Severe Acute Pancreatitis: Prognostic Factors in 270 Consecutive Patients

Abstract

Acute pancreatitis (AP) is a common abdominal disorder with severity varying from mild to fatal disease. Predicting a patient's outcome remains problematic. The aim of this study was to analyze a large consecutive series of patients with severe AP and to identify prognostic factors for hospital mortality. Between 1989 and 1997, a consecutive series of 270 patients with severe AP were included in the study. All patients fulfilled the criteria of Atlanta classification for severe AP. Retrospectively and prospectively collected data included age, gender, etiology, number of previous episodes of pancreatitis, medication history, type of admission, body-mass index (BMI), respiratory failure, renal failure, need for pressor support, and abdominal surgery performed during hospitalization. The overall mortality rate was 24.4%. In univariate survival analysis advanced age, history of continuous medication, patient transferred from other hospital, high BMI, respiratory or renal failure, need for pressor support, and need for abdominal surgery were significant prognostic factors for hospital mortality. In a multivariate stepwise logistic regression analysis, the need of pressor support, renal failure requiring dialysis, advanced age, history of continuous medication and need for abdominal surgery were identified as independent prognostic factors for mortality. A logistic regression analysis of variables available on admission (the first seven above mentioned variables) showed that transferral admission, advanced age, and history of continuous medication were independent prognostic factors for mortality. In patients with severe AP, advanced age, history of continuous medication, and need for dialysis, mechanical ventilator support, and pressor support predict fatal outcome and thus should be taken into account in clinical evaluation.

Prospective study of 310 patients: can early CT predict the severity of acute pancreatitis?

“…Our study confirmed prior results that age proved relevant to determine the severity of acute pancreatitis [8][9][10][11][12].…”

Practice Guidelines in Acute Pancreatitis

“…In recent series, among the total number of patients with severe pancreatitis who were cared for in referral hospitals, the median percentage of referred patients was 63% (range 32-73%) (55,60,62,64,68,83,106,110,138,156,161,164). In some series (60,62,68), but not all (83,138), patients who were transferred were more seriously ill than those who were admitted directly to the reporting hospital. The clinician should keep in mind that organ failure (and particularly multisystem organ failure) rather than the extent of necrosis appears to be a more important factor in the morbidity and mortality of acute pancreatitis.…”

“…Furthermore, etiology has also been shown to have no prognostic significance (46,53,60,61,75,83,87,91,168) other than one report that indicated that patients with alcoholic pancreatitis in their first episode of pancreatitis have a greater need for intubation and greater prevalence of pancreatic necrosis (74).…”

“…There is now an increasing consensus that patients with sterile necrosis should continue to be managed medically during the first 2-3 wk for the following reasons. First, there have been several retrospective reports suggesting that a delay in surgical necrosectomy and at times a total avoidance of surgery results in less morbidity and mortality than early surgical debridement (55,60,68,(107)(108)(109)138). Secondly, when sterile necrosis is debrided surgically, a common sequela is the development of infected necrosis and the need for additional surgery (55,91,112,138,160).…”

Acute kidney injury following acute pancreatitis: A review

“…SAP is an acute clinical syndrome characterised by acute onset, rapid progression, high incidence of complications and high mortality, estimated as from 7% to 47% (ref. 2,3 ). One common complication of SAP in critically ill patients due to intraabdominal hypertension, septic shock and/or abdominal compartment syndrome is acute kidney injury (AKI).…”