdCAM-1 expression during cerulein-induced pancreatitis, and examined MAdCAM-1 expression, regulation and function in cytokine-treated pancreatic endothelial cells. Acute pancreatitis was induced by serial injections of cerulein over 10h, at which point tissue samples were collected. Pancreas endothelial cells (PMEC) were prepared from H2Kb-tsA58 (Immortomouse) mice. MAdCAM-1 expression was examined by immunoblotting after cytokine (TNF-, ILor IFN-) stimulation. 2 nd messages regulating MAdCAM-1 were studied by adding pharmacological blockers prior to cytokines. MAdCAM-1 dependent lymphocyte adhesion was monitored using 4 7-integrin expressing lymphocytes. In cerulein-pancreatitis, MAdCAM-1 was upregulated by 10h, and closely correlated with histopathology. In PMEC, only TNF-induced MAdCAM-1 dose (0-20ng/ml) and time (>12h-48h) dependently. MAdCAM-1 expression was PKC, tyrosine kinase, p38 MAPK, and NF-B-PARP dependent. PMEC-lymphocyte adhesion was increased by TNF-, and significantly reduced by MAdCAM-1 antibody. MAdCAM-1 is induced in the inflamed pancreas, and in TNF-stimulated PMEC, and may represent a novel determinant of pancreatic-lymphocyte recruitment in inflammation. PMEC cells might provide a useful system to study mechanisms related to both acute and chronic pancreatitis.

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Mortality from Acute Pancreatitis: Late Septic Deaths Can Be Avoided But Some Early Deaths Still Occur

Cited by 48 publications

References 10 publications

Fatal Outcome in Acute Pancreatitis: Its Occurrence and Early Prediction

Fatal Outcome in Acute Pancreatitis: Its Occurrence and Early Prediction

Co-morbidity is a Strong Predictor of Early Death and Multi-organ System Failure among Patients with Acute Pancreatitis

TNF-α Regulated MAdCAM-1 Expression in Pancreatic Microvessel Endothelium: A Possible Role for MAdCAM-1 in Pancreatitis?

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