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Late mortality in patients with severe acute pancreatitis
1Department of Visceral and Transplantation Surgery, University Hospital of Berne, Inselspital, CH-3010 Berne, Switzerland.
Background:
Mortality due to severe or necrotizing acute pancreatitis most often results from multiorgan dysfunction syndrome (MODS) occurring either early (within the first 14 days) or 2 weeks or more after the onset of symptoms due to septic complications. The aim of this study was to analyse the course of the disease in patients who died from severe acute pancreatitis.
Methods:
Between January 1994 and August 2000 details of 263 consecutive patients with acute pancreatitis were entered prospectively into a database. All patients were treated in an intermediate or intensive care unit.
Results:
The overall mortality rate was 4 per cent (ten of 263 patients). The mortality rate was 9 per cent (ten of 106) in patients with necrotizing disease. No patient died within the first 2 weeks of disease onset. The median day of death was 91 (range 15-209). Six patients died from septic MODS. Ranson score, Acute Physiology and Chronic Health Evaluation (APACHE) II score during the first week of disease, pre-existing co-morbidity, body mass index, infection and extent of necrosis were significantly associated with death (P < 0.01 for all parameters). However, only infection of the necrotic pancreas was an independent risk factor in the multivariate analysis.
Conclusion:
Early deaths in patients with severe acute pancreatitis are rare, mainly as a result of modern intensive care treatment. Nine of the ten deaths occurred more than 3 weeks after disease onset. Infection of pancreatic necrosis was the main risk factor for death.
Insights
Severe acute pancreatitis deaths are rare early on, with most occurring over three weeks post-onset. Pancreatic necrosis infection is the primary risk factor for mortality in these critical cases.
Area of Science:
- Gastroenterology
- Critical Care Medicine
Background:
- Severe acute pancreatitis mortality often stems from multiorgan dysfunction syndrome (MODS), either early or late, frequently due to septic complications.
- This study aimed to analyze the disease progression in patients who succumbed to severe acute pancreatitis.
Purpose of the Study:
- To investigate the clinical course and mortality factors in patients with severe acute pancreatitis.
- To identify the primary causes and timing of death in severe acute pancreatitis.
Main Methods:
- Prospective data collection of 263 consecutive acute pancreatitis patients from January 1994 to August 2000.
- All patients received intermediate or intensive care unit treatment.
Main Results:
- Overall mortality was 4% (10/263), rising to 9% (10/106) in necrotizing pancreatitis cases.
- No deaths occurred within the first two weeks; the median day of death was 91.
- Septic MODS caused six deaths, with pancreatic necrosis infection identified as the sole independent risk factor in multivariate analysis.
Conclusions:
- Early mortality in severe acute pancreatitis is infrequent due to advanced intensive care.
- The majority of deaths (9/10) occurred more than three weeks after symptom onset.
- Infection of pancreatic necrosis is the principal risk factor contributing to fatal outcomes.