Mortality Indicators and Risk Factors for Intra-Abdominal Hypertension in Severe Acute Pancreatitis

Zhao, Jing; Liao, Quan; Zhao, Yong; Hu, Ya

doi:10.9738/intsurg-d-13-00182.1

Cited by 10 publications

(7 citation statements)

References 18 publications

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“…Consistent with previous studies, our results indicate that age, multiple organ failure, and timing of intervention dramatically affect mortality [10,11,16,17]. An association between markedly increased WBC count and death has earlier been shown in studies of acute pancreatitis and severe acute pancreatitis [18][19][20][21].…”

Section: Discussionsupporting

confidence: 90%

Open necrosectomy in acute pancreatitis–obsolete or still useful?

et al. 2020

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Background: Multiple organ failure and early surgery are associated with high morbimortality after open necrosectomy. Data are mostly derived from historical cohorts with early necrosectomy bereft of step-up treatment algorithm implementation. Thus, mostly circumstantial evidence suggests a better clinical course following miniinvasive surgical and endoscopic necrosectomy. We studied the results of open necrosectomy in a contemporary cohort of patients with complicated pancreatic necrosis treated at a tertiary center. Methods: A retrospective cohort study from a university teaching hospital. Results of 109 consecutive patients treated with open necrosectomy during a 12-year period are reported. Results: The overall 90-day mortality rate was 22.9%. The 90-day mortality rate was 10.6% if necrosectomy could be delayed until 4 weeks from symptom onset and the necrosis had become walled off on preoperative imaging. The risk factors for 90-day mortality were age over 60 years (OR 19.4), pre-existing co-morbidities (OR 16.9), necrosectomy within 4 weeks (OR 6.5), multiple organ failure (OR 12.2), white blood cell count over 23 × 10 9 (OR 21.4), and deterioration or prolonged organ failure as an indication for necrosectomy (OR 10.4). None or one of these risk factors was present in 52 patients (47.7% of all patients), and these patients had no mortality. Conclusion: Late open necrosectomy for walled-off necrosis has a low mortality risk. Open necrosectomy can be done without mortality in the absence of multiple risk factors for surgery.

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Section: Discussionsupporting

confidence: 90%

Open necrosectomy in acute pancreatitis–obsolete or still useful?

et al. 2020

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“…Hypovolemia is a result of a systemic inflammatory state initiated by AP, associated with vasodilation, escape of fluid into the third space, and increase in intra-abdominal pressure. In patients with SAP, intra-abdominal hypertension is observed, which significantly contributes to the reduced perfusion of organs, including the kidneys [ 25 ]. Dehydration and hypovolemia are also intensified by vomiting or fever, often accompanying AP.…”

Section: Discussionmentioning

confidence: 99%

Angiopoietin-2 Is an Early Indicator of Acute Pancreatic-Renal Syndrome in Patients with Acute Pancreatitis

Sporek

Dumnicka

Gala-Błądzińska³

et al. 2016

Mediators of Inflammation

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Within the first week of the disease, acute kidney injury (AKI) is among the most common causes of mortality in acute pancreatitis (AP). Recently, serum angiopoietin-2 (Ang-2) has been associated with hyperdynamic state of the systemic circulation. The aim of this study was to examine the associations between Ang-2 and the clinical AP severity during the first 72 hours of the disease, and organ disfunction, including AKI. Methods. Study included patients admitted to the surgery ward, diagnosed with AP. AKI was diagnosed according to KDIGO guidelines and renal failure according to modified Marshall scoring system. Ang-2 was determined in serum with ELISA. Results. AP was classified as mild (MAP) in 71% of patients, moderately severe (MSAP) in 22%, and severe (SAP) in 8%. During the first 72 hours of AP, 11 patients developed AKI and 6 developed renal failure. Ang-2 at 24, 48, and 72 hours following the onset of AP symptoms significantly predicted SAP and MSAP, as well as AKI and renal failure. Also, Ang-2 significantly correlated with acute phase proteins as well as with the indicators of renal disfunction. Conclusions. Serum Ang-2 may be a relevant predictor of AP severity, in particular of the development of AP-renal syndrome.

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“…The IAP acts on the diaphragm and constricts the pulmonary segment, leading to alveolar collapse and a decreased ventilation to blood flow ratio, which causes hypoxemia, hypercarbia and ultimately respiratory failure (17,18). Patients with mechanical ventilation and ACS have a higher risk of developing IAH than those without ACS (19,20).…”

Section: Discussionmentioning

confidence: 99%

Comparison of pressure‑regulated volume control ventilation and pressure control ventilation in patients with abdominal compartment syndrome

et al. 2019

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Mechanical ventilation support is commonly required in abdominal compartment syndrome (ACS). In the present study, pressure-regulated volume control ventilation (PRVCV) was compared to pressure control ventilation (PCV) in patients with ACS. The prospective study included 40 patients with ACS who were randomized into the PCV or PRVCV groups and subjected to the different modes of ventilation. After 6 h of ventilation, arterial blood gas, respiratory mechanics and hemodynamics parameters, as well as the intra-abdominal pressure (IAP) and Sequential Organ Failure Assessment (SOFA) scores were calculated. Compared to the PCV mode, mechanical ventilation with PRVCV lead to a significant decrease in the partial pressure of carbon dioxide, the peak inspiratory pressure, the mean inspiratory pressure, the central venous pressure, the heart rate and the extravascular lung water index. In addition, a marked improvement in pH, partial pressure of oxygen, oxygenation index and pulmonary static compliance was noted. However, no significant differences in airway resistance, mean arterial pressure, or IAP and SOFA scores were obtained. In conclusion, the PRVCV mode is better than the PCV mode in ventilation patients with ACS, and should therefore be used as a lung protective strategy. The present study was registered at Chictr.org (no. ChiCTR1800016869).

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Mortality Indicators and Risk Factors for Intra-Abdominal Hypertension in Severe Acute Pancreatitis

Cited by 10 publications

References 18 publications

Open necrosectomy in acute pancreatitis–obsolete or still useful?

Open necrosectomy in acute pancreatitis–obsolete or still useful?

Angiopoietin-2 Is an Early Indicator of Acute Pancreatic-Renal Syndrome in Patients with Acute Pancreatitis

Comparison of pressure‑regulated volume control ventilation and pressure control ventilation in patients with abdominal compartment syndrome

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